Boards Of Institutions Research Articles

Medical specialty distribution in China, 2009–17: a longitudinal examination

BackgroundChina's practitioners are responsible for serving the most populous country in the world. Despite the pronounced shortages of areas, such as general practice and paediatrics, little is known about the discrepancies between supply and demand in each specialty. We aimed to examine China's supply of and demand for health care since 2009 to gain an understanding of the progress that reforms have brought about. MethodsWe analysed distribution data regarding licensed medical practitioners and patient visits for all clinical departments between 2009 and 2017 using annual reports and yearbooks provided by the Chinese National Health and Family Planning Commission, which are published by the government of China and the Peking Union Medical College. The institutional review board of the principal investigator's institution approved this study. FindingsFrom 2009 to 2017, the number of registered practicing physicians increased by 48·5%. Inpatient hospitalisations increased by 98·2%, and outpatient visits increased by 69·4%. Internal medicine had a 64·5% inpatient demand–supply gap in growth rate (DSG) and a 6·5% outpatient DSG. For all specialties, negative inpatient DSGs were found in general practice (–36·8%), preventive medicine (–30·5%), stomatology (–12·1%), and aesthetic medicine (–11·9%); negative outpatient DSG was only found in stomatology (–7·6%). General practice has −41·3% outpatient DSG at the hospital level, suggesting patients in need of general practice might no longer go to hospitals, instead favouring more convenient primary care near home. InterpretationA major goal of China's 2009 reforms was to improve the quality of service during primary care visits. Although between 2009 and 2017 most of the departments' growth rates in physician quantity were slower than those of the patients', China's efforts to train more general practices at primary care institutions over this period has so far been an effective means of promoting equal access to health care. FundingRepublic of China Ministry of Science and Technology (MOST 105-2629-S-010-001).

Abstract 5251: STAT1 and miR155 expression in human prostate cancer tissue

Abstract Background: Transcription factors (TFs) and microRNAs (miRNAs) form a gene regulatory network at transcriptional and posttranscriptional level. Increasing evidence shows that miRNAs regulates molecular pathways in cancer by targeting various oncogenes and tumor suppressor genes. However, the mutual regulations between TFs and miRNAs in cancer cells have not been well characterized. Signal transducer and activator of transcription 1 (STAT1) has been reported as a tumor suppressor, but recent evidence suggests that may also play a tumor-promoting role. An STAT1-miR155 feedback loop has been identified in normal tissues. We aimed to explore the STAT1 and miR155 expression in prostate cancer by a bioinformatics analysis combined with immunohistochemical evaluation of STAT1 in normal and prostate cancer tissues. Design: The expression of miR155 was explored in the dbDEMC2 database of Differentially Expressed miRNAs in Human Cancers. Potential targets of this miRNA were searched in the microRNA-target interactions database (miRTarBase), and STAT1 was selected. The protein expression level of STAT1 was analyzed in normal and tumor tissues, from the TCGA databases, by GEPIA bioinformatics tools; and by immunohistochemistry in a prostate tissue microarray (TMA), constructed from prostatectomy samples of patients with localized prostate cancer (PCa), including representative areas from PCa and benign prostate tissue (BPT). Immunohistochemical expression of STAT1 was evaluated by two pathologists, an H-score was obtained for each spot by microscopic assessment of the percentage of epithelial cells with positive staining. Differences in STAT1 expression were assessed by comparing H-Scores between BPT and PCa tissues using Mann-Whitney test, a p value less than 0.05 was considered statistically significant. The Ethical Review Board of the academic institution approved this study. Results: The analysis of miR155 and STAT1 expression in the Genome Cancer Atlas Database showed that both are overexpressed in a variety of tumors including prostate cancer. STAT1 expression at protein level was evaluated in 143 tissue cores representing PCa, and 78 tissue cores representing BPT. Mean STAT1 expression in cores with PCa, was significantly higher than mean of STAT1 expression in cores with BPT (p less than 0.0001). There was a higher mean staining score in PCa (210, 95% CI: 196,1-227,8), compared to BPT (105,5, 95% CI: 87,1-123,9). STAT1 staining was present predominantly in the cytoplasm, also in the membrane and nucleus, of prostate cancer tumor cells. Conclusions: Although miR155 and STAT1 are supposed to be involved in a negative auto-regulatory feedback mechanism, they were both found overexpressed in most of the prostate cancer tissues, which could be explained by the loss of the regulatory feedback loop equilibrium in the tumor environment. Additional studies to detect the in situ expression of miR155 are in progress to validate these results. Citation Format: Ines Benedetti, Lia Barrios Garcia, Juan Rebollo. STAT1 and miR155 expression in human prostate cancer tissue [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5251.

