bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperpartisan Sports Media in Trump’s America: The Metapolitics of Breitbart Sports
Authors: Falcous Mark , Hawzen Matthew G. , Newman Joshua I.
Published: October 2018

The rise of Donald Trump has widely been seen as concurrent to the emergence of the “Alt-Right” that coalesces around intersecting themes of conservativism: White ethno-nationalist “race realism,” populism, misogyny, evangelical theocracy, border protectionism, and anti-liberalism. Media has been a key site of struggle in these developments, with attacks on mainstream media bringing into focus wider questions of truth and legitimacy in journalism. In particular, Trump’s rise has been synonymous with the heightened profile of the Breitbart News website, a purveyor of hyperpartisan, conservative political ideologies. In this article, we consider the place of Breitbart Sports within this dynamic political and media order. Our analysis of the lead-up to the 2016 Presidential election reveals the extent to which Breitbart Sports conveyed a vision of U.S. sport that promoted hard-right agendas in relation to U.S. global stewardship, veiled “race” reclamation discourses, media, immigration, social criticism, policing, sexual politics, and party politics. Breitbart Sports framing casts sport as a liberally infested cultural battleground, where conservativism is under threat. We conclude with a brief discussion about the role of new media in framing political exigencies and the role of sport in contemporary American society.
Behavioural Aspects Influencing Decision to Purchase Apparels amongst Young Indian Consumers
Authors: Dhiman Rahul , Chand Pawan Kumar , Gupta Sahil
Published: October 2018

The study of consumer buying behaviour is essential for marketers to understand the key elements such as what is purchased, from where it is purchased, the quantity of purchase, how much money is spent and other related variables affecting buying behaviour. The purpose of this article is to assess the consumer buying behaviour for apparels. The study makes substantial effort to recognize the variables which affect decision of apparel purchase among youth. Theoretical foundation of the study is based on secondary sources such as research papers, articles, magazines and articles on consumer buying behaviour. Confirmatory factor analysis (CFA) is performed to extract factors which affect consumer buying behaviour and subsequently purchase decision. Total 6 factors were extracted with 20 prominent indicators. CFA confirms that all the obtained values of the indicators are model fit and comply with the standardized criteria. The findings show that consumer buying behaviour in apparel such as purchase frequency, average spending, preferred store type and preferred brand mostly depends on various demographic variables. Hence, the study validates the significance of segmentation, targeting and positioning (STP) for marketers of apparel. The present article reveals that all types of domestic and worldwide brands are available in Indian market and are purchased by consumers as long as those are perceived to deliver value to consumers. The study recommends that marketers must segment the market and target those segments which can be served expeditiously. Marketers must target a particular segment of consumers for which they can offer better value. The findings and recommendations of the study might be useful for academicians, policymakers, entrepreneurs and managers of apparel industry to understand industry trends and formulate appropriate strategies.
Customer Relationship Management as Tool to Enhance Competitive Effectiveness: Model Revisited
Authors: Sofi Maraj Rahman , Hakim Iqbal Ahmad
Published: October 2018

Maintaining collaborative relationships of a business firm with the customer is very important in the contemporary competitive business scenario, besides the service rendered by it. Against this backdrop, the study was undertaken which aims to analyse the customer relationship management (CRM) practices and dimensions in the business. The past research studies were reviewed and the CRM frameworks given by the various authors, in particular of Sin, Tse, and Yim (2005, European Journal of Marketing, 11(12), 1264–1290), were critically examined. The research article based on the study revisited the four behavioural dimensions of CRM. A total of 225 respondents were conveniently contacted from banks and hotel establishments. In view of the challenges faced by the business organizations in the contemporary scenario, in particular in the service sector, this article identified and discusses ‘customer prospecting’ and ‘personalization’ as additional practices/dimensions that need to be incorporated to design a robust CRM framework which has been presented as revisited model. Structural equation modeling (SEM) had been used to validate the revisited model. These dimensions, though need to be ratified in the future research.
Attraction and Retention Model: Case of Mexicali, B.C., Mexico
Authors: Wise Jorge A. , Rojas-Mendizabal Veronica A.
Published: October 2018

This article aims to present, in general terms, the phenomenon of employee turnover in Mexicali, Baja California, which is a Mexican city located on the US–Mexico border. This phenomenon has impacted the economy of many firms, and the entrepreneurs expressed their concern though different fora and media. For this purpose, important regional actors participated in focus groups sessions. During these sessions, they explained the impact of this phenomenon on their firms and how they have been dealing with it. As a result of the interaction during the focus group sessions, a model to attract and retain employees was developed. The model identifies 12 relevant variables that impact the employees’ performance. This study aims to lead to more detailed researches; based on these variables, employers and academicians would apply it in a different context, obtaining comparable results.
The Process of CSR Communication—Culture-Specific or Universal? Focusing on Mainland China and Hong Kong Consumers
Authors: Kim Sora
Published: October 2018

