bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital methodologies of education governance: Pearson plc and the remediation of methods
Authors: Williamson Ben
Published: December 2015

This article analyses the rise of software systems in education governance, focusing on digital methods in the collection, calculation and circulation of educational data. It examines how software-mediated methods intervene in the ways educational institutions and actors are seen, known and acted upon through an analysis of the methodological complex of Pearson Education’s Learning Curve data-bank and its Center for Digital Data, Analytics and Adaptive Learning. This calls for critical attention to the ‘social life’ of its methods in terms of their historical, technical and methodological provenance; their affordances to generate data for circulation within the institutional circuitry of Pearson and to its wider social networks; their capacity to configure research users’ interpretations; and their generativity to produce the knowledge to influence education policy decisions and pedagogic practices. The purpose of the article is to critically survey the digital methods being mobilized by Pearson to generate educational data, and to examine how its methodological complex acts to produce a new data-based knowledge infrastructure for education. The consequence of this shift to data-based forms of digital education governance by Pearson is a challenge to the legitimacy of the social sciences in the theorization and understanding of learning, and its displacement to the authority of the data sciences.
Advanced lighting technology in controlled environment agriculture
Authors: Pocock T
Published: December 2015

There is a recent awareness of the importance of plants in our everyday lives. Light is a requirement for plants and serves two important roles. It provides energy for growth and provides information that elicits plant responses including, among others, plant shape, pigmentation, nutritional content and resistance to stress. Light is paradoxical to plants, it is a requirement however, in excess it is damaging. Plants sense and interpret light through many families of photoreceptors and through the energy state of the photosynthetic apparatus. Light emitting diodes (LEDs) are quickly replacing traditional light sources for human applications, and currently there is effort being put into tailoring these technology platforms for the plant community. Potential plant sensing pathways and the spectral effects on pigmentation and photochemistry in red lettuce are described.
Quality and Reporting of Cluster Randomized Controlled Trials Evaluating Occupational Therapy Interventions
Authors: Tokolahi Ema , Hocking Clare , Kersten Paula , Vandal Alain C.
Published: December 2015

Growing use of cluster randomized control trials (RCTs) in health care research requires careful attention to study designs, with implications for the development of an evidence base for practice. The objective of this study is to investigate the characteristics, quality, and reporting of cluster RCTs evaluating occupational therapy interventions to inform future research design. An extensive search of cluster RCTs evaluating occupational therapy was conducted in several databases. Fourteen studies met our inclusion criteria; four were protocols. Eleven (79%) justified the use of a cluster RCT and accounted for clustering in the sample size and analysis. All full studies reported the number of clusters randomized, and five reported intercluster correlation coefficients (50%): Protocols had higher compliance. Risk of bias was most evident in unblinding of participants. Statistician involvement was associated with improved trial quality and reporting. Quality of cluster RCTs of occupational therapy interventions is comparable with those from other areas of health research and needs improvement.
Teachers’ perceptions of school leaders’ empowering behaviours and psychological empowerment
Authors: Lee Ai Noi , Nie Youyan
Published: December 2015

Using a convenience sample of 289 teachers in Singapore, this study examined: (1) whether there were significant differences between teachers’ perceptions of principal’s and immediate supervisor’s empowering behaviours; and (2) teachers’ perceptions of principal’s and immediate supervisor’s empowering behaviours in relation to teachers’ psychological empowerment. Results indicated that teachers perceived their principals and immediate supervisors as exercising empowering behaviours in their daily practices, but they also perceived their principal and immediate supervisor differing in magnitude in some specific dimensions of empowering behaviours such as delegation of authority, providing individualised concern and support, articulating a vision and fostering collaborative relationships. Results also indicated that teachers’ perceptions of principal’s and immediate supervisor’s empowering behaviours were positively associated with teachers’ psychological empowerment, and that they added unique variance to each other in predicting teachers’ psychological empowerment. This study suggests the importance of considering teachers’ perceptions of principal’s and immediate supervisor’s empowering behaviours as two distinct constructs in empirical research so that their unique predictive power could be more aptly captured. From a practical standpoint, it suggests the importance for school leadership developers to enhance school leaders’ awareness and capacity in exercising empowering behaviours towards their teachers in their daily practice. Essentially, schools may stand to gain from developing empowering leaders at different levels of management to promote teachers’ psychological empowerment.
Contextualizing, orchestrating and learning for leading
Authors: Grootenboer Peter , Hardy Ian
Published: December 2015

