bluuebunny/crossref_metadata_2025 huggingface dataset:
A finite frequency domain-based approach for active fault tolerant control of linear time-delay systems with residual feedback
Authors: Dong Quanchao , Yang Hongyan
Published: August 2017

This paper presents a finite frequency-based active fault tolerant control approach for the compensation of unknown failures in linear time-delay plants. An integration of fault detection filter based on observer technology and [Formula: see text] controller in residual feedback form is considered in the active fault tolerant control system. Different from the traditional schemes, exact fault estimation is not necessary in the proposed active fault tolerant control. To achieve the desired system performance when a fault occurs, the residual is directly embedded in the control loop as a feedback term to compensate the influence of fault. By employing the Generalized Kalman–Yakubovich–Popov lemma, we derive the sufficient conditions of the existence of such an active fault tolerant control plant, and iterative algorithms are applied to obtain the solutions to the fault detection filter and controller parameter matrices. Finally, simulation results are proposed to demonstrate the effectiveness of the developed scheme.
The moving frame method in dynamics: Reforming a curriculum and assessment
Authors: Impelluso Thomas J
Published: August 2017

Rigid body dynamics, a gateway course to the mechanical engineering major (and related majors), focuses on a view of motion that is not commensurate with the contemporary age in which mobile devices have on-board inertial firmware. The traditional approach to this topic deploys a mathematical notation, and associated algebra, that inordinately privileges the inertial frames and 2D motion. This limits the study of machines to two-dimensional problems, lends an appearance of whimsy to solutions that obfuscates the theory of motion. We propose a new mathematical approach to dynamics to reinvigorate the discipline and motivate students. The new approach uses modern mathematical tools which have been distilled to tractability: Lie Group Theory, Cartan’s Moving Frames and a new compact notation from Geometrical Physics. The reconstructed course abandons the cross product—a toxic algebraic operation due to its failure to adhere to associativity. We minimize the use of vectors and replace them with rotation matrices. Sophomores learn to solve 3D Dynamics problems with as much ease as solving 2D problems. Typical problems include the precession of tops, gyroscopes, inertial devices to prevent ship roll at sea, and 3D robot and crane kinetics. A critical aspect of this new method is the consistency: the notation is the same for 3D and 2D problems, from advanced robotics to introductory dynamics, students learn the name notational method. The first objective of this paper presents the new mathematical approach to rigid body dynamics—it amounts to an introductory, yet simplified, lecture on a new method. The second objective presents assessment over a three-year period. In the first year, we taught using the old 2D vector-based approach. In the second year, we transitioned to the new method and compared student perceptions in the first two years. In the third year, the course was refined. The goal of this effort is to retain students in mechanical engineering by offering them a new view of the discipline, rather than simple pedagogical course interventions such as e-learning or flipped classrooms. The course content is delivered using the emerging visualization technology: WebGL. WebGL represents the future of the 3D web. It requires no downloads and no plugins. Students are directed to a web site where all images for the lectures are 3D and interactive. The animations run on cell phones, laptops and other mobile devices. It is the contention of this paper that modernizing the math will do more to reduce attrition than learning interventions. This new approach reduces conceptual difficulties that accompany 2D restrictions. It opens many questions on how students perceive 3D space and invites research into how exploiting more modern mathematical math may improve learning.
Moving From Knowledge to Action in Partnership: A Case Study on Program Adaptation to Support Optimal Aging in the Context of Migration
Authors: Barenfeld Emmelie , Wallin Lars , Björk Brämberg Elisabeth
Published: August 2017

This case study explored how a researcher–community partnership contributed to program adaptations when implementing person-centered group-based health promotion services to older people who have migrated to Sweden. The study was conducted over 3 years and various data sources were used: focus groups, individual interviews, documents, and archive material. Findings from different data sources and partners’ perspectives were triangulated to an overall case description using an iterative process. Adaptations were shaped through a dynamic process, negotiating toward suitable solutions that culminated in actions taken to adapt or inhibit adaptations. The negotiations were driven by the interplay within and between three reasons to adapt. The partners’ opportunities to influence the negotiation process depended on establishing common ground to shape adaptations. Practical implications are provided on how to move from knowledge to action when implementing person-centered group-based health promotion to support optimal aging in the context of migration.
Leadership clinique en faveur de la santé de la population
Authors: Roy O. , Tremblay L.
Published: August 2017

Les professionnels de la santé sont directement interpellés par le défi du système de santé québécois et canadien. La diversité et la force du leadership infirmier agissent comme un véritable levier dans la transformation du système. Cet article fait valoir l’engagement des infirmières autour du projet proposé par l’Ordre des infirmières et infirmiers du Québec (OIIQ), à la fois mobilisateur et facilitateur du changement. Fortement inspirées par l’approche LEADS du Collège canadien des leaders en santé (CCLS)1, les auteures ajoutent d’autres marqueurs cruciaux propres au leadership clinique infirmier, réunis sous l’acronyme de LEADERS. La présentation de résultats auprès des personnes soignées, de leur famille, des équipes de soins et des établissements, renforce la marque distinctive de ce leadership exercé sur le terrain. Des témoignages glanés auprès de leaders soutiennent la place déterminante de l’infirmière dans le réseau de la santé. Pour façonner l’avenir, les auteures misent sur les forces du leadership clinique.
No need to grow my resumé? Mentorship and the intersection of learning between emerging and established leaders
Authors: Stevenson Lynn , Vaulkhard Kimberley
Published: August 2017

