bluuebunny/crossref_metadata_2025 huggingface dataset:
About thymic carcinomas: challenges in diagnosis and management
Authors: Mlika Mouna , Boudaya Sadok , Braham Emna , Chermiti Fatma , Sayi Ahmed , Marghli Adel , El Mezni Faouzi
Published: March 2016

Background

Thymic carcinomas are rare tumors with a challenging diagnosis. Our aim was to report our 17-year experience of these tumors and to highlight the challenges encountered and the main differential diagnoses ruled out.

Methods

We studied 12 (92%) men and 1 (7.7%) woman with a mean age of 37 years (range 15–60 years). All patients were symptomatic, with chest pain representing the most frequent symptom. Radiology revealed anterior mediastinal masses in all cases, with either infiltration of the adjacent organs or pulmonary parenchymal metastases.

Results

The diagnosis was made on surgical biopsies in 12 cases and a lymph node biopsy in one. Microscopic examination revealed squamous carcinoma in 3 cases, synovial sarcoma in 1, mucinous adenocarcinoma in 1, undifferentiated carcinoma in 2, clear cell carcinoma in 1, lymphoepithelioma-like carcinoma in 2, atypical carcinoid tumor in 2, and sarcomatoid carcinoma in 1. Total surgical resection was possible in one patient after neoadjuvant chemotherapy and radiotherapy. Follow-up was possible in only 6 patients, and the mean survival reached 13 months.

Conclusion

In spite of the lack of follow-up information, this study demonstrates the poor outcome associated with these tumors and the need for standardized treatment.
Theory-based models enhancing the understanding of four types of elder maltreatment
Authors: Jackson Shelly L , Hafemeister Thomas L
Published: March 2016

Notwithstanding that elder abuse has existed since antiquity, it was only during the 1990s that society began to recognize that elder abuse is a pervasive and pernicious problem needing a systematic response. Despite this emerging attention to elder abuse and society’s dedicated efforts to address it, little attention has been given to articulating a theory-based foundation to explain the occurrence of elder maltreatment, which in turn may explain why society’s efforts have had limited success. Using the results of our research as the foundation, we present here distinct models that encapsulate four types of elder maltreatment, including one model that focuses on what transpires when two relatively distinct forms of abuse co-occur. We assert that elder maltreatment should be divided into distinct subtypes reflecting their different etiologies, risk factors, interpersonal dynamics, correlates, and consequences, and which in turn necessitate distinct societal responses. Without recognizing that this abuse occurs in the context of a relationship, understanding of elder abuse and the building of relevant models will be significantly limited. Although the application of these models has not yet been empirically tested, their articulation should enhance the understanding of elder maltreatment and promote new lines of related research and societal responses.
Making the grade
Authors: Lucken Karol , Rosky Jeffrey
Published: March 2016

In the USA, civil protection orders, commonly known as restraining orders, have been underutilized as a means of protecting victims of intimate partner violence. It has been proposed that part of the reason for this underutilization is victim apprehension over treatment by the courts. To improve the experience of accessing legal relief, Court Watch programs have been implemented in various jurisdictions across the country. Court Watch programs monitor judicial behavior on several dimensions, including whether interactions with victims are informational, explanatory, participatory, and respectful. Using secondary data obtained from a Florida Court Watch program, this study examines judicial behavior in 500 civil protection order hearings for intimate partner violence. Applying quantitative and qualitative analytic strategies, we examine Court Watch perceptions of judicial behavior, the association between Court Watch perceptions of judicial behavior and civil protection order outcomes, and factors that might account for judicial behavior.
A Modified Dialogic Reading Intervention for Preschool Children With Autism Spectrum Disorder
Authors: Fleury Veronica P. , Schwartz Ilene S.
Published: March 2016

We examined the effect of a modified dialogic reading intervention on levels of verbal participation and vocabulary growth in nine preschool children with autism spectrum disorder (ASD) using single-case design methodology. Baseline book reading resulted in consistently low levels of verbal participation followed by an immediate increase in verbal participation during dialogic book reading sessions for all children. Dialogic reading also resulted in greater gains in book-specific vocabulary for all children, as compared with baseline book reading sessions. The improvement in verbal participation was characterized by more frequent responses to the adults’ question prompts during reading. No improvements in children’s independent initiations of comments or questions during the book reading activity were observed.
Knowledge Acquisition and Readiness Assurance Testing
Authors: Young Mark R.
Published: March 2016

The responsibility for knowledge acquisition is increasingly being shifted to students though the utilization of experiential learning, teamwork, online, and flipped classroom pedagogies. Students are expected to enter the classroom prepared to engage in thoughtful knowledge application activities; however, many students have not adequately prepared, leading to minimal team contribution and learning. Readiness Assurance Testing is often implemented to help enforce student preclass preparation. These individual and group quizzing techniques can help motivate some students to keep current in the readings, but they do not assist students in learning comprehension. In order to improve learning comprehension and document preclass preparedness, an innovative note-taking method, Connected Notes, is offered as a way to assist students in recording, organizing, and connecting content in personally relevant ways. To improve comprehension and stimulate deeper levels of learning cognitive science supports the effectiveness of creating connections through multiple pathways. Students generate connections between chapter concepts and their consumer experiences, their careers, and company examples in preparation for team-based activities. Results from this study suggest the Connected Notes intervention improved the direct learning outcome (exams) while producing no negative effect on student evaluation of teaching.
Haptic Object Recognition is View-Independent in Early Blind but not Sighted People
Authors: Occelli Valeria , Lacey Simon , Stephens Careese , John Thomas , Sathian K.
Published: March 2016

