bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated design of aluminum foam processing parameters and sandwich panels under uncertainty
Authors: Jang Sungwoo , Park Yongjin , Choi Hae-Jin
Published: November 2014

Aluminum foam is a useful material for lightweight structural and impact attenuation applications due to its excellent energy-absorbing characteristics. The aim of this study is to further enhance the performance of closed-cell aluminum foam-cored sandwich panels while satisfying given design requirements. A new design approach is employed, whereby the materials and product design are integrated, and which incorporates multilevel design optimization under various types of uncertainty in the analysis and manufacturing processes. Sandwich panels are designed by controlling the processing parameters for the foam core and panel geometry according to the design methods being used. The design variables are optimized through traditional multilevel optimization and analytical target cascading method. Inductive design exploration method is introduced to identify the feasible regions for the design variable in a design hierarchy to be insensitive to uncertainty. This work presents an in-depth examination of the design results and the efficiency of the design methods for pursuing robust design solutions.
Everyday peace: Bottom-up and local agency in conflict-affected societies
Authors: Mac Ginty Roger
Published: November 2014

This article is a conceptual scoping of the notion and practice of everyday peace, or the methods that individuals and groups use to navigate their way through life in deeply divided societies. It focuses on bottom-up peace and survival strategies. The article locates everyday peace in the wider study of peace and conflict, and constructs a typology of the different types of social practice that constitute everyday peace. While aware of the limitations of the concept and the practice, the article argues that everyday peace can be an important building block of peace formation, especially as formal approaches to peacebuilding and statebuilding are often deficient. An enhanced form of everyday peace (everyday diplomacy) has the potential to go beyond conflict-calming measures to encompass more positive actions linked with conflict transformation. The article can also be read as an exploration of ‘the local’ and ‘agency’ in deeply divided societies. It provides a counterweight to accounts of conflict-affected societies that concentrate on top-down actors, formal institutions and conflict resolution ‘professionals’. The apparent ‘banality’ of the everyday challenges us to think creatively about perspectives and methodologies that can capture it.
Advent of a ‘Game Changer’?: India’s Economic, Political and Strategic Engagement in Sub-Saharan Africa from 1991 until 2014
Authors: Michael Arndt
Published: November 2014

In her position as a rising power, India has reassessed and reinvigorated the entirety of her relations with Africa in the past decade. These relations cover the economic, political and the security spheres. They are the result of India’s ideational foreign policy change, her economic growth trajectory, looming energy insecurity and India’s role as an increasingly important international stakeholder. The main argument of the article is that India has successfully worked out her own policies, institutional structures and inter-regional development schemes with unique characteristics to develop and deepen linkages with sub-Saharan Africa. The article concludes that India now has a potential of assuming the role of ‘game changer’ in the new scramble for Africa’s resources and the struggle for votes and support of African states in international institutions and fora.
Book Review: Singh, Sinderpal, India and South Asia: Domestic Identity Politics and Foreign Policy from Nehru to the BJP
Authors: Chandra Vikash
Published: November 2014

Singh, Sinderpal, India and South Asia: Domestic Identity Politics and Foreign Policy from Nehru to the BJP (Abingdon: Routledge, 2013). Pp. 163, Price not mentioned.
Challenges in Using Comparison Data in Child Welfare Evaluations
Authors: White Catherine Roller , O’Brien Kirk , Davis Cynthia W. , Rogg Carla , Rudlang-Perman Kristen , Morgan Linda Jewell , Houston Millicent
Published: November 2014

Objective:

This article describes the evaluation of permanency roundtables, an intervention to help youth in foster care achieve legal permanency and the challenges evaluators faced in finding and using appropriate comparison data.

Method:

In 2009, permanency roundtables were conducted for 496 children in Georgia, most of whom had spent extended time in care. Half (50%) achieved legal permanency within 24 months of the roundtables.

Results:

Five potential sources of comparison data, none of which provide an ideal comparison, are presented and discussed.

Conclusions:

Ideally, evaluators should plan for one or more comparison groups at the very beginning of the evaluation. However, post hoc comparisons should not be dismissed altogether. The challenge for evaluators is to generate valid comparison groups to determine whether an intervention made a significant improvement, despite challenges such as limited funding, tight timelines, and unmeasured contextual differences between groups.
Health Care Professionals’ Perspectives of the Experiences of Family Caregivers During In-Patient Cancer Care
Authors: Ekstedt Mirjam , Stenberg Una , Olsson Mariann , Ruland Cornelia M.
Published: November 2014

Being a family member of a patient who is being treated in an acute care setting for cancer often involves a number of challenges. Our study describes Norwegian cancer care health professionals’ perceptions of family members who served as family caregivers (FCs) and their need for support during the in-hospital cancer treatment of their ill family member. Focus group discussions were conducted with a multidisciplinary team of 24 experienced social workers, physicians, and nurses who were closely involved in the patients’ in-hospital cancer treatment and care. Drawing on qualitative hermeneutic analysis, four main themes describe health professionals’ perceptions of FCs during the patient’s in-hospital cancer care: an asset and additional burden, infinitely strong and struggling with helplessness, being an outsider in the center of care, and being in different temporalities. We conclude that it is a challenge for health care professionals to support the family and create room for FC’s needs in acute cancer care. System changes are needed in health care, so that the patient/FC dyad is viewed as a unit of care in a dual process of caregiving, which would enable FCs to be given space and inclusion in care, with their own needs simultaneously considered alongside those of the patient.
Risk Factors and the Maturity of Subnational Debt
Authors: Pérez Javier J. , Prieto Rocío
Published: November 2014