Active ongoing learning is a foundational expectation of every healthcare leader whether at the beginning or end of their career. In order for leaders to be nimble and responsive to the ongoing changes in the healthcare environment, they must actively engage in a multiplicity of learning activities. One way of ensuring diversity of learning is for emerging and established leaders to learn together through formal or informal mentoring. This article will explore that intersection and the value add of a reciprocal mentoring relationship where mentor and mentee roles become blurred and joint learning becomes the goal. Capabilities from the LEADS in a Caring Environment framework will be drawn upon, and a challenge is suggested for experienced leaders to go beyond resumé building and invest in emerging leaders, as ultimately it is an investment in their own learning and the future.
Effect of plasma actuator in boundary layer on flat plate model with turbulent promoter
Authors: Julian James , Harinaldi  , Budiarso  , Wang Chin-Cheng , Chern Ming-Jyh
Published: August 2017

This paper shows experimental results for velocity measurement in the boundary layer with the use of a flat plate model. The flat plate model is disrupted with a wire trip and the effect of the plasma actuator to alter the flow in the boundary layer is then observed. The purpose of this research is to characterize the performance of the plasma actuator in a no-flow condition and with the use of a 2 m/s flow and also to theoretically analyze the performance of actuator in the boundary layer namely, displacement thickness, momentum thickness, and energy thickness. This is all done to acquire a deeper understanding of the capabilities of plasma actuator as one of the alternative active flow control equipment and to increase the effect of aerodynamic drag reduction. One of the ways to decrease the aerodynamic drag is to manipulate the flow to have a low boundary layer thickness value in order to prevent an adverse pressure gradient from happening, which then may lead to the formation of a flow separation. From experimental results, it is known that plasma actuator could decrease the thickness of the boundary layer by 9 mm.
Is Romantic Desire Predictable? Machine Learning Applied to Initial Romantic Attraction
Authors: Joel Samantha , Eastwick Paul W. , Finkel Eli J.
Published: August 2017

Matchmaking companies and theoretical perspectives on close relationships suggest that initial attraction is, to some extent, a product of two people’s self-reported traits and preferences. We used machine learning to test how well such measures predict people’s overall tendencies to romantically desire other people (actor variance) and to be desired by other people (partner variance), as well as people’s desire for specific partners above and beyond actor and partner variance (relationship variance). In two speed-dating studies, romantically unattached individuals completed more than 100 self-report measures about traits and preferences that past researchers have identified as being relevant to mate selection. Each participant met each opposite-sex participant attending a speed-dating event for a 4-min speed date. Random forests models predicted 4% to 18% of actor variance and 7% to 27% of partner variance; crucially, however, they were unable to predict relationship variance using any combination of traits and preferences reported before the dates. These results suggest that compatibility elements of human mating are challenging to predict before two people meet.
Esthetics and Methods in the Study of Sexual Rights
Authors: Goldberg-Hiller Jonathan
Published: August 2017

The study of sexuality has been and remains a seminal project for Social & Legal Studies. This article utilizes the political/esthetic theory of Jacques Rancière in order to explore the dimensions of this project as an intervention in the field of sociolegal studies from the Journal’s inception to contemporary concerns. Early studies of sexuality in the Journal developed three methodological themes: law as deconstructable process, as consequential for the performative aspects of nonessentialized identities, and as potentially destabilized by highly mobile rights claiming. This article seeks to understand whether this unique agenda for the study of gender, sexuality, and law remains viable. It concludes that the nonessentialist fluidity of gender and sexuality which framed early approaches to the study of the consequences of rights and the relationship of sexual and gender identity requires renewed attention to the structures of race, colonialism, and imperialism enabling and enabled by contemporary queer critique.
Change in Police Organizations: Perceptions, Experiences, and the Failure to Launch
Authors: Schafer Joseph A. , Varano Sean P.
Published: August 2017

Studies and accounts of change in police organizations frequently emphasize case studies of specific efforts enacted during relatively discrete periods of time in one or a few agencies. The narratives often emphasize the success of change efforts or seek to explain why initiatives failed in the case study agency. While instructive, such accounts do not provide broader insights into successes and failures with change across longer periods of time, differing types of change, and diverse organizational contexts. Using survey data from mid-career police supervisors attending the FBI National Academy program, this study considers change experiences. In particular, consideration is given to the frequency of change, its results, and the factors associated with successful and failed outcomes.
Prognostic Indicators in Differentiated Thyroid Carcinoma
Authors: Dean Diana S. , Hay Ian D.
Published: August 2017

Background

Thyroid cancer ranges from well-differentiated lesions with an excellent prognosis to anaplastic carcinoma, which is almost uniformly fatal. Thus, methods to assess the behavior of thyroid malignancies are necessary to arrive at appropriate treatment decisions.