Object recognition, whether visual or haptic, is impaired in sighted people when objects are rotated between learning and test, relative to an unrotated condition, that is, recognition is view-dependent. Loss of vision early in life results in greater reliance on haptic perception for object identification compared with the sighted. Therefore, we hypothesized that early blind people may be more adept at recognizing objects despite spatial transformations. To test this hypothesis, we compared early blind and sighted control participants on a haptic object recognition task. Participants studied pairs of unfamiliar three-dimensional objects and performed a two-alternative forced-choice identification task, with the learned objects presented both unrotated and rotated 180° about the y-axis. Rotation impaired the recognition accuracy of sighted, but not blind, participants. We propose that, consistent with our hypothesis, haptic view-independence in the early blind reflects their greater experience with haptic object perception.
The effects of familiarity and language of background music on working memory and language tasks in Singapore
Authors: Chew Agnes Si-Qi , Yu Ya-Ting , Chua Si-Wei , Gan Samuel Ken-En
Published: March 2016

The effect of background music on learning and academic performance is highly relevant to the everyday lives of millions of students worldwide. To investigate this, we recruited 165 undergraduate students (71 males and 94 females, mean age of 21.87 years) to complete arithmetic, reading comprehension, and word memory tasks while exposed to familiar or unfamiliar, foreign or first language music, and no music. With the task scores as dependent variables, a significant main effect was observed for music familiarity but not for language. Further analysis showed that only the word memory task was affected by music with significantly higher scores in the familiar than unfamiliar music conditions. Despite a slight negative trend, no significant effect was found in the interaction between music and language conditions. Depending on the task, familiarity but not language of music affected learning and task performance when compared to the no music condition.
The Effect of Autologous Hamstring Graft Diameter on the Likelihood for Revision of Anterior Cruciate Ligament Reconstruction
Authors: Spragg Lindsey , Chen Jason , Mirzayan Raffy , Love Rebecca , Maletis Gregory
Published: March 2016

Background:

Hamstring autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) have become popular in the past 2 decades; however, it is difficult to predict the diameter of the harvested tendons before surgery. Previous biomechanical studies have suggested that a smaller graft diameter leads to a lower load to failure, but clinical studies looking at various predictors for failure, including graft size, have been inconclusive.

Purpose:

To evaluate the relationship of hamstring graft diameter to ACL revision within a large cohort of patients, while controlling for sex, age, body mass index (BMI), and femoral and tibial fixation type.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A case-control study using patients registered in an ACLR registry was conducted. Revision was used as a marker for graft failure. A case was defined as a patient who underwent primary ACLR with a hamstring autograft that was revised during the study period (April 2006 to September 2012). Three controls, defined as patients who underwent primary ACLR with a hamstring autograft that was not revised, were matched to each of the cases according to age, sex, BMI, and femoral and tibial fixation type. Descriptive characteristics were employed, and conditional logistic regression was conducted to produce estimates of odds ratios and 95% CIs.

Results:

A total of 124 cases and 367 controls were identified. There were no significant differences between cases and controls in the distribution of sex (52.4% male vs 52.9% male, respectively; P = .932), median age (17.6 years [interquartile range (IQR), 15.9-20.4] vs 17.6 years [IQR, 15.9-20.4], respectively; P = .999), median BMI (23.4 kg/m2 [IQR, 21.5-26.4] vs 23.4 kg/m2 [IQR, 21.6-25.8], respectively; P = .954), femoral fixation ( P = .459), and tibial fixation ( P = .766). The mean (±SD) graft diameter was 7.9 ± 0.75 mm in the cases and 8.1 ± 0.73 mm in the controls. The likelihood of a patient needing revision ACLR in the study cohort was 0.82 times lower (95% CI, 0.68-0.98) for every 0.5-mm increase in the graft diameter from 7.0 to 9.0 mm.

Conclusion:

In this study, within the range of 7.0 to 9.0 mm, there was a 0.82 times lower likelihood of being a revision case with every 0.5-mm incremental increase in graft diameter.
College Women’s Perceptions of and Inclination to Use Campus Sexual Assault Resources
Authors: Burgess-Proctor Amanda , Pickett Scott M. , Parkhill Michele R. , Hamill Timothy S. , Kirwan Mitchell , Kozak Andrea T.
Published: March 2016