Through two representative surveys—one in Beijing the other in Hong Kong (HK)—this study empirically validates an existing U.S.-based model of corporate social responsibility (CSR) communication process. The study also extends the model by adding government trust as a second moderator and government involvement as a unique dimension of CSR communication. The perceived presence of CSR communication factors results in increases in consumers’ cognitive, affective, and behavioral responses. In turn, these increases improve favorable corporate reputation perception. Such results demonstrate the significant contributions of CSR communication dimensions to positive consumer outcomes in Chinese contexts. The process of CSR communication has significantly different features in Chinese contexts than in Western ones. Chinese consumers (both Beijing and HK) revealed a very high tolerance and acceptance of CSR communication with a self-promotional tone. The trust levels of HK consumers in the government tended to negatively moderate the effectiveness of CSR communication, while those of Beijing consumers did not.
Policies and Programmes of Higher Education in Manipur Since the 1990s
Authors: Devi Leisangthem Binita
Published: October 2018

Policies and programmes of higher education play an important role to make accomplishment of the higher education objectives. If the policies and schemes of government for higher education has a good strategy to implement them, then only they will accomplish the objectives of higher education which in turn will bring progress and quality education. In this article various policies and schemes of government for higher education are analysed and discussed. For this purpose, documentary analysis of various government documents, such as annual reports of Manipur University, acts and statutes of Manipur University, annual reports of Directorate of Higher Education, Manipur, college statistics published by College Development Council, Manipur University and State Higher Education Commission report, are done. It tries to identify the changes which the policies and schemes of government have brought for the development of higher education in the state. Towards the end, the article tries to find out the problems of implementation of higher education policies and the gap in its implementation.
Versatile Learning Ecosystem: A Conceptual Framework
Authors: Pillai K. R. , Upadhyaya Pallavi , Balachandran Asha , Nidadavolu Janaki
Published: October 2018

This article intends to propose an integrative framework to make learning versatile, comprehensive and more effective, giving due cognizance to the fact that students of the future may require more knowledge and skill sets to thrive in the evolving digital era. The study followed an interpretivist philosophy to accomplish its goal. As a conceptual article, the research team has contemplated on the proposed design, which was deliberated with academic administrators and experts, and students. The study has proposed a supplementary architecture to reinforce the traditional learning ecosystem by leveraging the ubiquitous presence of technology-enabled learning atmosphere. The conceptual framework proposed would guide higher education institutions to relook at their course structure and implement flexible, versatile programmes. Exposure to multiple discipline verticals can help learners develop a civic citizenship. The article has attempted to overhaul the existing confined-learning environment with a new outlook.
Towards an Understanding of the Work of Teacher Education Professoriate in India
Authors: Srinivasan Rajashree
Published: October 2018

Reforming the teacher education system has been a key government policy towards improving school education in India. While recent curriculum and governance reforms articulate a new vision of teacher education that underscores a symbiotic relationship between teacher education and school education, it fails to engage enough with the most important participant of the teacher education system—the teacher educator. Changes to curriculum and governance process in the absence of a pro-active engagement of teacher educators with the reforms can do little to influence the teacher education processes and outcomes. The work of pre-service teacher educators is complex because their responsibilities relate to both school and higher education. The distinctiveness of their work, identity and professional development has always been marginalized in educational discourse. This article analyses select educational documents to examine the construction of work and identity of higher education-based teacher educators. It proposes the development of a professional framework of practice through a collective process, which would help understand the work of teacher educators and offer various possibilities for their professional development.
Communication Skills Training for Surgical Inpatient Advanced Practice Providers in an Academic Health-Care System
Authors: Joseph Johncy , Sicoutris Corinna , Raper Steven E
Published: October 2018

Background:

Good communication skills enhance the patient experience, clinical outcomes, and patient satisfaction.

Objective:

A course was developed by an interdisciplinary team (surgeon, nurse practitioner, and nurse MBA) for advanced practice providers (APPs) working for the department of surgery—a mix of practice and hospital-employed professionals—to enhance communications skills in an inpatient setting.

Methods:

Current concepts on provider–patient communication were discussed. Participants also asked to view and critique a video “provider–patient communication gone wrong” scenario. Lastly, participants were provided with techniques for improving provider–patient communication. The participants assessed the course. Provider communication scores were tracked from quarter 1, Fiscal Year 2014 to quarter 4 Fiscal Year 2017.

Results:

Of 110 eligible APPs, 95 (86%) attended the course. The anonymous survey response rate was 90% (86/95). Participants expressed satisfaction with the course content confirmed by Likert score weighted averages of >4.6/5 in all 8 domains. Communication scores increased with time.