The importance of leadership for improving educational outcomes in schools has been widely promoted. However, the nature of leadership practices, in context, has received less attention in the educational leadership literature. In this article, we present a case study of the specific leadership practices that developed in one school site serving the learning needs of students in a complex, diverse, low socio-economic community in south-east Queensland, Australia. Rather than focusing on the person/role of ‘the leader’, or various leadership qualities/traits, we examine the nature and particularity of the leadership practices as praxis, across a variety of roles and dispositions, as developed within the school. To help make sense of the praxis and particularity of educational leadership practices, we draw upon recent neo-Aristotelian practice theory to reveal the specific actions (‘doings’), dialogue (‘sayings’) and relationships (‘relatings’), which constituted leadership-in-practice, as praxis. These ‘doing’, ‘sayings’ and ‘relatings’ for praxis were evident in: formal leadership practices responsive to the context and history of the particular school site; formal and informal leadership practices involved in establishing a ‘leadership group’ within the school to address students’ needs, and; and informal leadership practices focused on cultivating teacher learning for student learning. Such an approach does not simply reinforce sedimented notions of what constitutes ‘educational leadership’, but sheds new light upon the nature of ‘leading practices for praxis’.
The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach
Authors: Chambers Jeffrey , Généreux Philippe , Lee Arthur , Lewin Jack , Young Christopher , Crittendon Janna , Mann Marita , Garrison Louis P.
Published: December 2015

Background:

Patients who undergo percutaneous coronary intervention (PCI) for severely calcified coronary lesions have long been known to have worse clinical and economic outcomes than patients with no or mildly calcified lesions. We sought to assess the likely cost-effectiveness of using the Diamondback 360® Orbital Atherectomy System (OAS) in the treatment of de novo, severely calcified lesions from a health-system perspective.

Methods and results:

In the absence of a head-to-head trial and long-term follow up, cost-effectiveness was based on a modeled synthesis of clinical and economic data. A cost-effectiveness model was used to project the likely economic impact. To estimate the net cost impact, the cost of using the OAS technology in elderly (⩾ 65 years) Medicare patients with de novo severely calcified lesions was compared with cost offsets. Elderly OAS patients from the ORBIT II trial (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) [ClinicalTrials.gov identifier: NCT01092426] were indirectly compared with similar patients using observational data. For the index procedure, the comparison was with Medicare data, and for both revascularization and cardiac death in the following year, the comparison was with a pooled analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)/Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials. After adjusting for differences in age, gender, and comorbidities, the ORBIT II mean index procedure costs were 17% ( p < 0.001) lower, approximately US$2700. Estimated mean revascularization costs were lower by US$1240 in the base case. These cost offsets in the first year, on average, fully cover the cost of the device with an additional 1.2% cost savings. Even in the low-value scenario, the use of the OAS is cost-effective with a cost per life-year gained of US$11,895.

Conclusions:

Based on economic modeling, the recently approved coronary OAS device is projected to be highly cost-effective for patients who undergo PCI for severely calcified lesions.
Radiation delivered to patients during endourological surgery – are they overexposed?
Authors: Hennessey DB , Martin J , Tyson M , Lawrentschuk N , Young M , Pahuja A
Published: December 2015

Introduction:

Ionising radiation is commonly used in urological practice in the form of fluoroscopy. To date there is a remarkable scarcity of information concerning patient exposure to ionising radiation during urological procedures and the potential risk of developing of a lethal malignancy due to excessive radiation exposure.

Objectives:

We aimed to determine the radiation exposure for a patient during the most commonly performed urological procedures, and to assess the potential risk of developing a fatal cancer as a result of endourological fluoroscopy.

Methods:

Data was collected prospectively in two institutions on endoscopic urological operations. Procedures were classified as retrographic, semi-rigid ureteroscopic and flexible ureterorenoscopic (FURS). Data collected included procedure type and difficulty, Dose Area Product [DAP (Gy*Cm2)]. The effective dose (ED) measured in millisievert (mSv) was determined from the DAP by using the Monte Carlo calculation.

Results:

In total 395 consecutive operations from two institutions were assessed. The mean ED for all procedures in this study was 0.394 mSv, IQR (0.1184–0.7583). The maximum ED was 5.93 mSv. The radiation exposure for all procedures was relatively small; for diagnostic retrographic procedures the median ED was 0.112 mSv. For retrograde procedures that involved stent insertion, the median ED was 0.438 mSv. The median ED for all ureteroscopic surgeries was 0.295 mSv, and the median ED for all FURS procedures was 0.491.