The purpose of this study is to explore whether college women’s perceptions of and inclination to use campus sexual assault resources vary as a function of their sexual victimization histories. First, using data from the full sample of female undergraduate students selected from the psychology subject pool ( N = 247), we performed t-tests to analyze whether perceptions of sexual assault as a problem on campus, knowledge of and confidence in campus sexual assault resources, and likelihood of attending a university sexual assault self-defense course differed for victims and nonvictims. Victims indicated significantly less confidence in campus resources and significantly less interest in attending the self-defense course than nonvictims. Second, using data from a subsample of participants ( n = 57) who reported being unlikely to attend the self-defense course, we performed a qualitative analysis of the open-ended responses. Student-reported reasons for not attending the self-defense course were categorized into instrumental barriers such as time and schedule constraints and perceptual barriers such as belief that the self-defense course was unnecessary, with similar response patterns emerging for victims and nonvictims. The results underscore the need for colleges and universities to improve sexual assault service provision for students, especially women with sexual victimization histories.
La comparaison internationale et les données de terrain - Des incomparables au cas-limite
Authors: Woollven Marianne
Published: March 2016

International Comparison and Field Data - Incomparables in Borderline Cases - Although the collection of similar material is presented as a strong methodological requirement in comparative research, incomparables are common, even inevitable. Based on a qualitative sociological survey on dyslexia in France and the UK, this article shows how empirical data initially envisaged as comparison residuals could be included in the analysis in two ways. On one hand, the finding that data on British speech therapy was incomparable with French data led to reorienting the investigation towards the establishment of more relevant and comparable material. In addition, two British schools with no French equivalent have been considered as borderline cases which enriched the description and analysis.
An investigation into the effect of temperature-dependent stiffness of rail pads on vehicle-track coupled vibrations
Authors: Wei Kai , Liu Zi-xuan , Liang Ying-chun , Wang Ping
Published: March 2016

To consider the rail pads of thermoplastic polyurethane elastomer (TPE), chloroprene rubber (CR), and ethylene propylene diene monomer (EPDM) that are usually used in the Chinese subway as test subjects, their static stiffness at temperatures of −40℃ to 70℃ was measured by a universal testing machine equipped with a temperature control box. Then, the influence of the temperature-dependent stiffness of the rail pads on the vertical vehicle-track coupled vibrations was investigated with application of a vehicle-track coupled dynamic model. It was found that the static stiffness of these rail pads exhibits a nonlinear variation with temperature. Their static stiffness is considerably sensitive to temperatures below 20℃, when the CR rail pad is the most sensitive. At temperatures above 20℃, their static stiffness slightly alters with increasing temperature. The temperature-dependent stiffness of these rail pads mainly affects the vertical vibrations of the vehicle system above the one-third octave center frequency of 31.5 Hz and the vertical rail vibrations near the center frequency of 63 Hz. Moreover, the influence of the low-temperature stiffness of rail pads at −40℃ to 20℃ is far greater than the effect of the high-temperature stiffness of rail pads at 20–70℃. Thus, TPE, CR, and EPDM rail pads have excellent high-temperature stability and adverse low-temperature sensibility.
The Pandora Effect
Authors: Hsee Christopher K. , Ruan Bowen
Published: March 2016

Curiosity—the desire for information—underlies many human activities, from reading celebrity gossip to developing nuclear science. Curiosity is well recognized as a human blessing. Is it also a human curse? Tales about such things as Pandora’s box suggest that it is, but scientific evidence is lacking. In four controlled experiments, we demonstrated that curiosity could lead humans to expose themselves to aversive stimuli (even electric shocks) for no apparent benefits. The research suggests that humans possess an inherent desire, independent of consequentialist considerations, to resolve uncertainty; when facing something uncertain and feeling curious, they will act to resolve the uncertainty even if they expect negative consequences. This research reveals the potential perverse side of curiosity, and is particularly relevant to the current epoch, the epoch of information, and to the scientific community, a community with high curiosity.
After the War
Authors: Lemaitre Julieta
Published: March 2016

This article examines internally displaced women’s narratives of rebuilding their life after displacement, focusing on questions of moral agency and community governance. The data come from a 3-year research project (2010–2013) with internally displaced women in Colombia, during the emergence of a new transitional justice regime. The article finds in internally displaced women’s narratives of the injuries of war, of their own resistance and overcoming, and of their aspirations for the future, concerns that go beyond poverty alleviation and redistribution in peace-building efforts. Internally displaced women’s narratives also engage with questions of ordinary ethics and community governance, describing the loss of moral agency in civil war and its painstaking recovery. This article questions the limitations of transitional justice regimes and peace-building efforts that ignore concerns with the loss of moral agency and community during civil war as well as the role of ordinary ethics in peace building at the grassroots.
Why Firms Invest Abroad? A Bibliometric Study on OFDI Determinants from Developing Economies
Authors: Bruhn Nádia Campos Pereira , de Alcântara Juciara Nunes , Tonelli Dany Flávio , Reis Ricardo Pereira , Antonialli Luiz Marcelo
Published: March 2016

While a substantial body of literature has grown around the developing economies as the world’s main recipient of foreign direct investment (FDI) and its economic development and management practice consequences, much less attention has been paid to the determinants of outward FDI (OFDI) from developing economies becoming multinationals. Our aim is to assess whether OFDI from developing countries conforms to the mainstream international business literature of OFDI by comparing with new evidences for the character and evolution of recent OFDI found for developing economies. Our results suggest that while the mainstream FDI theories and frameworks regarding OFDI are suitable for developed economies, some important theoretical adjustments and refinements are needed in order to better explain the internationalization strategies of multinational corporations (MNCs) from developing economies.
The WVal
Authors: Consiglio Chiara , Cenciotti Roberto , Borgogni Laura , Alessandri Guido , Schwartz Shalom H.
Published: March 2016