Conclusion:

An interdisciplinary course aimed at enhancing provider–patient communication skills was well-received by the APP participants. The course was part of ongoing system-wide efforts to improve patient experiences, satisfaction, and outcomes. Continuing education in communication continues to play a key role in improving clinical outcomes and patient satisfaction.
Action Plan for Stroke in Europe 2018–2030
Authors: Norrving Bo , Barrick Jon , Davalos Antoni , Dichgans Martin , Cordonnier Charlotte , Guekht Alla , Kutluk Kursad , Mikulik Robert , Wardlaw Joanna , Richard Edo , Nabavi Darius , Molina Carlos , Bath Philip M , Stibrant Sunnerhagen Katharina , Rudd Anthony , Drummond Avril , Planas Anna , Caso Valeria
Published: October 2018

Two previous pan-European consensus meetings, the 1995 and 2006 Helsingborg meetings, were convened to review the scientific evidence and the state of current services to identify priorities for research and development and to set targets for the development of stroke care for the decade to follow. Adhering to the same format, the European Stroke Organisation (ESO) prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the Stroke Alliance for Europe (SAFE). The ESAP included seven domains: primary prevention, organisation of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment and life after stroke. Research priorities for translational stroke research were also identified. Documents were prepared by a working group and were open to public comments. The final document was prepared after a workshop in Munich on 21–23 March 2018. Four overarching targets for 2030 were identified: (1) to reduce the absolute number of strokes in Europe by 10%, (2) to treat 90% or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care, (3) to have national plans for stroke encompassing the entire chain of care, (4) to fully implement national strategies for multisector public health interventions. Overall, 30 targets and 72 research priorities were identified for the seven domains. The ESAP provides a basic road map and sets targets for the implementation of evidence-based preventive actions and stroke services to 2030.
Augmented Reality, Surgical Navigation, and 3D Printing for Transcanal Endoscopic Approach to the Petrous Apex
Authors: Barber Samuel R. , Wong Kevin , Kanumuri Vivek , Kiringoda Ruwan , Kempfle Judith , Remenschneider Aaron K. , Kozin Elliott D. , Lee Daniel J.
Published: October 2018

Otolaryngologists increasingly use patient‐specific 3‐dimensional (3D)–printed anatomic physical models for preoperative planning. However, few reports describe concomitant use with virtual models. Herein, we aim to (1) use a 3D‐printed patient‐specific physical model with lateral skull base navigation for preoperative planning, (2) review anatomy virtually via augmented reality (AR), and (3) compare physical and virtual models to intraoperative findings in a challenging case of a symptomatic petrous apex cyst. Computed tomography (CT) imaging was manually segmented to generate 3D models. AR facilitated virtual surgical planning. Navigation was then coupled to 3D‐printed anatomy to simulate surgery using an endoscopic approach. Intraoperative findings were comparable to simulation. Virtual and physical models adequately addressed details of endoscopic surgery, including avoidance of critical structures. Complex lateral skull base cases may be optimized by surgical planning via 3D‐printed simulation with navigation. Future studies will address whether simulation can improve patient outcomes.
Lentinan inhibits tumor angiogenesis via interferon γ and in a T cell independent manner
Authors: Deng Shengming , Zhang Guoxi , Kuai Jiajie , Fan Peng , Wang Xuexiang , Zhou Pei , Yang Dan , Zheng Xichen , Liu Xiaomei , Wu Qunli , Huang Yuhui
Published: October 2018

Background

Antiangiogenic agents are commonly used in lung and colon cancer treatments, however, rapid development of drug resistance limits their efficacy.

Methods

Lentinan (LNT) is a biologically active compound extracted from Lentinus edodes. The effects of LNT on tumor angiogenesis were evaluated by immunohistochemistry in murine LAP0297 lung and CT26 colorectal tumor models. The impacts of LNT on immune cells and gene expression in tumor tissues were determined by flow cytometry, qPCR, and ELISA. Nude mice and IFNγ blockade were used to investigate the mechanism of LNT affecting on tumor angiogenesis. The data sets were compared using two-tailed student’s t tests or ANOVA.

Results

We found that LNT inhibited tumor angiogenesis and the growth of lung and colon cancers. LNT treatments elevated the expression of angiostatic factors such as IFNγ and also increased tumor infiltration of IFNγ-expressing T cells and myeloid cells. Interestingly, IFNγ blockade, but not T cell deficiency, reversed the effects of LNT treatments on tumor blood vessels. Moreover, long-lasting LNT administration persistently suppressed tumor angiogenesis and inhibited tumor growth.

