bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-Income Women with Breast Abnormalities: System Predictors of Timely Diagnostic Resolution
Authors: Mojica Cynthia M. , Bastani Roshan , Boscardin W. John , Ponce Ninez A.
Published: August 2017

Background

Incomplete or delayed diagnostic resolution of breast abnormalities suspicious for cancer may contribute to poor breast cancer outcomes. We examine system predictors of timely diagnostic resolution in low-income, mostly Latina women with breast abnormalities at two Los Angeles County public hospitals.

Methods

We collected medical record data on 1,671 women. The outcome – timely diagnostic resolution – was defined as receipt of definitive diagnosis (malignant or benign) within six months of the index referral. Predictors of the outcome were examined with bivariate and multivariate logistic regression models.

Results

Only 56% of women received timely diagnostic resolution; however, the proportion was higher at Hospital B (67%) compared to Hospital A (51%). The effect of predictors differed by hospital. At Hospital B, the odds of timely diagnostic resolution were lower for women with self-identified abnormalities (P<.033) and higher for women referred to Radiology rather than Surgery for their first appointment (P<.005). At Hospital A, the odds of timely diagnostic resolution were higher for women with self-identified abnormalities (P<.043) and lower for women referred to Radiology rather than Surgery for their first appointment (P<.001).

Conclusions

Rates and predictors of timely diagnostic resolution differed by hospital. System barriers may be a function of referral processes and patient tracking. Interventions may need to be tailored to a hospital's unique culture.
Therapy for Unresectable Recurrent and In-Transit Extremity Melanoma
Authors: Gimbel Mark I. , Delman Keith A. , Zager Jonathan S.
Published: August 2017

Background

Unresectable recurrent and in-transit extremity melanoma presents a dilemma for the treating physician. While the disease is confined to the involved limb, the survival mimics that of multiple nodal metastases, with a 10-year survival rate of approximately 40%. This represents late-stage disease for which curative treatment options are limited.

Methods

To review the current treatment strategies for stage IIIB (N2c) in-transit and recurrent melanoma focusing on the options for unresectable disease, MEDLINE was searched for studies of known and experimental treatments for in-transit and recurrent extremity melanoma. Further results were obtained after review of the initial citations.

Results

For unresectable recurrences and in-transit metastases, therapies are limited to palliative (radiation), local (intratumoral injection, laser ablation and electroporation), regional (isolated limb perfusion/infusion), and systemic (chemotherapy) when local or regional techniques are not feasible.

Conclusions

In this patient population, intratumoral techniques have a limited role with current treatment regimens, but with the development of new drugs, these techniques may have more utility. If not contraindicated, regional techniques provide the greatest control and have minimal operative morbidity. Until new regimens are available, systemic therapy continues to be associated with considerable toxicity and only marginal response rates.
Employment and Quality of Survivorship among Women with Cancer: Domains not Captured by Quality of Life Instruments
Authors: Frazier Linda M. , Miller Virginia A. , Horbelt Douglas V. , Delmore James E. , Miller Brigitte E. , Averett Ellen P.
Published: August 2017

Background

Many quality of life instruments assess the amount of paid work in combination with role function at home in the same items and do not specifically assess social support in the workplace. The goal of this study was to obtain women's views on the relationship between employment and health-related quality of life.

Methods

A focus group and questionnaire study was conducted among 73 women with gynecologic cancer who were employed at diagnosis and 25 people who provided them with psychosocial support.

Results

The women held a variety of blue collar and white collar jobs at diagnosis. Employment provided a strong sense of accomplishment and a welcome distraction during treatment. The employment experience was described as distinct from role function at home. No one equated working more hours with better quality of life. Social support at work could be poor at the same time that support from family and friends grew stronger.

Conclusions

The contribution to their quality of life that cancer survivors feel they receive from employment may not be linearly related to the quantity of their role function in the workplace. Employment-related items could be useful as an adjunct to standard quality of life measures.
Limiting the Morbidity of Inguinal Lymphadenectomy for Metastatic Melanoma
Authors: Sarnaik Amod A. , Puleo Christopher A. , Zager Jonathan S. , Sondak Vernon K.
Published: August 2017

Background

Surgery is currently the primary treatment modality for metastatic mela-noma involving the inguinal lymph nodes. However, inguinal lymph node dissections are associated with substantial morbidity including infection, wound dehiscence, lymphedema, seroma, and deep venous thromboembolism (DVT). Improved understanding is needed regarding the factors predisposing patients to complications and the operative and perioperative maneuvers that can decrease morbidity.

Methods

We reviewed recently published literature regarding the morbidity associated with lymphadenectomy in the treatment of inguinal metastatic melanoma. Where available, emphasis was focused on appropriately designed studies aimed at reducing treatment-related morbidity. When appropriate, the review was supplemented by our personal experience.