Methods

We discuss the factors that affect the prognosis of patients with well-differentiated thyroid malignancies, including papillary, follicular, Hürthle cell, and medullary thyroid carcinomas. We also review the presentation, therapy, and outcome of patients seen at our center over a span of 50 years. These data have identified those prognostic factors that are predictive of survival and recurrence in differentiated thyroid cancer.

Results

Several classifications with different variables have been developed to define risk-group categories. Three widely used systems, in addition to the TNM staging system, include AGES, AMES, and MACIS.

Conclusions

A better understanding of independently important prognostic variables will result in improved patient care and treatment.
Medullary Carcinoma of the Thyroid
Authors: Randolph Gregory W. , Maniar Dipti
Published: August 2017

Medullary thyroid cancer (MTC) is a distinct C-cell tumor of the thyroid. We review the oncogenesis and management of both sporadic tumors and those tumors arising as part of specific inherited syndromes. The RET proto-oncogene plays a role in the development of inherited forms of MTC and has become important in the clinical management of patients and their families. The recognition of the high rate of regional nodal involvement has led to lymphadenectomy being strongly considered for patients undergoing thyroidectomy for MTC.
Bladder-Sparing Treatment of Invasive Bladder Cancer
Authors: Rivera Inoel , Wajsman Zev
Published: August 2017

Background

Radical cystectomy with pelvic lymph node dissection is the standard treatment for patients with invasive bladder cancer. However, many alternative techniques to spare the bladder have been investigated.

Methods

We review the experience reported in the literature on bladder-sparing techniques, including transurethral resection, chemotherapy, and radiation for muscle-invasive disease.

Results

Most comparative studies indicate that local recurrence and survival outcomes for bladder-sparing approaches are inferior to those from radical cystectomy to control muscle-invasive bladder cancer.

Conclusions

Although molecular biologic techniques may have the capacity to identify a subgroup who may benefit from a bladder-sparing approach, cystectomy is normally required for optimal results.
Prostate Cancer: Screening and Early Detection
Authors: Cookson Michael S.
Published: August 2017

Background

Despite more than a decade of prostate-specific antigen (PSA)-based screening, the proven impact of screening on mortality due to prostate cancer continues to be controversial.

Methods

A literature review of issues pertaining to the epidemiology, screening, early detection, and mortality as they relate to prostate cancer was conducted. Included in the review are PSA refinements, controversies of screening, and organization guidelines. Finally, recent reports of mortality rates in the post-PSA era are presented for discussion.

Results

Prostate cancer mortality rates have begun to decline for the first time since statistics have been recorded. The recent decline in age-adjusted mortality rates from prostate cancer is significant, and this decline appears to be earlier than would have been predicted. This finding, coupled with the dramatic decline in metastatic disease, implies that PSA-based screening may be responsible for a significant portion of this improvement in mortality.

Conclusions

The cost of prostate cancer screening appears to be acceptable. Randomized studies of PSA-based screening are currently ongoing, although the results may not be available for a decade. Currently, the best evidence is derived from population-based studies that appear to show a benefit to prostate cancer screening.
Breast Cancer Sentinel Node Metastases: Histopathologic Detection and Clinical Significance
Authors: Ollila David W. , Stitzenberg Karyn B.
Published: August 2017

Background

Lymphatic mapping with sentinel lymphadenectomy (LM/SL) is an accurate and less morbid means of determining the tumor status of the axilla in breast cancer patients than standard level I and II axillary lymph node dissection (ALND). This review addresses the handling and pathologic examination of the sentinel node (SN), the clinical significance of tumor within the SN, and the risk factors for non-SN tumor involvement.

Methods

The seminal works that have addressed pathologic examination of ALND specimens and SN specimens are summarized, and the important studies attempting to identify predictors of non-SN metastases in patients with a tumor-involved SN are reviewed.

Results

Standard single-section hematoxylineosin (H&E) examination is inadequate for reliable detection of axillary or SN metastases. Large studies appropriately powered to detect a survival difference for patients with micrometastatic disease are reviewed. The current data on the clinical significance of micrometastatic nodal disease is inconclusive. While several strong predictors of non-SN tumor involvement have been identified, none is reliable enough to allow omission of ALND in patients with a tumor-involved SN.

