bluuebunny/crossref_metadata_2025 huggingface dataset:
HSR19-079: Disparities in Accessing Screening Mammography: Opportunities for Improving Diagnostic Outcomes
Authors: Alsheik Nila , Su Zhaohui , Lafontant Anna , Donadio Gregory , Troeger Kathleen , Pohlman Scott , Talley Melinda , Menon Vandana , Conant Emily
Published: March 2019

Introduction: Screening mammography is a key component of secondary prevention programs targeting reductions in breast cancer mortality. The early detection of cancers facilitates treatment at a more curable, locoregionally limited stage. We describe characteristics and outcomes of women who had only one screening mammogram versus those who had annual or biennial screens. Methods: A cloud-based big data platform is being used to integrate and transform data from electronic medical records, radiology management systems, and tumor registries to create a learning health system. This analysis includes data from 227,834 women, aged 40–79 years, who underwent screening mammograms between January 2015 and June 2018 at 64 imaging facilities within 3 large, geographically diverse healthcare organizations. Patients with breast cancer history or implants were excluded. Women were defined as having one screen if they had >24 months of follow-up with evidence of only one screen and were defined as having more than one screen if they had 2 screens at least 9 months apart. Interval cancer was defined as a breast cancer in the 12 months following a negative baseline mammogram. The chi-square test was used to test for differences between cohorts. Results: Of 227,834 women, 18.8% (n=42,911) met criteria for one screen [1-screen] and 81.2% (n=184,923) for 2 screens [2-screens]. There were significant differences between the groups in age (40.4% 60-79 years in the 1-screen cohort vs 49.1% in 2-screens; P<.001), race (24.7% African American and 5.3% Asian in the 1-screen cohort and 18.5% and 3.6% in 2-screens; P<.001), and lifetime risk of breast cancer (6.9% were in the elevated risk category in the 1-screen cohort and 9.3% in 2-screens; P<.001). Recall rate for the 1-screen cohort was 16.6% compared to 7.7% for the second screen for the 2-screens (P<.001). The interval cancer rate was significantly higher (P<.001) for the 1-screen cohort (2.9 per 1000 screens) as compared to the second screen for the 2-screens (0.8 per 1000 screens). Conclusion: Women with evidence of only one screen during the 3.5-year study period tended to be younger and non-white. Although they had lower scores for lifetime risk of breast cancer, recall rates were twofold higher and interval cancer rates were threefold higher in the 1-screen cohort. Targeted initiatives are needed to improve adherence to screening in women at risk of noncompliance.
BPI19-017: Clinical Pathway Toward Quality and Efficient Care of Breast Cancer in Women Under 50
Authors: Reed Elizabeth , Lally Robin M. , Zak Roksana
Published: March 2019

Background: Nationally, gaps exist in the timely and appropriate care of young women with breast cancer. Few women receive genetic and fertility counseling, while contralateral prophylactic mastectomy rates rise. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer direct breast cancer treatment and symptom management, but care of young newly diagnosed women requires providers to combine elements of several guidelines and consider an appropriate order of assessments and treatments utilizing multidisciplinary consultation. In Nebraska, fewer than 300 women under age 50 are diagnosed with breast cancer annually. One-third of these women live rurally, miles from the NCCN Member Institution. Thus, rural physicians encounter these patients infrequently and may lack local specialists with whom to consult and refer, thus challenging the provision of the highest quality care. Purpose: To improve the efficacy and efficiency with which rural oncology care providers recognize and address physical, psychosocial, and decision-making needs of young women with breast cancer through development and delivery of education, multidisciplinary consultation, and clinical pathways. Methods: Baseline, 2-year electronic medical record data on surgical, medical, and supportive oncology practice patterns for women with breast cancer under age 50 were collected from the University of Nebraska Medical Center and collaborating rural cancer centers. Records were hand searched for fertility and genetic data. The PROMIS Global Health Survey and Sexual Function Profile, the Brief Subjective Decision Quality Measure, and a project-specific care satisfaction survey were mailed to these patients. Data were entered into SPSS and descriptive statistics used to identify the project’s starting point. Results: To date, clinics (rural and urban) identified a 2-year total of 199 women with breast cancer, ages 21 to 49 years. Cancers were stage 0 (n=21), 1 (n=50), 2 (n=40), 3 (n=19), 4 (n=3), and unavailable (n=66). Eight clinical pathways based on ER, PR, and HER2 status were developed to guide treatment, considerations, evidence-based neoadjuvant and adjuvant therapy, and survivorship care. Pathways, with associated educational webinars and links to NCCN Guidelines, are accessible to providers and patients on the project-derived Pathway to Cure website. Website use and webinar views following program implementation will be reported as will comparison of baseline practice patterns with data at the first 3-month analysis.
QIM19-138: Care Coordination Between Prescribers and the Specialty Pharmacy—Qualitative Insights Into Designing a Quality Improvement Program for Multisite Community Oncology Practices
Authors: MucCullough Stacey W. , Blaisdell David , Kish Jonathan K. , Farmer Pat , Laney JaLyna , Valuck Tom , Dickson Natalie , Blakely Johnetta , Shipley Dianna , Berdeja Jesus , Shepard Gregg , Anz Bertrand M. , Kelsey Carolyn , Taylor Jack , Nabhan Chadi , Patton Jeffrey F. , Powers Annette
Published: March 2019

