Single National Research Articles

Treating Brain Metastases from Breast Cancer: Outcomes after Stereotactic Radiosurgery

AimsStereotactic radiosurgery (SRS) is an alternative to surgery or whole brain radiotherapy for the control of single or multiple brain metastases in patients with breast cancer. To date, there is no clear consensus on factors that might predict overall survival following SRS. The aim of this study was to assess the overall survival of breast cancer patients with brain metastases treated with SRS at a single centre and to examine the factors that might influence survival. Materials and methodsA retrospective analysis of consecutive patients with breast cancer and brain metastases, considered suitable for SRS by the regional neuro-oncology multidisciplinary team. All patients were treated at a single National Health Service centre. ResultsIn total, 91 patients received SRS between 2013 and 2017, of whom 15 (16.5%) were alive at the time of analysis. The median overall survival post-SRS was 15.7 months (interquartile range 7.7–23.8 months) with no significant effect of age on survival (67 patients ≤ 65 years, 16.3 months; 26 patients > 65 years, 11.4 months, P = 0.129). The primary tumour receptor status was an important determinant of outcome: 31 oestrogen receptor positive (ER+)/human epidermal growth factor receptor 2 negative (HER2–) patients had a median overall survival of 13.8 months, 14 ER+/HER2+ patients had a median overall survival of 21.4 months, 30 ER–/HER2+ patients had a median overall survival of 20.4 months and 16 patients with triple negative breast cancer (TNBC) had a median overall survival of 8.5 months. A larger total volume of tumour treated (>10 cm3), but not the number of individual metastases treated, was associated with worse survival (P = 0.0002) in this series. Patients with stable extracranial disease at the time of SRS had improved overall survival compared with those with progressive extracranial disease (30 patients stable extracranial disease overall survival = 20.1 months versus 33 patients progressive extracranial disease overall survival = 11.4 months; P = 0.0011). Seventeen patients had no extracranial disease at the time of SRS, with a median overall survival of 13.1 months. ConclusionsThis single-centre series of consecutive patients with brain metastases from breast cancer, treated with SRS, had a similar overall survival compared with previous studies of SRS. TNBC and ER+/HER2– histology, metastatic volumes >10 cm3 and progressive extracranial disease at the time of SRS were associated with worse survival.

Internal Pathology Review of Invasive Melanoma: An Academic Institution Experience

BackgroundPrior studies of internal pathology review (IPR) for melanoma have shown that changes in the pathology analysis are common. How these changes impact clinical management of melanoma or how the margin status reports may modify has not been evaluated. Our goal was to determine what changes to staging and surgical management occurred after IPR of newly diagnosed melanomas and to determine how the final surgical pathology report may correlate with the IPR. MethodsA retrospective study was conducted from 2014 to 2016 of newly diagnosed invasive melanomas referred to a single National Comprehensive Cancer Network tertiary care center. ResultsA total of 370 cases met inclusion criteria. The most common feature changed after internal review was mitotic rate, in 155 (41.7%) patients, followed by Breslow depth in 99 (26.9%) patients. Tumor staging was changed in 45 (12.2%) patients. The most common change was a T1a lesion being upgraded to a T1b lesion. These tumor staging changes lead to 38 (10.3%) overall staging differences. A biopsy's deep margin status was changed in 27 (7.3%) patients. Outside hospital reports lacked information about deep margin status in 71 (19.2%) of specimens. Based on the National Comprehensive Cancer Network guidelines, 22 (5.9%) patients had changes in their sentinel lymph node biopsy recommendations and one of these patients had a positive node found on pathology. Of those patients who had changes in the T-stage, 16 (4.3%) of them also had changes in the recommended wide local excision radial margin. ConclusionsIPR of invasive melanoma leads to both changes in staging and the surgical management of melanoma and should remain an important component of care of melanoma patients at a tertiary referral center.

Power Optimization of NACA 0018 Airfoil Blade of Horizontal Axis Wind Turbine by CFD Analysis

The country or region where energy production is based on imported coal or oil will become more self-sufficient by using alternatives such as wind power. Electricity produced by the wind produces no CO2 emissions and therefore does not contribute to the greenhouse effect. Wind energy is relatively labour intensive and thus creates many jobs. Wind energy is the major alternative of conventional energy resources. A wind turbine transforms the kinetic energy in the wind to mechanical energy in a shaft and finally into electrical energy in a generator. The turbine blade is the most important component of any wind turbine. In this article is considered the single airfoil National Advisory Committee for Aeronautics (NACA) 0018 and a computational fluid dynamics (CFD) analysis is done at different blade angles 0º, 10º, 15º, and 30º with a wind velocity of 4 m/s. The analysis results show that a blade angle of 10º gives the best possible power and pressure and velocity distributions are plotted for every case.

