bluuebunny/crossref_metadata_2025 huggingface dataset:
“Infection prevention and control idea challenge” contest: a fresh view on medical education and problem solving
Authors: Arianpoor Arash , Zarifian Ahmadreza , Askari Emran , Akhavan-Rezayat Arash , Dayyani Mojtaba , Rahimian Amin , Amini Elahe , Amel Roya , Ziaeemehr Aghigh , Zingg Walter , Aelami Mohammad Hasan , Pittet Didier
Published: February 2020

Background

Healthcare-associated infections (HAIs) challenge modern medicine. Considering their high prevalence in Iran, we aimed to provide knowledge on the subject, and to teach about the importance of infection prevention and control (IPC) to a broad audience of pre-graduate healthcare professionals, focusing on education as the cornerstone of IPC.

Main body

We invited Iranian medical students to present ideas on “how to reduce HAIs.” Projects were eligible if being original and addressing the call. Accepted projects were quality assessed using a scoring system. Forty-nine projects were submitted, of which 37 met the inclusion criteria. They had a mean score of 69.4 ± 18.3 out of the maximum possible score of 115. Four reviewers assessed the 37 projects for clinical applicability, impact on patient safety, and innovation, and selected the best 12 to compete at the 2nd International Congress on Prevention Strategies for Healthcare-associated Infections, Mashhad, Iran, 2018. The competition took place in three rounds. The selected teams presented their projects in the first round and debated one by one in a knockout manner, while the jury reviewed their scientific content and presentation skills. In the second round, the top 5 projects competed for reaching the final stage, in which the teams presented their ideas in front of a panel of international IPC experts to determine the first three ranks. At the end of the contest, the participants gained valuable criticisms on how to improve their ideas. Moreover, by its motivating atmosphere, the contest created an excellent opportunity to promote IPC in medical schools.

Conclusions

Using innovation contests in pre-graduates is an innovative education strategy. It sensitizes medical students to the challenges of IPC and antimicrobial resistance and drives them to think about solutions. By presenting and defending their innovations, they deepen their understanding on the topic and generate knowledge transfer in both ways, from students to teachers and vice versa.
Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis
Authors: Hemilä Harri , Chalker Elizabeth
Published: February 2020

Background

Our recent meta-analysis indicated that vitamin C may shorten the length of ICU stay and the duration of mechanical ventilation. Here we analyze modification of the vitamin C effect on ventilation time, by the control group ventilation time (which we used as a proxy for severity of disease in the patients of each trial).

Methods

We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials and reference lists of relevant publications. We included controlled trials in which the administration of vitamin C was the only difference between the study groups. We did not limit our search to randomized trials and did not require placebo control. We included all doses and all durations of vitamin C administration. One author extracted study characteristics and outcomes from the trial reports and entered the data in a spreadsheet. Both authors checked the data entered against the original reports. We used meta-regression to examine whether the vitamin C effect on ventilation time depends on the duration of ventilation in the control group.

Results

We identified nine potentially eligible trials, eight of which were included in the meta-analysis. We pooled the results of the eight trials, including 685 patients in total, and found that vitamin C shortened the length of mechanical ventilation on average by 14% (P = 0.00001). However, there was significant heterogeneity in the effect of vitamin C between the trials. Heterogeneity was fully explained by the ventilation time in the untreated control group. Vitamin C was most beneficial for patients with the longest ventilation, corresponding to the most severely ill patients. In five trials including 471 patients requiring ventilation for over 10 h, a dosage of 1–6 g/day of vitamin C shortened ventilation time on average by 25% (P < 0.0001).

Conclusions

We found strong evidence that vitamin C shortens the duration of mechanical ventilation, but the magnitude of the effect seems to depend on the duration of ventilation in the untreated control group. The level of baseline illness severity should be considered in further research. Different doses should be compared directly in future trials.
A simple rehabilitation regime improves functional outcome in patients with patellafemoral pain after 12 month
Authors: Nielsen Torsten Grønbech , Miller Lene Lindberg , Mygind-Klavsen Bjarne , Lind Martin
Published: February 2020

Purpose

The purpose of the present study was to investigate the effects of a 3-month multimodal intervention including patient education, a simple hip exercise program, footwear adjustment, and foot orthoses to reduce symptoms in patients with patellafemoral pain (PFP).

Methods

Patients were diagnosed based on a physical examination, patient symptoms and ruled out intra-articular knee pathologies by MRI. Patients were educated on PFP and participated in a 3-month exercise program; shoes with solid heel-caps were recommended, and custom made orthoses with arch support were recommended to patients with foot pronation. The Anterior Knee Pain Scale (AKPS) and the pain numeric rating scale (NRS) were used to evaluate the outcomes of the intervention and collected at baseline, 3 and 12-months follow-ups.