Results

Strategies to limit treatment-related morbidity involve optimizing the preoperative assessment, operative technique, and postoperative care. Establishing the diagnosis of nodal metastasis early using minimally invasive techniques is critical to reduce subsequent perioperative complications. Morbidity is higher for inguinal compared to cervical or axillary lymphadenectomy, and many variations in extent of inguinal lymphadenectomy and operative technique have been reported. The lack of definitive trials has led to controversy regarding surgical technique such as indications for pelvic lymphadenectomy (“deep” node dissection), saphenous vein preservation, and sartorius transposition. In the postoperative period, the use of DVT and lymphedema prophylaxis should be considered to potentially improve patient outcomes.

Conclusions

While the morbidity of inguinal lymphadenectomy can be substantial, several straightforward pre- and postoperative measures can be instituted to limit morbidity. Controversy persists regarding the indications for and benefit of pelvic lymphadenectomy, saphenous vein preservation, and sartorius muscle transposition. A multi-institutional trial is currently in progress to investigate the safety of avoiding lymphadenectomy in patients with microscopic metastases in the sentinel node.
Molecular and Functional Imaging of Breast Cancer
Authors: Tafreshi Narges K. , Kumar Virendra , Morse David L. , Gatenby Robert A.
Published: August 2017

Background

Significant efforts have been directed toward developing and enhancing imaging methods for the early detection, diagnosis, and characterization of small breast tumors. Molecular and functional imaging sets the stage for enhancement of current methodology.

Methods

Current imaging modalities are described based on the molecular characteristics of normal and malignant tissue. New molecular imaging methods that have the potential for clinical use are also discussed.

Results:

Dynamic contrast-enhanced magnetic resonance imaging is more sensitive than mammography in BRCA1 carriers. It is used in screening and in the early evaluation of neoadjuvant therapy. Positron emission mammography is 91% sensitive and 93% specific in detecting primary breast cancers. Sentinel node scintigraphy is a key component of axillary lymph node evaluation. Other imaging modalities being studied include Tc99m sestamibi, radiolabeled thymidine or uridine, estrogen receptor imaging, magnetic resonance spectroscopy, and diffusion magnetic resonance imaging.

Conclusions

Molecular and functional imaging of the breast will likely alter clinical practice in diagnosing and staging primary breast cancer and assessing response to therapy since it will provide earlier information regarding the underlying biology of individual breast cancers, tumor stage, potential treatment strategies, and biomarkers for early evaluation of treatment effects.
Emerging Technologies in Prostate Cancer Radiation Therapy: Improving the Therapeutic Window
Authors: Biagioli Matthew C. , Hoffe Sarah E.
Published: August 2017

Background

Radiation therapy is a standard of care in the treatment of prostate cancer. Relatively recent advances in technologies in the delivery of radiation therapy are altering our current approach to treatment of prostate cancer.

Methods

This review discusses the results of retrospective, prospective, and randomized clinical trials that have evaluated clinical outcomes in prostate cancer treated with newer radiation therapy technologies.

Results

Randomized trials have demonstrated that higher doses of radiation therapy improve clinical outcomes but with increased toxicity to normal tissue. The introduction of more conformal radiation therapy techniques such as intensity-modulated radiation therapy, proton therapy, stereotactic body radiotherapy, and brachytherapy have allowed for further dose escalation with simultaneous reduction in toxicity. However, use of more conformal treatments requires a better understanding of prostate motion and the ability to track prostate movements in real time.

Conclusions

Technological advancements have improved radiation dose delivery to the prostate and have reduced normal tissue toxicity. Randomized trials are warranted to ultimately evaluate clinical benefit and outcomes.
Graft-vs-Host Disease following Allogeneic Hematopoietic Cell Transplantation
Authors: Pidala Joseph
Published: August 2017

Background

Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative therapy with proven efficacy in the management of hematologic malignancies. However, it is complicated by the syndromes of acute and chronic graft-vs-host disease (GVHD).

Methods

A narrative review is provided to summarize major biologic insights into the pathogenesis of these immune-mediated disorders, as well as advances in diagnosis, classification, prevention, management, and allied supportive care with the aim of providing essential understanding for clinicians with or without subspecialty experience in the field of blood and marrow transplantation.

Results

Major scientific advances have contributed to enhanced understanding of the pathogenesis of these disorders, and clinical investigation has provided more effective preventive and therapeutic strategies for GVHD. However, since acute GVHD and chronic GVHD remain leading sources of transplantation-related morbidity and mortality, ongoing investigation is needed to develop new approaches to addressing these syndromes.

Conclusions

The major challenge for future investigation will be to capitalize on biologic insights in order to develop novel strategies for the prevention and therapy of acute and chronic GVHD that will address the current shortcomings in existing therapeutic approaches.
Imaging of Prostate Carcinoma
Authors: Outwater Eric K. , Montilla-Soler Jaime L.
Published: August 2017

Background

Imaging of prostate carcinoma is an important adjunct to clinical evaluation and prostate-specific antigen measurement for detecting metastases and tumor recurrence. In the past, the ability to assess intraprostatic tumor was limited.

Methods

Pertinent literature was reviewed to describe the capabilities and limitations of the currently available imaging techniques for assessing prostate carcinoma. Evaluation of primary tumor and metastatic disease by ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine techniques is discussed.