Enhancing the Competence and Effectiveness of Shar¯ı‘ah Advisory Boards: Case of Islamic Banking Institutions in Pakistan

The objective of this paper is to make an assessment of the competence of the members of Shar¯ı‘ah Boards of the Islamic Banking Institutions (IBIs) in terms of enabling and ensuring Shar¯ı‘ah compliance of banks business. The competency of Shar¯ı‘ah board members is considered as a critical issue in the State Banks Shar¯ı‘ah Governance Framework (SGF), which considers degree from any Waf ¯aq al-Mad¯aris as the basic qualification for their appointment. The paper investigates into the curricula of mad¯aris (religious schools) in Pakistan and orientation of the mad¯aris graduates for understanding increasingly innovative banking and finance operations. It also analyzes the syllabubs of the specialization/takhas. s.us. f¯ı al-fiqh/takhas. s.us. f¯ı al-ift¯a in the mad¯aris. Some pragmatic recommendations have been made to enhance the expertise of the Shar¯ı‘ah board members in the light of SBPs Fit & Proper criteria. This is a pioneer study discussing the scheme of studies in Pakistani mad¯aris and provides a basis for further research on this area.

Derechos políticos de las mujeres: una incipiente acción afirmativa en Costa Rica

Este artículo analiza la discusión política y periodística que suscitó una moción presentada en la Asamblea Legislativa de Costa Rica, en 1954, que pretendía que se dispusiera por Ley, un puesto de cinco posibles, para una mujer en la junta directiva de una institución autónoma. Aunque para entonces, la Constitución Política amparaba el derecho de las costarricenses de ocupar cargos públicos, en el plenario legislativo salieron a la luz argumentos estereotipados que impidieron que esa propuesta se concretara. Se recurrió al análisis crítico del discurso como principal herramienta metodológica. Los ejemplares de Diario de Costa Rica y La República constituyen la fuente primaria del presente estudio, con su elección se buscó obtener una perspectiva equilibrada de los eventos debido a que la polarización política de la época, se trasladó a la prensa. El corpus lo conforman noticias, crónicas y entrevistas efectuadas a diputadas y diputados. También se analizaron las actas de las sesiones de la Asamblea Legislativa. En el curso de la investigación se identificó la creencia de que la aprobación de la ciudadanía en la Constitución Política (1949) garantizaría el acceso de las mujeres, de manera inmediata y sin restricciones, a cargos de alta responsabilidad. Este argumento obstaculizó por décadas el acceso efectivo de mujeres a puestos de decisión política. El artículo denomina la moción presentada por el diputado Echandi Jiménez como “una incipiente acción afirmativa”, debido a que constituye un precedente de lo que se conocerían como acciones de discriminación positiva a finales del siglo XX.

Gender diversity and firm value: evidence from UK financial institutions

PurposeThe purpose of this paper is, first, to empirically examine whether the appointment of females (board gender diversity) to the corporate boards of UK financial institutions can improve firm value, and second, to examine whether having females on the boards of UK financial institutions can impact firm value during the pre-/post-global financial crisis periods.Design/methodology/approachThe paper uses secondary data obtained from DataStream covering 63 financial institutions over a period of 12 years. A number of additional statistical estimations, including random effects and fixed effects, are conducted to test the robustness of the findings.FindingsThe outcome of this empirical research shows that the presence of females on the corporate boards of UK financial institutions has a positive and statistically significant relationship with firm value. The authors’ evidence reveals a positive and statistically significant impact on the firm’s value prior to the financial crisis, that is, during the pre-crisis period (2000-2006), meaning that women contributed significantly to the firm’s value. However, after the financial crisis, the presence of females on the board had no significant effect on the firm’s value. A reasonable explanation may be that, whilst the financial crisis was over in the period 2009-2011, the entire UK economy was still experiencing an economic downturn, and financial firms were no exception, irrespective of whether there was female representation on any corporate board. Overall, the findings are consistent with the prior studies.Practical implicationsThe results have practical implications for governments, policy-makers and regulatory authorities, by indicating the importance of women to corporate success.Originality/valueDespite several research projects on board gender diversity (BGD), this research is unique compared to the previous empirical studies, primarily because it is the first-time research of this nature is empirically ascertaining BGD and firm value in UK financial institutions, also during the pre-/post-financial crisis era. This paper contributes to the corporate governance literature by offering new insights on board diversity and firms’ value relationship. Overall, the results help fill any gaps on gender diversity and firm value in UK financial institutions.