Conclusions

Routine examination of the SN specimen should include serial sections with H&E stain. Ongoing prospective clinical trials should help to define the clinical significance of SN micrometastases. Furthermore, these trials could help identify predictors of non-SN metastasis that would allow a subset of patients with a tumor-involved SN to avoid the morbidity of ALND.
Management of Breast Cancer in the Older Woman
Authors: Balducci Lodovico , Extermann Martine , Carreca Ignazio
Published: August 2017

Background

Approximately half of all breast cancer cases occur after age 65. Several aspects for the treatment of early breast cancer may be influenced by patient age, including postoperative irradiation after partial mastectomy, axillary lymphadenectomy, primary medical treatment of early breast cancer, and adjuvant chemotherapy.

Methods

The authors review the literature regarding age-specific issues in the management of breast cancer, and they report their own experience in treating older women with breast cancer.

Results

In terms of survival and disease-free survival, tamoxifen alone in primary breast cancer is inferior to surgical treatment followed by adjuvant tamoxifen. Tamoxifen alone should be reserved for patients with absolute contraindications to mastectomy. Adjuvant chemotherapy is beneficial to women with hormone receptor-poor tumors. In those with hormone receptor-rich tumors, adjuvant chemotherapy is beneficial for HER2-positive tumors, and the regimen should contain an anthracycline.

Conclusions

Although the risk of local recurrence after partial mastectomy declines with increasing age, the decision to forego radiation therapy is individualized based on risk of recurrence and on patient desires and resources. The advent of lymph node mapping obviates the need for lymphadenectomy in most patients. The benefits and risks of adjuvant chemotherapy should be individually assessed according to tumor stage, life expectancy, comorbidity, and expected tolerance of treatment.
External-Beam Radiotherapy in the Management of Carcinoma of the Prostate
Authors: Zlotecki Robert A.
Published: August 2017

Background

External-beam radiotherapy (EBRT) has been used in the treatment of adenocarcinoma of the prostate gland for more than 30 years. Well-documented clinical series have demonstrated the effectiveness of EBRT in achieving both cause-specific survival and freedom from biochemical (prostate-specific antigen [PSA]) progression.

Methods

The indications and expected treatment results for treatment by EBRT in the management of adenocarcinoma of the prostate gland are reviewed. The treatment of early-stage disease definitively by EBRT alone or as complement to radioactive seed implant is emphasized. In the management of locally advanced disease, the use of EBRT with combined androgen ablation is discussed as definitive therapy and also as indicated in the postoperative adjuvant management of surgically identified pathologic stage T3 disease.

Results

The relative clinical benefit of EBRT compared with the mostly predictable and well-defined moderate side effects, which are manageable in most instances by conservative measures treatment, is well established. Advances in defining radiation-beam parameters have led to more effective and safer treatment for prostate cancer.

Conclusions

EBRT has historically been a mainstay in the management of prostate cancer. It remains a useful and indicated treatment modality in patients with early-stage, locally advanced, and metastatic disease.
Transoral Laser Microsurgery in Carcinomas of the Oral Cavity, Pharynx, and Larynx
Authors: Werner Jochen A. , Dünne Anja A. , Folz Benedikt J. , Lippert Burkard M.
Published: August 2017

Background

Since the introduction of laser technology in the 1960s, use of the technique in treating laryngeal diseases has demonstrated several advantages over conventional resections in selected cases.

Methods

The authors review the published data on oncologic laser surgery for the treatment of head and neck carcinomas, and they also describe their own clinical experience with transoral laser surgery for the treatment of carcinomas of the oral cavity, pharynx, and larynx.

Results

Laser surgery has achieved a key position in minimally invasive treatment concepts in the ears, nose, and throat area, especially for the treatment of malignancies of the upper aerodigestive tract. The CO2 laser is the approach most commonly used.

Conclusions

New and improved applications of laser therapy in the treatment of cancer are being explored. As more surgeons become experienced in the use of lasers and as our knowledge of the capabilities and advantages of this tool expands, lasers may play a larger role in the management of head and neck cancers.
Clinical Considerations in the Management of Individuals at Risk for Hereditary Breast and Ovarian Cancer
Authors: Robson Mark E.
Published: August 2017

Background

Hereditary predisposition to breast and ovarian cancer, most commonly due to germline mutations in BRCA1 and BRCA2, has been recognized for many years. The optimal clinical management of individuals with such a predisposition is not yet completely defined.

Methods

The current literature regarding the clinical management of individuals at risk for hereditary breast and ovarian cancer was reviewed.

Results

Women with germline BRCA1 or BRCA2 mutations are at substantially increased risk for breast and ovarian cancer, although the risks may not be as high as originally reported. Current surveillance options are restricted in their effectiveness by both host and tumor factors as well as limitations of the techniques. Surgical prevention options, while effective, may be complicated by physical or psychological morbidity. Nonsurgical prevention options are under development.

Conclusions

The ability to define women as being at hereditary risk for breast and ovarian cancer facilitates the use of specialized surveillance and prevention strategies. Genetic testing, which plays a role in defining risk, requires careful pre- and post-test counseling to discuss the limitations of testing itself and available management strategies.
Aromatase Inhibitors in Breast Cancer: An Update
Authors: Lake Diana E. , Hudis Clifford
Published: August 2017

Background

Tamoxifen has been the endocrine treatment of choice for patients with breast cancer. The development of selective aromatase inhibitors has offered an alternative management approach for patients in whom a hormonal approach is indicated.