Conclusion:

The findings of this study are reassuring. Endoscopic urological procedures appear to expose patients to relatively small radiation compared with other procedures requiring fluoroscopy, thus conferring a very low lifetime risk of malignancy.
Transurethral biopsy of the prostatic urethra is associated with final apical margin status at radical cystoprostatectomy
Authors: von Rundstedt Friedrich-Carl , Mata Douglas A , Shen Steven , Li Yi , Godoy Guilherme , Lerner Seth P
Published: December 2015

Purpose:

Biopsy of the prostatic urethra is an integral part of clinical staging in patients prior to radical cystoprostatectomy (RC) and urinary diversion. We examined whether preoperative transurethral resection (TUR) biopsy was associated with final apical urethral margin status and hypothesized that a negative biopsy could replace intraoperative frozen section for decision making regarding the feasibility of orthotopic neobladder reconstruction.

Methods:

TUR biopsy, frozen section, urethrectomy, and final apical urethral margin pathologic data were extracted from the charts of men who had undergone RC at the Houston Methodist Hospital between 1987 and 2013. TUR biopsies were performed at five and seven o’clock adjacent to the verumontanum. A positive biopsy was defined as the presence of in situ or invasive urothelial carcinoma. Clinical and perioperative variables were analyzed using descriptive and inferential statistics.

Results:

We reviewed the medical records of 272 men. Preoperative TUR biopsies of the prostatic urethra were negative in 74% (200/272) and positive in 26% (72/272) of men. The overall incidence of apical urethral margin positivity on final pathology was 2.2% (six of 272). Four men underwent primary or secondary urethrectomy. TUR biopsy negative and positive predictive values for apical urethral margin positivity were 99.5% (95% confidence interval (CI): 97.2 to 99.9) and 6.9% (95% CI: 2.3 to 15.5), respectively.

Conclusions:

The incidence of a positive apical urethral margin was low in patients undergoing RC. A negative preoperative TUR biopsy of the prostatic urethra was reliably associated with a negative final margin, obviating the need for intraoperative frozen section. Furthermore, a positive biopsy was not reliably associated with final margin status. These data will aid in the counseling of patients regarding the feasibility of neobladder reconstruction.
Interdisciplinary Approach to Legal Scholarship: A Blend from the Qualitative Paradigm
Authors: Nkansah Lydia A. , Chimbwanda Victor
Published: December 2015

Interdisciplinary legal studies requires that the researcher generates knowledge from the social world. The problem, however, is that where law students and academicians are usually prepared to undertake legal research and analysis, they normally lack the methodological skills to undertake interdisciplinary legal studies. As a result, such studies are often not anchored in any scientific research methodological paradigm. As a matter of fact, a major criticism against interdisciplinary legal studies is that legal researchers who dabble in it lack the methodological skills to effectively undertake research of that nature. This article seeks to address how this problem may be approached. It will show how legal methods could be infused with one of the social science research methods—the qualitative paradigm—to augment legal scholarship.
Teaching Legal Ethics to Law Students: Why, What, How and Who Might Teach?
Authors: Beca Juan
Published: December 2015

The article explores what a specific course on ethics should be in a law school, and what is the impact of such curricular changes on this field.

Learning of ethics is not always regarded as something important in the law curriculum, but it is crucial to education of future lawyers. Teaching ethics in law schools is also necessary to deal with public perception about the legal profession. Lawyers have to make choices all the time, so students need to be prepared to do so. Ethical decision making should be taught to students, giving them the necessary tools to go through a discernment process. It is also essential to cultivate students’ autonomy to make decisions. An active-participative paradigm might enhance learning among students. They can learn more while doing different activities, and especially working in groups with their peers, to solve ethical dilemmas. In order to be prepared to solve those dilemmas, students need to learn a discernment method. We offer one in particular: the See–Judge–Act method.

There are three approaches to what students should be challenged to learn: knowing the rules, working with dilemmas and judging. We advocate for the third one. We explore the necessary relation of an ethics course with legal clinics and other courses, stating that teaching legal ethics needs a context, and that the context may be given by the other courses. Having an interdisciplinary approach to ethics is beneficial for students, and this can be achieved by sharing the class with a non-lawyer professor.
Clinical Legal Education—A Bare Necessity in the Scientific Era
Authors: Pati Jayadev , Mohanty Madhubrata
Published: December 2015