This study presents a new scale to measure work values. The Work Values questionnaire (WVal) consists of 10 sets of 5 value items that respondents rank for importance. Each item expresses 1 of the 10 basic values of the Schwartz theory in the work context. Seven hundred fifty-nine employees from 94 organizations responded to the WVal. Confirmatory factor analysis (CFA) assessment of the 10 work values exhibited adequate factorial distinctiveness as well as high internal reliability. Multidimensional scaling analyses yielded a circular motivational structure of relations among the 10 work values similar to the higher order values in the basic values’ theory. We note and discuss meaningful differences in the importance of work values associated with gender, age, organizational tenure, and professional role. The study supports the applicability of the Schwartz basic value theory to the organizational setting, with some variations traceable to the work context. We discuss research possibilities and practical applications of the WVal.
Individuals With Disabilities in Self-Employment Through Vocational Rehabilitation
Authors: Yamamoto Scott H. , Alverson Charlotte Y.
Published: March 2016

Since the passage of the Rehabilitation Act of 1973, federal and state governments have played a significant role in the employment of individuals with disabilities. In the present study, one aspect of that relationship was analyzed—individuals with disabilities who received vocational rehabilitation (VR) services to become self-employed. The authors utilized a two-level hierarchical generalized linear modeling to analyze national data from the Rehabilitation Services Administration for fiscal years 2008–2012. Among several significant ( p < .001) predictors of successful VR self-employment case closure across the years, ethnicity had the largest effect, followed by gender. Although the findings from this study build on those from a previous study, conclusions about the predictors are tentative. Nevertheless, the findings add to a sparse literature on VR self-employment of individuals with disabilities, and the authors discuss the study’s implications for researchers and VR and provide suggestions for further research.
Risky, Impulsive, and Self-Destructive Behavior Questionnaire (RISQ): A Validation Study
Authors: Sadeh Naomi , Baskin-Sommers Arielle
Published: March 2016

Risky behaviors increase the likelihood of premature death, long-term disability, and poor mental health outcomes. Most current measures of risky behavior only assess behaviors within a single domain, fail to evaluate affective triggers for engaging in these behaviors, do not index the consequences of these behaviors, and are often limited to a narrow developmental period. The present study developed and evaluated a new 38-item questionnaire-based measure, the Risky, Impulsive, and Self-Destructive Behavior Questionnaire (RISQ), designed to address each of these limitations by expanding the breadth and depth of previous questionnaires. A bifactor model with a general factor and eight domain-specific factors (measuring drug use, aggression, self-harm, gambling, risky sexual behavior, impulsive eating, heavy alcohol use, and reckless behavior) best fit the RISQ, and indicators of internal consistency, as well as, construct validity were strong. Results provide initial validation for the RISQ as a broad, yet relatively brief, measure that quantifies and qualifies risky behaviors by assessing the severity, chronicity, and triggers for a range of harmful behaviors.
Consumer perceptions, descriptive profile, and mechanical properties of a novel product with chickpea flour: Effect of ingredients
Authors: Jiménez María José , Tárrega Amparo , Fuentes Raúl , Canet Wenceslao , Álvarez María Dolores
Published: March 2016

Increasingly popular in the West is hummus, a spread that is made with pureed chickpeas and other healthful ingredients. The changes in texture measurements and sensory properties in a novel chickpea flour-based product occurring when water is partially replaced by common ingredients of hummus were investigated. Eleven chickpea gels containing different amounts of minced garlic, lemon juice, curry powder, and inulin were prepared and compared with two control gels. These ingredients were chosen to make the product tastier, appealing, and similar to hummus. Instrumental texture tests were carried out: uniaxial compression, stress relaxation, and texture profile analysis. Quantitative descriptive analysis was used to describe differences in sensory properties perceived by a trained panel, whereas repertory grid method combined with free choice profile was used to determine differences perceived by untrained consumers. Gels with higher curry powder content presented lower force to breakdown, whereas increasing inulin content led to gels with higher hardness. Principal component analysis was applied to instrumental parameters and quantitative descriptive analysis data, whereas generalized Procrustes analysis was applied to free choice profile data. This newly developed chickpea gel may make a nutrition claim with respect to protein (“ high in protein,” or at least a “ source of protein”).
Audio versus written feedback: Exploring learners’ preference and the impact of feedback format on students’ academic performance
Authors: Morris Cecile , Chikwa Gladson
Published: March 2016