Results

Ultrasonography and MRI have limited usefulness for local staging of prostate cancer because of suboptimal sensitivity and specificity for identifying tumor extent and capsular penetration. Additional MRI techniques such as magnetic resonance-based perfusion imaging, diffusion imaging, and spectroscopy may provide incremental benefit. CT and bone scanning provide an assessment of metastatic disease but are also limited by the poor sensitivity of lymph node size as a criterion for detecting metastases. Novel imaging techniques such as hybrid imaging devices in the form of single-photon emission CT/CT gamma cameras, positron emission tomography/CT cameras, and, in the near future, positron emission tomography/MRI combined with tumor-specific imaging radiotracers may have a significant impact on tumor staging and treatment response.

Conclusions

Cross-sectional imaging and scintigraphy have an important role in assessing prostate carcinoma metastases and treatment response. Increasingly, the incremental value of primary tumor imaging through MRI is being realized.
Surgical Management of Primary and Metastatic Spinal Tumors
Authors: Kaloostian Paul E. , Zadnik Patricia L. , Etame Arnold B. , Vrionis Frank D. , Gokaslan Ziya L. , Sciubba Daniel M.
Published: August 2017

Background

The axial skeleton is a common site for primary tumors and metastatic disease, with metastatic disease being much more common. Primary and metastatic spinal tumors have a diverse range of aggressiveness, ranging from benign lesions to highly infiltrative malignant tumors.

Methods

The authors reviewed the results of articles describing the treatment and outcomes of patients with metastatic disease or primary tumors of the spinal column.

Results

En bloc resection is the mainstay of treatment for malignant primary tumors of the spinal column. Intralesional resection is generally appropriate for benign primary tumors. Low-quality evidence supports the use of chemotherapy in select primary tumors; however, radiation therapy is often used for incompletely resected or unresectable lesions. Surgical considerations for the treatment of metastatic disease are more nuanced and require that the health care professional consider patient performance status and the pathology of the primary tumor.

Conclusions

The treatment of metastatic and primary tumors of the spinal column requires a multidisciplinary approach in order to offer patients the best opportunity for long-term survival.
Advances in the Molecular Analysis of Breast Cancer: Pathway toward Personalized Medicine
Authors: Rosa Marilin
Published: August 2017

Background

Breast cancer is a heterogeneous disease that encompasses a wide range of clinical behaviors and histological and molecular variants. It is the most common type of cancer affecting women worldwide and is the second leading cause of cancer death.

Methods

A comprehensive literature search was performed to explore the advances in molecular medicine related to the diagnosis and treatment of breast cancer.

Results

During the last few decades, advances in molecular medicine have changed the landscape of cancer treatment as new molecular tests complement and, in many instances, exceed traditional methods for determining patient prognosis and response to treatment options. Personalized medicine is becoming the standard of care around the world. Developments in molecular profiling, genomic analysis, and the discovery of targeted drug therapies have significantly improved patient survival rates and quality of life.

Conclusions

This review highlights what pathologists need to know about current molecular tests for classification and prognostic/predictive assessment of breast carcinoma as well as their role as part of the medical team.
Treatment of Head and Neck Paragangliomas
Authors: Hu Kenneth , Persky Mark S.
Published: August 2017

Background

Commonly occurring in the head and neck, paragangliomas are typically benign, highly vascular neoplasms embryologically originating from the extra-adrenal paraganglia of the neural crest. Frequently, these tumors are associated with the vagus, tympanic plexus nerve, the carotid artery, or jugular bulb. Their clinical presentation can vary across a wide spectrum of signs and symptoms.

Methods

We reviewed and compared standard treatment approaches for paragangliomas of the head and neck.

Results

In general, surgery is the first-line choice of therapy for carotid body tumors, whereas radiotherapy is the first-line option for jugular and vagal paragangliomas.

Conclusions

Because of the complexity of clinical scenarios and treatment options for paragangliomas, a multidisciplinary algorithmic approach should be used for treating paragangliomas. The approach should emphasize single-modality treatment that yields excellent rates of tumor control, low rates of severe, iatrogenic morbidity, and the preservation of long-term function in this patient population.
Black Heterogeneity in Cancer Mortality: US-Blacks, Haitians, and Jamaicans
Authors: Pinheiro Paulo S. , Callahan Karen E. , Ragin Camille , Hage Robert W. , Hylton Tara , Kobetz Erin N.
Published: August 2017

Introduction

The quantitative intraracial burden of cancer incidence, survival and mortality within black populations in the United States is virtually unknown.

Methods

We computed cancer mortality rates of US- and Caribbean-born residents of Florida, specifically focusing on black populations (United States, Haiti, Jamaica) and compared them using age-adjusted mortality ratios obtained from Poisson regression models. We compared the mortality of Haitians and Jamaicans residing in Florida to populations in their countries of origin using Globocan.

Results

We analyzed 185,113 cancer deaths from 2008 to 2012, of which 20,312 occurred in black populations. The overall risk of death from cancer was 2.1 (95% CI: 1.97–2.17) and 1.6 (95% CI: 1.55–1.71) times higher for US-born blacks than black Caribbean men and women, respectively (P < .001).