DIFFERENT BRANCHES OF GLOBAL ACCOUNTING AND ACCOUNTANTS RESPONSIBILITIES: A STUDY IN BRIEF SPECTRUM

Modern organizations are increasingly becoming more complex whether it is sole proprietorships, partnerships or Limited Liability Companies (LLC) (and in many cases global) thereby engendering the need for complete, transparent, reliable and accurate information that can be accessed quickly by the assistance of different branches of global professional accountants such as Certified Professional Accountant, Chartered Accountant, Certified Public Accountant, Management Accountant, Cost Accountant, Financial Accountant, General Accountant, Auditor, Tax Accountant, CA, CPA, CMA, CIMA, CFA, CFO, ICPA and so on. Internationally most large business organizations are well organized by a broad and disparate set of shareholders. These shareholders require the information i.e. quantitative (financial) and qualitative (non-financial) relating to their various organizations in order to make ongoing decisions through financially like dividend or non-financially or strategic decisions – which can range from deciding to invest more and hold more shares, sell off part or all of their holdings, take critical decision on the management and boards of the financial institutions and banks etc. Besides, other stakeholders need the information to make decisions relating to lending, taxation, employee benefits and remuneration. It is essential that the quality of decisions that investors can make is largely dependent on the reliable and quality of information available to them. However, one thing that is common to all organizations is that the accountant plays a pivotal role towards the successful achievement of their strategic objectives by ensuring that the critical ingredient required for decision making is prepared and presented in the required format.

Inicjatywy opiekuńcze i oświatowo-wychowawcze łódzkiej społeczności żydowskiej w latach I wojny światowej – Przytulisko dla Dzieci Wyznania Mojżeszowego

In 1914–1918, the Łódź Jewish community organized activities for children and teenagers in more than ten social and charitable organizations and institutions. Some of them were established even before 1914, some were opened during WWI. The Shelter for Jewish Children was among the centres operating during the difficult war times and dating back to the time before the Great War. The Shelter was established on the initiative of Sara Poznańska, wife of Maurycy Poznański, a prominent Jewish industrialist and social activist in Łódź. Members of the Board of the new institution included rich, middle class Jewish women, factory owners and merchants. In 1917, they were joined by S. Poznańska as President, Maria Hertzowa as Vice-President, Stefania Hirszbergowa as Treasurer and Paweł Becker as Secretary of the Board. Several sections were identified in the Shelter with different functions in mind: the Pedagogical, Medical, Food, Maintenance, and Clothes Sections. The task of the Pedagogical section was care for the intellectual and physical development of the children. Efforts were made to propagate Polish issues in education (the children were taught history and the Polish language). The Medical Section focused on hygiene and the children’s health. The Food Section prepared hot meals, i.e. dinners and breakfasts. The Maintenance Section’s responsibility was to develop a sense of cleanliness and order in the children. The Clothes Section put an emphasis on maintaining the children’s clothes in order, mainly by mending them. During WWI, the Shelter took care of over 200 pre-school and school children (aged 4–12).

Board gender diversity and the capital structure of microfinance institutions: A global analysis

As far as we know, the question of whether increasing gender diversity on boards of microfinance institutions carries any implications for their financing decisions has not been answered. To answer this question, we employ a global dataset from 441 microfinance institutions located in 69 countries to investigate the effect of board gender diversity on capital structure. A robust negative and statistically significant effect of board gender diversity on capital structure is produced by the three panel regression estimation techniques used in this paper. Our conclusion is that board gender diversity is a significant driver of MFI’s capital structure and that it decreases the gearing levels of MFIs and, by extension, lowers their exposure to bankruptcy risk.