Very little is known about the impact of the different types of feedback on students’ academic performance. This article explores students’ preference in the use of audio and written feedback and how each type of feedback received by students impacts their academic performance in subsequent assignments. The study involved 68 students who were divided into two groups that received either audio or written feedback in their first assignment which was then recalled and applied into the second assignment. An analysis of results obtained in the second assignment was conducted and comparisons made between students in the audio and written feedback group. Students were also surveyed using an online questionnaire to ascertain their perceptions about the type of feedback they had received. The study established that the type of feedback received did not impact students’ grades in the subsequent assignment. In addition, while students were broadly positive about audio feedback, they indicated a strong preference for written feedback in future assignments. The study recommends, among other things, further investigation into the link between students’ learning styles and their preferences for different types of feedback.
Capturing the significance of place in the lived experience of dementia
Authors: McGovern Justine
Published: March 2016

In this article, the author reports on a study exploring the impact of an urban setting on the lived experience of dementia for older couples where one member of each couple was diagnosed with the illness over age 64, the other was the primary care partner, and both were residing together in the greater New York metropolitan area at the time of the research. Certain features of city living, such as accessible medical care, public transportation, and social services, are known to provide substantial instrumental and affective support during challenging times However, how dementia care partnerships transform other aspects of urban environments to their own individual and unpredictable advantage is less documented. By describing how older dementia-affected couples make use of informal features of place to meet complex needs, such as affirming couplehood and sustaining autonomy, the study uncovers links between place and quality of life with dementia. There are implications for dementia care and research. These include deepening understanding of the role of place in dementia, establishing knowledge of place as a component of cultural competence, and implementing policies that support place-based care. Moreover, findings propose pathways to greater inclusivity in knowledge building by promoting creative approaches to data collecting supported by naturalistic inquiry. By adopting a strength perspective and a person-inenvironment approach to service provision, social work practice, and research stand to make a difference in the lives of persons affected by dementia and those who care for them.
Cop Watch/Cop Listen/Cop Move
Authors: Luckett Sharrell D. , Middlebrook Jeb Aram
Published: March 2016

In this essay, the authors argue for sound and movement as performative methodologies for studying policing. The proposed performative methodology, “Cop Watch/Cop Listen/Cop Move,” provides a space for (re)seeing, (re)listening, and (re)experiencing policing and, thus, prepares participants to navigate and challenge police surveillance and brutality. The questions that the essay addresses include the following: What theoretical and methodological contributions arise from a space where sounds and experiences of policing are sonically and kinesthetically performed? And how might rehearsal for this performance, and the performance itself, exist as a kind of laboratory for social movements that challenge policing?
Addressing challenges of clinical trials in acute pain: The Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study
Authors: Nottage Kerri A , Hankins Jane S , Faughnan Lane G , James Dustin M , Richardson Julie , Christensen Robbin , Kang Guolian , Smeltzer Matthew , Cancio Maria I , Wang Winfred C , Anghelescu Doralina L
Published: March 2016

Background/aims:

Neuropathic pain is a known component of vaso-occlusive pain in sickle cell disease; however, drugs targeting neuropathic pain have not been studied in this population. Trials of acute pain are complicated by the need to obtain consent, to randomize participants expeditiously while optimally treating pain. We describe the challenges in designing and implementing the Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study (NCT01954927), a phase II, randomized, double-blind, placebo-controlled trial to determine the effect of gabapentin for vaso-occlusive crisis.

Methods:

In the Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study, we aim to assess the analgesic effect of gabapentin during vaso-occlusive crisis. Difficulties we identified included avoiding delay of notification of study staff of potential participants which we resolved by automated notification. Concern for rapid randomization and drug dispensation was addressed through careful planning with an investigational pharmacy and a single liquid formulation. We considered obtaining consent during well-visits to avoid the time constraints with acute presentations, but the large number of patients and limited duration that consent is valid made this impractical.

Results:

In all, 79% of caregivers/children approached have agreed to participate. The trial is currently active, and enrollment is at 45.8% of that targeted (76 of 166) and expected to continue for two more years. Maintaining staff availability after-hours remains problematic, with 8% of screened patients missed for lack of available staff.

Lessons learned:

Lessons learned in designing a trial to expedite procedures in the acute pain setting include (1) building study evaluations upon a standard-of-care backbone; (2) implementing a simple study design to facilitate consent and data capture; (3) assuring ample, well-trained study staff; and (4) utilizing technology to automate procedures whenever possible.

Conclusion:

This study design has circumvented many of the logistical barriers usually associated with acute pain trials and may serve as a prototype for future studies.
Electronic palliative care coordinating systems (EPaCCS) may not facilitate home deaths: A mixed methods evaluation of end of life care in two English counties
Authors: Wye Lesley , Lasseter Gemma , Simmonds Bethany , Duncan Lorna , Percival John , Purdy Sarah
Published: March 2016