Conclusions

Race alone is not a determinant of cancer mortality. Among all analyzed races and ethnicities, including Whites and Hispanics, US-born blacks had the highest mortality rates while black Caribbeans had the lowest. The biggest intraracial difference was observed for lung cancer, for which US-blacks had nearly 4 times greater mortality risk than black Caribbeans. Migration from the islands of Haiti and Jamaica to Florida resulted in lower cancer mortality for most cancers including cervical, stomach, and prostate, but increased or stable mortality for 2 obesity-related cancers, colorectal and endometrial cancers. Mortality results in Florida suggest that US-born blacks have the highest incidence rate of “aggressive” prostate cancer in the world, rather than Caribbean men.
Melanoma Metastasis
Authors: Fidler Isaiah J.
Published: August 2017

Cancer metastasis requires a series of sequential steps, each of which is rate limiting. Neoplasms are biologically heterogeneous, and the process of metastasis is highly selective. Multiple metastases often differ in biologic characteristics and can change during the course of the disease. Clonal analysis of human melanoma suggest that systemic, physiologic signals can be recognized by neoplastic cells. Brain metastases are particularly common in patients with metastatic melanoma. The blood brain barrier does not prevent the invasion of the brain parenchyma by circulating metastatic cells, and its permeability varies among different experimental brain metastases.
Accurate Nodal Staging of Malignant Melanoma
Authors: Reintgen Douglas , Albertini John , Berman Claudia , Cruse C. Wayne , Fenske Neil , Glass Frank , Puleo Chris , Wang Xiangang , Wells Karen , Rapaport David , Deconti Ronald , Messina Jane , Heller Richard
Published: August 2017

The incidence of malignant melanoma is increasing at a faster pace than that of any other cancer in the United States. It is estimated that people born in the year 2000 will have a 1:75 risk of developing melanoma sometime during his or her lifetime. Stimulated by novel lymphatic mapping techniques, the surgical care of the melanoma patient is evolving toward more conservative resections that can provide the same staging information but without the added morbidity of more radical surgeries. This approach promises to yield positive results in the age of health care reform, outcome measurements, and cost:benefit considerations.
Radioimmunoguided Surgery in the Treatment and Evaluation of Rectal Cancer Patients
Authors: Arnold Mark W. , Schneebaum Schlomo , Martin Edward W.
Published: August 2017

Several therapeutic options are available for the treatment of rectal cancer. To determine the most appropriate method of treatment, Radioimmunoguided Surgery (RIGS) can be used as an intraoperative diagnostic tool and as an adjuvant to traditional methods for more accurate staging. RIGS employs radiolabeled monoclonal antibodies directed against tumor-associated antigens and a gamma-detection probe to discriminate between normal and abnormal tissue. Most patients with primary or recurrent rectal cancer are considered good candidates for surgery using RIGS scanning. Use of the RIGS system may result in improved patient survival through accurate assessment of extent of disease and the selection of appropriate therapy. Prospective studies are necessary to define the optimal use of this approach as an experimental and clinical tool.
Overview of Hospice and Palliative Care in Oncology
Authors: Schonwetter Ronald S.
Published: August 2017

Background

The concept of palliative care in oncology has not yet reached the forefront of American medicine, and hospice care may be underused.

Methods

Data on increasing needs for palliative care and the development of the hospice movement are compared with practice behavior patterns of physicians in regard to palliative care.

Results

Hospice/palliative care has grown from an alternative health care movement to an accepted part of the American health field. Limitations of hospice/palliative care include health professionals’ discomfort with care of the terminally ill as well as difficulties in predicting limited prognoses that may hinder access to such care.

Conclusions

Hospice/palliative care principles should be integrated into other elements of cancer control to ensure comprehensive care for all cancer patients.
Intermediate Markers and Molecular Genetics of Lung Carcinogenesis
Authors: Szabo Eva , Shaw Gail L.
Published: August 2017

Background

Various options are available for the local control of cancer in the breast - mastectomy, conservation therapy, and mastectomy with reconstruction.

Methods

To evaluate the benefits and drawbacks of the available management options, the authors combine their extensive experience with a review of the literature on outcomes from these approaches.

Results

Conservation therapy provides survival outcomes similar to those from mastectomy. Differences in local recurrence rates can be minimized by close adherence to guidelines for patient selection, operative approach, and radiation technique.

Conclusions

The role of the physician in selecting a local therapy for breast cancer has changed from one of informing the patient of the treatment to assessing the presence of medical contraindications to any of the treatments, educating the patients on each treatment approach, providing access to multidisciplinary consultation, and allowing the patient to choose an appropriate treatment approach.
New Agents in the Management of Non-Small-Cell Lung Cancer
Authors: Chiappori Alberto , Devore Russell F. , Johnson David H.
Published: August 2017

Background

Non-small-cell carcinoma of the lung has long been considered a chemotherapeutically resistant neoplasm. Newer agents and combinations are being tested.