We study the determinants of the maturity structure of public debt, taking as case study the regional governments of Spain. The structure of public debt is a source of vulnerability and contagion in public debt markets. Our empirical models show that regional governments reacted to increasing financing needs by leaning more toward short-term debt, instead of resorting to longer-term debt to seek the minimization of liquidity risks, a fact that is consistent with theories that predict the willingness of public financial managers to reveal to the markets their fundamental solvency and their commitment to fiscal (consolidation) plans. At the same time, we find that increased central government transfers raise the tendency of markets to hold long-term instruments, which may reflect their expectation that regional debt be bailed out/guaranteed by the center. Finally, we do not find evidence of significant differences in the maturity structure depending on the quality of the issuer.
Developing mental health mobile apps: Exploring adolescents’ perspectives
Authors: Kenny Rachel , Dooley Barbara , Fitzgerald Amanda
Published: November 2014

Mobile applications or ‘apps’ have significant potential for use in mental health interventions with adolescents. However, there is a lack of research exploring end users’ needs from such technologies. The aim of this study was to explore adolescents’ needs and concerns in relation to mental health mobile apps. Five focus groups were conducted with young people aged 15–16 years ( N = 34, 60% male). Participants were asked about their views in relation to the use of mental health mobile technologies and were asked to give their responses to a mental health app prototype. Participants identified (1) safety, (2) engagement, (3) functionality, (4) social interaction, (5) awareness, (6) accessibility, (7) gender and (8) young people in control as important factors. Understanding end users’ needs and concerns in relation to this topic will inform the future development of youth-oriented mental health apps that are acceptable to young people.
Youth participation in qualitative research: Challenges and possibilities
Authors: Schelbe Lisa , Chanmugam Amy , Moses Tally , Saltzburg Susan , Williams Lela Rankin , Letendre Joan
Published: November 2014

Research often excludes youth participants, omitting their social and psychological realities, undermining their rights to participate and benefit from research, and weakening the validity of research. Researchers may be discouraged from including youth due to logistical (e.g. gaining access) or ethical (e.g. coercion risks based on developmental level) concerns. Increased discussion is needed around appropriate methods to use with child and youth participants that manage challenges related to developmental capacities, legal status, power differentials, and unpredictable aspects of qualitative research. This paper pools experiences of six researchers, describing solutions we have developed in studies employing varied qualitative methodologies with varied vulnerable youth subpopulations. We detail successful approaches to access, compensation, consent, assent, and confidentiality. Social work researchers are wellsuited to navigate the challenges, and we share our examples with the aim of facilitating increased youth participation in research.
Between the bench, the bedside and the office: The need to build bridges between working neuroscientists and ethicists
Authors: Brosnan Caragh , Cribb Alan
Published: November 2014

This paper presents findings from an empirical study that explored the meaning of ethics in the everyday work of neuroscientists. Observation and interviews were carried out in one neuroscience research group that was involved in bench-to-bedside translational research. We focus here specifically on the scientists’ perceptions of bioethics. Interviewees were often unfamiliar with bioethics as a discipline, particularly the more junior members of the group. Those who were aware of its existence largely viewed it as something distant from them, and as either too abstract, not relevant or an alien imposition on their work. Some interviewees themselves pointed to the need for better ‘bridge building’ between ethical principles and real-world examples drawn from scientific practice, and we argue that this space is where a more empirically grounded ethics may be useful in terms of actually engaging scientists at both the bench and the bedside.
Skimming Mother’s Breast Milk at Home
Authors: Gilgan Holly , Deveau Diane , O’Leary Gina
Published: November 2014

Persistent pleural effusion is a rare but challenging problem encountered by some patients after thoracic surgery or trauma. Chylothorax is a condition in which a milky fluid called chyle drains into the pleural space. Children with chylothorax are treated with a special diet restricted in long-chain triglycerides. In our center, mothers’ breast milk has not traditionally been used as part of the treatment protocol for chylothorax because of its long-chain triglyceride content. This article presents a novel approach to skimming mothers’ breast milk, which allows this important nutrient-rich food to be offered to infants with chylothorax, while still allowing for discharge home.
Code Compliant School Buildings Boost Student Achievement
Authors: Lumpkin Ronald B. , Goodwin Robert T. , Hope Warren C. , Lutfi Ghazwan
Published: November 2014

Much of the focus in the literature in raising student achievement has included parental involvement, principal leadership, quality of instruction, students’ socioeconomic status, curriculum, and use of technology. Limited empirical research relates the condition of the school building as a variable that affects student achievement. Furthermore, there is no research that has examined the impact of building codes on achievement outcomes in the state of Florida. This research determined whether academic achievement of 4th-, 8th-, 9th-, and 10th-grade students as measured by the mathematics and reading subtests of the Florida Comprehensive Achievement Test (FCAT) increased in new school buildings compliant to the 2000 Florida State Requirements for Educational Facilities. A causal-comparative design determined whether the independent variables, old and new school building influenced student achievement as measured by students’ FCAT mathematics and reading subtest scores. The control group was two cohorts of 4th-, 8th-, 9th-, and 10th-grade students who attended school in old buildings. The experimental group was two cohorts of 4th-, 8th-, 9th-, and 10th-grade students who attended school in new buildings. Transition from an old school into a new school was the treatment. Two hypotheses were formulated for testing and the research question for the inquiry was whether the percentage of students passing the FCAT mathematics and reading subtests increases after transitioning from an old school building into a new 2000 UBC (Uniform Building Code) compliant facility.
Melting of multipass surface tracks in steel incorporating titanium carbide powders
Authors: Mridha S. , Md Idriss A. N. , Maleque M. A. , Yaacob I. I. , Baker T. N.
Published: November 2014