Conclusions

LNT inhibits tumor angiogenesis by increasing IFNγ production and in a T cell-independent manner. Our findings suggest that LNT could be developed as a new antiangiogenic agent for long-term treatment of lung and colon cancers.
Facial expression recognition using optimized active regions
Authors: Sun Ai , Li Yingjian , Huang Yueh-Min , Li Qiong , Lu Guangming
Published: October 2018

In this paper, we report an effective facial expression recognition system for classifying six or seven basic expressions accurately. Instead of using the whole face region, we define three kinds of active regions, i.e., left eye regions, right eye regions and mouth regions. We propose a method to search optimized active regions from the three kinds of active regions. A Convolutional Neural Network (CNN) is trained for each kind of optimized active regions to extract features and classify expressions. In order to get representable features, histogram equalization, rotation correction and spatial normalization are carried out on the expression images. A decision-level fusion method is applied, by which the final result of expression recognition is obtained via majority voting of the three CNNs’ results. Experiments on both independent databases and fused database are carried out to evaluate the performance of the proposed system. Our novel method achieves higher accuracy compared to previous literature, with the added benefit of low latency for inference.
Cell toxicity mechanism and biomarker
Authors: Zhang Yong
Published: October 2018

Cell toxicity may result in organ dysfunction and cause severe health problem. Recent studies revealed many toxicants may induced the over production of Nitric oxide, reactive oxygen species and the subsequent oxidative stress, cause cell toxicity. Mitochondrion dysfunction maybe the subsequent consequence of oxidative stress and has been recognized as another contributing factor in cell toxicity. Besides, oxidative products induced by some toxicants may also produce the compounds that damage cell DNA, leading to toxicity. Especially, the significance of nanoparticle induced cell toxicity was disclosed recently and attract more concern. The mechanism mainly includes inflammation, oxidative stress and DNA damage. On the other side, some biomarkers of cell toxicity including autophagy, cytokines, miRNA has been identified. The understanding of these phenomenon may enable us to clarify the cell toxicity mechanism then contribute to cell toxicity protection, disease treatment and drug side effect prevention.
Differential earthquake footprints on the masonry styles at Qal’at al-Subayba (Nimrod fortress) support the theory of its ancient origin
Authors: Margalit Alon
Published: October 2018

Qal’at al-Subayba (Nimrod Fortress), one of the largest medieval fortresses in the Middle East, is strategically located above the city of Banias on the ancient highway from Tyre to Damascus. Scholars have attributed the founding of the fortress to different rulers and periods. Current theory attributes the fortress founding to the Ayyubids. Although the Ayyubic theory is widely accepted, it relies primarily upon alternative interpretation of historical sources rather than firsthand observations. The fortress was constructed using distinctively different masonry styles. The primary styles, Massive, Crusader, Ayyubic, and Mamluk, are characterized here. Some of these masonries carry earthquake footprints and findings show that the damage is correlated with the specific masonry rather than geographical or other constraints. The Massive masonry sustained the greatest damage. The Crusader masonry was damaged to a lesser extent and the Ayyubic and Mamluk were spared. Based on these findings, it is concluded that the fortress was hit by two powerful earthquakes, the one of A.D 749 and the one of A.D 1202. The earthquake of A.D 749 devastated the Massive masonry, prior to later constructions. As this masonry has Hellenistic characteristics, it is suggested that the fortress was founded by the Greco-Syrians.
Transforming Clinical Trial Eligibility Criteria to Reflect Practical Clinical Application
Authors: Kim Edward S. , Atlas Jennifer , Ison Gwynn , Ersek Jennifer L.
Published: October 2018

Historically, oncology clinical trials have focused on comparing a new drug’s efficacy to the standard of care. However, as our understanding of molecular pathways in oncology has evolved, so has our ability to predict how patients will respond to a particular drug, and thus comparison with a standard therapy has become less important. Biomarkers and corresponding diagnostic testing are becoming more and more important to drug development but also limit the type of patient who may benefit from the therapy. Newer clinical trial designs have been developed to assess clinically meaningful endpoints in biomarker-enriched populations, and the number of modern, molecularly driven clinical trials are steadily increasing. At the same time, barriers to clinical trial enrollment have also grown. Many barriers contribute to nonenrollment in clinical trials, including patient, physician, institution, protocol, and regulatory barriers. At the protocol level, eligibility criteria have become a large roadblock to clinical trial accrual. Over time, eligibility criteria have become more and more restrictive. To accrue an adequate number of patients to molecularly driven trials, we should consider eligibility criteria carefully and attempt to reduce restrictive criteria. Reducing restrictive eligibility criteria will allow more patients to be eligible for clinical trial participation, will likely increase the speed of drug approvals, and will result in clinical trial results that more accurately reflect treatment of the population in the clinical setting.
Biosimilars: Here and Now
Authors: Lemery Steven J. , Esteva Francisco J. , Weise Martina
Published: October 2018

