bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular phylogeny reveals strong biogeographic signal and two new species in a Cape Biodiversity Hotspot endemic mini-radiation, the pygmy geckos (Gekkonidae: Goggia)
Authors: HEINICKE MATTHEW P. , TURK DILARA , BAUER AARON M.
Published: August 2017

The gekkonid genus Goggia includes eight described species of mostly small-bodied rock dwelling gecko endemic to the southwestern portion of southern Africa, in South Africa and extreme southern Namibia. Previous studies focused on Goggia have employed external morphology and allozyme electrophoresis, but no sequence-based molecular phylogeny of the group has been produced. We have generated a molecular phylogeny of Goggia including all named species and multiple individuals within each species, using sequences of the mitochondrial gene ND2 and nuclear genes RAG1 and PDC. The phylogeny depicts a basal divergence between eastern and western species of small-bodied Goggia, with additional divergences also showing structure strongly correlated with geography. Goggia lineata and G. rupicola are shown to be non-monophyletic, and examination of external morphology supports the distinctiveness of these lineages. We describe two new species to accommodate the southern lineages of “G. lineata” and “G. rupicola”: Goggia incognita sp. nov. and Goggia matzikamaensis sp. nov. Both new species are separated from their northern relatives by geographic barriers: the Knersvlakte plain for G. incognita sp. nov. and G. lineata, and the high Kamiesberg mountains for G. matzikamaensis sp. nov. and G. rupicola. The possible roles of geography, ecology, and climate in promoting diversification within Goggia are discussed.
Two new species and new records of the genus Parachironomus Lenz, 1921 (Diptera, Chironomidae) from northern Russia
Authors: OREL OKSANA V.
Published: August 2017

Two new species of the genus Parachironomus Lenz, P. aquilonis sp. n. from the northern Urals and P. khatyrka sp. n. from the Russian Far East, are described and figured based on the morphology of the adult males. Adult males of P. hazelriggi Spies, 2000 and P. subalpinus (Goetghebuer, 1931) are redescribed and illustrated; both species are recorded for the first time from Russia, P. hazelriggi is new for the Palaearctic region.
Thermal Configuration of the Bay of Bengal–Tibetan Plateau Region and the May Precipitation Anomaly in Yunnan
Authors: Cao Jie , Zhang Wei-kang , Tao Yun
Published: August 2017

This paper describes the study of the relationship between the thermal configuration of the Bay of Bengal (BOB)–Tibetan Plateau (TP) region and the precipitation anomaly in Yunnan, a province in China, in May using ERA-Interim data and precipitation data for May from 125 meteorological stations across Yunnan for 1979–2014. Results from the analysis indicate that the interannual variability of May precipitation in Yunnan is significantly modulated by the BOB–TP thermal configuration. Model runs with a linear baroclinic model suggest physical consistency. The thermal conditions over the BOB mainly impact the May precipitation anomaly in Yunnan via changes in water vapor transport from the eastern BOB northeastward to southwestern Yunnan. The second factor influencing precipitation anomalies relates to the characteristics and variability of cold air transport from the TP to northeastern Yunnan. When the BOB (the TP) is occupied by positive (negative) diabatic heating, a thermal gradient with a warmer (colder) center over the BOB and a colder (warmer) center over the TP is established, and more-than-normal (less than normal) precipitation in Yunnan will occur in May. This relationship can persist from April to the following May to some extent; therefore, the BOB–TP thermal configuration in April could be used to forecast May precipitation in Yunnan.
Subseasonal Variations of Wintertime North Pacific Evaporation, Cold Air Surges, and Water Vapor Transport
Authors: Ren Xuejuan , Yang Xiu-Qun , Hu Haibo
Published: August 2017

This study addresses subseasonal variations of oceanic evaporation E over the North Pacific during winter and the connection with the cold air surges (CASs) and atmospheric water vapor transport using the OAFlux and ERA-Interim daily data. By performing an empirical orthogonal function (EOF) analysis, two dominant modes of subseasonal evaporation anomaly E′ are identified: a zonal wave train–like pattern (EOF1) and an east negative–west positive dipolar pattern (EOF2) in the midlatitude basin. Further analyses yield the following conclusions. 1) The Siberian high (SH)-related CAS has a crucial role in generation of the EOF1 mode of E′. When the dry and cold air mass passes the region of the warm Kuroshio and its extension [Kuroshio–Oyashio Extension (KOE)], the increased air–sea temperature and moisture differences and intensified wind speed lead to the above-normal oceanic E, and vice versa. 2) The Aleutian low (AL)-related CAS contributes to the EOF2 mode of E′. The intensified AL transports a dramatically colder and drier air mass toward the KOE region and a slightly warmer and wetter one toward the west coast of North America, leading to the east negative–west positive structure of E′ in the midlatitude basin. 3) A quasi-linear relationship exists between E′ and divergent water vapor transport anomalies over the KOE region. Positive (negative) E′ is generally accompanied by anomalous vapor source (sink). 4) The divergent water vapor transport anomalies associated with the two EOFs are preliminarily decided by their individual lower-level wind field anomalies and second by the meridional inhomogeneity of subseasonal specific humidity anomalies. Hydroclimate effects on precipitation over the pan–North Pacific region are also discussed.
Development of a Model Performance Metric and Its Application to Assess Summer Precipitation over the U.S. Great Plains in Downscaled Climate Simulations
Authors: Tian Baijun , Lee Huikyo , Waliser Duane E. , Ferraro Robert , Kim Jinwon , Case Jonathan , Iguchi Takamichi , Kemp Eric , Wu Di , Putman William , Wang Weile
Published: August 2017