This is an attempt by the authors to justify the necessity of clinical legal education with a humanistic approach in this scientific era so as to enhance human sensibility. As law is considered as the most flexible instrument of social order that not only influences, but also regulates almost all activities of human being, thus in order to provide social justice in true sense, there is a need for imparting value-based pragmatic legal education so as to make them competent enough to identify social problems in their future properly and to find solutions for eradicating social evils like corruption, injustice, nepotism and poverty etc. Legal education, like medical education, also needs to be imparted as a clinical method so as to cope with modern-day complexities of society. The objective of clinical legal education is to develop the perception, the attitudes, the responsibility and the skills to become a lawyer after completion of the course from law schools. Acquiring knowledge in non-clinical subjects like language, history, economics, political science, sociology, philosophy etc., would motivate a student of law to undertake the responsibility to face complicated problems and to analyze facts with the help of studies in literature, arts, science, economics, commerce and other relevant subjects. Clinical legal education not only requires students to take active part in the learning process, but also assume a degree of control over their own education and analyze law in real-life context.
The Choking Game on YouTube
Authors: Defenderfer Ellen K. , Austin Jillian E. , Davies W. Hobart
Published: December 2015

The choking game (TCG) is an adolescent activity in which asphyxiation is used to obtain a “high,” occasionally resulting in seizures or death. A plethora of TCG information is available through YouTube, though this content has not been evaluated recently. The current study described TCG as portrayed in YouTube videos and compared views and ratings of TCG videos to unrelated videos. The TCG videos demonstrated diverse methods of asphyxiation, with a minority showing injury to the participants. TCG videos were less likely to be commented on or rated positively than non–choking game videos. TCG prevention videos differed significantly from actual TCG videos in the way they depicted the social context of TCG. Thus, TCG videos are accessible through YouTube, but the prevention materials available on YouTube are not accurate or representative. Accurate and educational online prevention materials should be created to decrease the occurrence of TCG.
Instructional Tendencies in the Teaching of Reading Comprehension
Authors: Davis Dennis S. , Bippert Kelli , Villarreal Lorena
Published: December 2015

Using videos from 63 teachers in grades 4–8 who were part of the Measures of Effective Teaching study, we identified five tendencies in the teaching of reading comprehension that can inform future work on the design and implementation of reading instruction. The five tendencies are: (1) Instruction is generally text-centric, but dominated by instructional vignettes; (2) Text talk is common, but is dominated by teacher-facilitated questioning; (3) Instruction is intentional and explicit, but at a cost; (4) Instruction is strategy-centric, but not necessarily strategic; and (5) Knowledge-building is underemphasized during classroom textual interactions. This study addresses the need for more current understanding of the state of instructional practices in reading comprehension.
Creating New Opportunities for Lesson Study in an Online Reading Clinic
Authors: Sharma Sue Ann , Pang Sangho
Published: December 2015

Multimedia expands the opportunity for graduate teachers to develop a community of learners in an online reading clinic as they reflect and collaborate on a variety of reading and writing experiences during an online lesson study of a comprehensive corrective reading lesson. This qualitative method study explores (a) the pedagogical shifts of teachers in an online reading clinic lesson study of their own self-selected literacy teaching. The findings reveal that the pedagogical shifts made by graduate teachers in an online lesson study resulted in changes in 1) knowledge of assessment and diagnosis as evident in metacognitive reflection and progressive of understandings; 2) teachers instructional differentiation and intervention skills refined by examination of practice as evident in their analytical reasoning; and 3) increased commitment to providing corrective reading instruction based on formal and informal data—driven decisions.
Discourses as Resources
Authors: Paugh Patricia
Published: December 2015

This microanalysis of an extended discussion in an urban classroom explores the context in which rich discourses interacted to develop and extend deeper forms of meaning making by elementary students. The analysis first situates the study in the literature on classroom cultures where dialogic interactions are encouraged; such cultures develop when students’ intellectual work and agency as learners are valued. Next, a critical discourse analysis focuses on one classroom event as a microculture where a variety of discursive patterns are highlighted. This exemplar demonstrates that the teacher and the students utilized multiple linguistic moves to respond to each other. The teacher modeled serious regard for the ideas of others, but also retained her authority to push students to question assumptions or think more deeply. Her fourth grade students’ interactions mirrored these moves, indicating confidence and agency. The analysis connects these languages and literacy practices to the high levels of student engagement, stamina, and critical participation identified over time in this teachers’ classroom. The goal of the analysis is to argue that high academic expectations lie not in the standardization of practices that are most often touted in reform agendas, but in meaningful classroom teaching that honors the social, cultural, and linguistic resources of students. It also seeks to emphasize the rich and additive opportunities that this type of exchange of perspectives offers for complex intellectual work in urban classrooms; classrooms that are often subject to subtractive rhetoric from the reform movement.
Prior Knowledge Activation in Design and in Practice
Authors: Hattan Courtney , Singer Lauren M. , Loughlin Sandra , Alexander Patricia Ann
Published: December 2015