Methods

The authors have reviewed data on recent and active phase I and phase II trials of several new agents and combinations.

Results

New drugs that affect both response rates and survival include vinorelbine, paclitaxel, docetaxel, gemcitabine, topotecan, and irinotecan.

Conclusions

The advent of several relatively well-tolerated agents that alone have beneficial effects in advanced non-small-cell lung cancer provides reasonable hope that more effective drug combinations will soon be available for this disease.
Radioimmunoguided Surgery for Gastrointestinal Malignancies: An Analysis of 14 Years of Clinical Experience
Authors: Martinez Deborah A. , Barbera-Guillem Emilio , Lavalle Gregory J. , Martin Edward W.
Published: August 2017

Background

The identification of all sites of intra-abdominal adenocarcinoma is key to optimal surgical resection and tumor staging. Conventional imaging methods and direct visualization and palpation have limited sensitivity and specificity. Radioimmunoguided surgery (RIGS) has a potential to improve these parameters.

Methods

The development of the RIGS concept is presented, and the studies of tumor localization, detection of disseminated disease, staging, and survival are correlated with the tumor biopsy of gastrointestinal carcinoma, particularly colorectal carcinoma.

Results

RIGS can detect clinically and histologically occult neoplasm. Also, by providing immediate intraoperative information, the RIGS approach improves surgical staging, impacts on surgical and medical care, and affects patient prognosis.

Conclusions

RIGS may become the standard of care for the surgical staging and treatment of colorectal cancer and other gastrointestinal malignancies.
Antisense Oligodeoxynucleotide Technology: Potential Use for the Treatment of Malignant Brain Tumors
Authors: Engelhard Herbert H.
Published: August 2017

Background:

Antisense oligodeoxynucleotides (ODNs) have been proposed as a new therapy for patients with cancer, including malignant brain tumors. Antisense ODNs are taken up by tumor cells and selectively block gene expression. Use of ODNs for brain tumors is attractive due to their theoretical specificity, relative ease of production and, to date, paucity of reported adverse effects. This article presents current information regarding antisense ODNs and their possible future use for the treatment of brain tumors.

Methods:

The available published experimental and clinical information regarding antisense ODN treatment of glioblastoma cells and administration into the central nervous system (CNS) was reviewed. Other clinically relevant information pertaining to the molecular biology of antisense ODNs was also collected and summarized.

Results:

Targets for antisense ODN therapy in malignant glioma cells have included c-myc, c-myb, c-sis, c-erb B, CD44, p34cdc2, bFGF, PDGF, TGF-beta, IGF-1, PKC-alpha tumor necrosis factor, urokinase, and S100beta protein. Few in vivo studies of ODN treatment of brain tumors have yet been reported. Systemically administered ODNs enter the brain only in extremely small quantities; therefore, microinfusion into the brain has been recommended.

Conclusions:

Antisense ODNs have been used successfully to block glioblastoma gene expression in vitro and expression of multiple genes within the CNS of experimental animals. Upcoming clinical trials will address the safety of antisense ODN use against malignant brain tumors.
Management of Myeloma: Current and Future Approaches
Authors: Oken Martin M.
Published: August 2017

Background

The treatment of multiple myeloma, relatively stagnant for many years, appears to be entering a promising era for improvement. This paper reviews treatment interventions available for patients with multiple myeloma to indicate a standard approach and to evaluate the spectrum of current standard therapy.

Methods

The author reviews published literature on the treatment of multiple myeloma. Both journal articles and papers presented at national and international meetings are utilized.

Results

Intensive combination chemotherapy offers relatively modest improvement over standard melphalan plus prednisone, but the use of interferon for maintenance therapy lengthens response duration and possibly survival. High-dose chemotherapy with stem-cell transplantation is a relatively safe and effective treatment modality for patients under 70 years of age at first relapse. Studies in progress will determine its role in first response consolidation. Use of hematopoietic growth factors, prophylactic antibiotics, and bisphosphonate treatment of lytic bone disease has diminished disease morbidity.

Conclusions

While cure of multiple myeloma remains elusive and 10-year survival is still uncommon, newer treatment approaches offer better control of disease manifestations and perhaps a real opportunity to prolong functional life. Future treatments that will address minimal residual disease may improve long-term survival.
Pharmacoeconomics of Cancer Therapy
Authors: Beltz Susan E. , Yee Gary C.
Published: August 2017

Background

In 1990, annual costs of the diagnosis and treatment of cancer reached nearly $100 billion and currently constitutes approximately 10% of health care expenditures in the United States. As new and often more expensive therapies for cancer treatment become available, the health care decision- maker must consider the cost effectiveness of the therapy.

Methods

Key principles of economic analyses and the inherent differences among these analyses are reviewed.

Results

While pharmacoeconomic analyses are increasingly being used in treatment decision-making, several issues relating to study design, data collection, and research methods are controversial.