Implementation of Management Standards (Case Study of Management Standards in Accreditation Assessment at PKBM Sejahtera Pontianak East Institute)

<p>This study aims to reveal information relating to (1) the leadership profile of the head of the management of the Community Learning Center (PKBM) Prosperous Center; (2) Work plan for accreditation management standards in PKBM Sejahtera institutions; (3) Organizing accreditation management standards in PKBM Sejahtera institutions; (4) Implementation of management of education units in PKBM Sejahtera institutions; (5) Supervision of education units in PKBM Sejahtera institutions; and (6) Reporting of the results of activities at PKBM Sejahtera institutions. The approach in this study uses a qualitative approach to the type of case study research. The results obtained from this study are the first chairman of the new prosperous PKBM has a D3 certificate in Civil Engineering and has 13 types of training/workshop / technical guidance certificates that are relevant to PKBM, and PKBM Sejahtera already has a community representative forum. Second, PKBM prosperous has clear and realistic vision, mission, and unit objectives, assisted villages / urban village that are in accordance with the vision, mission and objectives, long-term strategic plan (5year work plan), operational plan (annual work plan) clear; plan for the use of funds for a period of 5 years, already carrying out identification of community learning needs (IKBM) before determining the type of service program, already using the IKBM results as the basis for determining the type of service program; has included community members / leaders / RT heads, RW leaders (representing the community) in each service program preparation. Third, PKBM Sejahtera already has an institution's board posted/posted on the front fence but, the standard size has not been fulfilled all elements/explanations of certain activities in it, and there is no Tut Wuri Handayani symbol and has a network with 4 or more partner institutions in Last two years. Fourth, PKBM Sejahtera already has an activity schedule for each structured activity and unstructured activities, already has a list of participants in each study group (groups of students) for each type of service program, and already has a continuous service program so that there is no free time in each year. Fifth, PKBM Sejahtera has carried out monitoring and evaluation of service programs that are held regularly, has carried out monitoring and evaluation of learning by periodic managers and PKBM prosper does not make monitoring and evaluation reports. Sixth, PKBM prosperous has made a report on the results of each activity's complete activities, making a complete financial report after each activity, making a report on the results of its activities and finances supplemented by four documents of financial transactions consisting of bank accounts, cash books, diaries, documents financial transactions. As well as prosperous PKBM has submitted periodic reports of activity and financial results to the Pontianak City Education Office, Ditjen PAUD and Dikmas as well as agencies that provide assistance.</p>

IT Productivity Paradox pada Perguruan Tinggi Swasta

Pengambilan kebijakan terkait implementasi teknologi informasi pada perguruan tinggi harus disertai dengan komitmen yang didukung oleh analisa mengenai besarnya kontribusi teknologi informasi pada kinerja institusi. Sehingga implementasi tersebut tidak serta merta hanya mengikuti tren yang berlaku, dimana hampir semua perguruan tinggi yang lain telah melakukan implementasi teknologi informasi. Serta menghindari adanya investasi yang sia-sia dikarenakan adanya kesalahan kebijakan dalam implementasi teknologi informasi. Information Technology Productivity Paradox merupakan sebuah perspektif baru dalam bidang tatakelola teknologi informasi untuk mengetahui besarnya kontribusi teknologi informasi pada peningkatan kinerja. Implementasi teknologi informasi selalu melibatkan banyak pihak dan membutuhkan biaya yang cukup besar, sehingga selalu timbul sebuah pertanyaan dalam benak pengambil kebijakan, apakah biaya dan sumberdaya yang dialokasikan untuk implementasi teknologi informasi adalah sebuah investasi yang tepat atau sia-sia. Tujuan penelitian ini adalah mendapatkan sebuah model konseptual tentang variabel yang berperan dalam pengaruh implementasi IT/Teknologi Informasi terhadap peningkatan produktivitas pada perguruan tinggi dengan menggunakan pendekatan secara langsung dan tidak langsung. Diharapkan dengan adanya model ini, pimpinan perguruan tinggi mampu menghindari/meminimalisasi terjadinya kegagalan investasi Teknologi Informasi/ Paradox. Dari hasil penelitian, dapat disimpulkan bahwa sumberdaya TI memiliki pengaruh secara langsung yang lebih signifikan daripada pengaruh secara tidak langsung,