Despite the importance of prior knowledge to learning, few studies have systematically addressed the extent to which or ways in which instructional resources support teachers in the activation of students' prior knowledge, or the extent to which teachers prompt students' prior knowledge activation in practice. In study one, a content analysis was applied to the language in four instructional resources to come to an understanding of the ways in which resources guide teachers to activate students' prior knowledge. In study two, we went beyond teacher resources to examine prior knowledge activation in four (two male, two female) public elementary teachers' reading classrooms. A two-step procedure was followed to analyze teachers' utterances, first discriminating language intended to activate students' prior knowledge ( n = 27) from other utterances ( n = 1,770), and then examining the 27 knowledge activation utterances and scoring them according to the frame of reference. The results suggest that instances of prior knowledge activation were rare during reading lessons, both with recommended statements and demonstrated actions. Additionally, the analysis found that instructional resources focused predominantly on world knowledge and personal experience, whereas the practitioners focused on knowledge from previously taught lessons.
Struggling Readers? Using Theory to Complicate Understandings of What It Means to Be Literate in School
Authors: Frankel Katherine K. , Jaeger Elizabeth L. , Brooks Maneka Deanna , Randel Maryl A.
Published: December 2015

Theories guide many aspects of literacy research. In this article we describe four theoretical approaches that we have used in qualitative research with students who are perceived to struggle with reading in school, including: New Literacy Studies, Disability Studies in Education, Bioecological Systems Theory, and Cultural Historical Activity Theory. We provide a brief overview of each of the theories and then explain how we have used them to gain insights about students with whom we have worked in the context of our research. Although grounded in distinct perspectives, we argue that each of the theories are lenses through which we were better able to understand the complexities of students’ struggles with reading. We further argue that the theories are united in their ability to broaden the perspectives of researchers and teachers to better account for the social, cultural, and institutional factors that shape literacy teaching and learning in schools. We conclude by questioning the use of the term “struggling reader” and highlighting the implications of our individual theoretical frames and analyses for both research and practice.
From Expressive Reading to Rapid Reading
Authors: Taylor Laura A.
Published: December 2015

Reading rate, a component of reading not closely attended to by educators and researchers prior to the 20th century, quickly became the subject of considerable research shortly after the turn of the century. This article uses historical content analysis to examine primary source documents from that period (1910–1925) to explore why reading rate emerged as a key component of reading during that time. Situating this rise with the concurrent rise in the efficiency movement within education, a critical analysis of these documents reveals that reading rate became relevant in part due to its alignment with three ideological tenets of the efficiency movement: efficiency, measurement, and sorting. In considering the similarities between the focus on rate during the turn of the 20th century and the related focus on automaticity today, these findings suggest the need for critical examination of current approaches to fluency.
Intertextuality and Dialogic Interaction in Students’ Online Text Construction
Authors: Ronan Briana
Published: December 2015

This study examines the online writing practices of adolescent emergent bilinguals through the mediating lenses of dialogic interaction and intertextuality. Using a multimodal discourse analysis approach, the study traces how three students develop online academic texts through intertextual moves that traverse modal boundaries. The analysis reveals how cross-modal, dialogic interactions allow emergent bilingual students to pool linguistic resources, background knowledge, and writing expertise. Such collaborative interactions ultimately serve to support their academic writing. Findings suggest the importance of developing research methodologies and literacy pedagogies that bridge boundaries across social actors, spaces, modes, and languages.
Value Creation in Citizen Services: Sakala as India’s Most Effective Citizen-first Public Engagement Model
Authors: Rajneesh Shalini
Published: December 2015

Red tape, corruption, discourteous behaviour, lack of citizen focus and ease of doing simple tasks as getting copies of say, birth certificate, driving licence, vehicle registration and others, have been major areas of concern in governance. Recognizing this, the government initiated a regulation for ensuring time-bound public services called Sakala. This article examines reasons for its introduction, details of the scheme, its implementation, its effectiveness and the value it creates for citizens.
Innovation Management Theory and Practice: Part 1
Authors: Miller William L.
Published: December 2015

This article identifies the root cause of a group of wicked global problems which is lack of value creation from radical innovation that has existed over the last four decades. This article describes the essential part of a solution which is adoption of a new fourth generation of innovation management (4G) to emerge as best practice since 1900. 4G effectively enables radical innovation.