Methods

The authors reviewed reports in which aromatase inhibitors were compared with tamoxifen for the treatment of metastatic disease, as well as information pertinent to their use as adjuvant therapy.

Results

Both nonsteroidal (anastrozole and letrozole) and steroidal (exemestane) aromatase inhibitors for metastatic disease appear to provide superior efficacy and a better toxicity profile in first- and second-line treatment of metastatic disease than tamoxifen. Early results from the ATAC trial suggest anastrozole is superior to tamoxifen for disease-free survival, particularly in receptor-positive patients, and in reducing the incidence of contralateral breast cancer.

Conclusions

Aromatase inhibitors have important roles in optimal management of postmenopausal patients with hormone-responsive metastases in both the adjuvant and advanced-disease settings.
Cancer Genetics Knowledge and Beliefs and Receipt of Results in Ashkenazi Jewish Individuals Receiving Counseling for BRCA1/2 Mutations
Authors: Kelly Kimberly , Leventhal Howard , Marvin Monica , Toppmeyer Deborah , Baran Jill , Schwalb Marvin
Published: August 2017

Background

Genetic counseling for BRCA1 and BRCA2 mutations (mutations associated with increased risk of breast-ovarian cancer) endeavors to communicate information that will help individuals make informed decisions regarding genetic testing.

Methods

This repeated-measures study examined cancer genetics knowledge and beliefs before and after counseling and their relationship to receipt of results for BRCA1/2 mutations in 120 highly educated Ashkenazi Jewish individuals.

Results

A repeated-measures analysis examined change in knowledge and beliefs regarding personal behavior, mechanisms of cancer inheritance, meaning of a positive result, practitioner knowledge, frequency of inherited cancer, and meaning of a negative result from pre- to post-counseling with the between subjects variables of education (with/without graduate training) and personal history of breast or ovarian cancer (yes/no), and risk of having a mutation entered as a covariate. Mechanisms of cancer inheritance, meaning of a positive result, and practitioner knowledge increased from pre- to post-counseling. Those with graduate training had higher ratings of mechanisms of cancer inheritance ratings and lower ratings of frequency of inherited cancers than those without. Mann-Whitney U tests found those testing had higher ratings in mechanisms of cancer inheritance, specifically in the association of multiple primary cancers with hereditary cancer, than those not testing.

Conclusions

Genetic counseling is helpful in improving overall knowledge of cancer genetics even for highly educated individuals. Particular areas of knowledge improvement should be explored in relation to receipt of results, especially to further elucidate the relationship of knowledge of the association of multiple primary cancers with hereditary cancer to receipt of test results.
Newer Imaging Modalities to Assess Tumor in the Prostate
Authors: Hersh Marla R. , Knapp Edson L. , Choi Junsung
Published: August 2017

Background

Several advances in the imaging of prostate cancer have been made in recent years. Diagnostic staging has become increasingly complex and confusing as newer technologies have developed more rapidly than research has been able to confirm or refute the accuracy of these technologies. By the time research has been performed, the technology used for a study has often become outdated and newer and more sophisticated imaging has become available.

Methods

We reviewed the literature on local and nodal staging of prostate cancer, as well as the role of magnetic resonance imaging (MRI), magnetic resonance spectroscopic imaging (MRSI), dynamic contrast-enhanced MRI, positron emission tomography (PET), endorectal power Doppler, lymphotropic MRI contrast agents, and future possibilities such as diffusion MRI. This review is not systematic, but rather focused on these imaging modalities.

Results

Advances in MRI, ultrasound, and lymphotropic contrast agents have improved our ability to differentiate between T2 and T3 prostate tumors. PET imaging has proven less successful at staging prostate cancer. A literature review suggests patients with moderate risk of extracapsular extension benefit most from endorectal MRI evaluation. Spectroscopy, dynamic imaging, and lymphotropic contrast agents are expected to continue to improve sensitivity and specificity of staging of prostate cancer. Power Doppler evaluation with endorectal ultrasound has proved useful for evaluation during endorectal biopsy for identifying hypervascular tumors for directed biopsy. Diffusion-weighted MRI remains untested clinically and represents a future direction for research.

Conclusions

Future studies using these new techniques are needed to demonstrate changes in outcomes in large patient populations.
Pathology of Germ Cell Tumors of the Testis
Authors: Sesterhenn Isabell A. , Davis Charles J.
Published: August 2017

Background

An increasing incidence of testis tumors has been noted over the second half of the 20th century. Congenital malformation of the male genitalia, prenatal risk factors, nonspecific and specific exposures in adulthood, and male infertility have all been associated with the etiology of germ cell tumors.

Methods

The histologic classification, pathology, and current concepts of testicular germ cell tumors are reviewed.