Conclusions

Pharmacoeconomics analyses are necessary in the current health care environment, but the assumptions used within the analyses warrant careful evaluation.
Laboratory and Bone Marrow Evaluation in Patients with Cancer
Authors: Moscinski Lynn C.
Published: August 2017

Anemia in patients with cancer has multiple causes. Since establishing a diagnosis can be difficult, evaluation via laboratory findings and bone marrow histopathology is often necessary. Cytopenias can result either directly or indirectly from the malignancy, or they occasionally are the result of other causes, such as AIDS or infection.
Chemotherapy for Advanced Gastric Cancer: Focus on New Agents and Combinations
Authors: Murad André M.
Published: August 2017

Background

Although many treatments for advanced gastric cancer have been developed, systemic therapy remains elusive.

Methods

The author reviewed data on recent phase II and III trials of the main new agents and combinations.

Results

Chemotherapy appears to improve survival of patients with advanced disease, albeit slightly. New drugs that might improve response rates and survival include the taxanes.

Conclusions

New combinations, including the taxanes, must be designed and evaluated to further improve the outcome for patients with advanced gastric cancer.
“She Gave Me the Confidence to Open Up”: Bridging Communication by Promotoras in a Childhood Obesity Intervention for Latino Families
Authors: Falbe Jennifer , Friedman Lily E. , Sokal-Gutierrez Karen , Thompson Hannah R. , Tantoco Nicole K. , Madsen Kristine A.
Published: August 2017

Childhood obesity is a public health threat that disproportionally affects Latino youth in the United States. Active and Healthy Families (AHF) is a culturally tailored, family-based program for addressing obesity disparities in a predominantly immigrant Latino population. AHF was the first primary care, culturally tailored intervention for Latino children to significantly reduce BMI in a randomized controlled trial. The 10-week AHF intervention reduced BMI (kg/m2) among overweight or obese children by 0.5, compared with an increase of 0.3 in the control group, yielding a −0.8 difference ( p < .01). A unique aspect of the program is its provider team: a physician, dietitian, and promotora. Because early feedback from families highlighted the importance of promotoras specifically, we sought to understand the unique mechanisms of promotora effectiveness in AHF. We conducted in-depth, semistructured interviews with the AHF providers ( n = 5) and parent participants ( n = 23) by phone between November 2012 and May 2013. In a grounded theory analysis, three main categories encompassing five themes emerged: (a) bridging communication by promotoras; (b) promotoras’ personal qualities, including themes of kindness and caring and shared experiences with patients; and (c) impactful task performance, including themes of motivation, positive environment, and self-efficacy. Together, the themes serve as the basis of a conceptual model illustrating the process through which promotoras may enhance the impact of team-based obesity programs for the Latino community. Because this study identifies the specific ways through which promotoras can bridge cultural, linguistic, and other divides, it may inform development and dissemination of evidence-based approaches for obesity prevention in the Latino community.
Beyond the RCT
Authors: Goodman Lisa A. , Epstein Deborah , Sullivan Cris M.
Published: August 2017

Programs for domestic violence (DV) victims and their families have grown exponentially over the last four decades. The evidence demonstrating the extent of their effectiveness, however, often has been criticized as stemming from studies lacking scientific rigor. A core reason for this critique is the widespread belief that credible evidence can derive only from research grounded in randomized control trials (RCTs). Although the RCT method has its strengths, we argue that it is rarely an optimal—or even a possible—approach for evaluating multifaceted DV programs. This article reviews the reasons that RCT is a poor fit for such programs and argues that a more inclusive conceptualization of credible evidence is critical to expanding our knowledge base about how DV programs affect survivors’ safety and well-being.
A highly active K/Cu-Mn-O catalyst for the removal of nitric oxide in indoor air
Authors: Wang Chan , Li Feng , Sun Zishu , Song Qijun
Published: August 2017

Nitric oxide is a frequently encountered pollutant in indoor air. It could have a number of harmful effects on human health even at low concentration. Aiming to improve the indoor air quality, an environment-friendly method was developed for the elimination of nitric oxide at ppm level based on a low temperature effective catalyst potassium-doped copper–manganese oxide (K/Cu-Mn-O). The catalyst was obtained through a co-precipitation method using metal nitrates in aqueous solution and the precipitate was calcinated at 400℃ for 5 h. After impregnation with K, the best catalytic activity was observed for the K/Cu-Mn-O catalyst with a Cu/Mn ratio of 1:2 and surface concentration of doping K 7.03% (7.4 mg/g). The composition and the structure of the catalyst were comprehensively characterized by X-ray diffraction, X-ray photoelectron spectroscopy, scanning electron microscopy, and Brunauer–Emmett–Teller. The results showed that the potassium doping improved the adsorption ability of catalyst, and promoted the formation of the nitrate salt, and thereby further improved the elimination rate of nitric oxide. Finally, the possible reaction mechanisms are discussed.
Calculation of the kinematics of hypoid gears towards developing a method for an equivalent crossed helical gear pair selection for use in tribological experimental evaluations
Authors: Athanasopoulos E , Salpistis C , Mohammadpour M , Mihailidis A , Theodossiades S , Grekoussis R
Published: August 2017