Results

Sixty-five patients (age 18 years (9–32)) were included in a consecutive prospective cohort. The AKPS score improved from 71 ± 24 to 89 ± 9 (p < 0.01) at 12 months follow up. The NRS-rest and NRS-activity improved from 3 to 0 (p < 0.01) and 7 to 3 (p < 0.01) respectively. 78% of the patients clinically improved (i.e., demonstrated a > 10-point improvement (minimal clinically important difference (MCID))) considering the AKPS; and 76% and 73% clinically improved (i.e., demonstrated (MCID) a ≥ 2-point improvement) in their NRS-rest and NRS-activity, respectively. No patients experienced a decrease in their AKPS score or an increase in their NRS-rest and NRS-activity scores at 12-months.

Conclusion

A 3-month PFP multimodal treatment strategy focusing on patient education, footwear adjustment, orthoses, and simple hip muscle exercises significantly improved functional outcomes and reduced pain at a 12 month follow-up.
Time-dependent effects of histone deacetylase inhibition in sepsis-associated acute kidney injury
Authors: Wen Xiaoyan , Li Shengnan , Frank Alicia , Chen Xiukai , Emlet David , Hukriede Neil A. , Kellum John A.
Published: February 2020

Background

Sepsis, a dysregulated host response to infection with results in organ dysfunction, has been a major challenge to the development of effective therapeutics. Sepsis-associated acute kidney injury (S-AKI) results in a 3–5-fold increase in the risk of hospital mortality compared to sepsis alone. The development of therapies to reverse S-AKI could therefore significantly affect sepsis outcomes. However, the translation of therapies from preclinical studies into humans requires model systems that recapitulate clinical scenarios and the development of renal fibrosis indicative of the transition from acute to chronic kidney disease.

Results

Here we characterized a murine model of S-AKI induced by abdominal sepsis developing into a chronic phenotype. We applied a small molecule histone deacetylase-8 inhibitor, UPHD186, and found that early treatment, beginning at 48 h post-sepsis, worsened renal outcome accompanied by decreasing mononuclear cell infiltration in the kidney, skewing cells into a pro-inflammatory phenotype, and increased pro-fibrotic gene expression, while delayed treatment, beginning at 96 h post-sepsis, after the acute inflammation in the kidney had subsided, resulted in improved survival and kidney histology presumably through promoting proliferation and inhibiting fibrosis.

Conclusions

These findings not only present a clinically relevant S-AKI model, but also introduce a timing dimension into S-AKI therapeutic interventions that delayed treatment with UPHD186 may enhance renal histologic repair. Our results provide novel insights into successful repair of kidney injury and sepsis therapy.
Hope, Despair, and Justice in Postwar European Culture:Bicycle Thieves,The Plague, andThe Man Outsideas Case Studies
Authors: Engel Amir
Published: February 2020

While there is growing interest in the postwar era, the cultural characteristics of the period after World War II and the period’s historical scope are still largely underdetermined. The purpose of this article is to offer a more nuanced use of the term postwar and insights into the cultural landscape of this enormously significant moment in the history of the West. To do so, it examines three major works of what is termed here the immediate postwar. These works are fundamentally dissimilar and yet, it is argued, share an emotional disposition. As shown, all three works exhibit a complex dialectical coupling of horror and anticipation. In other words, this article demonstrates that the cultural production of the postwar period (in the exact sense of the term) is characterized, on the one hand, by a sincere depiction of suffering and depravity but, on the other, by an intense engagement with questions about the moral and social future.
Too Soon and Too Late: The Problem of Archive Work in Christian Petzold’sPhoenix
Authors: Osborne Dora
Published: February 2020

Christian Petzold’s Phoenix (2014) is set in the immediate aftermath of World War II but dedicated to Fritz Bauer, the man credited with initiating the Frankfurt Auschwitz trials almost two decades later. In light of other recent films about Bauer, this article argues that Petzold’s dedication indicates the director’s interest in “archive work” as a fundamental task of “working through” the Nazi past (performed emblematically by Bauer). It considers Petzold’s return to Bauer’s archive work in conjunction with the former’s attempt to reconstruct an archive image for the film’s opening, an attempt Petzold eventually abandoned. In the postwar world of Phoenix, it is too soon to perform the reconstructive work undertaken by Bauer—here reconstruction has to do, rather, with erasure and forgetting. For contemporary memory work, meanwhile, all that remains are the material traces of the archive—Petzold must turn to this material but sees that its (re)mediatization in mainstream Holocaust cinema has obscured its relationship to the traumatic events at stake. This article shows how Petzold uses his film to describe the difficulties of working with the archive from the positions of prematurity and belatedness, indicating as he does so how both the recuperative and the effacing work of postwar reconstruction inflect the material legacy available to subsequent generations.
Estimating the contamination resulting from hypothetical nuclear accidents during nuclear emergency exercises
Authors: Synodinou B. M.
Published: February 2020