Several dynamically downscaled climate simulations with various spatial resolutions (24, 12, and 4 km) and spectral nudging strengths (0, 600, and 2000 km) have been run over the contiguous United States from 2000 to 2009 using the high-resolution NASA Unified Weather and Research Forecasting (NU-WRF) regional model initialized and constrained by the Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2). This paper summarizes the authors’ efforts on the development of a model performance metric and its application to assess summer precipitation over the U.S. Great Plains (USGP) in these downscaled climate simulations. A new model performance metric T was first developed that uses both the linear correlation coefficient and mean square error and is consistent with other commonly used metrics, but gives a bigger separation between good and bad simulations. This metric T was then applied to the summer mean precipitation spatial pattern, diurnal Hovmöller diagram, and diurnal spatial pattern over the USGP from the simulations focusing on the summer precipitation diurnal cycle related to mesoscale convective systems (MCSs). The metric T skill scores increase significantly from the control simulation to the nudged simulations and from the nudged simulations with shorter wavelengths to the nudged simulations with longer wavelengths, but do not change much from MERRA-2 to the downscaled simulations or between the various downscaled simulations with different spatial resolutions. Thus, there is some credibility, but no significant value added compared to MERRA-2, of the downscaled climate simulations of the summer precipitation over the USGP.
Future Costs of Long-term Care in Japan and Sweden
Authors: Lagergren Mårten , Kurube Noriko , Saito Yasuhiko
Published: August 2017

Population aging is expected to increase long-term care (LTC) costs in both Japan and Sweden. This study projected LTC costs for 2010 through 2040 for different assumptions of population change, LTC need by age group and gender, and LTC provided per level of need and cost in Japan and Sweden. Population data were taken from the official national forecasts. Needs projections were based on epidemiological data from the Nihon University Japanese Longitudinal Study of Aging and the Swedish Survey of Living Conditions. Data on LTC provision by need and cost were taken from nine Japanese municipalities collected by assessments in the LTC insurance system and from surveys in eight Swedish municipalities. Total initial costs were calibrated to official national figures. Two projections based on two different scenarios were made for each country from 2010 to 2040. The first scenario assumed a constant level of need for LTC by age group and gender, and the other assumed a continuation of the present LTC need trends until 2025. For Japan, this resulted in a projected cost increase of 93% for the one and 80% for the other; for Sweden it was 52% and 24%, respectively. The results reflected differences in population aging and health development.
Why one size fits all approach to transition in Disability Employment Services hinders employability of young people with physical and neurological disabilities in Australia
Authors: Stafford Lisa , Marston Gregory , Chamorro-Koc Marianella , Beatson Amanda , Drennan Judy
Published: August 2017

The education-to-work pathways for young people with disabilities are becoming more diverse and lengthier in our post-industrial economy. Furthermore, it is recognized that a multitude of barriers still remain in securing employment at the end of these pathways. In this paper, we focus on Australia’s Disability Employment Services (DES) to understand how views of transition in DES policy may be influencing program rules in supporting secondary and tertiary students with physical and/or neurological disabilities in their employability and employment. We do this through critical policy analysis of DES and in-depth Interpretive accounts from service providers and advocacy organizations.
Increasing the performance of a Discrete Event System Specification simulator by means of computational resource usage “activity” models
Authors: Van Tendeloo Yentl , Vangheluwe Hans
Published: August 2017

Domain-specific simulators often have an edge on general-purpose simulators in terms of performance. Their intricate knowledge of the domain allows them to aggressively optimize and take shortcuts. In contrast, simulators for more general formalisms, such as Discrete Event System Specification (DEVS), need to support a wider set of models. Their inability to use domain information prevents DEVS simulators from achieving as high performance as their domain-specific variants. To solve this problem, we introduce a way to enhance the simulation performance of DEVS models through the use of computational resource usage models, often termed “activity” models. These models augment general-purpose DEVS models with domain-specific information, which can be used by the simulator. We apply this information in the context of data structure optimization, load balancing, and model allocation. Activity-awareness is a non-invasive extension to the DEVS formalism, meaning that activity-augmented models remain perfectly valid for use in activity-unaware simulators. Similarly, models without activity can still be simulated by an activity-aware simulator. Our approach is validated by making PythonPDEVS, a Parallel DEVS simulator, activity-aware and evaluating the performance impact on a set of benchmark models.
Stakeholders’ Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach
Authors: Alameddine Mohamad , Yassoub Rami , Mourad Yara , Khodr Hiba
Published: August 2017