Congress passed the Biologics Price Competition and Innovation Act (BPCI Act) as part of the Affordable Care Act on March 23, 2010. The BPCI Act authorized an approval pathway for biosimilar and interchangeable products. It defines biosimilarity to mean “that the biological product is highly similar to the reference product notwithstanding minor differences in clinically inactive components” and that “there are no clinically meaningful differences between the biological product and the reference product in terms of safety, purity, and potency of the product.” The biosimilar pathway has the potential to facilitate access to biologic products through increased competition, in the same manner as biosimilars have done for almost 10 years in Europe. The goal of a biosimilar program is not to independently establish safety and effectiveness for each condition of use. Rather, the goal is to demonstrate biosimilarity through an extensive analytical characterization and a targeted clinical program designed to assess for clinically meaningful differences, if they exist. The regulatory approaches in both the United States and Europe involve a totality-of-the-evidence approach to demonstrate biosimilarity. Importantly, the biosimilar pathway allows for extrapolation of data across indications so that a sponsor, with adequate scientific justification, need not conduct clinical studies in each intended condition of use. Without extrapolation, development may not be feasible for many products, and patients and resources could be diverted from clinical studies of newer agents for cancer.
The Cancer Survivorship Journey: Models of Care, Disparities, Barriers, and Future Directions
Authors: Halpern Michael T. , McCabe Mary S. , Burg Mary Ann
Published: October 2018

Although the number of long-term cancer survivors has increased substantially over past years, the journey of survivorship does not always include high-quality, patient-centered care. A variety of survivorship care models have evolved based on who provides this care, the survivor population, the site of care, and/or the capacity for delivering specific services. Other areas of survivorship care being explored include how long follow-up care is needed, application of a risk-based approach to survivorship care, and the role of the survivor in his or her own recovery. However, there is little evidence indicating whether any models improve clinical or patient-reported outcomes. A newer focus in survivorship care has included assessment of potential disparities; the sociodemographic characteristics of population subgroups associated with barriers to receiving high-quality cancer treatment may also affect the survivorship period. Developing policies and programs to address disparities in survivorship care is not simple, and examining how financial hardship affects cancer outcomes, reducing economic barriers to care, and increasing incorporation of patient-centered strategies may be important components. Here too, there is little evidence regarding the best strategies to address these disparities. Barriers to providing high-quality, patient-centered survivorship care include lack of evidence, lack of a trained survivorship workforce, lack of reimbursement structures/insurance coverage, and lack of a health care system that reduces fragmented care. Future research needs to focus on developing a survivorship care evidence base, exploring strategies to facilitate provision of survivorship care, and disseminating best survivorship care practices to diverse and international audiences.
Real-World Conundrums and Biases in the Use of White Cell Growth Factors
Authors: Smith Thomas J. , Hillner Bruce E.
Published: October 2018

We present the 2015 American Society of Clinical Oncology (ASCO) white cell growth factors, or colony-stimulating factor (CSF), guidelines, updated from 2006. One new indication has been added–dose-intense chemotherapy for bladder cancer–to accompany the existing use for dose-dense breast cancer chemotherapy. Colony-stimulating factors remain appropriate for any regimen where the risk of febrile neutropenia is about 20% per cycle and dose reduction is not appropriate. Based on new evidence from multiple trials, CSF use is no longer indicated in treatment of lymphoma unless there are special risk factors. The United States accounts for 78% of the sales of CSF. The panel approved the use of all biosimilars, but the cost savings will be small as the price is about 80% of the branded CSFs. More biosimilars at lower cost are awaited. Methods to reduce use without harm to patients, by requiring justification according to accepted guidelines, are ongoing.
Strategies for Sustainable Cancer Care
Authors: Kerr David J. , Jani Anant , Gray Sir Muir
Published: October 2018

Editor's Note: The following article is based on the 2016 ASCO Annual Meeting Education Session “NICE or Not? Evaluating Global Strategies for Sustainable Cancer Care.” The authors review strategies for sustainable cancer care and the National Institute for Health and Care Excellence's role in the assessment of clinical and cost-effectiveness of new pharmaceutical and biopharmaceutical products in the United Kingdom.
Basic Overview of Current Immunotherapy Approaches in Cancer
Authors: Velcheti Vamsidhar , Schalper Kurt
Published: October 2018

Recent success of immunotherapy strategies such as immune checkpoint blockade in several malignancies has established the role of immunotherapy in the treatment of cancer. Cancers use multiple mechanisms to co-opt the host-tumor immune interactions, leading to immune evasion. Our understanding of the host-tumor interactions has evolved over the past few years and led to various promising new therapeutic strategies. This article will focus on the basic principles of immunotherapy, novel pathways/agents, and combinatorial immunotherapies.
Advances in the Genetics and Therapy of Acute Lymphoblastic Leukemia
Authors: Chiaretti Sabina , Gianfelici Valentina , O’Brien Susan M. , Mullighan Charles G.
Published: October 2018