An assessment of the radiological contamination of Europe, following radioactive pollutant releases and using prognostic meteorological data is presented. A modified and simplified version of SHEAR code, a Lagrangian long-range transport and dispersion model, taking into account the wind shear effect, is used. This is possible by applying the diurnal differences in vertical mixing to the winds in the vertical layer used to calculate advection. In its present version the code takes account of dry deposition processes and different mixing heights for day and night conditions. Prognostic temperature and u, ν wind parameters every 6 hours for a total of 72, are provided by the National Meteorological Service of Greece in two levels 0 and 850 mb of pressure. The wind field is then calculated in both heights. This field forms an input to the SHEAR code. Plume direction and radioactive pollutant concentration have been calculated for hypothetical releases postulated during a recent ΝΕΑ/OECD exercise. The results of this study indicated that the code predicted well direction and concentration of the plume, in agreement with the predictions by other programs. Since the code in this version uses surface winds, at most, which are much weaker than the higher altitude winds used by other codes, the results of the plume spread are smaller in the present study. We believe that taking into account the surface winds during an eventual accident produces more realistic results. If predictions in more heights are available mixing heights would be calculated with greater accuracy, with consequent improvement of the results.
Shape Coexistence In The Neutron-Deficient Lead Isotopes, As Seen From Within Complimentary Models
Authors: Fossion Ruben , Lalazissis G. A.
Published: February 2020

In the neutron-deficient lead isotopes, at low excitation energies, the nucleus does not have one preferred excitation mode. Instead, three different coexisting "families" of excitation states are found in the excitation spectrum. Theoretical approaches are offered within the mean-field models (both relativistic and non-relativistic) and within the Interacting Boson Model (IBM). Recently, a third approach using bosoncoherent states has shown to offer a possible bridge between the former two approaches.
Measurement of Nuclear Lifetimes and B(E2) Values in 130Xe as a Test for E(5) Symmetry
Authors: Konstantinopoulos T. , Al. Et
Published: February 2020

As a continuation of the previous measurement in 128Xe [1], [2], [3], another E(5) candidate, 130Xe, has been studied through the novel experimental technique Coulex-plunger in inverse kinematics. The measurements have been undertaken at the JYFL accelerator facility in Jyvaskyl ̈a, Finland. For the purpose of this experiment the Cologne plunger was coupled to the JYFL cyclotron which delivered the 130Xe beam. Excited states in 130Xe were populated by the natFe(130Xe, 130Xe*) reaction at E(130Xe)=500 MeV and the subsequent de-excitations were detected in the JUROGAM γ-ray array. By applying the well known Differential Decay Curve Method (DDCM) [4], lifetimes of the 2^+_1 and 4^+_1 excited states were determined. In addition, since the investigated nucleus is excited through the Coulomb interaction, it is possible to perform a full Coulomb excitation analysis of the data using the computer code GOSIA [5] which will allow the determination of B(E2) values of the transitions up to the 6^+_1 excited state.
ТЕНДЕНЦИИ РАЗВИТИЯ ЭКОНОМИЧЕСКИХ ОТНОШЕНИЙ КРЕДИТНЫХ ОРГАНИЗАЦИЙ И ОРГАНИЗАЦИЙ ПРЕДПРИНИМАТЕЛЬСКОГО СЕКТОРА В УСЛОВИЯХ ЦИФРОВОЙ ЭКОНОМИКИ
Authors: Generalnitskaia Elena Igorevna
Published: February 2020

Состояние вопроса: в статье описаны перспективы влияния цифровизации отечественной экономики на ежегодный прирост отечественного ВВП, обоснована важность изучения экономических отношений между кредитными организациями и организациями предпринимательского сектора в условиях перехода к цифровой экономике как субъектов экономики, способных внести существенный вклад в повышение ВВП.Методы исследования: системные, структурные и сравнительные методы анализа, методы научной абстракции, а также специализированные методы экспертных оценок, построения графиков.Результаты исследования: были выделены 12 тенденций трансформации экономических отношений кредитных организаций и организаций предпринимательского сектора в условиях цифровой экономики, что позволило уточнить альтернативные возможности их интеграции в цифровую среду.Обсуждение: выделены альтернативные возможности развития экономических отношений кредитных организаций и организаций предпринимательского сектора в условиях цифровой экономики: основным каналом связи между кредитными организациями и организациями предпринимательского сектора является интернет; использование дистанционного банковского обслуживания организациями предпринимательского сектора, имеющими банковские счета; цифровая трансформация банковского сектора, создание новых банковских продуктов; рост доли цифрового взаимодействия между организациями предпринимательского сектора и кредитными организациями, в том числе расчетов в электронном виде.Заключение: представлена сравнительная характеристика уровня проникновения цифровых технологий в банковский сектор и предпринимательский сектор, сформулирован ключевой фактор для развития экономических отношений между ними.
АКТУАЛЬНЫЕ ПРОБЛЕМЫ ПЕРЕВОДА НАУЧНО-ТЕХНИЧЕСКИХ ТЕРМИНОВ НА МАТЕРИАЛЕ МНОГОТОМНОЙ БАШКИРСКОЙ ЭНЦИКЛОПЕДИИ НА БАШКИРСКОМ ЯЗЫКЕ
Authors: Kabirova Gulnaz Uralovna
Published: February 2020