Overlapping tracks were processed by melting preplaced titanium carbide (TiC) powder on steel surfaces using a tungsten inert gas torch. The tracks produced ∼1·0 mm melt depth free from cracks, but occasional pores were observed. The microstructure consisted of unmelted and partially melted TiC particulates together with reprecipitated TiC particles, which were prominent in tracks processed in the initial stage. A greater number of reprecipitated globular and cubic TiC particles were observed in tracks processed in the later stages, indicating more dissolution of TiC particulates from the overlapping operation. Those multitracks processed in the initial stage developed a maximum hardness of 850–1000 HV, which was lower in most other tracks, although comparable hardness values were recorded in the last track.
Synthesis of zinc oxide nanostructures on graphene/glass substrate by electrochemical deposition: effects of current density and temperature
Authors: Hambali Nur Ashikyn , Yahaya Hafizal , Mahmood Mohamad Rusop , Terasako Tomoaki , Hashim Abdul Manaf
Published: November 2014

The electrochemical growth of zinc oxide (ZnO) nanostructures on graphene on glass using zinc nitrate hexahydrate was studied. The effects of current densities and temperatures on the morphological, structural, and optical properties of the ZnO structures were studied. Vertically aligned nanorods were obtained at a low temperature of 75°C, and the diameters increased with current density. Growth temperature seems to have a strong effect in generating well-defined hexagonal-shape nanorods with a smooth top edge surface. A film-like structure was observed for high current densities above -1.0 mA/cm2 and temperatures above 80°C due to the coalescence between the neighboring nanorods with large diameter. The nanorods grown at a temperature of 75°C with a low current density of -0.1 mA/cm2 exhibited the highest density of 1.45 × 109 cm-2. X-ray diffraction measurements revealed that the grown ZnO crystallites were highly oriented along the c-axis. The intensity ratio of the ultraviolet (UV) region emission to the visible region emission, I
UV/I
VIS, showed a decrement with the current densities for all grown samples. The samples grown at the current density below -0.5 mA/cm2 showed high I
UV/I
VIS values closer to or higher than 1.0, suggesting their fewer structural defects. For all the ZnO/graphene structures, the high transmittance up to 65% was obtained at the light wavelength of 550 nm. Structural and optical properties of the grown ZnO structures seem to be effectively controlled by the current density rather than the growth temperature. ZnO nanorod/graphene hybrid structure on glass is expected to be a promising structure for solar cell which is a conceivable candidate to address the global need for an inexpensive alternative energy source.
Immuno-PET of epithelial ovarian cancer: harnessing the potential of CA125 for non-invasive imaging
Authors: Sharma Sai Kiran , Wuest Melinda , Wang Monica , Glubrecht Darryl , Andrais Bonnie , Lapi Suzanne E , Wuest Frank
Published: November 2014

Background

Epithelial ovarian cancer (EOC) is characterized by the overexpression of cancer antigen 125 (CA125), a mucinous glycoprotein that serves as a tumor biomarker. Early diagnosis of EOC is plagued by its asymptomatic nature of progression and the limitations of currently used immunoassay techniques that detect CA125 as a shed antigen in serum samples. Presently, there is no technique available for the in vivo evaluation of CA125 expression in malignant tissues. Moreover, there could be an unexplored pathophysiological time window for the detection of CA125 in EOC, during which it is expressed on tumor cells prior to being shed into the bloodstream. A method for the in vivo evaluation of CA125 expression on ovarian neoplasms earlier along disease progression and/or recurrence can potentially contribute to better disease management. To this end, the present work utilizes an anti-CA125 monoclonal antibody (MAb) and a single-chain variable fragment (scFv) labeled with the positron-emitting radionuclide 64Cu for preclinical molecular imaging of CA125 expression in vivo.

Methods

Anti-CA125 MAb and scFv were prepared and functionally characterized for target binding prior to being tested as radiotracers in a preclinical setting.

Results

Immunoblotting, immunofluorescence, and flow cytometry revealed specific binding of CA125-targeting vectors to NIH:OVCAR-3 cells and no binding to antigen-negative SKOV3 cells. 64Cu-labeled anti-CA125 MAb and scFv were obtained in specific activities of 296 and 122 MBq/mg, respectively. Both radioimmunoconjugate vectors demonstrated highly selective binding to NIH:OVCAR-3 cells and virtually no binding to SKOV3 cells. In vivo radiopharmacological evaluation using xenograft mouse models injected with 64Cu-labeled anti-CA125 MAb provided a standardized uptake value (SUV) of 5.76 (29.70 %ID/g) in OVCAR3 tumors 24 h post-injection (p.i.) versus 1.80 (5.91 %ID/g) in SKOV3 tumors. 64Cu-labeled anti-CA125 scFv provided an SUV of 0.64 (3.21 %ID/g) in OVCAR3 tumors 24 h p.i. versus 0.25 (1.49 %ID/g) in SKOV3 tumors. Results from small-animal PET imaging were confirmed by ex vivo autoradiography and immunohistochemistry.