Electronic palliative care coordination systems (EPaCCS) detail preferred place of death across health and voluntary sector boundaries. Quantitative studies suggest that individuals recorded on EPaCCS are more likely to die at home. This study aimed to explore this relationship between EPaCCS and home deaths. Patient records from EPaCCS were collected from 1 September 2011 to 29 February 2012, linked to death data and analysed using descriptive statistics. We interviewed 101 professionals, including community nurses, and employed framework analysis. Few eligible patients were entered on EPaCCS (9% North Somerset, 13% Somerset). Of those, the majority died in community settings (87%, 81/93 North Somerset; 93% 307/331 Somerset). However, interviews and EPaCCS record analysis suggested that EPaCCS was almost exclusively used by community nurses and GPs, so, unsurprisingly, the relationship between EPaCCS and home deaths was strong. Difficulties included professional reluctance to discuss death, and the burden of data entry falling on daytime staff for out-of-hours colleagues. These results challenge assumptions that EPaCCS facilitates increased home deaths, as qualitative investigation identified selection bias. To avoid misinterpretations, future studies should employ mixed methods. The implementation of an electronic tool is not enough on its own to ensure that advanced care wishes are available, as long-standing organisational and cultural issues, such as professionals working in silos and professional reluctance to have ‘end of life’ discussions, also need to be addressed.
The new kid on the block for advanced imaging in Barrett’s esophagus: a review of volumetric laser endomicroscopy
Authors: Trindade Arvind J. , Smith Michael S. , Pleskow Douglas K.
Published: March 2016

Advanced imaging techniques used in the management of Barrett’s esophagus include electronic imaging enhancement (e.g. narrow band imaging, flexible spectral imaging color enhancement, and i-Scan), chromoendoscopy, and confocal laser endomicroscopy. Electronic imaging enhancement is used frequently in daily practice, but use of the other advanced technologies is not routine. High-definition white light endoscopy and random four quadrant biopsy remain the standard of care for evaluation of Barrett’s esophagus; this is largely due to the value of advanced imaging technologies not having been validated in large studies or in everyday practice. A new advanced imaging technology called volumetric laser endomicroscopy is commercially available in the United States. Its ease of use and rapid acquisition of high-resolution images make this technology very promising for widespread application. In this article we review the technology and its potential for advanced imaging in Barrett’s esophagus.
Recanalization treatments in basilar artery occlusion—Systematic analysis
Authors: Lindsberg Perttu J , Sairanen Tiina , Nagel Simon , Salonen Oili , Silvennoinen Heli , Strbian Daniel
Published: March 2016

Background and aims

Basilar artery occlusion is a most devastating form of stroke, and the current practice is to reverse it with revascularization therapies. Pharmacological thrombolysis, intravenous or intraarterial, has been adjuncted or replaced with invasive, endovascular thrombectomy procedures. The preferred approach remains unknown and many recanalizations are futile with no clinical benefit. We sought to determine reasons for futility and weigh the existing reports to find whether endovascular mechanical interventions provide superior outcomes over pharmacological thrombolysis alone.

Methods

After analyzing systematically the reports of outcomes produced by variable basilar artery occlusion recanalization protocols, information was retrieved and reconciled from 15 reports published from year 2005 comprising 803 patients in 17 cohorts. In the largest single-center cohort (162, Helsinki), predictors of futile recanalization (three-month modified Rankin Scale score 4 to 6) were determined.

Results

Good outcome was reported by mechanical approaches either alone or on demand more frequently than by pharmacological, intravenous or intraarterial thrombolysis protocols (35.5% versus 24.4%, p < 0.001), accompanied by higher recanalization rates (84.1% versus 70.9%, p < 0.001). Along with superior recanalization rate at 91%, good outcome was reached by primary thrombectomy in 36% at the cost of substantial futile recanalization rate at 60%, which was lower when using modern stentrievers only (52.8%). In the Helsinki cohort, the single most significant predictor was extensive baseline ischemia, increasing the odds of futility 20-fold (95%CI 4.39–92.29, p < 0.001). Other attributes of futility were ventilation support and history of atrial fibrillation or previous stroke.

Conclusions

Endovascular mechanical approaches have been reported to provide superior outcomes over pharmacological thrombolysis in basilar artery occlusion. Stricter patient selection, most notably to exclude victims of already extended ischemia, would assist in translating excellent recanalization rates into improved clinical outcomes and more acceptable futility rates.
Sensitivity and correlation of hypervariable regions in 16S rRNA genes in phylogenetic analysis
Authors: Yang Bo , Wang Yong , Qian Pei-Yuan
Published: March 2016

Background

Prokaryotic 16S ribosomal RNA (rRNA) sequences are widely used in environmental microbiology and molecular evolution as reliable markers for the taxonomic classification and phylogenetic analysis of microbes. Restricted by current sequencing techniques, the massive sequencing of 16S rRNA gene amplicons encompassing the full length of genes is not yet feasible. Thus, the selection of the most efficient hypervariable regions for phylogenetic analysis and taxonomic classification is still debated. In the present study, several bioinformatics tools were integrated to build an in silico pipeline to evaluate the phylogenetic sensitivity of the hypervariable regions compared with the corresponding full-length sequences.

Results

The correlation of seven sub-regions was inferred from the geodesic distance, a parameter that is applied to quantitatively compare the topology of different phylogenetic trees constructed using the sequences from different sub-regions. The relationship between different sub-regions based on the geodesic distance indicated that V4-V6 were the most reliable regions for representing the full-length 16S rRNA sequences in the phylogenetic analysis of most bacterial phyla, while V2 and V8 were the least reliable regions.