Цель. В данной работе рассматриваются наиболее распространенные трудности, возникающие при переводе научно-технических терминов, а также пути достижения адекватности и эквивалентности перевода терминов с русского на башкирский язык при разработке многотомной энциклопедии на башкирском языке. В настоящее время особенности перевода технических терминов на башкирский язык изучены недостаточно: нет специальных словарей, глоссариев и т.д. Автор ставит целью изучить научно-технические термины и способы их перевода.Метод работы. В ходе исследования были использованы методы обобщения языковых фактов, сравнительный метод.Результаты. В процессе исследования были выявлены и проанализированы основные способы перевода технических терминов на башкирский язык: заимствование, калькирование, дословный и описательный перевод. Кроме того, были определены особенности применения каждого способа перевода. Был сделан вывод о необходимости комбинирования данных способов перевода.Область применения результатов. Результаты исследования могут быть применены при составлении терминологических словарей, при переводе технической документации на башкирский язык.
ЛЕКСИКА ГОСТЕПРИИМСТВА В РУССКОЙ ЯЗЫКОВОЙ КАРТИНЕ МИРА
Authors: Chirich Irina Viktorovna , Shtukareva Elena Borisovna
Published: February 2020

Актуальность исследования лексики гостеприимства связана с ее недостаточной изученностью, между тем как она отражает национальное самосознание, систему ценностей этноса, национальные качества и при этом переживает изменения.Цель исследования – выявить оттенки значения и особенности употребления лексики гостеприимства в современном русском языке.Методы исследования: описательно-аналитический, структурно-семантический, метод контекстологического анализа.Результаты. В статье рассмотрены слова, связанные с темой приглашения в гости, угощения и застолья (угощать, потчевать, питать, кормить, забегать на огонек, гулять, на чашку чая, с распростертыми объятиями и др.), уточнены их значения в сравнении с толкованием в лексикографической практике, прослежены исторические семантические сдвиги в значениях слов, изменения их сочетаемости на основе наблюдений за функционированием в речи (художественной, публицистической, в интернет-общении). Результаты исследования могут быть применимы при составлении толковых словарей и в переводческой практике, в преподавании лексикологии и лингвокультурологии.
Attitudes of Portuguese nursing undergraduate students toward suicidal behaviour
Authors: Vedana Kelly Graziani Giacchero , dos Santos José Carlos , Zanetti Ana Carolina Guidorizzi , Miasso Adriana Inocenti , Ventura Carla Aparecida Arena , Pillon Sandra Cristina , de Souza Jacqueline , Silva Aline Conceição
Published: February 2020

Background/Aims

The attitudes toward suicidal behaviour and related factors are still not understood and may influence the quality of assistance. The attitudes of nursing students regarding suicide and associated factors was investigated in this study.

Methods

A cross-sectional study was carried out with 351 nursing students in a Portuguese higher education institution. Data were collected in 2017–2018, using a self-administered sociodemographic questionnaire and the Suicide Behaviour Attitude Questionnaire. Statistical analyses included Mann–Whitney's U-test, Student's t-test and Spearman's correlation.

Results

The students had more educational exposure to suicide during the undergraduate course than in extracurricular activities or interpersonal contact. Students nearing the end of the course and older students had more positive attitudes and greater perception of their professional competence. Negative attitudes were associated with condemnatory attitudes and a lower self-perception of professional competence. Condemnatory attitudes were associated with participation in scientific events. Suicidal thoughts were associated with reading about suicide and not attending a class about this subject.

Conclusions

This study promotes knowledge that may support future investigations and interventions regarding provisional education and support to nursing students.
How to have the ‘ideal’ Down syndrome screening discussion at antenatal appointments
Authors: John Sophie , Kirk Maggie , Tonkin Emma , Stuart-Hamilton Ian
Published: February 2020

This is the fourth in a series of papers. The previous papers inform midwifery practice by providing insight into whether, to what extent and how cognitive status influences understanding of Down syndrome screening information, the importance of tailoring information, and highlighting areas of communication that are effective in facilitating understanding. These findings led to the development of recommendations to inform a ‘best practice’ model for midwifery communication of screening information within a conceptual framework that recognises the importance of accurate facts, empathic communication and support for decision-making in a woman-centred approach. These recommendations may have wider relevance beyond midwife communication of Down syndrome screening and may impact upon the communication of other screening information provided within antenatal and neonatal screening. It is important that screening information is communicated effectively in light of changes to screening programmes, such as the introduction of non-invasive prenatal testing.
Photo-mineralization of azo dye reactive yellow 145 in aqueous medium by TiO2-coated non-woven fibres
Authors: Alahiane Said , Sennaoui Asma , Sakr Fatima , Dinne Mohamed , Qourzal Samir , Assabbane Ali
Published: February 2020

This study aims the degradation of the Reactive Yellow 145 dye (RY 145), chosen as a model molecule in aqueous solution. Photocatalytic experiments have been conducted at ambient temperature in a lab-scale batch reactor, operating with TiO2 catalyst supported on paper in an aqueous medium. The ultraviolet irradiation was provided by using an artificial source. The evolution of the pollutant concentration has been followed over time by spectrophotometry and high-performance liquid chromatography (HPLC). The Mineralization and identification of reactive intermediates products were also studied. The results obtained indicate that TiO2 has the most interesting photocatalytic properties and that the measurement of the Chemical Oxygen Demand (COD) has an important abatement of the organic load of an order of 89.13%. The identification of photoproducts helped to better understand the mechanism of the molecule attack by hydroxyl radicals.
Temporal imaging for ultra-narrowband few-photon states of light
Authors: Mazelanik Mateusz , Leszczyński Adam , Lipka Michał , Parniak Michał , Wasilewski Wojciech
Published: February 2020