Background: There is 1 multiple myeloma (MM) quality metric available (treatment with bisphosphonates, developed by the American Society of Hematology) to evaluate the quality of cancer care delivered to improve patient experience and outcomes. As many community practices integrate specialty pharmacy (SP) services into their practice, patient education, treatment adherence, and visit scheduling coordination are becoming increasingly complex, particularly for treatments with Risk Evaluation and Mitigation Strategies (REMS) programs. We sought to understand the fundamental challenges facing a multisite community oncology practice undergoing SP centralization to identify potential quality gaps for patients with MM. Methods: Structured, in-depth interviews were conducted with physicians treating the highest volume of MM patients across 5 different urban and rural sites of a single multisite community practice. The interviews covered 6 domains: access to care or clinical advice/communication (ACC/AC); care coordination (CC); disease management for MM (DMMM); patient education (PE); medication management (MedMgmt); and data and quality improvement (DQI). Results: Five providers treating 304 MM patients from January 2016 through April 2018 identified several key issues related to the interaction between the SP and clinical sites: ACC/AC, coordination of efforts to ensure patient affordability of both oral/intravenous components; CC, centralize pharmacy workflow processes (specifically REMS enrollment) to ensure timely receipt of medication (high priority); DMMM/PE, inconsistent patient education regarding the role of the centralized pharmacy in the REMS programs, side-effect management, and intent of therapy; MedMgmt, limited concern/understanding of the impact of oral therapy adherence; DQI, no set standards for MM-specific quality measures for benchmarking performance between SP and practices. Conclusions: This qualitative survey identified several areas for improving MM-related quality of care in terms of the relationship between a centralized SP and satellite offices. To address these themes, the practice further integrated licensed practical nurses into the SP. Additionally, 2 quality improvement measurement opportunities were proposed: (1) measuring adherence using pharmacy refill data and (2) overall treatment delay (number of days from prescribing to pick-up/ship to patient).
HSR19-106: Association Between Pathological Complete Responses and Long-Term Survival Outcomes Among Triple-Negative Breast Cancer Patients Receiving Neoadjuvant Chemotherapy
Authors: Qi Cynthia Z. , Huang Min , Haiderali Amin , Xie Jipan , Zhou Zheng-Yi , Wu Eric Q. , Fasching Peter
Published: March 2019

Objective: Pathological complete response (pCR) has been a commonly used endpoint in neoadjuvant trials for breast cancer (BC). A pooled analysis of 12 neoadjuvant BC trials by Cortazar et al (2014) reported a positive association between pCR and long-term survival outcomes among patients with general BC and certain subtypes including triple negative BC (TNBC). To update and extend the evidence to assess the association of pCR and survival outcomes in TNBC, this study reviewed and summarized cohort studies and recent clinical trials in the literature. Methods: English publications reporting association between pCR and survival outcomes among TNBC patients receiving neoadjuvant chemotherapy were searched in MEDLINE, EMBASE, Cochrane CENTRAL, and Northern Light Sciences Conference Abstracts. Full-text publications from all years and conference abstracts since year 2016 were identified. Relevant clinical trials, real-world evidence (RWE) studies, and meta-analyses were included for review and extraction. Results: Of total 1,880 publications retrieved, 35 reported association between pCR and survival outcomes for neoadjuvant TNBC (9 clinical trials, 21 RWE studies, and 5 pooled/meta-analyses). The sample size of TNBC patients varied between 25 and 1,645. Different pCR definitions were used across studies, of which absence of tumor in the breast and axillary nodes was most common (N=29). The prognostic impact of pCR was evaluated for multiple survival outcomes: overall survival (OS; N=19), disease-free survival (DFS; N=14), relapse-free survival (RFS; N=7), event-free survival (N=5), distant DFS (N = 4), and local RFS (N=2). Kaplan-Meier analysis was used to assess the association between pCR and these outcomes in 31 studies. Clear separation of survival curves in favor of pCR was observed in all the studies. Log-rank tests were conducted in 18 studies, and statistically significant association was reported in majority of them, except for 1 RWE study with small sample size (N=35) and 1 pooled analysis with a different pCR definition (absence of tumor in the breast) than most of the others. Cox proportional hazards model was used in 17 studies, wherein hazard ratios of survival outcomes comparing pCR vs non-pCR ranged from 0.08 to 0.53. Conclusions: Despite divergent study designs and pCR definitions, evidence from both clinical and real-world settings consistently suggest that pCR is a strong predictor of OS and other survival outcomes among TNBC patients.
BPI19-018: Cancer Screening Rates and Adherence of Uninsured Cancer Patients in Free Clinics
Authors: Robinson Katherine , Todd Amber , Mirza Abu-Sayeef , Macdonald Madeline , Ayoubi Noura , Mhaskar Rahul , Roetzheim Richard , Woodard Laurie , Pabbathi Smitha
Published: March 2019