Conclusions

Radiolabeling of anti-CA125 MAb and scFv with 64Cu did not compromise their immunoreactivity. Both radioimmunoconjugates presented specific tumor uptake and expected biological clearance profiles. This renders them as potential immuno-PET probes for targeted in vivo molecular imaging of CA125 in EOC.
Effectiveness of communication of spatial engineering information through 3D CAD and 3D printed models
Authors: Dadi Gabriel B , Goodrum Paul M , Taylor Timothy RB , Maloney William F
Published: November 2014

Background

Poor engineering information provided to construction crews results in inefficient communication of design, leading to construction rework, disputes, and lower worker morale. The resulting errors, omissions, and misinterpretations indicates that a significant opportunity exists to improve the traditional documentation of engineering information that craft professionals use to complete their work. Historically, physical three dimensional (3D) models built by hand provided 3D physical representations of the project to assist in sequencing, visualization, and planning of critical construction activities. This practice has greatly diminished since the adoption of three dimensional CAD (computer-aided design) and BIM (building information modeling) technologies. Recently, additive manufacturing technologies have allowed for three dimensional printing of 3D CAD models.

Methods

The effectiveness of 2D drawings, a 3D computer model, and a 3D printed model in delivering engineering information to an end-user are scientifically measured.

Results

The 3D printed model outperformed the 2D drawings and 3D computer interface in productivity and workload measures.

Conclusions

A physical model has the ability to improve communication of spatial design for certain tasks. This could lead to improved productivity, reduction of errors, and better quality for construction tasks. This paper's primary contribution to the body of knowledge is that it identifies how different mediums of engineering information impact the communication of spatial engineering information.
Chip-based adaptive skin color detection using trajectory constraints on hue
Authors: Yu Ying-Hao , Lee Tsu-Tian , Kwok Ngai-Ming , Chen Pei-Yin
Published: November 2014

Background

In a construction site, the safety of workers can be better secured if vehicle or robot can be properly maneuvered by using image-based gesture guidance. This kind of semi-automatic motion control is based on the features extracted in colors, outlines, textures, and motion intentions. Among these features, detecting worker’s skin color on face and hands could serve as an essential method for enabling robot to determine the region of interest (ROI). However, the performance of skin detection is usually unreliable due to interferences from reflections and shadows. Although many efficient skin color detection methods had been developed in past years, those are mostly based on complicated learning and statistical processes and are unsuitable for embedded systems. The exploration of a concise and efficient skin color detector, therefore, becomes a challenge for applications in mobile robots.

Method

In this paper, we propose a novel adaptive skin detector on face and hands as a fundamental capability of a gesture tracking system. This approach enhances the detection performance of traditional HSV color space but only requires a low computing power. For the design criteria of small size, low-power, low-cost, and minimum computing resource usages on mobile robots, the entire detecting system is built on single field-programmable-gate-array (FPGA) chip. Meanwhile, besides the contributions of adaptive algorithms and FPGA chip designs, the proposed skin detector also employs a touch screen to designate expected skin color of worker as the human-robot interaction (HRI) in real-time.

Results

The chip design of the FPGA is based on hardware circuits in register-transfer-level (RTL) for real-time image processing. A reasonable amount of hardware resource usages of FPGA have consumed 8% of logic elements (LEs) and 1.4% for embedded random access memory (RAM). Demonstrations with various pictures had indicated that sufficient ROI can be efficiently identified by using the proposed adaptive skin color detector.

Conclusions

According to our experimental results, the proposed adaptive skin detection can work well for non-ideal illumination. It has demonstrated the reliability and feasibility on supporting the embedded robotic control in the future.
Spectroscopic techniques and the conservation of artists’ acrylic emulsion paints
Authors: Willneff Elizabeth A , Schroeder Sven LM , Ormsby Bronwyn A
Published: November 2014

Introduction

Artists’ acrylic emulsion paints are used in many contexts such as paintings, murals, sculptures, works on paper and mixed media; and are forming increasing proportions of modern and contemporary art collections. Although acrylic emulsion paints have been the focus of museum-led research over the past decade, the impact of artists’ technique and conservation treatment on the upper-most surface of these paints remains essentially unexplored.

Results

This paper summarises previous studies using vibrational (FTIR) spectroscopy and presents initial assessments of paint surfaces using X-ray spectroscopies (XPS and NEXAFS) aimed at characterising artists’ acrylic paint film surfaces after natural ageing and wet surface cleaning treatment. Both techniques were found to be well suited for surface-sensitive investigations of the organic materials associated with artists’ acrylic paints, including explorations into: (A) cleaning system residues, (B) surfactant extraction from paint surfaces, (C) the identification of migrated surfactant, and (D) monitoring pigment changes at the paint/air interface of paint films.