Results

Germ cell tumors occur at all ages. The tumors are identified as pure form (those of one histologic type) and mixed form (more than one histologic type). Over half of germ cell tumors consist of more than one cell type, requiring appropriate sampling for the correct diagnosis and correlation with the serum tumor markers. Burned-out germ cell tumors may occur in patients with metastatic disease with no gross evidence of a testicular tumor.

Conclusions

Appropriate management of testis tumors relies on accurate pathology and classification of these tumors.
Molecularly Targeted Therapies for Breast Cancer
Authors: Hobday Timothy J. , Perez Edith A.
Published: August 2017

Background:

The management of patients with localized and advanced breast cancer continues to evolve. Chemotherapy, endocrine therapy, and trastuzumab are effective therapies but leave considerable room for improvement. As the cellular aberrations inherent to cancer cells in general and breast cancer cells specifically are better understood, therapies to target specific cellular pathways continue to be developed with the goal of expanding available effective therapy through better patient selection.

Methods:

We conducted a computerized search of the medical literature as well as a manual search of selected meeting abstracts.

Results:

Several targeted therapies are in phase III clinical trials testing their promise in the treatment of breast cancer. Many other agents are completing phase I and II testing. An overview of the most promising agents in clinical development is discussed herein.

Conclusions:

Targeted therapy for breast cancer is a reality at this time, and several new agents hold promise for expanding and refining the pool of patients likely to further benefit from this approach in the near future.
Targeted Therapies in the Treatment of Colorectal Cancers
Authors: Alekshun Todd , Garrett Chris
Published: August 2017

Background:

In solid organ malignancies, no tumor type has seen a greater impact from the development of novel targeted therapies in 2004 than metastatic colorectal cancer.

Methods:

We review the current progress to date with the use of monoclonal antibodies in colorectal cancer and look at newer therapies under investigation.

Results:

Two monoclonal antibodies received Food and Drug Administration approval in early 2004, both for the indication of advanced, metastatic colorectal cancer. A large, randomized, placebo-controlled study demonstrated that the addition of a monoclonal antibody to vascular endothelial growth factor, bevacizumab, led to a statistically significant improvement in overall survival, with tolerable additional toxicity. Chimeric monoclonal antibody therapy directed at the epidermal growth factor receptor was associated with radiographic responses in a significant minority of patients with irinotecan-refractory colon cancer in a randomized phase II study of patients with irinotecan-refractory disease.

Conclusions:

These dramatic successes have led to further clinical studies of targeted therapy in colorectal cancer, making it one of the most promising areas of cancer research.
Misperceptions of Medical Understanding in Low-Literacy Patients: Implications for Cancer Prevention
Authors: Rogers Edwin S. , Wallace Lorraine S. , Weiss Barry D.
Published: August 2017

Background

Patients with limited literacy skills often have difficulty understanding medical information, are less likely to undergo cancer screening, and present with cancer at later stages than patients with better literacy skills. Since primary care physicians are responsible for performing or initiating the majority of cancer screening in the United States, they need to be able to not only identify patients who might not understand medical information but also communicate effectively with them about cancer prevention and screening.

Methods

To determine whether family medicine residents could identify patients who might have difficulty understanding medical information because of limited literacy, we measured the literacy skills of patients in a university-based family medicine clinic using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). After the patients completed their office visits with a physician, we asked family medicine residents to rate the patients’ ability to understand medical information.

Results

Among 140 patients who met with 18 family medicine resident physicians, 24% had limited literacy skills based on testing with the S-TOFHLA. Residents identified only about half of these patients as having poor or below average understanding of medical information.

Conclusions

In many cases, family medicine residents are unable to identify patients who, based on assessment of their literacy skills, are likely to have difficulty understanding medical information. When working with residents, medical educators should promote the habit of taking poor literacy into account when communicating with patients.
Interaction between Comorbidity and Cancer
Authors: Extermann Martine
Published: August 2017

Background

Older patients have an average of three comorbidities in addition to their cancer. Oncologic studies have usually ignored this aspect when adjusting for confounders. There is mounting evidence that comorbidity interacts with risk, survival, disease progression, and treatment of elderly patients with cancer. The strength of many of these interactions increases with age.

Methods

A review of the literature was undertaken regarding two of these interactions: cancer risk and prognosis.

Results

In older patients, the risk and behavior of cancer can be strongly affected by comorbidities and their related treatment. Rather than a blanket effect, this effect might be attached to groups of syndromes with common pathophysiologic mechanisms. This is notably true for metabolic disorders and inflammatory diseases.

Conclusions

In addition to focusing on the influence of cancer treatment on comorbidity or on the effect of comorbidity in delivering cancer treatment, future endeavors will need to consider the direct impact of comorbidity on the risk and the behavior of the cancer in elderly patients.
The Diagnosis, Staging, and Treatment Options for Mycosis Fungoides
Authors: Keehn Connie A. , Belongie Iriana P. , Shistik Galina , Fenske Neil A. , Glass L. Frank
Published: August 2017

Background

Cutaneous T-cell lymphoma (CTCL) represents a spectrum of diseases composed of malignant T lymphocytes. The most common type is mycosis fungoides (MF). An accurate diagnosis of early MF may be difficult because of the varied clinical and histologic expressions of the disease.