Abstract 5412: miR155 and miR9 expression in human prostate cancer cell lines and prostate cancer tissue

Abstract Background: Differential expression of miRNAs between malignant, precancerous lesions, and nonmalignant prostate tissues may indicate that these molecules play a role in cancer biology. Several miRNAs have been commonly reported to be differentially expressed in prostate cancer, compared to benign prostate tissue, but some results have been contradictory. Expression patterns of specific miRNAs across prostate cancer, precancerous lesions, and benign tissue have not been determined. Design: The expression patterns of 20 miRNAs were determined in the metastatic prostate cancer cells lines LNCaP and PC3, using the nontumorigenic prostate cell line PWR-1E as reference. Differentially expressed miR-9 and miR-155 were subsequently evaluated in epithelial cells obtained by laser capture microdissection from cancerous lesions, high-grade prostatic intraepithelial neoplasia, proliferative inflammatory atrophy, and benign tissue from radical prostatectomy and transurethral prostatectomy tissue specimens, from patients diagnosed with prostate cancer. Total RNA was extracted from the cell lines and microdissected epithelial cells and expression of miR-9 and miR-155 was evaluated by qPCR; miRNA levels in individual samples were normalized to corresponding RNU62 levels. Fold-change values were calculated, and p value < 0.05 was considered statistically significant. The Ethical Review Board of the academic institution approved this study. Results: Differential expression of several miRNAs was found between cell lines. Four miRNAs showed a similar expression profile in the cancer cell lines, two were overexpressed in metastatic cell lines LNCaP and PC3 compared to the nontumorigenic PWR-1E cells (hsa-miR-195, hsa-miR-9), and two were underexpressed (hsa-miR-143, hsa-miR-155). Evaluation of miRNA expression in laser capture microdissected epithelial cells showed a trend towards higher expression of miR-9, and lower expression of miR-155 in microdissected epithelial cells derived from prostate tissue with cancer and proliferative inflammatory atrophy compared to epithelial cells from benign tissue. Conclusions: Our results are in agreement with the description of miR-9 as oncomiRNA. miR-155 was underexpressed in LNCaP and PC3 cells in relation to nontumorigenic PWR-1E cells. Also, this miRNA showed a trend towards underexpression in epithelial cells microdissected from prostate tissue with cancer and proliferative inflammatory atrophy compared to epithelial cells from benign tissue. Further studies of these deregulated miRNAs will help clarify their role in prostate tumorigenesis. Citation Format: Ines Benedetti, Juan Rebollo, Niradiz Reyes. miR155 and miR9 expression in human prostate cancer cell lines and prostate cancer tissue [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5412.

Clinical Utility of Routine Pleural Manometry During Large Volume Thoracentesis: A Multicenter Randomized Trial