Conclusions

It has been shown is that these X-ray spectroscopic techniques can be used for the analysis of almost purely organic materials in a way that complements mass spectroscopic techniques, FTIR and XRF. This investigation forms part of broader, currently ongoing, multi-technique investigation into the properties of artists’ acrylic paints and development of conservation treatments for works-of-art made with these materials.
A silicon nanowire photodetector using Au plasmonic nanoantennas
Authors: Jee Sang-Won , Zhou Keya , Kim Dong-Wook , Lee Jung-Ho
Published: November 2014

We suggest a silicon nanowire (SiNW) photodetector side-contacted with hemispherical Au nanoantennas (NAs) that can remarkably amplify the intensity of the near-infrared optical field. The plasmonic NA suppresses visible-range guided mode excitation in SiNW, which enables our photodetector to possess a near-infrared-selective response and overcome the inherent poor optical absorption of Si. The NA can form Schottky contacts with SiNWs for enhancing carrier collection. The vertical NW array also has the geometrically beneficial effects of wide tolerance in light polarization with reduced material consumption.
Human Epidermal Growth Factor Receptor 2 Testing in Primary Breast Cancer in the Era of Standardized Testing: A Canadian Prospective Study
Authors: Hanna Wedad M. , Barnes Penny J. , Chang Martin C. , Gilks C. Blake , Magliocco Anthony M. , Rees Henrike , Quenneville Louise , Robertson Susan J. , SenGupta Sandip K. , Nofech-Mozes Sharon
Published: November 2014

Purpose

Therapies that target overexpression of human epidermal growth factor receptor 2 (HER2) rely on accurate and timely assessment of all patients with new diagnoses. This study examines HER2 testing of primary breast cancer tissue when performed with immunohistochemistry (IHC) and additional in situ hybridization (ISH) for negative cases (IHC 0/1+). The analysis focuses on the rate of false-negative HER2 tests, defined as IHC 0/1+ with an ISH ratio ≥ 2.0, in eight pathology centers across Canada.

Patients and Methods

Whole sections of surgical resections or tissue microarrays (TMAs) from invasive breast carcinoma tissue were tested by both IHC and ISH using standardized local methods. Samples were scored by the local breast pathologist, and consecutive HER2-negative IHC results (IHC 0/1+) were compared with the corresponding fluorescence or silver ISH result.

Results

Overall, 711 surgical excisions of primary breast cancer were analyzed by IHC and ISH; HER2 and chromosome 17 centromere (CEP17) counts were available in all cases. The overall rate of false-negative samples was 0.84% (six of 711 samples). Interpretable IHC and ISH scores were available in 1,212 cases from TMAs, and the overall rate of false-negative cases was 1.6% (16 of 978 cases).

Conclusion

Our observation confirms that IHC is an adequate test to predict negative HER2 status in primary breast cancer in surgical excision specimens, even when different antibodies and IHC platforms are used. The study supports the American Society of Clinical Oncology/College of American Pathologists and Canadian testing algorithms of using IHC followed by ISH for equivocal cases.
Individual Patient Data Analysis of Progression-Free Survival Versus Overall Survival As a First-Line End Point for Metastatic Colorectal Cancer in Modern Randomized Trials: Findings From the Analysis and Research in Cancers of the Digestive System Database
Authors: Shi Qian , de Gramont Aimery , Grothey Axel , Zalcberg John , Chibaudel Benoist , Schmoll Hans-Joachim , Seymour Matthew T. , Adams Richard , Saltz Leonard , Goldberg Richard M. , Punt Cornelis J.A. , Douillard Jean-Yves , Hoff Paulo M. , Hecht Joel Randolph , Hurwitz Herbert , Díaz-Rubio Eduardo , Porschen Rainer , Tebbutt Niall C. , Fuchs Charles , Souglakos John , Falcone Alfredo , Tournigand Christophe , Kabbinavar Fairooz F. , Heinemann Volker , Van Cutsem Eric , Bokemeyer Carsten , Buyse Marc , Sargent Daniel J.
Published: November 2014

Purpose

Progression-free survival (PFS) has previously been established as a surrogate for overall survival (OS) for first-line metastatic colorectal cancer (mCRC). Because mCRC treatment has advanced in the last decade with extended OS, this surrogacy requires re-examination.

Methods

Individual patient data from 16,762 patients were available from 22 first-line mCRC studies conducted from 1997 to 2006; 12 of those studies tested antiangiogenic and/or anti–epidermal growth factor receptor agents. The relationship between PFS (first event of progression or death) and OS was evaluated by using R2statistics (the closer the value is to 1, the stronger the correlation) from weighted least squares regression of trial-specific hazard ratios estimated by using Cox and Copula models.

Results

Forty-four percent of patients received a regimen that included biologic agents. Median first-line PFS was 8.3 months, and median OS was 18.2 months. The correlation between PFS and OS was modest (R2, 0.45 to 0.69). Analyses limited to trials that tested treatments with biologic agents, nonstrategy trials, or superiority trials did not improve surrogacy.

Conclusion

In modern mCRC trials, in which survival after the first progression exceeds time to first progression, a positive but modest correlation was observed between OS and PFS at both the patient and trial levels. This finding demonstrates the substantial variability in OS introduced by the number of lines of therapy and types of effective subsequent treatments and the associated challenge to the use of OS as an end point to assess the benefit attributable to a single line of therapy. PFS remains an appropriate primary end point for first-line mCRC trials to detect the direct treatment effect of new agents.
Evaluation of 30-Day Hospital Readmission After Surgery for Advanced-Stage Ovarian Cancer in a Medicare Population
Authors: Eskander Ramez N. , Chang Jenny , Ziogas Argyrios , Anton-Culver Hoda , Bristow Robert E.
Published: November 2014

Purpose

To analyze rate, risk factors, and costs associated with 30-day readmission after ovarian cancer surgery.