This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future.
Aftermarket Performance of Health Care and Biopharmaceutical IPOs: Evidence From ASEAN Countries
Authors: Komenkul Kulabutr , Kiranand Santi
Published: August 2017

We examine the evidence from the long-run abnormal returns using data for 76 health care and biopharmaceutical initial public offerings (IPOs) listed in a 29-year period between 1986 and 2014 in the Association of Southeast Asian Nations (ASEAN) countries such as Indonesia, Malaysia, Singapore, Thailand, the Philippines, Vietnam, Myanmar, and Laos. Based on the event-time approach, the 3-year stock returns of the IPOs are investigated using cumulative abnormal return (CAR) and buy-and-hold abnormal return (BHAR). As a robustness check, the calendar-time approach, related to the market model as well as Fama-French and Carhart models, was applied for verifying long-run abnormal returns. We found evidence that the health care IPOs overperform in the long-run, irrespective of the alternative benchmarks and methods. In addition, when we divide our sample into 5 groups by listing countries, our results show that the health care stock prices of the Singaporean firms behaved differently from those of most of the other firms in ASEAN. The Singaporean IPOs are characterized by a worse post-offering performance, whereas the IPOs of Malaysian and Thai health care companies performed better in the long-run.
Freestanding Emergency Departments Are Associated With Higher Medicare Costs: A Longitudinal Panel Data Analysis
Authors: Patidar Nitish , Weech-Maldonado Robert , O’Connor Stephen J. , Sen Bisakha , Trimm Jerry M. , Camargo Carlos A.
Published: August 2017

The number of freestanding emergency departments (FSEDs) is growing rapidly in the United States. Proponents of FSEDs cite potential benefits of FSEDs including lower waiting time and reduced travel distance for needed emergency care. Others have suggested that increased access to emergency care may lead to an increase in the use of emergency departments for lower acuity patients, resulting in higher overall health care expenditures. We examined the relationship between the number of FSEDs in each county and total Medicare expenditures between 2003 and 2009. Our results show that each additional FSED in a county is associated with an expenditure increase of $55 per Medicare beneficiary. This finding suggests that even if FSEDs may increase access to emergency care, it may result in higher overall Medicare expenditures.
Studying Open Versus Traditional Textbook Effects on Students’ Course Performance
Authors: Griggs Richard A. , Jackson Sherri L.
Published: August 2017

To combat the high cost of textbooks, open (digitally free) textbooks have recently entered the textbook market. Griggs and Jackson (2017) reviewed the open introductory psychology textbooks presently available to provide interested teachers with essential information about these texts and how they compare with traditional (commercial) introductory textbooks. They did not, however, include any discussion of the research that has examined the effects of open introductory psychology textbooks and other open educational resources versus traditional introductory textbooks on students’ course performance (e.g., course grades). The present study provides a review of this research. The review indicated that no firm conclusions can be drawn not just because there are a limited number of studies with seemingly conflicting findings but more importantly because of numerous uncontrolled relevant variables in all of the studies. To aid researchers who want to conduct future studies on this topic and reviewers who will evaluate these studies, we discuss these variables and the control issues they create.
Breaking the Carnival Mirror
Authors: Culton Kenneth R. , Muñoz José A.
Published: August 2017

We present a reflexive paper assignment calling for students to report on their own family and/or personal experiences in order to answer the question, “From where does the greatest harm arise?” We find that, through the process of answering this question and sharing findings in class, students’ conception of criminality is broadened. Institutional forms of deviance and white-collar crime come to be understood as the real commonplace sources of harm while street crime is seen to be less common than typically imagined. The book The Rich Get Richer and the Poor Get Prison: Ideology, Class and Criminal Justice by Reiman and Leighton informs this assignment. The authors make the case that the criminal justice system presents to us a carnival mirror-like image of what causes the greatest harm to the society. The criminal justice system, through its policies and procedures, leads the public to conceive of only a narrow and distorted depiction of criminality. The typical crime is thought to be person to person, violent, and carried out by the typical criminal, who is assumed to be black, young, and urban. In opposition to this carnival mirror view, Reiman and Leighton explain that certain institutions cause immensely more harm than that caused by street criminality.
Infinity, infinite processes and limit concepts
Authors: Strydom Piet
Published: August 2017

This article seeks to recover a neglected chapter in the historical and theoretical background of social theory in general and critical theory in particular with a view to refining the understanding of the presuppositions of a cognitively enhanced critical social science appropriate to our troubled times. For this purpose, it offers a brief reconstruction of the mathematical-philosophical tradition from ancient to modern times by extrapolating that part of it that is marked by the ideas of infinity, infinite processes and limit concepts. It gives suggestive indications not only of how these ideas relate to extant social-theoretical thought, but especially also of the two related cognitive directions – the weak-naturalistic and the socio-cultural – in which such thought is currently challenged to go.
Prediction of high-stage liver fibrosis using ADC value on diffusion-weighted imaging and quantitative enhancement ratio at the hepatobiliary phase of Gd-EOB-DTPA–enhanced MRI at 1.5 T
Authors: Harada Taiyo L , Saito Kazuhiro , Araki Yoichi , Matsubayashi Jun , Nagao Toshitaka , Sugimoto Katsutoshi , Tokuuye Koichi
Published: August 2017

Background

Recently, diffusion-weighted imaging (DWI) and quantitative enhancement ratio measured at the hepatobiliary phase (HBP) of Gd-EOB-DTPA–enhanced magnetic resonance imaging (MRI) has been established as an effective method for evaluating liver fibrosis.