Background: In patients with non-expandable lung, pleural fluid removal can result in excessively negative pleural pressure, associated with chest discomfort, pneumothorax, and reexpansion pulmonary edema. Monitoring pleural pressure during thoracentesis may reduce discomfort and protect against complications. Methods: In this prospective randomized single-blind trial, subjects with large pleural effusions at two academic medical centers were randomly assigned (1:1 ratio) to symptom-guided (control) versus symptom-plus-manometry-guided (manometry) thoracentesis. All had free-flowing effusions meeting pre-specified criteria suggesting volume of at least 500 milliliters. Subjects, who were blinded to assignment, rated chest discomfort on visual analog scales before, during, and after drainage. Pleural pressure was measured at regular intervals in the manometry group. Drainage was discontinued before complete evacuation for persistent chest discomfort, incessant cough, complication, rapidly falling pleural pressure, or end-expiratory pleural pressure lower than -20 cm H2O (latter two only in the manometry group). We performed a modified intention-to-treat analysis. The primary outcome was overall procedural chest discomfort through 5 minutes post-procedure. Findings: Between March 4, 2016 and September 8, 2017, 191 patients were screened. One hundred twenty-eight eligible subjects were randomized with four excluded from the final analysis of 62 subjects per group due to manometer malfunction (n=2), inability to access effusion due to pleural tumor burden (n=1), and inability to remain seated (n=1). There was no difference in the primary outcome of overall procedural chest discomfort between groups (mean difference 2.4, 95% CI -5.7-10.5; p = 0.78). Six asymptomatic pneumothoraces ex-vacuo occurred in the control group; no serious complications occurred in either group. Interpretation: Measurement of pleural pressure during large-volume thoracentesis does not alter procedure-related chest discomfort. This is the first study to directly assess the impact of pleural manometry on important patient-centered clinical outcomes during thoracentesis, and does not support its routine use. This trial was registered at clinicaltrials.gov, NCT02677883 Funding: Centurion Medical Products Declaration of Interest: No authors report any financial or non-financial conflicts of interest pertinent to this work outside the declared funding source for this trial (see below re: role of funding source). Ethics Approval Statement: This randomized single-blind trial recruited inpatient and outpatient subjects at two academic medical centers (Vanderbilt University Medical Center, Nashville, TN, USA and Johns Hopkins Hospital, Baltimore, MD, USA). Institutional Review Boards of both institutions approved this trial (VUMC IRB number 151492; JHU IRB number 00119664).

Реализация концепции кадетского образования: модель деятельности кадетских, суворовских и нахимовских образовательных организаций

The results of development of the model as the element of the concept of cadet education that promotes the creation of optimal conditions for the upbringing and education of students to obtain professional education in the field of military or other public service, including the civil service of the Russian Cossacks, on the basis of established additional general developmental programs that are integrated with the main educational programs including synchronized with additional pre-service programs are described in the article. The model is developed in the framework of the federal target program of education development for 2016-2020 years. Results of the study will be used by representatives of the regional education authorities, chiefs, deputy chiefs of military schools, Suvorov and Nakhimov schools, heads of educational institutions, teaching staff, including officers, teachers, parents, representatives of the governing boards of educational institutions.

An FSB board member can better align corporate governance with SIFI sustainability

•The recommendation herein bifurcates regulation, amends shareholder theory and its consequent legal expression by putting a Financial Stability Board Stakeholder on every Systematically Important Financial Institution Board, and the Board of its holding company if applicable.•A FSB Stakeholder would take on the CRO role from the Board perspective with the entire financial system in mind rather than only assessing long-term risk for that particular SIFI.•At present, SIFI organizational theory and application allows diffuse shareholders the rewards of a diversified portfolio of SIFI assets, while exerting no potent corporate governance through what are commoditized voting rights.•The highly contextual nature of a fiduciary duty makes prediction of executive management extremely difficult and requires a more rigorous judicial function best executed by a FSB Stakeholder with Board vantage.•Financial stability is not forecasting, masterminding the future, an attempt to eliminate risk or even an attempt to minimize risk, but rather guarantees the core SIFI activities are capable of sustained functioning able to over-ride any action or pursuit that systematically or unreasonably threatens the public good of international banking.

Crossfire: Microfinance can serve the very poor, but does it?

Microfinance was started as a tool to address extreme poverty, or even ‘to put poverty in a museum’. There is continuing debate about whether it can or cannot do this. Some argue that microfinance can and does alleviate or even ‘cure’ poverty, others that it has little or no impact, or even that it may even exacerbates poverty, particularly for the very poorest people. Two well-informed protagonists from South Asia discuss this issue. Rabeya Yasmin worked for Bangladesh Rehabilitation Assistance Committee (BRAC) in Bangladesh for 19 years, and was director of the well-known BRAC targeting the ultra poor (TUP) programme. She was educated at the University of Dhaka and at the IDS in Sussex, and is a member of the boards of several institutions in Bangladesh. Frances Sinha is a Director and co-founder of M-Cril, the international financial services and social business rating and research agency, based in Delhi. She is originally from the United Kingdom but has lived and worked for over thirty years in India, but also throughout South Asia and Africa.

The Youth Project at the Istituto Nazionale Tumori in Milan.