Patients and Methods

The SEER-Medicare linked database (1992 to 2010) was used to evaluate readmission rates within 30 days of index surgery in patients with stage IIIC/IV ovarian, primary peritoneal, or fallopian tube cancer. Multivariable logistic regression was used to identify factors associated with readmission.

Results

Of 5,152 eligible patients, 1,003 (19.5%) were readmitted within 30 days of discharge. Mean patient age was 75 years. Diagnoses associated with readmission included infection (34.7%), dehydration (34.3%), ileus/obstruction (26.2%), metabolic/electrolyte derangements (23.1%), and anemia (12.3%). In multivariable analysis, year of discharge was significantly associated with 30-day readmission (1996 to 2000: odds ratio [OR], 1.32; 95% CI, 1.01 to 1.71; 2001 to 2005: OR, 1.58; 95% CI, 1.24 to 2.0; 2006 to 2010: OR, 1.73; 95% CI, 1.35 to 2.21; referent years 1992 to 1995), as were length of index hospital stay more than 8 days (OR, 1.39; 95% CI, 1.18 to 1.64) and discharge to a skilled nursing facility (OR, 1.3; 95% CI, 1.04 to 1.63). Patients readmitted within 30 days had a significantly greater 1-year mortality rate compared with patients not readmitted (41.1% v 25.1%, respectively; P < .001). The median cost of readmission hospital stay was $9,220 in year 2010 dollars, with a total cost of $9.3 million over the study period.

Conclusion

Early readmission after surgery for ovarian cancer is common. There is a significant association between 30-day readmission and 1-year mortality. These findings may catalyze development of targeted interventions to decrease early readmission, improve patient outcomes, and control health care costs.
Cigarette Smoking Prior to First Cancer and Risk of Second Smoking-Associated Cancers Among Survivors of Bladder, Kidney, Head and Neck, and Stage I Lung Cancers
Authors: Shiels Meredith S. , Gibson Todd , Sampson Joshua , Albanes Demetrius , Andreotti Gabriella , Beane Freeman Laura , Berrington de Gonzalez Amy , Caporaso Neil , Curtis Rochelle E. , Elena Joanne , Freedman Neal D. , Robien Kim , Black Amanda , Morton Lindsay M.
Published: November 2014

Purpose

Data on smoking and second cancer risk among cancer survivors are limited. We assessed associations between smoking before first cancer diagnosis and risk of second primary smoking-associated cancers among survivors of lung (stage I), bladder, kidney, and head/neck cancers.

Methods

Data were pooled from 2,552 patients with stage I lung cancer, 6,386 with bladder cancer, 3,179 with kidney cancer, and 2,967 with head/neck cancer from five cohort studies. We assessed the association between prediagnostic smoking and second smoking-associated cancer risk with proportional hazards regression, and compared these estimates to those for first smoking-associated cancers in all cohort participants.

Results

Compared with never smoking, current smoking of ≥ 20 cigarettes per day was associated with increased second smoking-associated cancer risk among survivors of stage I lung (hazard ratio [HR] = 3.26; 95% CI, 0.92 to 11.6), bladder (HR = 3.67; 95% CI, 2.25 to 5.99), head/neck (HR = 4.45; 95% CI, 2.56 to 7.73), and kidney cancers (HR = 5.33; 95% CI, 2.55 to 11.1). These estimates were similar to those for first smoking-associated cancer among all cohort participants (HR = 5.41; 95% CI, 5.23 to 5.61). The 5-year cumulative incidence of second smoking-associated cancers ranged from 3% to 8% in this group of cancer survivors.

Conclusion

Understanding risk factors for second cancers among cancer survivors is crucial. Our data indicate that cigarette smoking before first cancer diagnosis increases second cancer risk among cancer survivors, and elevated cancer risk in these survivors is likely due to increased smoking prevalence. The high 5-year cumulative risks of smoking-associated cancers among current smoking survivors of stage I lung, bladder, kidney, and head/neck cancers highlight the importance of smoking cessation in patients with cancer.
Changes in Cortical Volumetric Bone Mineral Density and Thickness, and Trabecular Thickness in Lactating Women Postpartum
Authors: Brembeck P. , Lorentzon M. , Ohlsson C. , Winkvist A. , Augustin H.
Published: November 2014

Context:

Lactation is associated with decreased areal bone mineral density (aBMD). Replenishment occurs especially after ceased lactation. Changes in volumetric bone mineral density (vBMD), microstructure, and dimensional parameters are unknown and may clarify the role of lactation for skeletal health.

Objective and Main Outcomes:

The objective of the study was to test the hypothesis that lactation is associated with changes in aBMD, vBMD, microstructure, and dimensional parameters.

Design:

At baseline (0.5 mo after delivery) and 4, 12, and 18 months thereafter, bone was assessed using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography.

Participants and Setting:

Eighty-one fair-skinned postpartum women and 21 controls aged 25–40 years were recruited. The completion ratio was 73%. Postpartum women were categorized depending on duration of lactation: 0–3.9, 4–8.9, and 9 months or longer.