Purpose

To evaluate which is a more favorable surrogate marker in predicting high-stage liver fibrosis, apparently diffusion coefficient (ADC) value or quantitative enhancement ratio measured on HBP.

Material and Methods

Eighty-three patients with 99 surgically resected hepatic lesions were enrolled in this study. DWI was performed with b-values of 100 and 800 s/mm2. Regions of interest were set on ADC map, and the HBP of Gd-EOB-DTPA–enhanced MRI, to calculate ADC value, liver-to-muscle ratio (LMR), liver-to-spleen ratio (LSR), and contrast enhancement index (CEI) of liver. We compared these parameters between low-stage fibrosis (F0, F1, and F2) and high-stage fibrosis (F3 and F4). Receiver operating characteristic analysis was performed to compare the diagnostic performance when distinguishing low-stage fibrosis from high-stage fibrosis.

Results

LMR and CEI were significantly lower at high-stage fibrosis than at the low stage ( P < 0.01 and P = 0.04, respectively), whereas LSR did not show a significant difference ( P = 0.053). No significant difference was observed in diagnostic performance between LMR and CEI ( P = 0.185). The best sensitivity and specificity, when an LMR of 2.80 or higher was considered to be low-stage fibrosis, were 82.4% and 75.6%, respectively. ADC value showed no significant differences among fibrosis grades ( P = 0.320).

Conclusion

LMR and CEI were both adequate surrogate parameters to distinguish high-stage fibrosis from low-stage fibrosis.
In vitro and in vivo evaluation of hypothermia on pharmacokinetics and pharmacodynamics of nimodipine in rabbits
Authors: Fei Yu-xing , Zhang Tian-hong , Zhao Jing , Ren He , Du Ya-nan , Yu Chun-ling , Wang Qiang , Li Shu , Ren Ting-lin , Jian Qiang , Fei Shu-yang , Zhang Zhen-qing , Zhang Yi
Published: August 2017

Objective

To investigate the effect of hypothermia on the pharmacokinetics and pharmacodynamics of nimodipine in rabbits using in vivo and in vitro methods.

Methods

Five healthy New Zealand rabbits received a single dose of nimodipine (0.5 mg/kg) intravenously under normothermic and hypothermic conditions. Doppler ultrasound was used to monitor cerebral blood flow, vascular resistance, and heart rate. In vitro evaluations of protein binding, hepatocyte uptake and intrinsic clearance of liver microsomes at different temperatures were also conducted.

Results

Plasma concentrations of nimodipine were significantly higher in hypothermia than in normothermia. Nimodipine improved cerebral blood flow under both conditions, but had a longer effective duration during the hypothermic period. Low temperature decreased the intrinsic clearance of liver microsomes, with no change in protein binding or hepatocyte uptake of nimodipine.

Conclusion

Nimodipine is eliminated at a slower rate during hypothermia than during normothermia, mainly due to the decreased activity of cytochrome P450 enzymes. This results in elevated system exposure with little enhancement in pharmacological effect.
Effect of hypercortisolism on bone mineral density and bone metabolism: A potential protective effect of adrenocorticotropic hormone in patients with Cushing’s disease
Authors: Guo Weihong , Li Fengao , Zhu Chonggui , Wang Baoping , Wang Kunling , Dai Chenlin , Jia Hongwei , Wei Hongyan , He Qing , Cui Jin , Yuan Menghua , Tang Shaofang , Liu Wei , Zhu Tiehong , Gao Zhihong , Zheng Fangqiu , Ma Zhongshu , Qu Huiqi , Zhu Mei
Published: August 2017

Objective

To investigate the effects of Cushing’s disease (CD) and adrenal-dependent Cushing’s syndrome (ACS) on bone mineral density (BMD) and bone metabolism.

Methods

Data were retrospectively collected for 55 patients with hypercortisolism (CD, n = 34; ACS n = 21) from January 1997 to June 2014. BMD was examined in all patients, and bone turnover markers were tested in some patients. Healthy controls (n = 18) were also recruited.

Results

The lumbar spine and femoral neck BMD were significantly lower in the ACS and CD groups than in the control group. Lumbar BMD was significantly lower in the ACS than CD group. The collagen breakdown product (CTX) concentrations were significantly higher while the osteocalcin and procollagen type I N-terminal propeptide (PINP) concentrations were significantly lower in the ACS and CD groups than in the control group. The PINP concentration was significantly lower while the CTX concentration was significantly higher in the ACS than CD group. In the CD group only, lumbar BMD and serum adrenocorticotropic hormone had a significant positive correlation.