Background: There are limited studies documenting the prevalence of malignancies and the cancer screening practices of the uninsured population. Cancer survivors require continued cancer surveillance and screening for recurrence and second primaries. However, screening may be suboptimal among the uninsured. Our objective was to identify and document the screening rates and adherence to ACS guidelines in our local uninsured community. Methods: Demographic data, cancer history and associated cancer screening measures were extracted from electronic medical records of patients managed in 8 free clinics between January 2016 and December 2017 in the Tampa Bay Area. Frequencies, proportions, and Pearson correlation coefficients were used to describe the population and statistically significant relationships. Using the ACS cancer screening recommendations, the charts were reviewed for appropriate cancer screening. Results: From manual chart review, 6,958 charts were reviewed and 201 (2.89%) patients had a diagnosis of cancer. The average age was 55.58 years and 134 (66.67%) were women. Most common malignancies included breast cancer (49, 24.38%), prostate (18, 8.96%), colorectal (13, 6.47%), leukemia/lymphoma (11, 5.47%), cervical (10, 4.98%), melanoma (10, 4.98%), ovarian (9, 4.48%), thyroid (9, 4.48%), renal (6, 2.99%), bladder (5, 2.49%), and uterine (5, 2.49%). Of the 201 patients diagnosed with cancer, 104 (51.74%) met the guidelines for a screening mammogram; however, only 49 (47.12%) had this completed. 115 (57.21%) met the guidelines for a screening Papanicolaou smear; 28 (24.35%) had it completed. 145 (72.14%) met the guidelines for a screening colonoscopy; 23 (15.86%) had it completed. 39 (19.4%) met the guidelines for prostate screening; 3 (7.69%) had it completed. Of the 201 patients, 14 (6.97%) reported a greater than 30 pack smoking history but no patients were screened with a low-dose CT of the thorax. Of the 10 patients with melanoma, 3 (30%) mentioned having routine skin exams. Conclusions: The uninsured population have many barriers to obtaining health care and appropriate screening for malignancies. This retrospective chart review highlights the need for easier access to screening. Increasing screening rates in the uninsured population will decrease cancer mortality as well as being cost effective to the community. It is important for free clinic providers to emphasize guideline-directed cancer screening at every visit.
CLO19-026: Determining the Treatment Decision of Tumors With Mixed Response
Authors: Baldeo Candice , Kaleem Tasneem , Paz-Fumagalli Ricardo , Copland John , Menefee Michael
Published: March 2019

Introduction: Individuals receiving systemic anticancer therapies for advanced solid tumors routinely undergo imaging studies to assess the efficacy of the treatment. Mixed response (MR) to cancer therapy is a common but poorly described phenomenon. There is a paucity of data regarding both the incidence and possible mechanisms of this clinical quandary. Potential etiologies include tumor heterogeneity, differences in tumor microenvironment, and discrepancies in drug delivery to different tumor deposits. It is also possible that MR simply reflects differences in the rate of resistance emerging. MR represents a therapeutic dilemma for the clinician. Methods: Mixed tumor response was defined as: One tumor decreasing in size; one tumor increasing in size (classified as RECIST response/progressions), One tumor stable; another tumor progressing, One tumor stable; another tumor responding, New tumor; another tumor responding or remaining stable. Between 2015 and 2017, 120 restaging CT scans were reviewed of patients who had received at least 1 line of therapy for advanced cancer diagnosis which showed MR; hematologic malignancies were excluded. Charts were reviewed to determine the clinical decision that was made at the time of the MR. Results: A total of 120 scans with MR were reviewed from various solid tumor diagnoses. 38 scans were excluded due to loss of follow-up or death. Of the remaining 82 scans, therapy was switched in 30, the same therapy was continued in 50, and an additional agent was added to the current treatment in 2 cases (Table). Of the patients in which treatment was switched, 20% (6/30) showed response to treatment on the following scan. Of the cases that were kept on current treatment, none showed response on the following restaging scan which was done 6–8 weeks later. There were 4 (10%) deaths prior to the next scan in the group that had treatment switched and similarly 5 deaths (10%) prior to the next scan in the group in which treatment remained the same. Conclusion: MR is associated with a poor prognosis, irrespective of treatment decisions. These data are retrospective and our sample size is small, so definitive conclusions cannot be drawn. However, changing therapy when a MR is observed may be of benefit to some patients. A prospective evaluation to more accurately describe and understand the MR phenomenon is warranted.
CLO19-027: Assessment of Metastatic Invasive Lobular Carcinoma Management and Outcomes From 2004-2014: A Single Institution Experience
Authors: Boutrid Hinda , Lustberg Maryam , Vandeusen Jeffrey , Sardesai Sagar , Stover Daniel , Wesolowski Robert , Cherian Mathew , Stephens Julie , Palettas Marilly , Morgan Evan , Kassem Mohmoud , Berger Michael , Vargo Craig A. , Ramaswamy Bhuvaneswari , Williams Nicole
Published: March 2019