Conclusions

Our results suggest that V4-V6 might be optimal sub-regions for the design of universal primers with superior phylogenetic resolution for bacterial phyla. A potential relationship between function and the evolution of 16S rRNA is also discussed.
Patterns of foot complaints in systemic lupus erythematosus: a cross sectional survey
Authors: Otter Simon J. , Kumar Sunil , Gow Peter , Dalbeth Nicola , Corkill Michael , Rohan Maheswaran , Davies Kevin A. , Pankathelam Sam , Rome Keith
Published: March 2016

Background

Foot complaints are common in inflammatory arthropathies such as rheumatoid arthritis and cause considerable disability. However, little is published about the nature and extent of foot complaints in systemic lupus erythematosus (SLE). We aimed to explore foot complaints among people with (SLE) and to evaluate the associations between foot pain and self‐reported activities of daily living and well‐being.

Methods

We developed and tested a new 40‐item item self‐administered questionnaire, using a five‐stage development process utilising patient involvement throughout to ensure face and content validity. The self‐administered instrument was posted to 406 people with SLE attending adult rheumatology clinics across three health boards in Auckland, New Zealand. The questionnaire enquired about symptoms of foot pain, extra‐articular features, anatomical distribution of symptoms according to validated foot‐mannequins and the impact of foot symptoms on activities of daily living and well‐being.

Results

In total, 406 questionnaires were posted, with 131 responses (response rate 32 %). We found 89 % were women, mean (SD) age 51 (15) years, mean (SD) diagnosis 12.5 (11.1) years. Overall, 77 % of those responding to the questionnaire reported foot pain during their SLE, with 45 % reporting current foot pain. All regions of the feet were affected, with the hindfoot (32 %) and ankles (30 %) most troublesome. The most common self‐reported extra‐articular foot complaints were cold feet, swelling and numbness. Almost two‐thirds (61 %) reported foot pain adversely affected their lives; foot pain prevented sleeping in 36 % and had a negative effect on emotions for 33 %. Only 33 % of participants had seen a podiatrist. Significant association was found between foot pain and standing longer than 15 min (p < 0.001), walking (p < 0.001), climbing stairs (p < 0.001) and going shopping (p < 0.001). Pain was the primary symptom to affect quality of life (47/100).

Conclusion

Foot complaints in SLE are heterogeneous in nature, and may have a substantial negative impact on patient well‐being. Foot complaints need to be addressed to reduce the burden of SLE and our findings support the need for wider access to specific foot care services.
Fixed point theorems of JS-quasi-contractions
Authors: Li Zhilong , Jiang Shujun
Published: March 2016

In this paper, we introduce the concept of JS-quasi-contraction and prove some fixed point results for JS-quasi-contractions in complete metric spaces under the assumption that the involving function is nondecreasing and continuous. These fixed point results extend and improve many existing results since some assumptions made there are removed or weakened. In addition, we present some examples showing the usability of our results.
Prognostic Impact of 21-Gene Recurrence Score in Patients With Stage IV Breast Cancer: TBCRC 013
Authors: King Tari A. , Lyman Jaclyn P. , Gonen Mithat , Voci Amy , De Brot Marina , Boafo Camilla , Sing Amy Pratt , Hwang E. Shelley , Alvarado Michael D. , Liu Minetta C. , Boughey Judy C. , McGuire Kandace P. , Van Poznak Catherine H. , Jacobs Lisa K. , Meszoely Ingrid M. , Krontiras Helen , Babiera Gildy V. , Norton Larry , Morrow Monica , Hudis Clifford A.
Published: March 2016

Purpose

The objective of this study was to determine whether the 21-gene Recurrence Score (RS) provides clinically meaningful information in patients with de novo stage IV breast cancer enrolled in the Translational Breast Cancer Research Consortium (TBCRC) 013.

Patients and Methods

TBCRC 013 was a multicenter prospective registry that evaluated the role of surgery of the primary tumor in patients with de novo stage IV breast cancer. From July 2009 to April 2012, 127 patients from 14 sites were enrolled; 109 (86%) patients had pretreatment primary tumor samples suitable for 21-gene RS analysis. Clinical variables, time to first progression (TTP), and 2-year overall survival (OS) were correlated with the 21-gene RS by using log-rank, Kaplan-Meier, and Cox regression.

Results

Median patient age was 52 years (21 to 79 years); the majority had hormone receptor–positive/human epidermal growth factor receptor 2 (HER2)–negative (72 [66%]) or hormone receptor–positive/HER2-positive (20 [18%]) breast cancer. At a median follow-up of 29 months, median TTP was 20 months (95% CI, 16 to 26 months), and median survival was 49 months (95% CI, 40 months to not reached). An RS was generated for 101 (93%) primary tumor samples: 22 (23%) low risk (< 18), 29 (28%) intermediate risk (18 to 30); and 50 (49%) high risk (≥ 31). For all patients, RS was associated with TTP (P = .01) and 2-year OS (P = .04). In multivariable Cox regression models among 69 patients with estrogen receptor (ER)–positive/HER2-negative cancer, RS was independently prognostic for TTP (hazard ratio, 1.40; 95% CI, 1.05 to 1.86; P = .02) and 2-year OS (hazard ratio, 1.83; 95% CI, 1.14 to 2.95; P = .013).