Methods

The authors review the epidemiology, possible risk factors, clinical manifestations, diagnostic techniques, staging, prognosis, and treatment options for MF.

Results

The varied and often nonspecific clinical and bistologic presentations of MF may delay diagnosis and staging, thus necessitating further studies such as immunophenotyping and T-cell receptor gene rearrangement analysis.

Conclusions

A multidisciplinary approach to the diagnosis, staging, and treatment of MF assists in optimizing outcomes from management of patients with this disease.
Classification and Treatment of Rare and Aggressive Types of Peripheral T-Cell/Natural Killer-Cell Lymphomas of the Skin
Authors: Rezania Dorna , Sokol Lubomir , Cualing Hernani D.
Published: August 2017

Background

The classification of cutaneous lymphomas has been contentious. Two major competing classifications were the World Health Organization (WHO) and the European Organization for Research and Treatment of Cancer (EORTC). The principal authors met for a consensus meeting resulted in a combined classification called WHO-EORTC Classification of Cutaneous Lymphoma.

Methods

We review the classification of “mature” or peripheral T-cell lymphoma (PTCL) with high predilection to the skin as published by the WHO-EORTC. We also highlight new information and changes from the previous classifications of cutaneous PTCL according to the WHO classification or the EORTC classification. Finally, the salient findings are compared with similar-looking nodal PTCLs with a high frequency of skin involvement.

Results

This review focuses on a rare group of cutaneous PTCLs other than mycosis fungoides or its variants. Changes from the previous classifications are discussed, and the rare group of nodal PTCLs with high predilection to the skin are presented. The salient findings, diagnostic features, and treatments are included, along with summary tables and clinical-histopathologic images.

Conclusions

This review may serve as a guide for hematologists, oncologists and dermatologists in the diagnosis and management of these rare, aggressive, and often difficult to diagnose lymphomas. Although cutaneous lymphomas are morphologically identical to systemic lymphomas, the former behave differently, require divergent management, and should be recognized as separate entities. The consensus WHO-EORTC classification presents unified terminology and definitions to promote conformity in diagnosing and treating these cases, to foster a multidisciplinary approach to these often-obscure diseases, and to lead to more advances in identifying molecular targets specific to these entities.
Factors Affecting Uptake of Cervical Cancer Screening among Clinic Attendees in Trelawny, Jamaica
Authors: Bessler Patricia , Aung Maung , Jolly Pauline
Published: August 2017

Background

Use of the Pap test has resulted in a decline in cervical cancer mortality in developed countries. Yet, despite established cervical cancer screening programs, a significant portion of Jamaican women are not undergoing screening for cervical cancer. This study was carried out to identify factors that affect Jamaican women's decisions to screen for cervical cancer.

Methods

A population survey was administered to 367 clinic-attending women 25 to 54 years of age in the Parish of Trelawny from May to July of 2005. An interviewer-administered questionnaire assessed the women's knowledge, attitudes, and practices regarding cervical cancer and cervical cancer screening.

Results

Overall, 11% of the women had never had a Pap smear and only 38% had a Pap test within the last year. Annual visits to a health provider have a strong influence on women's decisions to regularly screen for cervical cancer. Provider recommendation also positively affected initial receipt of a Pap smear as well as continued regular screening.

Conclusions

Programs that promote annual health checkups, encourage consistent provider recommendations, and emphasize screening as a preventive measure might positively influence women's decisions to screen for cervical cancer.
The Impact of Genomics in Understanding Human Melanoma Progression and Metastasis
Authors: Ren Suping , Liu Suhu , Howell Paul , Xi Yaguang , Enkemann Steven A. , Ju Jingfang , Riker Adam I.
Published: August 2017

Background

Recent technological advances in the analysis of the human genome have opened the door to improving our primitive understanding of the gene expression patterns in cancer. For the first time, we have an overview of the complexities of tumorigenesis and metastatic progression of cancer. The examination of the phenotypic and (epi)genetic changes in cutaneous melanoma has identified several genes deemed central to the development and progression of melanoma.

Methods

A review of the recent literature was performed to determine the role of array-based high-throughput gene expression analysis in understanding the specific genes involved as well as the pathways and the comparative gene expression patterns of primary and metastatic melanoma.

Results

Most studies utilizing gene microarray analysis and other whole genome approaches reveal a wide array of genes and expression patterns in human melanoma. Furthermore, several of the same genes have been found in comparative studies, with some studies attempting correlation with clinical outcome. Several genes have been identified as potential prognostic markers of tumor progression and overall clinical outcome.