To experimentally verify power loss and friction for hypoid gears, measurements in a closed power-loop test rig are necessary. However, these are costly and mechanically complex, since they require additional spur gear reducers in the loop. ISO directives document the use of crossed helical gear pairs as virtual gears for hypoids to calculate the sliding velocity, since the flank geometry at the mean point can be precisely represented. The use of such pairs can be a cost effective and simpler alternative for testing purposes. However, the validity of this analogy regarding contact mechanics and tribology for the full mesh cycle has not been investigated hitherto. In the current study, a new method for calculating the sliding and rolling speed along the full path of contact of a hypoid gear pair is presented. Cutter kinematics are considered, for the accurate definition of the contact bodies. Using tooth contact analysis, the load distribution on the tooth under quasi-static conditions and the sliding velocity are calculated for comparison purposes. By applying a selection algorithm, a single experimental crossed helical gear pair is chosen aiming to simulate the contact conditions of hypoid gears. Two test scenarios are studied using elastohydrodynamic film thickness equations and friction models for evaluating the power loss. The contact is an elongated ellipse with varying directions of the sliding and sum velocities, which are considered in the model. The kinematic equivalence shows good agreement, while the tribological equivalence is achievable using a reduced input torque.
Shuttle walk tests in people with COPD who demonstrate exercise-induced oxygen desaturation: An analysis of test repeatability and cardiorespiratory responses
Authors: McKeough Zoe , Leung Regina , Neo Ji Hui , Jenkins Sue , Holland Anne , Hill Kylie , Morris Norman , Spencer Lissa , Hill Catherine , Lee Annemarie , Seale Helen , Cecins Nola , McDonald Christine , Alison Jennifer
Published: August 2017

Exercise-induced oxygen desaturation (EID) is prevalent in people with chronic obstructive pulmonary disease (COPD). This article reports a sub-analysis from a randomized controlled trial (RCT) in people with COPD and EID (COPD/EID). The primary aim, in people with COPD/ EID, was to determine the repeatability of the distance and time walked in the incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT), respectively. A secondary aim was to determine whether any participant characteristics predicted those who did not demonstrate improvements on a repeat ISWT or ESWT. Participants with nadir oxygen saturation (SpO2) < 90% on the 6-minute walk test were recruited to the RCT. Two ISWTs and two ESWTs were then performed as part of the baseline assessments, and participants were included in this sub-analysis if their nadir SpO2 was <90% during the better of two ISWTs. Repeatability of the tests was analysed using Bland–Altman plots and paired t-tests. Participant characteristics of age, lung function, level of nadir SpO2 and end-test dyspnoea were used to predict those who were not likely to demonstrate improvements on a repeat test using receiver operating curves. Eighty-seven participants (mean age (standard deviation, SD) 70 (7) years; forced expiratory volume in one second (FEV1) 47 (17)% predicted) were included. The mean differences (coefficient of repeatability) for the ISWTs and ESWTs were 9 m (55 m) and 19 seconds (142 seconds) respectively ( p < 0.05). No participant characteristic predicted the absence of improvement on the second ISWT (area under the curve (AUC) ranged from 0.49 to 0.58, all p > 0.2) or the second ESWT (AUC ranged from 0.43 to 0.52, all p > 0.3). Although repeating the tests showed only small improvements in distance (ISWT) and time (ESWT) walked in people with COPD/EID, the variability was large making definite conclusions about test repeatability in these individuals difficult.
Agricultural Intensification Can Preserve the Brazilian Cerrado: Applying Lessons From Mato Grosso and Goiás to Brazil’s Last Agricultural Frontier
Authors: Spera Stephanie
Published: August 2017

Food security and climate change are two pressing issues shaping the future of tropical land use. Brazil, home to abundant land that is rich in carbon, water, and biodiversity and often cleared for agropastoral and renewable energy purposes, is the ideal location for studying socioeconomic and environmental trade-offs of land use dynamics. Here, I use recent (2000–2016) land-use land-cover change dynamics in the established agricultural states of Mato Grosso and Goiás to demonstrate how incentivizing intensive agricultural practices and improving degraded pastures may be a means by which Brazil can increase agricultural production while conserving the remainder of the Cerrado. I then discuss these outcomes with regard to agricultural expansion in the agricultural frontier region of Matopiba and briefly highlight contextual elements that need to be considered by other developing tropical countries looking toward Brazil as a model for agricultural and economic development.
Geography, materialism, and the neo-vitalist turn
Authors: Gandy Matthew , Jasper Sandra
Published: August 2017

In her article ‘Rethinking the subject, reimagining worlds,’ Susan M. Ruddick adds to a growing body of geographical literature that adopts a neo-vitalist approach to the understanding of nature and the human subject. In this brief article we suggest that whilst Ruddick’s argument raises many interesting points it is nonetheless hampered by a limited engagement with the historiography of scientific metaphors and the wider ethical and political tensions engendered by a contemporary recourse to vitalist ontologies.
Power, cooptation, and the multiplicity of response assemblages
Authors: Horowitz Leah S
Published: August 2017