Conclusion

The 21-gene RS is independently prognostic for both TTP and 2-year OS in ER–positive/HER2-negative de novo stage IV breast cancer. Prospective validation is needed to determine the potential role for this assay in the clinical management of this patient subset.
A Randomized, Double-Blind, Placebo-Controlled, Phase III Study to Assess Efficacy and Safety of Weekly Farletuzumab in Combination With Carboplatin and Taxane in Patients With Ovarian Cancer in First Platinum-Sensitive Relapse
Authors: Vergote Ignace , Armstrong Deborah , Scambia Giovanni , Teneriello Michael , Sehouli Jalid , Schweizer Charles , Weil Susan C. , Bamias Aristotelis , Fujiwara Keiichi , Ochiai Kazunori , Poole Christopher , Gorbunova Vera , Wang Wenquan , O’Shannessy Daniel , Herzog Thomas J.
Published: March 2016

Purpose

Farletuzumab is a humanized monoclonal antibody that binds to folate receptor-α, which is highly expressed in ovarian carcinoma and largely absent from normal tissue. Farletuzumab was investigated in a double-blind, randomized phase III study in platinum-sensitive ovarian cancer.

Patients and Methods

Eligible patients had first recurrent ovarian cancer 6-24 months following completion of platinum-taxane chemotherapy. All patients received carboplatin plus paclitaxel or docetaxel (for six cycles combined with randomly assigned test products in a 1:1:1 ratio: farletuzumab 1.25 mg/kg, farletuzumab 2.5 mg/kg, or placebo). The single-agent test product was continued weekly until disease progression. The primary end point was progression-free survival (PFS) by Response Evaluation Criteria in Solid Tumors. Additional analyses not outlined in the original protocol were prespecified in the final statistical analysis plan, including a subgroup analysis by baseline CA-125 and farletuzumab exposure levels.

Results

A total of 1,100 women were randomly assigned to treatment dose or placebo. PFS from the primary analysis was 9.0, 9.5, and 9.7 months for the placebo, farletuzumab 1.25 mg/kg, and farletuzumab 2.5 mg/kg groups, respectively. Neither farletuzumab group was statistically different from the placebo group (hazard ratio [HR], 0.99 [95% CI, 0.81 to 1.21] and 0.86 [95% CI, 0.70 to 1.06] for farletuzumab 1.25 mg/kg and 2.5 mg/kg group v placebo, respectively). In the prespecified subgroup, baseline CA-125 levels not more than three times the upper limit of normal (ULN) correlated with longer PFS (HR, 0.49; P = .0028) and overall survival (OS) (HR, 0.44; P = .0108) for farletuzumab 2.5 mg/kg versus placebo. Subgroup analysis of farletuzumab exposure above the median, regardless of dose, showed significantly better PFS versus placebo. The most common adverse events were those associated with chemotherapy.

Conclusion

Neither farletuzumab dose met the study’s primary PFS end point. Prespecified subgroup analyses demonstrated that patients with CA-125 levels not more than three times the ULN and patients with higher farletuzumab exposure showed superior PFS and OS compared with placebo.
Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: American Society of Clinical Oncology Endorsement of Cancer Care Ontario Guideline Recommendations
Authors: Henry N. Lynn , Somerfield Mark R. , Abramson Vandana G. , Allison Kimberly H. , Anders Carey K. , Chingos Diana T. , Hurria Arti , Openshaw Thomas H. , Krop Ian E.
Published: March 2016

Purpose

An American Society of Clinical Oncology (ASCO) panel considered the Cancer Care Ontario (CCO) recommendations on the role of patient and disease factors in selecting adjuvant therapy for women with early-stage breast cancer for endorsement.

Methods

ASCO staff reviewed the CCO guideline for methodologic rigor, and an ASCO panel of content experts reviewed the content of the recommendations.

CCO Recommendations

For making decisions regarding adjuvant therapy, nodal status, tumor size, estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) status, tumor grade, and lymphovascular invasion are relevant; Oncotype DX score and Adjuvant! Online may be used as risk stratification tools; and age, menopausal status, and medical comorbidities should be considered. Chemotherapy should be considered for patients with positive lymph nodes, ER-negative disease, HER2-positive disease, Adjuvant! Online mortality greater than 10%, grade 3 lymph node–negative tumors (T > 5 mm), triple-negative (ER-negative, PgR-negative, HER2-negative) tumors, lymphovascular invasion positivity, or estimated distant relapse risk of greater than 15% at 10 years based on Oncotype DX recurrence score (RS). Chemotherapy may not be beneficial or required for small node-negative tumors (T < 5 mm) without high-risk features or for patients with HER2-negative, strongly ER-positive, and PgR-positive cancer with micrometastatic nodal disease, T less than 5 mm, or Oncotype DX RS with an estimated distant relapse risk of less than 15% at 10 years.

ASCO Panel Conclusion

The ASCO panel endorses the recommendations with minor suggested revisions and highlights three areas that warrant further consideration: tumor histology and adjuvant therapy recommendations, risk stratification tools and proposed Oncotype DX RS thresholds to guide decisions about chemotherapy, and patient factors in decision making.