The paper describes the key issues of the Youth Project launched in 2011 at the pediatric oncology unit of the Istituto Nazionale Tumori in Milan dedicated to adolescents (over 15 years old) and young adults (up to 25 years old) with solid tumors. The Youth Project was developed within the pediatric oncology unit in the conviction that adolescent patients may benefit from the multidisciplinary team typical of the pediatric oncology setting, as well as the expertise in treating pediatric-type malignancies and enrolling patients in clinical trials. The project was an offshoot of existing activities, making no major changes to the hospital's organization and posing no major demands on the institution's administration and board. Patients are managed by the pediatric oncology staff, but they have access to particular services (e.g., regarding their psychosocial support, fertility preserving measures, access to care after completing therapy); dedicated, adequately equipped multifunctional rooms have been provided. The location of the pediatric unit within a cancer referral center and the cooperation with divisions dedicated to adults have played an important role in the project's creation.

Burnout in Chinese medical students and residents: an exploratory cross-sectional study

BackgroundChinese medical doctors have experienced unprecedented challenges over the past 10 years, including but not limited to heavy workload and violence against doctors. In the meantime, the National Health and Family Planning Commission issued guidelines for standardised medical training that include an additional 2–4 years of specialist training for junior doctors. Few studies have explored the relationship between burnout and associated factors at Chinese medical schools and hospitals. MethodsThe study population consisted of 3387 medical students (n=2097) and residents (n=1290) from all over China. In 2016, 85 medical schools and their teaching hospitals participated in this study. We used the following questionnaires: Chinese version of the Maslach Burnout Inventory; Job Content Questionnaire; Professionalism Assessment Scale; Moral Distress Questionnaire; Jefferson Scale of Physician Empathy—Student Version; Chinese version of the General Health Questionnaire; Center for Epidemiologic Studies Depression Scale (CES-D); Professional Role Formation Inventory including sections related to lifelong learning, humanism, social learning, and research advancement; and other social demographic questions to collect cross-sectional data. Statistical analyses were conducted using SPSS 20. Ethical approval was obtained by the Institutional Review Board of the principal investigator's institution. FindingsThe burnout mean scores were 11·42 (SD 6·25) for emotional exhaustion, 8·10 (4·85) for cynicism, and 21·08 (8·70) for reduced personal accomplishment. Statistically significant increases were found as age increased and between residents and medical students (p<0·001). Higher burnout scores were significantly associated with lower empathy (p<0·001), lower professionalism (p<0·001), lower general health (p<0·001), depression (p<0·001), lower humanism (p<0·001), lower social learning (p<0·001), and lower research advancement (p<0·001)). InterpretationBurnout affects not only the physical and mental health of future Chinese doctors but also their empathy, professional role formation, and professionalism. Given China's aging population and high disease burden, educators and policy makers should not ignore burnout, wellbeing, and their effects on future doctors. FundingROC Ministry of Science and Technology Grant MOST 105-2511-S-010-002-MY2. The funding source had no involvement in study design, data collection and analysis, interpretation of the results, writing of the report, and the decision to submit the paper for publication.

Abstract 2414: Fibromodulin expression in human prostate cancer tissue: Implications for prostate cancer progression