Background: Invasive lobular carcinoma (ILC) accounts for 5%–15% of all invasive breast cancer cases. ILC has the propensity for distant late recurrence with widespread metastatic disease. To our knowledge, there is limited data on the clinical outcomes and treatment strategies of metastatic ILC. This retrospective study evaluates the overall survival (OS) and progression-free survival (PFS) in the metastatic ILC population at a single institution, focusing on first line treatment received in the metastatic setting. Methods: A retrospective chart review was performed on patients (Pts) diagnosed with metastatic ILC diagnosed at The Ohio State University Comprehensive Cancer Center between January 1, 2004 and December 31, 2014 using an IRB approved protocol. Patient demographics, clinical characteristics, and treatment modalities were summarized with descriptive statistics. OS (time from metastasis to death or last known follow-up) and PFS (time from diagnosis of metastasis to progression) were compared between types of first-line treatment: endocrine therapy (ET), chemotherapy (chemo), chemo followed by ET, ET plus CDK 4/6 inhibitor, or other treatments. OS and PFS estimates were generated using Kaplan Meier methods and compared using Log-rank tests. Results: 60 female pts were included in this study. The median age was 59 years (24–78). 45 (75%) pts were postmenopausal, 44 (73%) ER+/PR+, 14 (23%) ER+/PR-, and 2 (3%) ER-PR-, 28 (47%) with only bone metastases, 19 (32%) with visceral and bone metastases, and 13 (22%) with liver metastases. Twenty-eight (47%) pts received first line ET therapy, 12 (20%) received ET + CDK 4/6 inhibitor, 7 (12%) received chemo alone, 4 (7%) received chemo followed by ET, and 9 (15%) received other types of first line therapy. The median OS was 3.0 years, and the median PFS was 1.4 years. No difference in the Kaplan-Meier curves was found between first-line treatment groups in OS or PFS (OS: P=.247; PFS: P=.436). Discussion: ILC is a histologically distinct disease from invasive ductal cancer. It has been previously shown that invasive lobular cancer may not be as sensitive to adjuvant chemotherapy. We showed that in the metastatic setting there was no difference in PFS and OS among first line treatment groups. ET remains preferred treatment option; however, based on our data, chemotherapy can be considered in patient with metastatic ILC in the appropriate clinical context such as visceral crisis.
BIO19-022: Reducing Patient Waiting Times for Treatment Decision Making, Helps in Improving the Treatment Planning Process
Authors: Ramarajan Naresh , Begum Farzana , Srivastava Gitika
Published: March 2019

Background: Availability of care is an important characteristic of effective primary healthcare systems. Imbalanced oncologist to patient ratios (∼1600: 1.8 M in India, ∼23,000: 15 M in USA), impedes access to expertise. On average it takes a week or more to get an online expert review from leading cancer hospitals in the United States and in India. Such delays have an important psychosocial impact on the patient and caregivers. Patients worldwide often race to start treatments at non-expert centers and may experience worse health outcomes from lack of expert tumor board review of their cases. This study aimed to examine the impact of Navya, a health services technology, on reducing the patient wait time in real-time treatment decision making. Methods: Navya generates personalized treatment plans that maps 98.8% within NCCN Resource Stratified Guidelines [SABCS 2017, NCCN 2018]. This is vetted on mobile by oncologists at tertiary centers like TMC NCG to provide expert opinion reports to patients. Since 2015, approximately 25,775 patients from 60 countries have reached out for an online opinion. On the ground, 78% of patients received evidence-based treatments recommended by Navya [ASCO 2017]. The Navya system releases preliminary system-generated opinions for patients whose treatment plans fit high confidence based on NCCN Guidelines and prior expert reviews. The mean reduction in time between a system-generated opinion and an expert-reviewed opinion was studied in a prospective cohort of patients between July 1, 2017, and August 30, 2018. Results: 313 patients received a system-generated treatment plan in the study period. Only approximately 10% of these plans were modified by experts to add additional treatment details since these were cases with high confidence in treatment decision-making. Navya delivered a preliminary treatment plan on an average of 86 hours (SD, 153 hours) prior to the expert response time. Of the 313 patients studied, 44% of patients would have waited an additional 3 days longer to receive an expert-reviewed recommendation. Conclusions: Navya’s NCCN and evidence-based treatment plans reduce the patient waiting times for an expert opinion average by 86 hours. This rapid confirmation of the right treatment plan at the time of patient need has potential to relieve patient anxieties at critical junctures in treatment decision-making and helps improve the treatment-planning process.
EPR19-066: Trends in Primary Squamous Cell Penile Cancer: A SEER Study
Authors: Cooper Scott , Zaher Mohammed , Diorio Gregory
Published: March 2019

Objective: Although rare worldwide, primary squamous cell penile cancer (PSPC) is associated with significant psychological stress and cancer-specific mortality. We aim to analyze trends in PSPC in the United States from 2000–2015 using U.S. Surveillance, Epidemiology, and End Results registry (SEER). Clinical identification of risk factors for adverse outcomes will allow for patient-specific counseling on prognosis and intervention. Methods: Population-based data from SEER 18 was used to assess PSPC. SEER Stat was used to calculate incidence, mortality, and survival statistics of PSPC, as well as demographic, geographic, socioeconomic, and clinical variables from 2000 to 2015. Trends were assessed over 5-year spans (2000–2005, 2006–2010, and 2011–2015) using annual percent change. Kaplan-Meier logistic regression analysis was used to calculate 5-year, cancer-specific survival. Results: From 2000–2015, 5,144 men in the U.S. were diagnosed with PSPC at a rate of 0.38 per 100,000, which remained unchanged throughout the entire study period. Asians and Pacific Islanders had the lowest incidence (0.02, 95% CI=0.2, 0.2; P<.05) of all racial groups. Hispanics had a higher incidence (0.58, 95% CI=0.54, 0.62; P<.05) than non-Hispanics. Incidence was highest in the South (0.46, 95% CI=0.43, 0.48; P<.05); however, cancer-specific mortality was similar across regions. No difference in mortality was observed between urban and rural dwelling. Those lacking a high school education and living in areas with more than 10% poverty had a greater incidence of PSPC than others (P<.05). Overall, 5-year cancer-specific survival was 57%, which remained consistent across each studied time interval (P<.05). Compared to previous years, those diagnosed between 2011 and 2015 lacked surgical intervention, were of advanced age (>74–85 years), stage (T1, T2, T3), and with greater lymph node burden (>4) (P<.05). Increased mortality was associated with unmarried men, >20% poverty rate, advanced age, advanced T stage, and lack of surgical treatment (P<.05). Conclusion: Disparity in PSPC continues to exist. Incidence of penile cancer has increased with advanced age and stage. Unmarried, impoverished men with advanced stage and lack of surgical treatment have increased cancer-specific mortality. Efforts should be directed to those most at risk with hopes to identify disease at an earlier stage to provide surgical treatment with curative intent.
Sanctioned by Government? The Home Office, Peterloo and the Six Acts
Authors: Bend Nathan
Published: March 2019