Radical innovation is required for sustained, adequate rates of economic growth driven by improvements in productivity, quality and cost in industries such as health care, education, construction and energy. As a result of inadequate radical innovation for decades, a group of major economic, social and environmental wicked problems , such as, income inequality and global warming, remain unsolved, and these problems exist in all countries including the United States. In his landmark book Capital in the Twenty-first Century, Thomas Piketty linked inadequate economic growth to income inequality.

A distinguished economist and professor at Northwestern University, Robert Gordon, has identified the current global situation as a period of potentially permanently stalled economic growth unless value creation driven by radical innovation is resumed at a level and with rates similar to what occurred in the three industrial/information revolutions since 1750.

Since 1900, there have been three separate and successive periods of time in which a new generation of innovation management was created and then adopted as best practice to replace, augment and improve the practices in earlier generations. The root cause of the global problem is that none of the three generations have been effective in creating an adequate amount of radical innovation which requires a new dominant design to transform (a) capabilities in organizations based on knowledge, tools (which include purchased products and services), technology and processes, (b) business models and (c) the structure of markets and industries.

4G is guided by 12 new principles and practices to effectively and efficiently create radical innovation based on new dominant designs while also improving the efficient creation of incremental innovation. Part 1 of this article describes 4G and the first four principles of 4G in detail. Another companion article, Part 2, will later describe the remaining eight principles in detail as essential part of a solution.
Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management
Authors: Denning David W. , Cadranel Jacques , Beigelman-Aubry Catherine , Ader Florence , Chakrabarti Arunaloke , Blot Stijn , Ullmann Andrew J. , Dimopoulos George , Lange Christoph
Published: December 2015

Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include:Aspergillusnodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence ofAspergillusinfection (microscopy or culture from biopsy) or an immunological response toAspergillusspp. and exclusion of alternative diagnoses, all present for at least 3 months.Aspergillusantibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferablyviavideo-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with singleAspergillusnodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up.
Polymicrobial intensive care unit-acquired pneumonia: prevalence, microbiology and outcome
Authors: Ferrer Miquel , Difrancesco Leonardo Filippo , Liapikou Adamantia , Rinaudo Mariano , Carbonara Marco , Li Bassi Gianluigi , Gabarrus Albert , Torres Antoni
Published: December 2015

Background

Microbial aetiology of intensive care unit (ICU)-acquired pneumonia (ICUAP) determines antibiotic treatment and outcomes. The impact of polymicrobial ICUAP is not extensively known. We therefore investigated the characteristics and outcomes of polymicrobial aetiology of ICUAP.

Method

Patients with ICUAP confirmed microbiologically were prospectively compared according to identification of 1 (monomicrobial) or more (polymicrobial) potentially-pathogenic microorganisms. Microbes usually considered as non-pathogenic were not considered for the etiologic diagnosis. We assessed clinical characteristics, microbiology, inflammatory biomarkers and outcome variables.

Results

Among 441 consecutive patients with ICUAP, 256 (58 %) had microbiologic confirmation, and 41 (16 %) of them polymicrobial pneumonia. Methicillin-sensitive Staphylococcus aureus, Haemophilus influenzae, and several Enterobacteriaceae were more frequent in polymicrobial pneumonia. Multi-drug and extensive-drug resistance was similarly frequent in both groups. Compared with monomicrobial, patients with polymicrobial pneumonia had less frequently chronic heart disease (6, 15 % vs. 71, 33 %, p = 0.019), and more frequently pleural effusion (18, 50 %, vs. 54, 25 %, p = 0.008), without any other significant difference. Appropriate empiric antimicrobial treatment was similarly frequent in the monomicrobial (185, 86 %) and the polymicrobial group (39, 95 %), as were the initial response to the empiric treatment, length of stay and mortality. Systemic inflammatory response was similar comparing monomicrobial with polymicrobial ICUAP.

Conclusion

The aetiology of ICUAP confirmed microbiologically was polymicrobial in 16 % cases. Pleural effusion and absence of chronic heart disease are associated with polymicrobial pneumonia. When empiric treatment is frequently appropriate, polymicrobial aetiology does not influence the outcome of ICUAP.
vCCL2/vMIP-II, the viral master KEYmokine
Authors: Szpakowska Martyna , Chevigné Andy
Published: December 2015