Abstract Background: Fibromodulin is a small leucine-rich proteoglycan important for extracellular matrix organization and essential for tissue repair in multiple organs. Recently, differential expression of fibromodulin has been shown in human prostate cancer cell lines with different cancer phenotypes and in human prostate cancer tissue compared to normal/benign tissue. Methods: The protein expression level of fibromodulin was analyzed by immunohistochemistry using a prostate tissue microarray (TMA), constructed from archival radical prostatectomy and trans-urethral prostatectomy tissue specimens, from patients with localized prostate cancer (PCa). Stained sections from the donor blocks were evaluated, and a representative area from PCa, high grade prostatic intraepithelial neoplasia (HGPIN), proliferative inflammatory atrophy (PIA), and benign prostate tissue (BPT) was included into the TMA. Staining for each lesion was scored, using H-score, by microscopic assessment of the percentage of epithelial cells with positive staining. H-score values were compared between groups by ANOVA test, and p &amp;lt; 0.05 was considered statistically significant. The Ethical Review Board of the academic institution approved this study. Results: Fibromodulin expression at protein level was evaluated in 378 cores representing PCa (143 cores), HGPIN (58), PIA (102), and BPT (78). Mean fibromodulin expression in cores with PCa, HGPIN, and PIA was significantly higher than mean of fibromodulin expression in normal glands (p&amp;lt;0.0001). There was a higher mean staining score in PCa (156, 95% CI:144–167), compared to HGPIN (131.4, 95% CI:109-153), PIA (128, 95% CI:117-138), and BPT (33.3, 95% CI:27-38). Thus, fibromodulin expression increased across the PCa progression model. Conclusions: The expression pattern of fibromodulin showed a significant increase from benign prostate tissue through pre-cancerous lesions to PCa. These findings suggest that this proteoglycan may be involved in the process of prostate cancer progression, with low levels in pre-cancerous lesions and higher levels in cancer tissue. Additional studies are required to determine the biological role and potential clinical implications of fibromodulin in prostate cancer. Citation Format: Estebana Ines Benedetti Padron, Angelo De Marzo, Javier Baena Del Valle, Jan Geliebter, Niradiz Reyes. Fibromodulin expression in human prostate cancer tissue: Implications for prostate cancer progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2414. doi:10.1158/1538-7445.AM2017-2414

A STUDY OF MULTIPLE INTELLIGENCE IN RELATING TO LEARNING STYLE AMONG HIGHER SECONDARY STUDENTS

Students’ reveal different learning styles and multiple intelligences, and only by accommodating these several abilities can teachers appropriately plan and conduct tasks and evaluate what students have learned. The present study describes the types of learning styles and multiple intelligences of students, as well as instructional methods that work best with students’ relevant learning traits. The main motive is to study on multiple intelligence in relating to learning style among higher secondary students in Coimbatore district. This research is under taken with a view to examining the relationship with multiple intelligence and learning style of different high school students with a sample size 300. The investigation is analyzed by the descriptive analysis and differential analysis. The result concluded from the study that there is no substantial change with respect to gender, locality, groups and board of institution in their mean score of multiple intelligence and learning style. The correlation is not significant with the multiple intelligence and learning style.

Aggregated N-of-1 trials for unlicensed medicines for small populations: an assessment of a trial with ephedrine for myasthenia gravis

BackgroundInexpensive medicines with a long history of use may currently be prescribed off-label for rare indications. Reimbursement is at the discretion of health insurance companies, and may be unpredictable. The example addressed was ephedrine as add-on treatment for myasthenia gravis. Stakeholders from academia, a patient organization, the Dutch National Health Care Institute (NHCI) and Dutch Medicines Evaluation Board (MEB) advised on the trial design. The NHCI and MEB agreed to provide scientific advice on the suitability of the evidence generated by the trial, for regulatory decisions. This paper describes the feasibility of the trial and the utility of its aggregated results.ResultsThe trialists experienced the trial as feasible. Retrospective interviews showed that the trial as performed was acceptable to patients. The treatment effect in the primary outcome measure, muscle strength, was statistically significant when inferred to the population level, though the effect size was modest. Secondary outcomes were statistically significant in a preplanned, fixed effects analysis within the four patients. The NHCI advised that it could potentially make reimbursement decisions based on the Fitting Evidence framework, should the trialists decide to apply for reimbursement. The MEB advised that for a licensing decision, the N-of-1 design is a last-resort option for demonstrating treatment benefit in a rare disease. N-of-1 trials alone do not provide enough evidence on potential risk. The MEB found the current trial inconclusive. It suggested doing a 2-armed trial of longer duration, possibly with a different outcome measure (postponement of corticosteroid use). It suggested engaging a consultancy or commercial sponsor, should the trialists decide to seek market authorization of the drug.ConclusionsIn theory, evidence from aggregated N-of-1 trials is suitable for use in licensing and reimbursement decisions. The current example illustrates differences in interpretation of N-of-1 results by health authorities. In the era of personalized medicine, consensus is required on the interpretation of data from study designs geared to small groups. Demonstrating effectiveness of inexpensive medicines in small populations may require involvement of non-commercial parties, to preserve affordability.