Plenty of quantum information protocols are enabled by manipulation and detection of photonic spectro-temporal degrees of freedom via light–matter interfaces. While present implementations are well suited for high-bandwidth photon sources such as quantum dots, they lack the high resolution required for intrinsically narrowband light–atom interactions. Here, we demonstrate far-field temporal imaging based on ac-Stark spatial spin-wave phase manipulation in a multimode gradient echo memory. We achieve a spectral resolution of 20 kHz with MHz-level bandwidth and an ultralow noise equivalent to 0.023 photons, enabling operation in the single-quantum regime.
Inverse design of digital nanophotonic devices using the adjoint method
Authors: Wang Kaiyuan , Ren Xinshu , Chang Weijie , Lu Longhui , Liu Deming , Zhang Minming
Published: February 2020

A high-efficiency inverse design of “digital” subwavelength nanophotonic devices using the adjoint method is proposed. We design a single-mode 3 dB power divider and a dual-mode demultiplexer to demonstrate the efficiency of the proposed inverse design approach, called the digitized adjoint method, for single- and dual-object optimization, respectively. The optimization comprises three stages: 1) continuous variation for an “analog” pattern; 2) forced permittivity biasing for a “quasi-digital” pattern; and 3) a multilevel digital pattern. Compared with the conventional brute-force method, the proposed method can improve design efficiency by about five times, and the performance optimization can reach approximately the same level. The method takes advantages of adjoint sensitivity analysis and digital subwavelength structure and creates a new way for the efficient and high-performance design of compact digital subwavelength nanophotonic devices, which could overcome the efficiency bottleneck of the brute-force method, which is restricted by the number of pixels of a digital pattern, and improve the device performance by extending a conventional binary pattern to a multilevel one.
Entscheidungen, Entscheidungsfindung und Entscheidungsunterstützung in der Immobilienwirtschaft: Eine systematische Literaturübersicht
Authors: Krieger Patrick , Lausberg Carsten
Published: February 2020

Dieser Artikel untersucht den Stand der immobilienwirtschaftlichen Forschung zu menschlichen Entscheidungen und Entscheidungsunterstützungssystemen (EUS). Er baut auf einer systematischen Literaturrecherche auf, die die Entwicklung der Forschung, untersuchte immobilienwirtschaftliche Felder, angewendete Methoden, Verbindungen zu anderen Disziplinen sowie favorisierte Zeitschriften identifiziert. Es werden Problemstrukturen aufgezeigt, die auf drei Bereiche verdichtet werden können: (1) Die primäre Forschungsleistung fließt in die Bereiche Investitionen und Bewertung. Andere immobilienwirtschaftliche Disziplinen sind bisher unterrepräsentiert. (2) Ein Wissenstransfer zwischen der verhaltensorientierten Immobilienforschung und der Informatik ist kaum zu beobachten. Insgesamt scheint die Forschung über immobilienwirtschaftliche Entscheidungsunterstützungssysteme noch am Anfang zu stehen. (3) Der in der Immobilienwirtschaft vorherrschende Risikobegriff ist unzureichend und muss um eine psychologische Dimension erweitert werden, um sein Potential für immobilienwirtschaftliche EUS-Anwendungen entfalten zu können.
ENSURING THE OPERATIONAL SURVIVABILITY OF THE AIRFRAME DESIGN
Authors: Popov Yu. I. , Serebryanskiy S. A. , Maisak M. V.
Published: February 2020

The article deals with the issues of ensuring the operational survivability of the airframe design of the aircraft during the design and operation stages. The distribution of incidents by types and sources of accidental damage is presented. The statistical data obtained as a result of the analysis of incidents related to structural damage characterizing the degree of a damaging factor danger are given. The analysis of factors affecting the structure safety is given. An approach to operational survivability schemes formation is discussed.
The Oncologist's Duty to Provide Hope: Fact or Fiction?
Authors: Wein Simon
Published: February 2020

Overview:

There are many sources of conflict in oncology. Conflicts arise because there are numerous therapeutic options, each of which is imperfect, and these conflicts produce ethical dilemmas. A recent American Medical Association (AMA) publication outlined the principles of medical ethics for managing conflicts. Common conflicts in oncology include whether to resuscitate, to give more chemotherapy, and how much truth to tell. These conflicts are magnified because of the life and death scenario of advanced cancer. Denial, avoidance, and hope are psychologic mechanisms that enable adaptation to the life-threatening circumstances. Hope is widely written about though poorly understood and defined. Ethical statements regarding its virtue and importance to preserve are frequently given. In an effort to progress the understanding of hope, two critical features are defined: (1) hope as a thought process only exists in the future, and (2) hope is only ever associated with positive and good thoughts. The future is unknown and uncertain; therefore, hoping can be manipulated by presenting statistics in a way to boost hoping. Thus a dilemma and specific ethical responsibility falls on oncologists when discussing conflicts. Furthermore, since hope is a subjective assessment of a possibility that is considered “good” by the hoper, it cannot be perceived as “false.” “False hope” is an erroneous assessment. Finally, this article introduces the concept that there might be a role to stop hoping—since hope of the future is also filled with doubt and fear—and instead live in the present and try to find joy and meaning today.
Multidisciplinary Management of Thymic Carcinoma
Authors: Riely Gregory J. , Huang James , Rimner Andreas
Published: February 2020