Acute lymphoblastic leukemia (ALL) remains an important cause of morbidity in children and adults. In this article, we highlight advances in the genetics and therapy of three key subtypes of ALL: T-cell ALL, BCR-ABL1 (Philadelphia [Ph] chromosone–positive), and Ph-like ALL. T-ALL is an aggressive disease that accounts for about 15% and 25% of ALL among pediatric and adult cohorts, respectively, and exhibits a multistep nature of cancer initiation and progression. The integration of cytogenetics, molecular biology, and immunophenotype analyses has led to the identification of defined T-ALL subgroups, such as early T-cell precursor ALL and novel lesions with a prognostic role, for which specific inhibitors are being developed. Ph–positive ALL was historically regarded as a subtype of ALL with a poor prognosis, and allogeneic stem cell transplant was recommended for all patients who could undergo this procedure. The deep complete responses seen with combination tyrosine kinase inhibitors (TKIs) and chemotherapy in Ph-positive ALL, and the reports of long-term survival among some patients not undergoing allogeneic stem cell transplant, has raised the question of whether there is a subset of patients who could be cured without this intervention. Ph-like ALL is a subtype of B-progenitor ALL common among older children and adults and associated with a diverse range of genetic alterations that activate kinase signaling. Ph-like ALL is also associated with poor outcome, for which precision medicine trials identifying kinase alterations and testing TKI therapy are being developed.
Using Technology to Improve Cancer Care: Social Media, Wearables, and Electronic Health Records
Authors: Fisch Michael J. , Chung Arlene E. , Accordino Melissa K.
Published: October 2018

Digital engagement has become pervasive in the delivery of cancer care. Internet- and cellular phone–based tools and systems are allowing large groups of people to engage with each other and share information. Health systems and individual health professionals are adapting to this revolution in consumer and patient behavior by developing ways to incorporate the benefits of technology for the purpose of improving the quality of medical care. One example is the use of social media platforms by oncologists to foster interaction with each other and to participate with the lay public in dialogue about science, medicine, and cancer care. In addition, consumer devices and sensors (wearables) have provided a new, growing dimension of digital engagement and another layer of patient-generated health data to foster better care and research. Finally, electronic health records have become the new standard for oncology care delivery, bringing new opportunities to measure quality in real time and follow practice patterns, as well as new challenges as providers and patients seek ways to integrate this technology along with other forms of digital engagement to produce more satisfaction in the process of care along with measurably better outcomes.
The Oncology Care Model: A Critique
Authors: Thomas Christian A. , Ward Jeffrey C.
Published: October 2018

Rapidly increasing national health care expenditures are a major area of concern as threats to the integrity of the health care system. Significant increases in the cost of care for patients with cancer are driven by numerous factors, most importantly the cost of hospital care and escalating pharmaceutical costs. The current fee-for-service system (FFS) has been identified as a potential driver of the increasing cost of care, and multiple stakeholders are interested in replacing FFS with a system that improves the quality of care while at the same time reducing cost. Several models have been piloted, including a Center for Medicare & Medicaid Innovation (CMMI)–sponsored medical home model (COME HOME) for patients with solid tumors that was able to generate savings by integrating a phone triage system, pathways, and seamless patient care 7 days a week to reduce overall cost of care, mostly by decreasing patient admissions to hospitals and referrals to emergency departments. CMMI is now launching a new pilot model, the Oncology Care Model (OCM), which differs from COME HOME in several important ways. It does not abolish FFS but provides an additional payment in 6-month increments for each patient on active cancer treatment. It also allows practices to participate in savings if they can decrease the overall cost of care, to include all chemotherapy and supportive care drugs, and fulfill certain quality metrics. A critical discussion of the proposed model, which is scheduled to start in 2016, will be provided at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting with practicing oncologists and a Centers for Medicare & Medicaid Services (CMS) representative.
Interrogating the Cancer Genome to Deliver More Precise Cancer Care
Authors: Mateo Joaquin , de Bono Johann S.
Published: October 2018

The aim of precision medicine is to select the best treatment option for each patient at the appropriate time in the natural history of the disease, based on understanding the molecular makeup of the tumor, with the ultimate objective of improving patient survival and quality of life. To achieve it, we must identify functionally distinct subtypes of cancers and, critically, have multiple therapy options available to match to these functional subtypes. As a result of the development of better and less costly next-generation sequencing assays, we can now interrogate the cancer genome, enabling us to use the DNA sequence itself for biomarker studies in drug development. The success of DNA-based biomarkers requires analytical validation and careful clinical qualification in prospective clinical trials. In this article, we review some of the challenges the scientific community is facing as a consequence of this sequencing revolution: reclassifying cancers based on biologic/phenotypic clusters relevant to clinical decision making; adapting how we conduct clinical trials; and adjusting our frameworks for regulatory approvals of biomarker technologies and drugs. Ultimately, we must ensure that this revolution can be safely implemented into routine clinical practice and benefit patients.
Evolving Recommendations on Prostate Cancer Screening
Authors: Brawley Otis W. , Thompson Ian M. , Grönberg Henrik
Published: October 2018