Viral CC motif chemokine or viral macrophage inflammatory protein-II is 1 of the 3 chemokines encoded by the human herpesvirus-8 to interfere with the host chemokine receptor network, facilitate the immune escape, and promote its survival. Viral CC motif chemokine 2 binds to a broad spectrum of viral and human chemokine receptors of all 4 classes and, depending on the receptor, acts either as an agonist or an antagonist, inducing or blocking the recruitment of specific immune cell subsets. These atypical binding and signaling properties make this viral chemokine not only a useful tool to investigate the complexity of the chemokine–receptor interaction network or the virus–host interplay but also for the development of receptor inhibitors. This mini-review summarizes the knowledge currently available on viral CC motif chemokine 2 binding, signaling, and structural mimicry and discusses its role and importance for the virus, the therapeutic potential, and the open questions regarding the biology of this fascinating chemokine.
Cortisol regulates the paracrine action of macrophages by inducing vasoactive gene expression in endometrial cells
Authors: Thiruchelvam Uma , Maybin Jacqueline A , Armstrong Gregory M , Greaves Erin , Saunders Philippa T K , Critchley Hilary O D
Published: December 2015

The human endometrium undergoes inflammation and tissue repair during menstruation. We hypothesized that the local availability of bioactive glucocorticoids plays an important role in immune cell–vascular cell interactions in endometrium during tissue repair at menstruation, acting either directly or indirectly via tissue resident macrophages. We sought to determine whether endometrial macrophages are direct targets for glucocorticoids; whether cortisol-treated macrophages have a paracrine effect on angiogenic gene expression by endometrial endothelial cells; and whether endometrial macrophages express angiogenic factors. Human endometrium (n = 41) was collected with ethical approval and subject consent. Donor peripheral blood monocyte-derived macrophages were treated with estradiol, progesterone, or cortisol. The effect of peripheral blood monocyte-derived macrophage secretory products on the expression of angiogenic RNAs by endothelial cells was examined. Immunofluorescence was used to examine localization in macrophages and other endometrial cell types across the menstrual cycle. Endometrial macrophages express the glucocorticoid receptor. In vitro culture with supernatants from cortisol-treated peripheral blood monocyte-derived macrophages resulted in altered endometrial endothelial cell expression of the angiogenic genes, CXCL2, CXCL8, CTGF, and VEGFC. These data highlight the importance of local cortisol in regulating paracrine actions of macrophages in the endometrium. CXCL2 and CXCL8 were detected in endometrial macrophages in situ. The expression of these factors was highest in the endometrium during the menstrual phase, consistent with these factors having a role in endometrial repair. Our data have indicated that activation of macrophages with glucocorticoids might have paracrine effects by increasing angiogenic factor expression by endometrial endothelial cells. This might reflect possible roles for macrophages in endometrial repair of the vascular bed after menstruation.
Breast Cancer Risk in Childhood Cancer Survivors Without a History of Chest Radiotherapy: A Report From the Childhood Cancer Survivor Study
Authors: Henderson Tara O. , Moskowitz Chaya S. , Chou Joanne F. , Bradbury Angela R. , Neglia Joseph Phillip , Dang Chau T. , Onel Kenan , Novetsky Friedman Danielle , Bhatia Smita , Strong Louise C. , Stovall Marilyn , Kenney Lisa B. , Barnea Dana , Lorenzi Elena , Hammond Sue , Leisenring Wendy M. , Robison Leslie L. , Armstrong Gregory T. , Diller Lisa R. , Oeffinger Kevin C.
Published: December 2015

Purpose

Little is known about the breast cancer risk among childhood cancer survivors who did not receive chest radiotherapy. We sought to determine the magnitude of risk and associated risk factors for breast cancer among these women.

Patients and Methods

We evaluated cumulative breast cancer risk in 3,768 female childhood cancer survivors without a history of chest radiotherapy who were participants in the Childhood Cancer Survivor Study.

Results

With median follow up of 25.5 years (range, 8 to 39 years), 47 women developed breast cancer at a median age of 38.0 years (range, 22 to 47 years) and median of 24.0 years (range, 10 to 34 years) from primary cancer to breast cancer. A four-fold increased breast cancer risk (standardized incidence ratio [SIR] = 4.0; 95% CI, 3.0 to 5.3) was observed when compared with the general population. Risk was highest among sarcoma and leukemia survivors (SIR = 5.3; 95% CI, 3.6 to 7.8 and SIR = 4.1; 95% CI, 2.4 to 6.9, respectively). By the age of 45 years, the cumulative incidence of breast cancer in sarcoma and leukemia survivors was 5.8% (95% CI, 3.7 to 8.4) and 6.3% (95% CI, 3.0 to 11.3), respectively. No other primary cancer diagnosis was associated with an elevated risk. Alkylators and anthracyclines were associated with an increased breast cancer risk in a dose-dependent manner (P values from test for trend were both < .01).