This commentary provides an empirical example that supports Briassoulis’s ‘response assemblage’ (RA) conceptualization but also suggests an extension of this framework. It uses an example of different approaches to protecting New Caledonia’s coral reefs—the United Nations Educational, Scientific and Cultural Organization’s World Heritage List and Rhéébù Nùù, an indigenous group targeting a multinational mining and refinery project—to demonstrate that RAs, as responses to specific environmental threats, may be not only parts of multiplicities (complex socioecological systems) but multiple themselves. Further, it shows that distinct RAs may compete and even come into conflict. Moreover, this example demonstrates the crucial role of power—or perceptions of power—in determining the outcomes of RAs, and in particular, of the interactions of multiple RAs.
Perceptions and control of assemblage in a ‘Glocal’ World
Authors: Haller Tobias
Published: August 2017

Assemblage theory has pushed us in the right direction but it should ontologically better articulate the question of actor’s perception of environment and power in a global-local (‘glocal’) context of a capitalist and monetized world. This commentary attempts to articulate how to marry assemblage theory with new concepts arising from a combination of New Institutionalism and Political Ecology approaches, as used in ecological and economic anthropology. It refers to actors in contexts of power and how they are able to shape their economic and political contexts by understanding who has what kinds of options available to them to assemble institutional constellations. As an example, the commentary refers to cash generating needs in subsistence-oriented societies. It also introduces the idea of institution shopping of actors and the way they increase their bargaining power by using ideological contexts (discourses and narratives) in order to legitimize their actions for generating cash in a capitalist system. Studies on institutional changes related to the household level and the management of the commons are used as illustrations to discuss how an integrated and historical approach combining institutional and ecological elements lead to a New Institutional Political Ecology (NIPE).
Storytelling in Mentoring: An Exploratory, Qualitative Study of Facilitating Learning in Developmental Interactions
Authors: D’Abate Caroline P. , Alpert Hali
Published: August 2017

How is it that mentors teach—that protégé’s learn—that wisdom is shared between a mentor and protégé? This exploratory, qualitative study responds to a call in the literature to better understand what occurs in mentoring interactions by examining storytelling as a mentoring tool. The focus is on how stories can convey meaning, inspire listeners, and transmit wisdom to help protégés grow, learn, and develop in their jobs and careers. Interview data from 39 professionals working in a wide variety of industries resulted in a rich data set of 48 work-related mentoring stories. Hermeneutical analysis enabled us to identify key mentoring functions that are fulfilled in the narrative text of stories. We conclude that storytelling is indeed a powerful tool in mentoring—allowing mentors to calm their protégés, encourage them, help them solve problems, build their confidence, teach them, give them direction, and provide numerous other functions.
Educational Accountability Relationships and Students’ Learning Outcomes in Tanzania’s Public Schools
Authors: Komba Aneth Anselmo
Published: August 2017

Drawing on the literature on educational accountability and the practices of public educational service provision in Tanzania, this study explores ex ante students’ learning outcomes associated with the existing accountability relationships in public preprimary, primary, and secondary schools. The article responds to three questions: (a) What accountability relationships exist and how do they explain learning outcomes in public schools? (b) What accountability arrangements exist and how do they stimulate a focus on the desired learning outcomes? (c) What are the approaches to accountability in education and how do they explain students’ learning outcomes? The study adapted the accountability framework developed by the 2004 World Development Report. The research approach used is qualitative and informed by historical case study design. Data were collected using documents and analyzed using content analysis. The study findings indicate that the term accountability is well-documented in Tanzanian educational policies and programs; however, there is lack of clear accountability relationships, arrangements and structures to support accountability at various levels, which is among the possible factors that contribute to students’ poor learning outcomes. This study’s findings also affirm that the four approaches to accountability—financial, regulatory, professional, and participatory accountability—are ineffective in enhancing positive students’ learning outcomes. The study recommends (a) establishing clear and effective accountability policies and relationships to enhance students’ learning outcomes, (b) promulgating guidelines to engage families in their children’s education, and (c) developing an eclectic model for managing public education whereby every level of the system is answerable to the Ministry of Education.
Does Emotional Intelligence Depend on Gender? A Study on Undergraduate English Majors of Three Iranian Universities
Authors: Meshkat Maryam , Nejati Reza
Published: August 2017

The intelligence of success, emotional intelligence, is said to be different in males and females. The present study was attempted to determine whether students from different genders are different in emotional intelligence and its related components in Iran. The Bar-On Emotional Quotient Inventory was distributed among 455 undergraduate university students majoring in English. These English majors were selected through availability sampling from Allameh Tabatabaee University, Khatam University, and Shahid Rajaee Teacher Training University in Tehran. They completed the inventory in 30 to 45 min and a MANOVA was run on the results of the questionnaire. Results showed that there was no significant difference between the genders on their total score measuring emotional intelligence, but the genders did tend to differ in emotional self-awareness, interpersonal relationship, self-regard, and empathy with females scoring higher than males. Self-regard, a component where males usually score higher, has yielded different results in this study which can open new avenues of research.