The role of the Home Office in the Peterloo Massacre remains contentious. This
article assesses the available evidence from the Home Office and the private
correspondence of Home Secretary Viscount Sidmouth to contest E. P.
Thompson’s claim that the Home Office ‘assented’ to the
arrest of Henry Hunt at St Peter’s Fields. Peterloo is placed within the
context of government’s response to political radicalism to show how the
Tory ministry had no clear counter-radical strategy in the months leading up to
the August event. The article further argues that although the Home Office may
not have assented to forceful intervention on the day, the event and its
aftermath were needed to justify the Six Acts which would ultimately cripple the
reform movement.
Recensão: The "Postmodern Turn" in the Social Sciences [Simon Susen, 2015, Basingstoke, Palgrave Macmillan]
Authors: Oliveira Nuno
Published: March 2019

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Trump: how did he happen and what will he do
Authors: Lachmann Richard
Published: March 2019

This article identifies the long-term bases of Republican electoral dominance. It then highlights the specific factors that allowed Trump to win in 2016. Third, it enumerates the policies that Trump and Congressional Republicans will be able to implement because they control the Federal government. Finally, it discusses the opportunities for opposition to Trump and speculates on the likelihood that those efforts will be successful and how unanticipated events might strengthen or undermine Republican power.
Estigma, intenções e estados-de-espírito
Authors: Dores António Pedro
Published: March 2019

O estudo das prisões requer a clarificação de noções como dolo, culpa ou intenção, com que os serviços de estado trabalham; assim como estigma ou repugnância social, que as pessoas sentem. Nenhuma destas noções é de uso exclusivo do sistema penal. A crítica à teoria social de Mouzelis identifica o reducionismo e a reificação como problemas recorrentes, a resolver através da consideração mais rigorosa dos movimentos dos protagonistas no espaço-tempo, analisáveis em diferentes níveis de realidade. Este artigo mobiliza o conceito de estados de espírito como forma de seguir estas sugestões, exemplificando os seus méritos com o caso da análise social das prisões. Fá-lo recorrendo à teoria da relatividade, que previu a plasticidade do espaço-tempo a níveis de energia suficientemente elevados, prognosticando a plasticidade das estruturas, instituições e níveis de realidade sociais em função da intensidade dos agentes e da ação. O estado de espírito é uma referência à estabilidade existencial, vital e institucional, desejada e possível, embora precária e sempre a necessitar de renovação.
A orquestra e a vida: percursos juvenis na Orquestra Geração
Authors: Lopes João Teixeira , Boia Pedro Dos Santos , Veloso Ana Luísa , Caldas Matilde
Published: March 2019

Na senda de uma sociologia da pluralidade disposicional, à qual se acrescenta a relevância do projeto e da construção de campos de possibilidade para a ação, analisam-se percursos juvenis de orquestra com base em retratos sociológicos, reconstituindo as transferências disposicionais entre os múltiplos processos e contextos de socialização, tendo por base a experiência na Orquestra Geração, projeto musical de inserção social com origem no El Sistema venezuelano. Assim, resgata-se a origem das disposições, bem como a força dos contextos da sua ativação (ou inibição), a par do seu potencial de transferibilidade para outros quadros de socialização. Conclui-se com o forte impacto da experiência orquestral na formação de novas competências e disposições, em desigual grau de intensidade consoante os atores, a singularidade dos seus percursos e os contextos em que se movem.
Trump: authoritarian, just another neoliberal republican, or both?
Authors: Lachmann Richard
Published: March 2019

I review Donald Trump’s actions as president to evaluate the extent to which he differs from longstanding Republican Party policies. I find that except for trade and immigration he has furthered existing Republican desires in the fields of tax cuts, deregulation, weakening labor unions, and the appointment of rightwing judges. I then turn to the question of whether Trump is an authoritarian. I show that while his rhetoric is an escalation of previous Republican racial demagoguery, Trump benefits more than he adds to his party’s decades-long strategy of suppressing minority and young voters, vulgarizing political discourse and normalizing brazen lying by candidates and officials, obstructing Democratic officeholders, and allowing unlimited campaign spending by rich people and corporations. I conclude that Trump is now the head of an increasingly authoritarian political party rather than a self-generated strongman. This reduces the insights one can gain from comparisons with rulers like Hitler, Putin or Erdogan.
Trabalhadores/as do sexo e ação coletiva: iniciativas no contexto português
Authors: Graça Marta
Published: March 2019