Results:

During the first 4 months, aBMD decreased at several sites (geometric mean ± SE; −0.73% ± 0.21% to −3.98% ± 0.76%) in women lactating at least 4 months. During the same time, cortical vBMD at the ultradistal tibia decreased in women lactating 4–8.9 months (−0.26% ± 0.08%) and 9 months or longer (−0.49% ± 0.10%). At 12 months postpartum, cortical thickness (≥9 mo, −2.48% ± 0.41%) and trabecular thickness (4–8.9 mo, −2.14% ± 0.92%; ≥ 9 mo, −2.56% ± 1.21%) also were lower than baseline. No decreases were found in women lactating less than 4 months or in controls in these parameters. At 18 months postpartum, both cortical vBMD (≥9 mo, −0.77% ± 0.17%) and trabecular thickness (4–8.9 mo, −2.25% ± 1.25%; ≥ 9 mo, −3.21% ± 1.41%) were lower in women with long lactation.

Conclusions:

Decreases in cortical vBMD, thickness, and trabecular thickness at the ultradistal tibia were found in women lactating 4 months or longer. Longer follow-up is needed to confirm whether women with extended lactation recover fully or whether the changes could potentially lead to an increased risk of fracture in later life.
Ligand-Acceleration by a Chiral Modifier in the Enantioselective Hydrogenation of Methyl Acetoacetate on a Raney Nickel Catalyst: Effect of a Modifier Configuration
Authors: Sugimura Takashi , Nakagawa Satoshi , Kamata Naoya , Tei Takahiro , Tajiri Takashi , Tsukiyama Ryo-ichi , Okuyama Tadashi , Okamoto Yasuaki
Published: November 2014

Reaction rate and enantioselectivity of asymmetric hydrogenation of methyl acetoacetate were studied over Raney nickel catalysts modified with (R,R)-tartaric acid, malic acid, or succinic acid to reveal the impacts of the modifier configuration. Catalysts comodified with two different acids were also examined to confirm the conclusions. From analysis of the enantiomer ratio of the hydrogenation product and initial reaction rate, tartaric acid (TA) was found to have dual functions as the modifier during the hydrogenation; effective suppression of the racemic catalysis on bare Ni surface and extensive enantiodifferentiating ligand acceleration by adsorbed TA. It was demonstrated that each adsorbed chiral modifier molecule independently takes part in the enantiospecific hydrogenation.
Three national leads appointed in England to support practice nurses
Authors: Moger Anne , Nicholson Wendy , Storey Karen
Published: November 2014

A commitment to support the development of a national career pathway and systematic CPD for practice nurses has been made with the appointment of three workforce leads for England
Assessing and managing FGM in the practice
Authors: Momoh Comfort
Published: November 2014

Comfort Momoh MBE discusses female genital mutilation and the practice nurse's role in identifying and providing care for victims and those at risk
Travel vaccines: changes to recommendations, Part 2
Authors: Umeed Margaret
Published: November 2014

Margaret Umeed provides an overview of travel vaccines for which the guidance has change
Standards and best practice in spirometry
Authors: Rodman Anne
Published: November 2014

Anne Rodman explores the use of spirometry in primary care and suggests how practice nurses can achieve the best outcomes for patients with respiratory symptoms
Tinea Corporis
Authors: Watkins Jean
Published: November 2014

A case of tinea corporis
Avoiding lipohypertrophy and injection site problems in diabetes
Authors: Diggle Jane
Published: November 2014

Effective self-injection is key to optimal glycaemic control. Jane Diggle explains how practice nurses can help people with diabetes to prevent injection site problems through site rotation and avoiding the reuse of pen needles
p16INK4a Immunohistochemistry in Cervical Biopsy Specimens
Authors: Reuschenbach Miriam , Wentzensen Nicolas , Dijkstra Maaike G. , von Knebel Doeberitz Magnus , Arbyn Marc
Published: November 2014

Objectives:

The interpretation of cervical biopsy specimens guides management of women with suspected cervical cancer precursors. However, morphologic evaluation is subjective and has low interobserver agreement. Addition of p16INK4a immunohistochemistry may improve interpretation.

Methods:

We performed a systematic review and meta-analysis of published data on interobserver agreement of p16INK4a positivity using p16INK4a immunohistochemistry and of cervical intraepithelial neoplasia grade 2 (CIN2+) and CIN grade 3 (CIN3+) classification using H&E morphology in conjunction with p16INK4a in comparison with H&E morphology alone.

Results:

The literature search revealed five eligible articles. The results show strong agreement of pathologists’ interpretation of cervical biopsy specimens as p16INK4a positive or negative (pooled κ = 0.90; 95% confidence interval [CI], 0.88–0.92) and significantly higher agreement for a CIN2+ diagnosis with H&E morphology in conjunction with p16INK4a (κ = 0.73; 95% CI, 0.67–0.79) compared with H&E morphology alone (κ = 0.41; 95% CI, 0.17–0.65). Also, a slightly higher agreement for CIN3+ can be observed (κ = 0.66; 95% CI, 0.39–0.94 for H&E morphology in conjunction with p16INK4a and κ = 0.61; 95% CI, 0.44–0.78 for H&E morphology alone), but this difference was not statistically significant.