Conclusions

Bone turnover markers indicated suppressed osteoblast and enhanced osteoclast activities. PINP and CTX changes might indicate bone mass deterioration. Adrenocorticotropic hormone might be protective for lumbar BMD in patients with CD.
The balance principle and the Reynolds transport theorem in introductory fluid mechanics
Authors: Gray Donald D , Huebsch Wade W
Published: August 2017

This paper traces the evolution of the use of the Reynolds transport theorem to derive finite control volume equations for mass, momentum, and energy in introductory engineering fluid mechanics textbooks used in the United States. The paper demonstrates the superior merits of an alternative approach using the balance principle. The balance principle is easier to teach, to understand, and to apply in more complex situations. It better prepares students to understand the derivation of the partial differential equations of fluid mechanics and the finite volume equations of computational fluid dynamics. For these reasons, instructors should consider using the balance principle instead of (or at minimum in addition to) the Reynolds transport theorem in introductory fluid mechanics courses.
Cognitive bias in health leaders
Authors: Campbell Samuel G. , Croskerry Pat , Petrie David A.
Published: August 2017

Cognitive bias can be a serious impediment to rational decision-making by health leaders. We use a hypothetical case study to introduce some basic concepts of bias with examples of mitigation strategies. We argue that the effect of biases should be considered when making every significant administrative decision.
Negotiating the coaching landscape: Experiences of Black men and women coaches in the United Kingdom
Authors: Rankin-Wright AJ , Hylton K , Norman L
Published: August 2017

The current article provides a critical examination of the racialised and gendered processes that reinforce disparities in sport coaching by exploring the experiences of Black men and women coaches in the United Kingdom. The findings are based on in-depth qualitative interviews with coaches from two national governing bodies of sport. Using a Critical Race Theory approach and Black feminist lens, the coaches’ narratives illuminate the complex, multifaceted and dynamic ways in which ‘race’, ethnicity and gender are experienced and negotiated by sport coaches. The coaches’ reflections are discussed under three themes: negotiating identities; privilege and blind spots; and systemic discrimination. The narratives from the coaches’ experiences emphasise the need for key stakeholders in sport to recognise the intersectional, structural and relational experiences that facilitate, as well as constrain, the progression of Black coaches in order to challenge racialised and gendered inequalities.
Innovative Treatment Strategies in Locally Advanced and/or Unresectable Non-Small Cell Lung Cancer
Authors: Movsas Benjamin
Published: August 2017

Background

While small improvements in outcome have occurred for patients with locally advanced non-small cell lung cancer (NSCLC), 5-year survival results remain low, ranging from 5% to 20%. Distant metastases and local-regional progression remain significant patterns of failure.

Methods

Trials investigating innovative treatment strategies for patients with locally advanced and/or unresectable NSCLC are reviewed, including altered radiation fractionation schema, conformal 3-dimensional radiotherapy, and combined chemoradiotherapy regimens.

Results

Whereas hyperfractionated radiation therapy (HFRT) alone does not appear to be beneficial, combined HFRT and chemotherapy appears promising in several trials. Patients treated with accelerated RT compared with standard RT have an improved survival. As higher radiation doses appear to enhance local tumor control, strategies involving 3-dimensional conformal radiotherapy merit further investigation. RT plus chemotherapy is superior to RT alone, albeit with greater toxicity. Amifostine is currently being investigated as a radioprotector. The optimal chemotherapy agents and their integration with radiotherapy are the subject of randomized trials.

Conclusions

Ongoing investigations are warranted to combat both local-regional and systemic failures for patients with locally advanced NSCLC. Treatment strategies need to consider not only the traditional endpoints of survival and local control, but also quality of life.
Evaluation and Treatment of Aerodigestive Tract Invasion by Well-Differentiated Thyroid Carcinoma
Authors: McCaffrey Judith Czaja
Published: August 2017

Background

Although rare, invasion of the upper aerodigestive tract by well-differentiated thyroid carcinoma can be a source of significant morbidity as well as mortality for the patient. Effective management of patients with invasive thyroid carcinoma requires an understanding of the patterns of invasion and methods of treatment, including surgical resection and adjuvant therapy.

Methods

The author reports on experience with invasive well-differentiated thyroid carcinoma, discussing diagnosis (based on physical examination, imaging studies, and endoscopy) as well as treatment options (based on degree of aerodigestive tract invasion).

Results

Direct intraluminal invasion of thyroid carcinoma requires definitive resection of aerodigestive tract lumen to remove all gross disease. However, when the lumen is not involved, “shaving” tumor from airway or esophagus is an acceptable treatment with a similar locoregional control rate and minimal morbidity when compared to definitive aerodigestive tract resection.

Conclusions

Successful treatment of invasive thyroid carcinoma should improve survival and reduce not only the morbidity of the disease, but also the morbidity of the surgical procedure.
Observation in the Management of Localized Prostate Cancer
Authors: Hoff Bryan , Pow-Sang Julio M.
Published: August 2017

Background

The widespread use of the prostate-specific antigen test, the availability of ultrasound, and improved techniques for prostate biopsy have led to the diagnosis of organ-confined prostate cancers at an earlier stage. An unknown number of these cancers will be incidental and will not impact the patient's quality or length of life.