Conclusions

High-throughput gene expression analysis has had a major impact in melanoma research. Several gene expression platforms have provided insight into the gene expression patterns in melanoma. Such data will provide the foundations for the future development of prognostic markers and improved targeted therapies for patients with melanoma.
Melanoma in Hispanic and Black Americans
Authors: Rouhani Panta , Hu Shasa , Kirsner Robert S.
Published: August 2017

Background

Although age-adjusted incidence rates (per 100,000) for melanoma are lower among Hispanics and blacks (4.5 and 1.0, respectively) compared with white non-Hispanics (21.6), melanomas among minority populations in the United States are more likely to metastasize and have poorer outcomes.

Methods

A review of the literature was conducted on melanomas affecting Hispanic and black Americans.

Results

Because of the low index of suspicion in both the medical community and these ethnic populations, diagnosis is often delayed, resulting in advanced presentation and a poorer prognosis.

Conclusions

More comprehensive medical training, expanded public educational campaigns, and increased awareness among patients of all skin types to perform self skin checks are recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are warranted.
Establishing Trusting Partnerships for Successful Recruitment of American Indians to Clinical Trials
Authors: Petereit Daniel G. , Burhansstipanov Linda
Published: August 2017

Background

Cancer mortality rates among American Indians (AIs) in the Northern Plains are among the highest in the nation. Reasons for this disparity are unclear but are probably due to multiple barriers. AIs appear to experience more intense side effects from therapeutic radiation compared with other populations. This differential response to treatment, a disparity in itself, might be overcome if the molecular reasons were better understood.

Methods

The National Cancer Institute developed the Cancer Disparity Research Partnership to address these inequities. This initiative, known as the Walking Forward program, attempts to lower cancer mortality rates for AIs by increasing access to innovative clinical trials, behavioral research, patient navigation, and the ataxia telangiectasia mutated (ATM) gene study. The ATM component of the project was initiated to determine if there is a molecular basis for this apparent differential response to therapeutic radiation. Successful implementation of the genetic study relied on achieving a trusting partnership with AIs since a lack of trust has historically been a barrier to performing research in this population. The authors detail the nature of building partnerships and trust by utilizing lessons learned.

Results

Establishing a trusting partnership between a community hospital and AIs in South Dakota resulted in successful recruitment to this ATM clinical trial. To date, 26 AIs and 40 non-AIs have consented to participate in this ATM analysis. Their shared human desire to assist others, especially family and community members, and their demonstrated responsiveness to community priorities by academic researchers are the primary reasons for participant eagerness to enroll on this study.

Conclusions

The relatively rapid approval of the ATM genetic study by multiple tribal organizations and the successful accrual of AIs on this study reflect the trusting partnerships achieved at the patient and community levels.
Current Treatment of Metastatic Endometrial Cancer
Authors: Temkin Sarah M. , Fleming Gini
Published: August 2017

Background

Endometrial cancer is the most common gynecologic malignancy. The majority of patients have disease confined to the uterus and have an excellent overall prognosis. However, subgroups of patients have advanced primary disease or recurrences following primary treatment.

Methods

The management of metastatic disease is variable, depending on factors such as comorbidities, tumor grade, performance status, and prior treatments. Management options include hormonal therapy and cytotoxic chemotherapy, as well as targeted therapies that inhibit angiogenesis and the cellular signaling pathways involved in cell growth and proliferation. A comprehensive review of these treatments for metastatic endometrial cancer was conducted and is discussed.

Results

Hormonal therapy and cytotoxic chemotherapy have traditionally been used in the treatment of metastatic endometrial cancer. Advances in molecular biology have led to multiple potential targeted therapies to be used in the treatment of metastatic endometrial cancer.

Conclusions

While several treatment modalities are now available to treat patients who present with metastatic endometrial cancer, overall prognosis remains poor.
Race Disparities between Black and White Women in the Incidence, Treatment, and Prognosis of Endometrial Cancer
Authors: Allard Jay E. , Maxwell G. Larry
Published: August 2017

Background

Uterine cancer is the most common gynecologic malignancy in the United States, with an estimated 40,100 new cases and 7,470 deaths occurring in 2008. Although the incidence of endometrial cancer is lower among black women compared with white women, the proportion of cancer-related deaths among blacks is higher and has continued to rise over the past two decades.

Methods

The authors conducted a survey of recent literature published in the English language and have used these articles as the basis for this review.

Results

The etiology for the racial disparity among black women with endometrial cancer is multifactorial and may be the result of barriers that impede access to care, an increased incidence of comorbidities among black women, inequalities in surgical care, adjuvant chemotherapy and radiation treatment, and underlying biological differences associated with more aggressive tumors that often develop in black women.

Conclusions

Black women with endometrial cancer have a poorer prognosis compared with white women. Factors that contribute to this racial disparity include later diagnosis, treatment disparities, comorbid conditions, and genetic differences in tumors. An improved understanding of the causative factors associated with racial disparities in endometrial cancer outcome is needed to facilitate efforts aimed at correcting this important health care problem and providing individualized care to those at highest risk for poor outcome.