Results of a number of studies demonstrate that the serum prostate-specific antigen (PSA) in and of itself is an inadequate screening test. Today, one of the most pressing questions in prostate cancer medicine is how can screening be honed to identify those who have life-threatening disease and need aggressive treatment. A number of efforts are underway. One such effort is the assessment of men in the landmark Prostate Cancer Prevention Trial that has led to a prostate cancer risk calculator (PCPTRC), which is available online. PCPTRC version 2.0 predicts the probability of the diagnosis of no cancer, low-grade cancer, or high-grade cancer when variables such as PSA, age, race, family history, and physical findings are input. Modern biomarker development promises to provide tests with fewer false positives and improved ability to find high-grade cancers. Stockholm III (STHLM3) is a prospective, population-based, paired, screen-positive, prostate cancer diagnostic study assessing a combination of plasma protein biomarkers along with age, family history, previous biopsy, and prostate examination for prediction of prostate cancer. Multiparametric MRI incorporates anatomic and functional imaging to better characterize and predict future behavior of tumors within the prostate. After diagnosis of cancer, several genomic tests promise to better distinguish the cancers that need treatment versus those that need observation. Although the new technologies are promising, there is an urgent need for evaluation of these new tests in high-quality, large population-based studies. Until these technologies are proven, most professional organizations have evolved to a recommendation of informed or shared decision making in which there is a discussion between the doctor and patient.
Immunotherapy and Checkpoint Inhibitors in Recurrent and Metastatic Head and Neck Cancer
Authors: Sadraei Nooshin Hashemi , Sikora Andrew G. , Brizel David M.
Published: October 2018

Immune surveillance is well recognized as an important mechanism to prevent development or progression of head and neck cancers. Head and neck cancer cells can escape the immune system through multiple mechanisms including development of tolerance in T cells and inhibition of T-cell–related pathways, generally referred to as checkpoint inhibitors. This article highlights advances in immuno-oncology treatment approaches in recurrent and metastatic head and neck squamous cell carcinoma. Clinical trials are discussed in detail, with an emphasis on response dynamics, oncologic efficacy, safety, and tolerability of checkpoint inhibitors. In addition, developing concepts and ongoing studies in this setting are also reviewed.
Paradigm Shift in the Management Strategy for Epithelial Ovarian Cancer
Authors: Fujiwara Keiichi , McAlpine Jessica N. , Lheureux Stephanie , Matsumura Noriomi , Oza Amit M.
Published: October 2018

The hypothesis on the pathogenesis of epithelial ovarian cancer continues to evolve. Although epithelial ovarian cancer had been assumed to arise from the coelomic epithelium of the ovarian surface, it is now becoming clearer that the majority of serous carcinomas arise from epithelium of the distal fallopian tube, whereas clear cell and endometrioid cancers arise from endometriosis. Molecular and genomic characteristics of epithelial ovarian cancer have been extensively investigated. Our understanding of pathogenesis of the various histologic types of ovarian cancer have begun to inform changes to the strategies for management of epithelial ovarian cancer, which represent a paradigm shift not only for treatment but also for prevention, which previously had not been considered achievable. In this article, we will discuss novel attempts at the prevention of high-grade serous ovarian cancer and treatment strategies for two distinct entities in epithelial ovarian cancer: low-grade serous and clear cell ovarian carcinomas, which are relatively rare and resistant to conventional chemotherapy.
Lung Cancer Screening, Cancer Treatment, and Addressing the Continuum of Health Risks Caused by Tobacco
Authors: Warren Graham W. , Ostroff Jamie S. , Goffin John R.
Published: October 2018

Tobacco use is the largest preventable risk factor for the development of several cancers, and continued tobacco use by patients with cancer and survivors of cancer causes adverse outcomes. Worldwide tobacco control efforts have reduced tobacco use and improved health outcomes in many countries, but several countries continue to suffer from increased tobacco use and associated adverse health effects. Continued tobacco use by patients undergoing cancer screening or treatment results in continued risk for cancer-related and noncancer-related health conditions. Although integrating tobacco assessment and cessation support into lung cancer screening and cancer care is well justified and feasible, most patients with cancer unfortunately do not receive evidence-based tobacco cessation support. Combining evidence-based methods of treating tobacco addiction, such as behavioral counseling and pharmacotherapy, with practical clinical considerations in the setting of lung cancer screening and cancer treatment should result in substantial improvements in access to evidence-based care and resultant improvements in health risks and cancer treatment outcomes.
Electronic Patient-Reported Outcomes: The Time Is Ripe for Integration Into Patient Care and Clinical Research
Authors: Schwartzberg Lee
Published: October 2018