Os movimentos de trabalhadores/as do sexo (TS) são bastante expressivos a nível internacional. Neste artigo, procuramos refletir sobre a (im)possibilidade atual de consolidação de dinâmicas de ação coletiva de TS, em Portugal. Começamos por contextualizar a emergência dos movimentos a nível mundial e da ação coletiva em Portugal. Seguidamente, a partir do projeto de investigação-ação participativa que desenvolvemos, retratamos as dificuldades em transformar subjetividades em ação coletiva. Concluímos que, apesar de encetadas várias iniciativas de mobilização, é ainda necessário reunir condições para a consolidação de um movimento organizado.
O papel dos códigos de ética na administração do setor da saúde em Portugal: A visão dos dirigentes
Authors: Correia Pedro Miguel Alves Ribeiro , Ferreira Ivone Carla de Matos e Dias , Bilhim João Abreu de Faria
Published: March 2019

As mudanças e reformas da administração pública e, em particular, da administração da saúde, criaram um conjunto de desafios aos dirigentes, nos quais se inclui a criação e implementação de códigos de ética, fator gerador de tensões no seio das instituições. Este artigo descreve a visão dos dirigentes superiores do setor público da saúde, em Portugal, relativamente ao tema da gestão da ética. A investigação teve lugar no final de 2015 e envolveu entrevistas aprofundadas a 11 dirigentes, bem como a análise do enquadramento legal relativo ao tema. Foram empregues técnicas de análise de conteúdo para estudar as narrativas recolhidas. As visões expressas pelos dirigentes colocam em evidência quatro tópicos relativos aos códigos de ética: a sua importância nas instituições do setor da saúde; a sua elaboração e revisão; a sua divulgação e conhecimento; e o seu papel no ambiente organizacional.
Flura-seq identifies organ-specific metabolic adaptations during early metastatic colonization
Authors: Basnet Harihar , Tian Lin , Ganesh Karuna , Huang Yun-Han , Macalinao Danilo G , Brogi Edi , Finley Lydia WS , Massagué Joan
Published: March 2019

Metastasis-initiating cells dynamically adapt to the distinct microenvironments of different organs, but these early adaptations are poorly understood due to the limited sensitivity of in situ transcriptomics. We developed fluorouracil-labeled RNA sequencing (Flura-seq) for in situ analysis with high sensitivity. Flura-seq utilizes cytosine deaminase (CD) to convert fluorocytosine to fluorouracil, metabolically labeling nascent RNA in rare cell populations in situ for purification and sequencing. Flura-seq revealed hundreds of unique, dynamic organ-specific gene signatures depending on the microenvironment in mouse xenograft breast cancer micrometastases. Specifically, the mitochondrial electron transport Complex I, oxidative stress and counteracting antioxidant programs were induced in pulmonary micrometastases, compared to mammary tumors or brain micrometastases. We confirmed lung metastasis-specific increase in oxidative stress and upregulation of antioxidants in clinical samples, thus validating Flura-seq’s utility in identifying clinically actionable microenvironmental adaptations in early metastasis. The sensitivity, robustness and economy of Flura-seq are broadly applicable beyond cancer research.
Neurotransmitter identity is acquired in a lineage-restricted manner in the Drosophila CNS
Authors: Lacin Haluk , Chen Hui-Min , Long Xi , Singer Robert H , Lee Tzumin , Truman James W
Published: March 2019

The vast majority of the adult fly ventral nerve cord is composed of 34 hemilineages, which are clusters of lineally related neurons. Neurons in these hemilineages use one of the three fast-acting neurotransmitters (acetylcholine, GABA, or glutamate) for communication. We generated a comprehensive neurotransmitter usage map for the entire ventral nerve cord. We did not find any cases of neurons using more than one neurotransmitter, but found that the acetylcholine specific gene ChAT is transcribed in many glutamatergic and GABAergic neurons, but these transcripts typically do not leave the nucleus and are not translated. Importantly, our work uncovered a simple rule: All neurons within a hemilineage use the same neurotransmitter. Thus, neurotransmitter identity is acquired at the stem cell level. Our detailed transmitter- usage/lineage identity map will be a great resource for studying the developmental basis of behavior and deciphering how neuronal circuits function to regulate behavior.
Hva slags medborger?
Authors: Sætra Emil , Stray Janicke Heldal
Published: March 2019