Methods

The most recent published reports and decision analysis studies on observation management were reviewed. We also analyzed our own series of observed patients.

Results

Three contemporary series on observation and three reports on decision analysis for treatment of early prostate cancer define a group of patients who may be treated with observation. Our own preliminary experience, however, demonstrates that a significant number undergo definitive treatment within 3 years from diagnosis. The optimal treatment for men with early prostate cancer is currently unknown.

Conclusions

A subset of patients with newly diagnosed prostate cancer may be managed by observation. Standard protocols for selection and follow-up of patients on observation need to be developed.
Laboratory Testing for HER2/neu in Breast Carcinoma: An Evolving Strategy to Predict Response to Targeted Therapy
Authors: Diaz Nils M.
Published: August 2017

Background

Laboratory testing of HER2/neu in breast carcinoma has become vital to patient care following the approval of trastuzumab as the first therapy to target the HER2/neu oncoprotein. Initial clinical trials used immunohistochemistry (IHC) to test for HER2/neu overexpression in order to select patients for therapy. Fluorescence in situ hybridization (FISH), which tests for gene amplification, is more specific and sensitive than IHC when either assay is compared with HER2/neu overexpression as determined by Northern or Western blot analysis. Many weak overexpressors on IHC testing are not gene amplified on FISH analysis. Such weak overexpressors may be considered false-positives and raise the question of how best to test for HER2/neu.

Methods

The literature was surveyed regarding testing for HER2/neu overexpression in breast carcinomas and alternative testing strategies.

Results

False-positive results are a significant problem when IHC is exclusively used to test for HER2/neu overexpression. The false-positives are overwhelmingly confined to the group of 2+ positives and do not respond to targeted therapy. In contrast, concordance between IHC and FISH is high when immunostaining is interpreted as either negative or strongly positive (3+). Whereas some recent studies have suggested that FISH may better predict response to anti-HER2/neu therapy than IHC, others have indicated that IHC is as effective a predictor as FISH. IHC is less technically demanding and costly than FISH.

Conclusions

IHC analysis of HER2/neu in breast carcinoma is a useful predictor of response to therapy with trastuzumab when strongly positive. Negative immunostaining is highly concordant with a lack of gene amplification by FISH. Most weakly positive overexpressors are false-positives on testing with FISH. Thus, screening of breast carcinomas with IHC and confirmation of weakly positive IHC results by FISH is an effective evolving strategy for testing HER2/neu as a predictor of response to targeted therapy.
The Treatment Challenge of Hormone-Refractory Prostate Cancer
Authors: Kish Julie A. , Bukkapatnam Raviender , Palazzo Felipe
Published: August 2017

Background

Both the demographics and treatment of hormone-refractory prostate cancer (HRPC) are changing. Patients are younger and healthier, with fewer comorbidities. The “no treatment until symptoms” approach is disappearing. Chemotherapy is increasingly being utilized.

Methods

The authors review the steps involved in hormone management before chemotherapy is considered. The roles for chemotherapy in current clinical trials are examined.

Results

Effective hormonal management of the prostate cancer patient incorporates an understanding of the stages of hormone sensitivity and prescribing additional interventions beyond simple castration. Once hormone refractoriness is established, the combination of mitoxantrone and prednisone has become a standard chemotherapeutic approach. New agents such as docetaxel are being tested in phase III trials against mitoxantrone plus prednisone.

Conclusions

HRPC is now regarded as a chemotherapy-sensitive tumor. The goals of chemotherapy in HRPC are to decrease PSA level and improve quality of life. New agents and combinations are needed to improve survival.
Radical Prostatectomy in the Management of Clinically Localized Prostate Cancer
Authors: Bukkapatnam Raviender , Pow-Sang Julio M.
Published: August 2017

Background

Several management options are available when prostate cancer is diagnosed at an early stage. However, the optimal treatment for localized prostate cancer is unknown, and reports in the literature are controversial regarding the best treatment modality for this early presentation.

Methods

The authors review improvements in surgical technique that have decreased complications, and they address long-term outcomes of surgery related to cancer control.

Results

Improvements in surgical techniques allow for decreased intraoperative complications. The incidence of long-term complications such as incontinence and impotency is also reduced. The 5- and 10-year progression-free survival with radical prostatectomy has improved.

Conclusions

Surgery today is safer with improvements in techniques. The long-term outcomes with surgery are excellent and, in several series, better than outcomes achieved with other treatment modalities.
High-Dose-Rate Brachytherapy in the Treatment of Carcinoma of the Prostate
Authors: Syed A.M. Nisar , Puthawala Ajmel , Sharma Anil , Gamie Sherief , Londrc Adina , Cherlow Joel M. , Damore Steven J. , Nazmy Nashwa , Sheikh Khalid M. , Ko Stephen J.
Published: August 2017

Background

Although radical prostatectomy for localized disease is considered as a standard of care, external-beam radiotherapy and brachytherapy are equally effective. We report on the technique and preliminary results of high-dose-rate (HDR) brachytherapy using a temporary iridium-192 implant technique.