In the emerging team-based approach to delivering cancer care, collecting patient-reported outcomes (PROs) provides longitudinal monitoring of treatment adverse effects, disease complications, functional statuses, and psychological states throughout the cancer continuum for all providers to use. Electronic systems offer added capabilities, including easy quantitation of individual symptom items and aggregated scales, standardization, and longitudinal tracking of patient surveys for trend analysis over time. An ideal electronic PRO (ePRO) platform is clinically relevant, validated, and reliable and would offer patient usability. Additionally, it should allow for automated responses to and from patients, have scheduling functionality, and send real-time alerts to site personnel and patients. Clinical interfaces should be easy to read and integrated into the electronic medical record. Multiple ePRO systems, often using electronic tablets, have been created and are beginning to be widely deployed. The Patient Care Monitor is one example of a system that has evolved into a comprehensive patient engagement platform, with a complete review of systems survey and capabilities for mobile health usage. Recent clinical trials have established ePRO systems as an effective method of providing information, which aids improved patient outcomes, including reduced health resource utilization and longer time on therapy. ePROs are also increasingly incorporated into clinical trials, where they can provide more thorough reporting of adverse events than can be captured by alternative methods. Mobile devices have the potential to become the method by which all members of the provider team communicate with patients both at the point-of-care and between clinic visits to optimize care delivery.
Tumor Heterogeneity and Therapeutic Resistance
Authors: Lovly Christine M. , Salama April K.S. , Salgia Ravi
Published: October 2018

The rapidly changing landscape of oncology has brought new light, and with it, new challenges to optimizing therapeutic strategies for patients. Although the concept of patient heterogeneity is well known to any practicing clinician, a more detailed understanding of the biologic changes that underscore the clinical picture is beginning to emerge. Thus, tumor heterogeneity has come to encompass more than just the clinical picture and can represent both intratumor and intertumor differences. Within the fields of thoracic oncology and melanoma, the discovery of key molecular drivers has resulted in landmark breakthroughs in therapy. However, the complexities of tumor genetics and the interaction within the environment continue to drive the search for better therapies. Ongoing challenges include the accurate and timely assessment of genetic changes as well as the development of resistance and the resultant compensatory mechanisms. Novel technologies, including commercially available next-generation sequencing, have allowed for a greater breadth and depth of information to be gained from a single pathologic specimen, and it is now being incorporated into routine clinical practice. Translational advances have subsequently provided valuable insight into mechanisms of resistance, with the development of novel treatment strategies. Future work will focus on novel diagnostic techniques and adaptive mechanisms that can ultimately drive the development of the next generation of cancer therapy.
Refining Breast Cancer Risk Stratification: Additional Genes, Additional Information
Authors: Kurian Allison W. , Antoniou Antonis C. , Domchek Susan M.
Published: October 2018

Recent advances in genomic technology have enabled far more rapid, less expensive sequencing of multiple genes than was possible only a few years ago. Advances in bioinformatics also facilitate the interpretation of large amounts of genomic data. New strategies for cancer genetic risk assessment include multiplex sequencing panels of 5 to more than 100 genes (in which rare mutations are often associated with at least two times the average risk of developing breast cancer) and panels of common single-nucleotide polymorphisms (SNPs), combinations of which are generally associated with more modest cancer risks (more than twofold). Although these new multiple-gene panel tests are used in oncology practice, questions remain about the clinical validity and the clinical utility of their results. To translate this increasingly complex genetic information for clinical use, cancer risk prediction tools are under development that consider the joint effects of all susceptibility genes, together with other established breast cancer risk factors. Risk-adapted screening and prevention protocols are underway, with ongoing refinement as genetic knowledge grows. Priority areas for future research include the clinical validity and clinical utility of emerging genetic tests; the accuracy of developing cancer risk prediction models; and the long-term outcomes of risk-adapted screening and prevention protocols, in terms of patients’ experiences and survival.
Treatment of Adult Lower-Grade Glioma in the Era of Genomic Medicine
Authors: Chang Susan M. , Cahill Daniel P. , Aldape Kenneth D. , Mehta Minesh P.
Published: October 2018

By convention, gliomas are histopathologically classified into four grades by the World Health Organization (WHO) legacy criteria, in which increasing grade is associated with worse prognosis and grades also are subtyped by presumed cell of origin. This classification has prognostic value but is limited by wide variability of outcome within each grade, so the classification is rapidly undergoing dramatic re-evaluation in the context of a superior understanding of the biologic heterogeneity and molecular make-up of these tumors, such that we now recognize that some low-grade gliomas behave almost like malignant glioblastoma, whereas other anaplastic gliomas have outcomes comparable to favorable low-grade gliomas. This clinical spectrum is partly accounted for by the dispersion of several molecular genetic alterations inherent to clinical tumor behavior. These molecular biomarkers have become important not only as prognostic factors but also, more critically, as predictive markers to drive therapeutic decision making. Some of these, in the near future, will likely also serve as potential therapeutic targets. In this article, we summarize the key molecular features of clinical significance for WHO grades II and III gliomas and underscore how the therapeutic landscape is changing.