In this article, we explore teachers’ ideas about teaching for democratic citizenship. In short, we want to understand “what kind of citizen” teachers aim to educate. We ground our study in three ideal types that represent different ways of understanding what education for democratic citizenship education revolves around: politically informed citizenship (politisk informert medborgerskap), rational autonomous citizenship (rasjonelt autonomt medborgerskap), and socially intelligent citizenship (sosialt intelligent medborgerskap). A first finding is that teacher emphasize that students should acquire knowledge that they can make use of as democratic citizens. Teachers are preoccupied with making students politically informed. A second finding is, however, that teachers understand democratic citizenship education as something more than just knowledge acquisition. One purpose that holds high priority with the teachers is that students should learn how to think critically; to become rationally autonomous. The pedagogical implication of this view is that students should acquire knowledge, skills, and attitudes that helps realize this ambition. This interpretation of what democratic citizenship is moves beyond being able to make an informed choice between different alternatives or representatives. In the last part of the article education for democratic citizenship is discussed in light of the third category; the socially intelligent citizen. We find that while teachers put much emphasis on knowledge and critical thinking, there is little emphasis on participation in democratic practices. We thus conclude that teachers talk about schooling as a tool for democracy much more than they talk about democracy as an ideal or model for schooling.
Comparative analysis of the complete mitochondrial genomes of five Achilidae species (Hemiptera: Fulgoroidea) and other Fulgoroidea reveals conserved mitochondrial genome organization
Authors: Xu Shi-Yan , Long Jian-Kun , Chen Xiang-Sheng
Published: March 2019

In the present study, the complete mitochondrial genomes (mitogenomes) of five Achilidae (Hemiptera: Fulgoroidea),Betatropis formosana, two new species (Magadhaideus luodianasp. nov andPeltatavertexalis horizontalissp. nov),Plectoderinisp. andParacatonidiasp., were sequenced for the first time through next-generation sequencing. The five mitogenomes ranged from 15,214 to 16,216 bp in length, with the typical gene content and arrangement usually observed in Hexapods. The motif “ATGATAA” betweenatp8andatp6was found in all the analyzed species. An overlap “AAGCTTA” betweentrnWandtrnCwas observed in the mitogenomes of most Fulgoroidea. The structural and compositional analyses of 26 Fulgoroidea mitogenomes, including the gene rearrangement of five tRNAs (trnW,trnCandtrnY;trnTandtrnP), the A + T content and AT-skew of the whole mitogenomes, and the nuclear acid and amino acid compositions of the protein-coding genes (PCGs), revealed family-level differences between Delphacidae and other families (Achilidae, Flatidae, Fulgoridae, Issidae and Ricaniidae). Phylogenetic analyses of 13 protein-coding genes from 26 Fulgoroidea species by maximum likelihood and Bayesian Inference were consistent and well supported the basal position of Delphacidae, a close affinity among the families Flatidae, Issidae and Ricaniidae, and a close relationship between Achilidae and Fulgoridae.
Dependência financeira dos municípios amazonenses de transferências da União
Authors: Mendonça Mauricio Brilhante , Ferreira Deósio Cabral , Costa André Ricardo Reis
Published: March 2019

No presente estudo analisamos a dependência dos municípios amazonenses em relação aos recursos da União. Estimamos a dependência financeira dos municípios, classificando-os em níveis por meio de análise de clusters com dados de 2006 a 2010. Dentre outros resultados concluímos que, exceto Manaus, os municípios amazonenses registraram dependência financeira da União, sendo que 88% destes estão no nível mais elevado de dependência.
Perspectiva histórica do planejamento regional no Brasil e Uruguai: uma análise comparada
Authors: Yuane Vivian Tatiana Rodriguez , Hoff Debora Nayar , Gonçalves Margarete Leniza Lopez
Published: March 2019

As disparidades regionais e históricas provocadas pela dinâmica do crescimento econômico capitalista deram origem a diferentes gerações de teorias de economia regional. O estudo apresentado tem por objetivo confrontar as teorias de desenvolvimento regional e a trajetória do planejamento regional no Brasil e Uruguai, buscando identificar se existem aproximações entre as políticas praticadas em distintos períodos por estes países e se coincidem com as discussões teóricas sobre o tema. O estudo é bibliográfico e documental e tem características de pesquisa histórica. As análises são feitas por triangulação entre os aspectos teóricos, as características do planejamento do desenvolvimento regional ao longo do tempo e os fatos observados nos dois países selecionados para o estudo. Como resultados, percebe-se: (a) um pequeno descompasso entre o surgimento das tendências internacionais e a sua emergência enquanto prática; (b) as oscilações nos modelos de desenvolvimento regional adotados relacionam-se com a práxis política dos países; (c) governos mais liberais tendem a reforçar a competição entre as regiões, em prol de vantagens de localização; (d) governos com uma visão mais social tendem a querer construir processos mais sistêmicos e endógenos; (e) alternâncias e descontinuidades nos processos de desenvolvimento regional destes países.
Reflexões sobre o conceito de desenvolvimento de uma perspectiva multidimensional
Authors: Van den Brule David Melo , Ferreira Ivete Helena Ramos Delgado Silves , Nascimento Diego Coelho do , Maciel Leonardo Nogueira de Queiroga
Published: March 2019

O tema desenvolvimento não é, apriori, status de uma única disciplina; quando o assunto envolve qualificar o que venha a ser desenvolvimento, diversos parâmetros e visões culturalmente distintas estarão em conflito na construção desse diálogo. Dessa forma, visto que existe uma interdisciplinaridade e uma pluralidade de ideias em torno do tema, o presente trabalho propõe destacar como objetivo principal, reflexões sobre o caráter multidimensional do referido conceito. Alguns aspectos foram escolhidos para o alcance desse objetivo, todos eles relacionados à multidimensionalidade do desenvolvimento enquanto eixo central da argumentação, tais como: a democracia; a articulação com o meio ambiente; a análise dos aspectos sociais, sobretudo a equidade social. Para tanto, fez-se uso de uma bibliografia que envolve diversas áreas do conhecimento científico.
Physiological Quality in Leucaena leucocephala Seeds Conditioned with Potassium Nitrate Submitted to Saline and Water Stresses
Authors: Silva Jackson Araújo , Silva Iris Renata Freire , Demartelaere Andréa Celina Ferreira , De Medeiros André Dantas , Pereira Marcio Dias
Published: March 2019