Conclusions

Women not exposed to chest radiotherapy who survive childhood sarcoma or leukemia have an increased risk of breast cancer at a young age. The data suggest high-dose alkylator and anthracycline chemotherapy increase the risk of breast cancer. This may suggest a possible underlying gene-environment interaction that warrants further study.
Randomized Trial of a Web-Based Intervention to Address Barriers to Clinical Trials
Authors: Meropol Neal J. , Wong Yu-Ning , Albrecht Terrance , Manne Sharon , Miller Suzanne M. , Flamm Anne Lederman , Benson Al Bowen , Buzaglo Joanne , Collins Michael , Egleston Brian , Fleisher Linda , Katz Michael , Kinzy Tyler G. , Liu Tasnuva M. , Margevicius Seunghee , Miller Dawn M. , Poole David , Roach Nancy , Ross Eric , Schluchter Mark D.
Published: December 2015

Purpose

Lack of knowledge and negative attitudes have been identified as barriers to participation in clinical trials by patients with cancer. We developed Preparatory Education About Clinical Trials (PRE-ACT), a theory-guided, Web-based, interactive computer program, to deliver tailored video educational content to patients in an effort to overcome barriers to considering clinical trials as a treatment option.

Patients and Methods

A prospective, randomized clinical trial compared PRE-ACT with a control condition that provided general clinical trials information produced by the National Cancer Institute (NCI) in text format. One thousand two hundred fifty-five patients with cancer were randomly allocated before their initial visit with an oncologist to PRE-ACT (n = 623) or control (n = 632). PRE-ACT had three main components: assessment of clinical trials knowledge and attitudinal barriers, values assessment with clarification back to patients, and provision of a video library tailored to address each patient’s barriers. Outcomes included knowledge and attitudes and preparation for decision making about clinical trials.

Results

Both PRE-ACT and control interventions improved knowledge and attitudes (all P < .001) compared with baseline. Patients randomly allocated to PRE-ACT showed a significantly greater increase in knowledge (P < .001) and a significantly greater decrease in attitudinal barriers (P < .001) than did their control (text-only) counterparts. Participants in both arms significantly increased their preparedness to consider clinical trials (P < .001), and there was a trend favoring the PRE-ACT group (P < .09). PRE-ACT was also associated with greater patient satisfaction than was NCI text alone.

Conclusion

These data show that patient education before the first oncologist visit improves knowledge, attitudes, and preparation for decision making about clinical trials. Both text and tailored video were effective. The PRE-ACT interactive video program was more effective than NCI text in improving knowledge and reducing attitudinal barriers.
Financial Concerns About Participation in Clinical Trials Among Patients With Cancer
Authors: Wong Yu-Ning , Schluchter Mark D. , Albrecht Terrance L. , Benson Al Bowen , Buzaglo Joanne , Collins Michael , Flamm Anne Lederman , Fleisher Linda , Katz Michael , Kinzy Tyler G. , Liu Tasnuva M. , Manne Sharon , Margevicius Seunghee , Miller Dawn M. , Miller Suzanne M. , Poole David , Raivitch Stephanie , Roach Nancy , Ross Eric , Meropol Neal J.
Published: December 2015

Purpose

The decision to enroll in a clinical trial is complex given the uncertain risks and benefits of new approaches. Many patients also have financial concerns. We sought to characterize the association between financial concerns and the quality of decision making about clinical trials.

Methods

We conducted a secondary data analysis of a randomized trial of a Web-based educational tool (Preparatory Education About Clinical Trials) designed to improve the preparation of patients with cancer for making decisions about clinical trial enrollment. Patients completed a baseline questionnaire that included three questions related to financial concerns (five-point Likert scales): “How much of a burden on you is the cost of your medical care?,” “I'm afraid that my health insurance won't pay for a clinical trial,” and “I’m worried that I wouldn’t be able to afford the costs of treatment on a clinical trial.” Results were summed, with higher scores indicating greater concerns. We used multiple linear regressions to measure the association between concerns and self-reported measures of self-efficacy, preparation for decision making, distress, and decisional conflict in separate models, controlling for sociodemographic characteristics.

Results

One thousand two hundred eleven patients completed at least one financial concern question. Of these, 27% were 65 years or older, 58% were female, and 24% had a high school education or less. Greater financial concern was associated with lower self-efficacy and preparation for decision making, as well as with greater decisional conflict and distress, even after adjustment for age, race, sex, education, employment, and hospital location (P < .001 for all models).

Conclusion

Financial concerns are associated with several psychological constructs that may negatively influence decision quality regarding clinical trials. Greater attention to patients’ financial needs and concerns may reduce distress and improve patient decision making.