Overview:

Thymic carcinomas represent approximately 10% of thymic tumors. In our approach to patients with thymic carcinoma, we emphasize multimodality treatment with close communication between the pathologist, thoracic surgeon, medical oncologist, and radiation oncologist. Given the paucity of high-quality clinical research data, treatment decisions are guided by a small amount of prospective trial data, retrospective reports, and clinical experience. Surgical management of thymic carcinoma must account for the more aggressive biology, higher degree of local invasion of neighboring structures, greater propensity for nodal metastasis, and higher risk of distant metastatic disease. Although surgical resection remains the most important component in the management of localized thymic tumors, radiation therapy (RT) may be used as adjuvant therapy after surgical resection or as the definitive treatment modality in patients who are deemed unresectable because of medical comorbidities or technical reasons. Systemic therapy for thymic carcinoma is used in two clinical scenarios: preoperative treatment and palliative therapy. First-line, platinum-based chemotherapy regimens are associated with response rates between 22% and 75%. Recent data from targeted therapy trials do not reveal a clear role for targeted therapies for patients with thymic carcinoma.
Lung Cancer in Brazil
Authors: Schwartsmann Gilberto
Published: February 2020

Overview:

Cancer is now the second leading cause of death in Brazil (after cardiovascular diseases) and a public health problem, with around 500,000 new cases in 2012. Excluding nonmelanoma skin cancer, lung cancer is the second most incident cancer type in men, with 17,210 expected new cases. In women, it is the fifth most incident cancer, with 10,110 expected new cases. The estimated age-adjusted lung cancer mortality rate is about 13/100,000 for men and 5.4/100,000 for women. Lung cancer rates in men increased until the early 1990s and decreased thereafter, especially in the younger population. In contrast, a steady upward trend was observed for women. The positive effects in men were probably due to the successful anti-tobacco campaign conducted in Brazil over the last decades, which led to a decrease in the adult smoking population, from 32% in the early 1980s to 17% in the 2000s. Although the Brazilian National Cancer Institute is strongly committed to providing excellence in multimodality care to cancer patients, limitations in availability and adequate geographic distribution of specialists and well-equipped cancer centers are evident. Major disparities in patient access to proper staging and state-of-the-art treatment still exist. Considering that World Health Organization (WHO) officials estimate that cancer will become the number one cause of death in most developing countries, including Brazil, in the next decades, it is highly recommended for government authorities to implement firm actions to face this tremendous challenge.
Short- and Long-term Cardiovascular Complications of Cancer Treatment: Overview for the Practicing Oncologist
Authors: Shenoy Chetan , Kimmick Gretchen
Published: February 2020

Overview:

As new therapies improve survival from cancer, attention to comorbid illness and complications of therapy—both short- and long-term—become much more important to improving not only quality of life but also overall survival. Recognized for its importance as the leading cause of death in the United States, heart disease often coexists with cancer, and cancer treatment may increase risk and/or severity. In addition, there are well-recognized cardiovascular toxicities of cancer treatment, including not only cardiomyopathy, but also hypertension, hypercholesterolemia, and others. Oncologists and cardiologists are working closely to learn more about the complex interaction and to improve management and outcome for patients.
Establishing the Standard of Care for Patients with Newly Diagnosed and Recurrent Glioblastoma
Authors: Gilbert Mark R.
Published: February 2020

Overview:

The current standard of care for patients with newly diagnosed glioblastoma includes maximal safe tumor resection followed by concurrent external-beam radiation with daily low-dose temozolomide followed by 6 to 12 months of adjuvant temozolomide, typically by using a cycle of 5 consecutive days out of 28. Efforts to improve on these results from the European Organisation for Research and Treatment of Cancer (EORTC)/National Cancer Institute of Canada (NCIC) trial using either dose-dense chemotherapy strategies or combinations with signal transduction modulators have, to date, been unsuccessful. Two large international randomized trials examining the efficacy of adding bevacizumab, an antiangiogenic agent, to the standard treatment have been completed, with expectations of results within in the next 2 years. For recurrent glioblastoma, there are no firmly established standards of care. Although intracavitary insertion of carmustine-impregnated polymers has been approved by the U.S. Food and Drug Administration (FDA), this strategy is not widely used. Bevacizumab has been FDA approved for recurrent glioblastoma, but no randomized trial has clearly demonstrated a survival benefit. Alternative dosing schedules of temozolomide (i.e., metronomic) has modest activity even in patients with prior temozolomide exposure. Clinical trials testing small-molecule signal transduction modulators have been disappointing, although most report a small response rate, suggesting that molecularly definable tumor subpopulations may help guide treatment decisions. Successful implementation of marker-based treatment would lead to personalized care and the creation of individualized standards of care.
Update of the Oxford Overview: New Insight and Perspectives in the Era of Personalized Medicine
Authors: Pritchard Kathleen I. , Bergh Jonas , Burstein Harold J.
Published: February 2020