Conclusions:

The published literature indicates improved interobserver agreement of the diagnosis of CIN2+ with the conjunctive use of H&E morphology with p16INK4a immunohistochemistry compared with H&E morphology alone.
The Next Chapter in Patient Blood Management
Authors: Goodnough Lawrence Tim , Shah Neil
Published: November 2014

Objectives:

Blood transfusion was identified by the American Medical Association as one of the top five most frequently overused therapies. Utilization review has been required by accreditation agencies, but retrospective review has been ineffective due to labor-intense resources applied to only a sampling of transfusion events. Electronic medical records have allowed clinical decision support (CDS) to occur via a best practices alert at the critical decision point concurrently with physician order entry.

Methods:

We review emerging strategies for improving blood utilization.

Results:

Implementation of CDS at our institution decreased the percentage of transfusions in patients with a hemoglobin level of more than 8 g/dL from 60% to less than 30%. Annual RBC transfusions were reduced by 24%, despite concurrent increases in patient discharge volumes and case mix complexity. This resulted in acquisition costs savings (direct blood product purchase costs) of $6.4 million over 4 years.

Conclusions:

We have been able to significantly reduce inappropriate blood transfusions and related costs through an educational initiative coupled with real-time CDS. In deriving increased value out of health care, CDS can be applied to a number of overuse measures in laboratory testing, radiology, and therapy such as antibiotics, as outlined by the American Board of Internal Medicine’s Choosing Wisely campaign.
Circulating Donor-Specific Anti–Human Leukocyte Antigen Antibodies and Complement C4d Deposition Are Associated With the Development of Cardiac Allograft Vasculopathy
Authors: Frank Renee , Molina Maria R. , Goldberg Lee R. , Wald Joyce W. , Kamoun Malek , Lal Priti
Published: November 2014

Background:

Cardiac allograft vasculopathy (CAV) continues to be a limiting factor in long-term survival of heart transplant recipients (HTRs). Pathophysiologic and immunologic factors affecting CAV are complex, and criteria for early diagnosis remain elusive.

Methods:

We performed a retrospective analysis of the relationship between donor-specific antibody (DSA), C4d immunofluorescence, and the development of CAV.

Results:

We evaluated 330 endomyocardial biopsy (EMB) specimens from 112 cardiac grafts. Twenty-four (21%) of 112 grafts developed CAV, and 18 (75%) of 24 were positive for C4d. Patients with DSA (n = 51) against human leukocyte antigen class I (n = 5), II (n = 26), or both (n = 20) developed CAV at a rate of 40%, 38%, and 20% and a mean time to CAV of 89, 47, and 25 months, respectively. Of 61 grafts without DSA, only 13% developed CAV, with a mean time to CAV of 116 months.

Conclusions:

Compared with the general HTR population, patients with graft dysfunction and DSA or positive C4d on EMB show a statistically significant increased incidence of CAV and allograft failure, suggesting an antibody-mediated injury. The presence of pre- and posttransplant DSA, even in the absence of positive C4d immunofluorescence, may identify a group of HTRs at increased risk of developing CAV.
Idolatry and sacrilege: Offenbach’s operetta in nineteenth-century Athens
Authors: Xepapadakou Avra
Published: November 2014

The ‘descent’ of the heroes of Greek mythology, Orpheus and Helen, to the modern Greek-speaking world took place secretly between the decades 1860 and 1870, when French troupes first started visiting Athens in order to perform at the Winter Theatre of the city, provoking a storm of reactions. This article aims to examine the impact of French light music on the newly formed urban Athenian society of the mid-nineteenth century, highlighting the dichotomy between the West and the Orient that characterizes modern Greek history. Their performances rekindled the controversy raging in the musical life of the new Greek state throughout the nineteenth century and became the bone of contention for the duel between European opera troupes – which enjoy the financial and moral support of the court, the government and ‘high society’ in general – and local drama troupes fighting hard to become established.
Sondheim’s A Little Night Music: Reconciling the comic and the sublime
Authors: Wolfe Graham
Published: November 2014

This article draws on Alenka Zupančič’s and Slavoj Žižek’s recent theorizations of comedy to examine Stephen Sondheim’s highly successful 1973 musical A Little Night Music. Zupančič and Žižek argue that by ‘looking awry’ on popular modes like comedy we can explore how our relation to reality is still structured by fantasy and by passionate attachments to sublime objects – indeed, we can discover in comedy new modes of configuring the sublime. To explore A Little Night Music as a ‘reconciliation’ of comedy and sublimity is to open a consideration of Sondheim’s contributions towards the very debates and deadlocks that Zupančič and Žižek identify and to suggest ways of extending their own psychoanalytic philosophy into the realms of musical theatre, a mode that they leave largely uninvestigated. In the process, the article aims to move beyond more traditional ‘applications’ of Lacanian psychoanalysis, arguing that Sondheim’s musical encourages us to think differently about Lacanian theory per se and to look in new (and comic) ways at enigmatic terms like the ‘Real’.
Framing The Bridges of Madison County
Authors: Accetta Valerie
Published: November 2014

The novel The Bridges of Madison County (1992) by Robert James Waller sold over 50 million copies and was made into a film that garnered an Academy Award nomination for Meryl Streep. Composer Jason Robert Brown and writer Marsha Norman, the creators of the musical The Bridges of Madison County, reframed the original love story for the Broadway stage using traditional musical theatre conventions such as the addition of a secondary comedic couple, the use of an ensemble and a linear plot structure. This article explores the function of these conventions and the critical reception of this adaptation, questioning the adherence to the traditional musical theatre forms in the telling of a non-traditional love story.