Methods

The authors reviewed the literature on the techniques, treatment protocols, and results of HDR brachytherapy in the treatment of carcinoma of the prostate, and they report their own protocols, technique, and results.

Results

The combination of HDR brachytherapy and external irradiation has been well tolerated by all 200 patients in our series, with less than 3% grade 3 late complications and with 95% PSA relapse-free survival with a median follow-up of 24 months.

Conclusions

HDR brachytherapy may be the most conformal type of irradiation in the treatment of carcinoma of the prostate regardless of tumor size, anatomical distortion, and organ mobility.
Management of Erectile Dysfunction Secondary to Treatment for Localized Prostate Cancer
Authors: Telöken Cláudio
Published: August 2017

Background

Management options for localized prostate cancer include radical prostatectomy, external radiation therapy, brachytherapy, and watchful waiting. Improvements in treatment techniques have resulted in fewer side effects. Nevertheless, long-term complications such as erectile dysfunction (ED) continue to affect a significant percentage of men treated for prostate cancer and can have a distressing and debilitating effect on the patient's quality of life.

Methods

The author reviews both the prevalence and the current options for the management of ED secondary to treatment for clinically localized prostate cancer.

Results

The ability to preserve potency after prostate cancer treatment is controversial, with reports ranging from 10%-90%. For patients complaining of impotence, efficacious alternatives are available such as oral drugs, intraurethral alprostadil, vacuum devices, intracavernous injections, and penile prostheses.

Conclusions

Sexual function is an integral part of patient satisfaction and quality of life. Although ED is a frequent complication of definitive treatment of localized prostate cancer, a variety of treatment options are now available to maximize quality of life despite age and other comorbidities.
Lymphatic Mapping in Solid Neoplasms: State of the Art
Authors: Zervos Emmanuel E. , Burak William E.
Published: August 2017

Background

Lymphatic mapping and sentinel lymph node biopsy is an established technique for the staging and treatment of melanoma. The success of lymphatic mapping in this realm has broadened its application to other solid neoplasms. This update reviews the status of sentinel lymph node biopsy in its most widely cited applications.

Methods

Seminal manuscripts on lymphatic mapping in melanoma, breast, colon, vulvar, cervical, lung, gastric, and head and neck cancers are reviewed.

Results

Studies suggest that the application of lymphatic mapping as a staging tool in breast cancer and melanoma is justified when applied by trained surgeons. Additional validation is necessary before sentinel node biopsy is advocated in gynecologic, colon, lung, and head and neck cancer.

Conclusions

As in breast cancer and melanoma, validation of the sentinel node concept in other solid tumors must occur in institutions other than those in which the technique is being developed before it is generally applied to other neoplasms.
Hypopituitarism in Childhood
Authors: Geffner Mitchell E.
Published: August 2017

Background

Childhood hypopituitarism may be present at birth or may be acquired. Early diagnosis and treatment promote the best possible outcomes.

Methods

The anatomy, etiologies, clinical presentation, diagnostic testing strategies, and current treatments relevant to childhood hypopituitarism are reviewed.

Results

Children with congenital hypopituitarism may present with life-threatening hypoglycemia, abnormal serum sodium concentrations, shock, microphallus in males, and, only later, growth failure. Causes of congenital hypopituitarism include septo-optic dysplasia, other midline syndromes, and mutations of transcription factors involved in pituitary gland development. Children with acquired hypopituitarism typically present with growth failure and may have other complaints depending on the etiology and the extent of missing pituitary hormones. Acquired hypopituitarism may result from tumors (most commonly craniopharyngioma), radiation, infection, hydrocephalus, vascular anomalies, and trauma.

Conclusions

An MRI of the head is critical in determining the etiology. Testing for pituitary hormone deficiencies is undertaken along with appropriate hormonal replacement and, in some cases, direct treatment of the cause of the hypopituitarism. All children with hypopituitarism require coordination of medical care by a pediatric endocrinologist and, when older, transition to the care of an internist endocrinologist. Referrals to a reproductive endocrinologist may be required as fertility issues arise.
Treatment of Locally Advanced Head and Neck Cancer: Historical and Critical Review
Authors: Al-Sarraf Muhyi
Published: August 2017

Background

Advanced squamous cell cancers of the head and neck have traditionally been associated with high rates of morbidity and mortality. Advances in management have improved outcomes for most of these patients.

Methods

The author reviews the historical progress in management of these difficult tumors and adds his own wide experience to describe and evaluate newer approaches to management.

Results

Over the last 10 years, overall survival rates for patients with head and neck cancers have improved as has quality of life. New standards of care have been defined for patients with nasopharyngeal cancer and for those with advanced unresectable disease. Organ preservation is more commonly achieved.

Conclusions

Newer targeted therapies are likely to add to the progress that has already been achieved in the multimodality management of patients with head and neck cancers.
Ethical Considerations in the Treatment of Head and Neck Cancer
Authors: Schenck David P.
Published: August 2017

Background

The second half of the 20th century saw not only important developments in medical science and technology, but also a rapid growth in the application of biomedical ethics in medical decision making. Withdrawal of treatment, allowing to die, informed consent, and patient autonomy are concerns that now comprise a part of the overall medical treatment, particularly in patients with head and neck cancers.