Overview:

There is great appreciation for the heterogeneity of breast cancers, particularly of hormone-receptor positive breast cancers. A goal of modern oncology managing such heterogeneity is to determine how to individualize therapy based on the specific pathological and biological features of a given tumor. Two distinctive clinical literatures exist to guide treatment of hormone-receptor-positive breast cancer. The Oxford Overview, a seminal meta-analysis effort, has recently been updated, and suggests that nearly all patients with ER-positive tumors benefit from adjuvant endocrine therapy. In addition, the overview finds that nearly all subsets of patients with ER-positive tumors also benefit from modern adjuvant chemotherapy regimens. Meanwhile, retrospective subset analyses of specific trials or populations suggests that the benefits of chemotherapy are not so uniform, and in particular that molecular diagnostics assays can identify patients who do not warrant chemotherapy. This article will highlight recent data and controversies in personalizing adjuvant breast cancer therapy.
New Developments in Urothelial Cancer
Authors: Galsky Matthew D.
Published: February 2020

Overview:

Urothelial cancer is among the most chemotherapy-sensitive neoplasms of all the solid tumors. However, for the majority of patients with advanced disease, response durations with conventional treatment are relatively short. Second-line systemic treatment regimens are associated with modest response rates and poor outcomes. Trials in both the first- and second-line settings have demonstrated that a ceiling in efficacy has likely been reached with cytotoxic drugs, particularly in unselected patient populations. Promising areas of investigation include integrating predictive biomarkers to optimize patient selection for specific therapies, disrupting driving oncogenomic mutations, and associated signaling pathways and cotargeting both tumor and the immune system or tumor stroma. In addition, expanded sources of evidence generation are of interest in an effort to refine treatment for the general population of patients with advanced urothelial cancer, not only those who meet the narrow eligibility criteria used in most clinical trials.
New Insights in Cross-Cultural Communication
Authors: Schapira Lidia
Published: February 2020

Overview:

Improving clinician-patient communication, improving clinical decision making, and eliminating mistrust have been identified as three key areas for reducing disparities in care. An important step is the training of cancer professionals to deliver culturally competent care in clinical settings as well as increasing the proportion of underrepresented minorities in the health care workforce. Providing care that is attuned to the patient's cultural preferences begins by talking to the patient about his or her cultural history and identifying the locus of decision making, preferences for disclosure of vital health information, and goals of care. Patients with low literacy and those with poor fluency of the dominant language require additional services. Language interpretation by trained professionals is fundamental to ensure that patients are able to provide informed consent for treatment. A working definition of culture involves multiple dimensions and levels and must be viewed as both dynamic and adaptive, rather than simply as a collection of beliefs and values. Effective cross-cultural education avoids stereotyping and promotes communication and negotiation to solve problems and minimize tension and conflict. Recent research has identified that unconscious biases held by clinicians affect their behavior and recommendations for treatment.
Thymoma: From Chemotherapy to Targeted Therapy
Authors: Girard Nicolas
Published: February 2020

Overview:

Thymic malignancies are rare epithelial tumors that may be aggressive and difficult to treat. Thymomas are frequently eligible for upfront surgical resection. However, nearly 30% of patients present with locally advanced tumor at time of diagnosis, and chemotherapy is then used to reduce the tumor burden—possibly allowing subsequent surgery and/or radiotherapy. Metastatic and recurrent thymic malignancies may be similarly treated with chemotherapy. More recently, the molecular characterization of thymoma led to the identification of potentially druggable targets, laying the foundation to implement personalized medicine for patients.
Important Early Advances in Squamous Cell Carcinoma of the Head and Neck
Authors: Bissada Eric , Brana Irene , Siu Lillian L.
Published: February 2020

Overview:

Therapeutic advances in squamous cell carcinomas of the head and neck (SCCHN) are attained by improvement in locoregional and/or distant disease control, as well as by reduction in treatment-related morbidity—especially long-term complications affecting normal organ functions and quality of life. New technological innovations in surgical management, such as transoral robotic surgery (TORS), and in radiotherapy (RT), such as proton and carbon ion therapy, bring promises of equal or superior efficacy outcomes coupled with the potential to minimize normal tissue toxicity. Scientific insights in the systemic treatment of SCCHN, such as novel approaches to overcome epidermal growth factor receptor (EGFR) resistance, may enable more effective molecular targeting in SCCHN beyond the current armamentarium of available agents. An overarching theme of these early multidisciplinary advances is to enable the delivery of precision-based therapeutic regimens from both the technical and scientific perspectives. Rigorous clinical trial evaluations are necessary to help define their roles in practice.
Upfront Therapy for Myeloma: Tailoring Therapy across the Disease Spectrum
Authors: Rajkumar S. Vincent
Published: February 2020

Overview:

The treatment of multiple myeloma is evolving rapidly. Despite the number of regimens and combinations available, there is lack of data from phase III trials demonstrating superiority of one regimen over the other in terms of overall survival and/or quality of life. The only clear survival signals have come from studies that compared newer regimens with historic ones such as melphalan-prednisone (MP) or vincristine-doxorubicin hydrochloride-thalidomide (VAD). Thus, the choice of therapy at present is often made based on physician discretion, bias, and limited data from phase II studies. Further, the regimens available have considerably different profiles in terms of safety, convenience, and cost. Given the dramatic variations in expected outcome depending on the various known prognostic factors, a risk-adapted strategy is required to provide the best available therapy to each patient based on host factors as well as prognostic markers of disease aggressiveness. This article reviews the current status of myeloma therapy and risk stratification. Results from major phase III trials are reviewed, and a risk-adapted individualized approach to therapy is presented and discussed.
What Is the Best First-Line Treatment Strategy for Patients with Indolent Lymphomas?
Authors: Salles Gilles , Ghesquières Hervé , Bachy Emmanuel
Published: February 2020

Overview:

Although advanced follicular lymphoma is considered incurable, patient outcomes have improved over the last decade with the use of anti-CD20 monoclonal antibodies. Multiple treatment options are available and their use depends on clinical presentation (i.e., Ann Arbor stage, tumor burden, symptoms) and patient condition and age. Radiation therapy for patients with limited stage disease remains useful, although its use in the era of anti-CD20 antibodies should be re-evaluated. Single-agent rituximab has been tested in multiple studies with patients with low tumor burden. Short treatment duration provides a response lasting 2 to 3 years, although the benefit of maintenance therapy with rituximab after induction therapy with rituximab remains unproven. When watchful waiting is not an option, a combination of rituximab with chemotherapy is the standard of care: alkylating agents with anthracycline or bendamustine appear to be the most widely used regimens, but alkylating agents alone may still be used in selected patients subgroups. The toxicity of regimens containing fludarabine appears to limit their indication as first-line treatment. In patients responding to one of these combinations, consolidation therapy with rituximab maintenance has been shown to prolong progression-free survival with acceptable toxicity. The benefit of radioimmunotherapy in first-line treatment is still uncertain. With patients surviving for many years, the therapeutic strategy of first-line management should weigh the quality and duration of response against the risk of long-term toxicities.
Preventing Errors in Oncology: Perspective of a Physician Who Is Also a Cancer Patient
Authors: Brook Itzhak
Published: February 2020

Overview:

This article presents my personal experiences as a physician who underwent laryngectomy for hypopharyngeal squamous cell carcinoma. I describe the numerous medical and surgical errors that occurred during my hospitalization at three different medical centers. It is my hope that my presentation will contribute to the reduction of such errors and lead to a safer hospital environment for patients.
A Critical Review of the Enrollment of Black Patients in Cancer Clinical Trials
Authors: Banda Deliya R. , Germain Diane St. , McCaskill-Stevens Worta , Ford Jean G. , Swain Sandra M.
Published: February 2020

Overview:

Although clinical trials represent a vital opportunity for improvements in cancer treatment, data show that a small proportion of patients with newly diagnosed cancer participate in clinical research. Black patients continue to have a worse prognosis for most cancers compared with other patients of other races/ethnicities. Racial/ethnic- and age-related disparities in clinical trial accrual are also well documented. The recruitment and retention of minorities in these trials present an even greater challenge despite regulatory efforts and initiatives to increase representation. Treatment data from homogenous populations prevent us from understanding therapeutic response and the true safety profile of novel therapies. Patient-, physician-, and system-level factors that affect trial participation have been extensively studied. However, years of accrual data remain largely unchanged, suggesting the challenge lies in effectively addressing these factors. Furthermore, data showing that black patients tend to have more advanced stage cancers at the time of diagnosis in fact beg their overrepresentation on clinical trials. An inability to successfully enroll diverse populations in clinical trials only exacerbates racial/ethnic differences in cancer treatment and survivorship.
Mechanisms of Resistance to RAF Inhibition in Melanomas Harboring a BRAF Mutation
Authors: Chapman Paul B.
Published: February 2020

Treatment of V600E/K BRAF-mutated melanomas with RAF inhibitors (either vemurafenib or dabrafenib) results in rapid and dramatic responses in most patients—results that are associated with improved progression-free survival (PFS) and in the case of vemurafenib, overall survival (OS). However, resistance develops at a median time of approximately 6 months. Understanding the mechanisms of resistance is critical to develop strategies to prolong PFS and OS. Negative feedback mechanisms inherent in the MAPK pathway serve to modulate responses to these drugs. However, genetic changes develop within the tumor, which lead to reactivation of the MAPK and resistance to these drugs. The mechanisms that have been demonstrated in many patients by multiple investigators are (1) development of an activating mutation in NRAS, and (2) appearance of a BRAFV600E splice variant that encourages RAF dimerization. Several other mechanisms of resistance have also been described in individual patients or in preclinical models of resistance. In addition, there is evidence that activation of parallel pathways, such as the PI3K/AKT pathway, may represent another mechanism of resistance. Understanding the various mechanisms of resistance will inform our attempts to prevent resistance to RAF inhibitors.