Leucaena leucocephala is a species that occurs in semi-arid regions capable of developing physiological and biochemical strategies under adverse environmental situations, such as saline soils and water deficiency. Even so, there are still losses in germination and initial development of plants, mainly due to abiotic stress effects, making it necessary to implement alternatives which are able to diminish the impact on the seeds with the use of potassium nitrate. The objective of this work was to evaluate the physiological quality in L. leucocephala seeds conditioned in potassium nitrate solution and subjected to saline and water stresses. After scarification, the unconditioned leucine seeds were separated and identified, and the conditioners were immersed in the 1.0 Mmol/L solution of potassium nitrate for 24 hours. The treatments were NaCl: 0; 30; 60; 90; 120 and 150 Mmol/L and the water potential: 0, 0; -0.2; -0.4; -0.6, and -0.8 MPa. The seeds were distributed over two Germitest® sheets, moistened with distilled water 2.5 times the dry weight and incubated in a B.O.D. at 25°C for 10 days. Then, the germination speed index, seedling length and seedling mass were measured for the normal seedlings. Eleven treatments with four replicates of 50 seeds were used. The design was completely randomized, and the statistical analyzes were performed in SAS. The use of potassium nitrate (KNO3) contributed to maintaining the physiological quality of L. leucochephala seeds under conditions of saline stress and water restriction.
Microbial Quality of Well Water in Upland and Riverine Communities of Rivers State, Nigeria
Authors: Nwankwo C. C. , Ovunda M. Julie,
Published: March 2019

In this study, health risk assessment of well water from twelve communities grouped into upland and riverine in Rivers State was carried out in several categories such as uses of water, skin infections and health assessment via questionnaire distribution. Malaria was recorded to be the most common disease related to water. Furthermore, water samples were collected and analysed for physiochemical, biochemical and pathological characteristics. The average pH was 7.52, an indication of neutrality. Several species of bacterial and fungal organisms were isolated and identified. The total heterotrophic bacteria (THB), total fungal and total coliform counts ranged from 14.0x104cfu/ml to 100.0x104cfu/ml, 3.2x103cfu/ml to 7.4x103cfu/ml and 4 cfu/100 ml to ≥2400 cfu/100 ml respectively. Morphological and biochemical observations revealed the presence of the following organisms: Aeromonas sp., Alcaligenes sp., Bacillus sp. Citrobacter sp. E. coli, Enterobacter sp, Klebsiella sp., Micrococcus sp., Proteus sp., Salmonella sp., Sarcina sp., Shigella sp., Staphylococcus sp., Streptococcus sp. and Vibrio sp. Staphylococcus sp. and Streptococcus sp. had the least percentage incidence of 8.3% while Vibrio sp had the most incidence of 100% in all the well water sampled. Well water is a source of pathogenic bacteria; hence, it is recommended that consistent water quality studies should be conducted on all the well water in the communities at least once in a year. Well water should also be treated before use to avoid the outbreak of water borne diseases.
Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016
Authors: Norman Mikael , Hallberg Boubou , Abrahamsson Thomas , Björklund Lars J. , Domellöf Magnus , Farooqi Aijaz , Foyn Bruun Cathrine , Gadsbøll Christian , Hellström-Westas Lena , Ingemansson Fredrik , Källén Karin , Ley David , Maršál Karel , Normann Erik , Serenius Fredrik , Stephansson Olof , Stigson Lennart , Um-Bergström Petra , Håkansson Stellan
Published: March 2019

Importance

Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown.

Objective

To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016.

Design, Setting and Participants

All births at 22-26 weeks’ gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016.

Exposures

Delivery at 22-26 weeks’ gestational age.

Main Outcomes and Measures

The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia).

Results

During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks’ gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks’ gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, −7% [95% CI, −11% to −2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks’ gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, −6% [95% CI, −11% to −1.7%], P = .008).

Conclusions and Relevance

Among live births at 22-26 weeks’ gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
Polymer Composites for Structural, Device, and Biomedical Applications
Authors: Gaur Anupama , Shukla Aparna , Saxena Dipti , Maiti Pralay
Published: March 2019

This article focuses on various polymer composites including their preparation, properties, and applications in three major fields like structural, device, and biomedical arena. The types of fillers used for the synthesis of composites and their properties have been discussed. The interactions, apparently the cause behind property improvement, between fillers and polymers have been revealed through different analytical techniques. The advantages of polymer composites are the major issues in this article, and the side effect of the filler has been highlighted. The improvement in various properties of the composites materials are discussed and compared with pure polymers. Applications of polymer composites in different fields are discussed in detail especially in structural, device, and biomedical fields. Structural applications focus on the use of composites for structural uses like building materials and in automobile industry. In device application, the use of polymer composites shed the light of energy harvesting to power the miniature devices and as sensor. Drug delivery and implants materials are summarized for biomedical applications using various composites.