Methods

The author discusses ethical issues relating to disfigurement/dysfunction in head and neck cancer patients and examines the aspects of “principlism” — autonomy, nonmaleficence, beneficence, and justice. Two case reports are presented to illustrate the ethical challenges that may confront physicians who treat head and neck cancer patients.

Results

Head and neck oncology generates unique problems relating to disfigurement and dysfunction. An algorithm that considers the patient's medical good and greater good, as well as the goods of others, can assist in arriving at appropriate ethical decisions.

Conclusions

Bioethical decision making requires the integration of virtues with principles, followed by the application of these standards to each patient.
Chemotherapy-Induced Amenorrhea and Fertility in Women Undergoing Adjuvant Treatment for Breast Cancer
Authors: Minton Susan E. , Munster Pamela N.
Published: August 2017

Background

The majority of women diagnosed with early-stage breast cancer have an excellent long-term prognosis, but many will undergo temporary or permanent chemotherapy-induced amenorrhea.

Methods

While breast cancer is more common in older women, about 1 in 200 women under the age of 40 is at risk to develop breast cancer. Many of these women benefit from chemotherapy but are afraid to risk the opportunity to bear children. The authors review the current studies on the impact of adjuvant chemotherapy on amenorrhea and fertility in women with breast cancer.

Results

The likelihood of amenorrhea is based on the specific adjuvant chemotherapy regimen administered and the age of the patient. Future childbirth is a viable option for women treated for breast cancer at an early stage. While the use of tamoxifen as a hormonal therapy in premenopausal breast cancer is now the standard of care, no conclusive data confirm the benefit of GnRH agonists in adjuvant therapy after treatment with chemotherapy followed by tamoxifen.

Conclusions

As more women over the age of 35 consider pregnancy, fertility issues are becoming important areas of investigation for the adjuvant treatment of breast cancer. Whether chemotherapy-induced amenorrhea has a prognostic effect remains unclear, and further studies are warranted.
The use of Bisphosphonates in Patients with Breast Cancer
Authors: Van Poznak Catherine H.
Published: August 2017

Background

Bone is the most common site of breast cancer metastases. Skeletal metastases may be associated with harmful and painful events such as fractures, spinal cord compression, and hypercalcemia. By inhibiting osteoclasts and bone resorption, bisphosphonates can interrupt the process of bone destruction and decrease the risk of skeletal complications.

Methods

A review of the literature was undertaken regarding the use of bisphosphonates in breast cancer management, with particular attention to prospective, randomized clinical trials that have influenced the treatment of bone metastases.

Results

Large prospective, randomized trials have demonstrated that bisphosphonates are effective in reducing skeletal-related complications from metastatic breast cancer.

Conclusions

For many patients with osseous lesions from breast cancer, bisphosphonate therapy is a useful intervention in managing their disease. Bisphosphonates are the treatment of choice for hypercalcemia of malignancy and bisphosphonates reduce the risk of pathologic fractures, spinal cord compromise, the need for radiation or surgery to bone, and bone pain.
Anti-aromatase Agents in the Treatment and Prevention of Breast Cancer
Authors: Goss Paul
Published: August 2017

Anti-aromatase agents now have a central role in the management of breast cancer in postmenopausal women; they are superior to megestrol acetate as second-line therapy and to tamoxifen for initial therapy of metastatic disease. They also are highly active as neoadjuvant therapy. Two classes of anti-aromatase agents are available: steroidal (eg, exemestane) and nonsteroidal (eg, anastrozole, letrozole). Although both types of agents act on the aromatase enzyme, they do so by different mechanisms and have different effects on cellular aromatase activity. Nonsteroidal agents are associated with increased aromatase enzyme content and steroidal agents are associated with decreased content. The increase in aromatase content seen with the non-steroidal agents may in part explain the development of resistance with these agents and the ability of the steroidal agent exemestane to induce a response when nonsteroidal agents fail.

Because the anti-aromatase agents almost completely eliminate endogenous estrogen production, they not only affect breast cancer tissues, but also may alter the function of other estrogen-responsive tissues. However, preclinical data show that the steroidal agent exemestane may actually improve bone and lipid metabolism. In addition, no increase in clinical fracture rate has been noted in women treated with exemestane in metastatic trials; the fracture risk has not yet been studied following prolonged exposure in healthy women. Exemestane-associated beneficial effects on these end organs may be due to the steroidal nature of both the parent compound and its principal metabolite, 17-hydroexemestane. Similar benefits have not been reported with nonsteroidal anti-aromatase agents. Based on their excellent activity in the metastatic setting, anti-aromatase agents are now being evaluated in the adjuvant setting and in pilot studies for chemoprevention. These studies will provide long-term data in healthy women and will help to differentiate anti-aromatase agents, in terms of their efficacy in the treatment of breast cancer and their effects on end organs.