Myths and problems of forestry reform in Russia

Situation analysis demonstrates that several forest management models coexist in Russia. One of them is the model set by the Russian Forest Code (2006), it is likely to sustain at areas leased for large logging companies for the long term. Some initial signs of more intensified forest management are visible there. Another model is typical extensive model – ‘wood mining’. This system evolves back to the one used to exist in Soviet times. There is an ambition to revitalize state-owned forest management enterprises or / and the state-owned all Russia wide corporation responsible for reforestation and logging at areas which are not leased for private companies. Forest data is largely absent and existing one is unavailable for state or public control. Funds available for forest management are misused. Federal forest management bodies ignore the fact that lack of available timber resources is due to lack of effective reforestation. Reforestation methods in use and those used in the past do not ensure establishment of economically valuable forest stands to replace those logged or burned. Reforestation is focused on production of plantlets and planting with no weeding and thinning of planted or natural young stands. Criteria to assess success of reforestation based on species composition are not developed and not established. Imitation of reforestation does not help to solve the problem of economical values degradation of secondary forests, including those on the most productive zone – Central European Russia. Authorities ignore exceptional values of intact forest landscapes for preservation of biodiversity and global climate change prevention. In 7 years since the Russian Forest Policy has been approved not a single National Forest heritage site has been established to contribute to development of the fund of forests to be preserved from economic development. Authors conclude that despite strategic documents approved in 2013–2018 forest management authorities continue supporting extensive forest management and make no substantial steps towards transition to more intensified forest management. One of the first steps should be calculation of rent fee based on rented area, but not on a volume of logged timber

Phase II randomised control feasibility trial of a nutrition and physical activity intervention after radical prostatectomy for prostate cancer

ObjectiveDietary factors and physical activity may alter prostate cancer progression. We explored the feasibility of lifestyle interventions following radical prostatectomy for localised prostate cancer.DesignPatients were recruited into a presurgical observational...

Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model

ObjectivesThis research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for out-of-hospital cardiac arrest (OHCA)? What is the...

Oxford Video Informed Consent Tool (OxVIC): a pilot study of informed video consent in spinal surgery and preoperative patient satisfaction

ObjectivesThe British Association of Spinal Surgeons recently called for updates in consenting practice. This study investigates the utility and acceptability of a personalised video consent tool to enhance patient satisfaction...

Comparison of the Cervex-Brush alone to Cytobrush plus Cervex-Brush for detection of cervical dysplasia in women with a transformation zone type 3.

Twenty percent of colposcopic assessments are inadequate due to a type 3 transformation zone (TZ3). In the absence of colposcopic or histological assessment, subsequent management is guided by the referral screening test. In the UK, routine cervical screening is completed by a Cervex-Brush alone. This study examines the effectiveness of a Cytobrush in addition to a standard Cervex-Brush when used in TZ3 assessment. An 18-month diagnostic accuracy study in a single National Health Service (NHS) Trust. Women with a TZ3 booked for large loop excision of the transformation zone (LLETZ) with a referral cytology of high-risk HPV and squamous dyskaryosis were recruited. Immediately prior to LLETZ, a Cervex-Brush plus Cytobrush liquid-based cytology sample was taken. Presence of endocervical cells was compared. Predictability of high-grade cervical intra-epithelial neoplasia (CIN2+) was by blind standardised reporting of the LLETZ histology. One hundred and five women were recruited from a total eligible population of 153 cases (68.8%). Endocervical cell yield was increased with the Cervex-Brush plus Cytobrush when compared to the Cervex-Brush alone (99.1% vs 79.1%, P<.001). Irrespective of cytological grade, age or parity, there was no difference in predictability of CIN2+ between sampling methods. When compared to Cervex-Brush sampling alone, the addition of a Cytobrush improves endocervical sampling but does not improve cytological predictability of CIN2+ in women with a TZ3. These data suggest that women who will reliably attend for cytological follow-up can be safely referred to primary care for a Cervex-Brush alone.

Magnetic Field Risetimes of Negative Lightning First Return Strokes Over Land and Ocean

AbstractWe examined risetimes for negative first strokes occurring over land (3,427 strokes) and ocean (4,302 strokes) in Florida reported by the U.S. National Lightning Detection Network. The waveform characteristics were measured by a single National Lightning Detection Network sensor located less than 2 km from the coastline in Florida. All risetime measurements (10–50, 50–90, 10–90%, and threshold to peak) over both land and ocean exhibited statistically significant positive correlation with estimated peak current, but with small correlation coefficients. For a subset of 1,247 strokes selected to mitigate bias in our data, the median 10–50% magnetic field risetime was found to be 11% longer and the proportion of strokes having 10–50% risetimes in the range of 2.6 to 4.8 μs was 42% larger over ocean. We speculate that the slow‐front portion of radiation field waveforms for negative first strokes is affected by differences in surface properties over land versus over ocean that impact upward leader initiation.

Elevations in MicroRNA Biomarkers in Serum Are Associated with Measures of Concussion, Neurocognitive Function, and Subconcussive Trauma over a Single National Collegiate Athletic Association Division I Season in Collegiate Football Players.

This prospective controlled observational cohort study assessed the performance of a novel panel of serum microRNA (miRNA) biomarkers on indicators of concussion, subconcussive impacts, and neurocognitive function in collegiate football players over the playing season. Male collegiate student football athletes participating in a Division I Football Bowl Subdivision of the National Collegiate Athletic Association (NCAA) were enrolled. There were a total of 53 participants included in the study, 30 non-athlete control subjects and 23 male collegiate student football athletes. Neurocognitive assessments and blood samples were taken within the week before the athletic season began and within the week after the last game of the season and measured for a panel of pre-selected miRNA biomarkers. All the athletes had elevated levels of circulating miRNAs at the beginning of the season compared with control subjects (p < 0.001). Athletes with the lowest standard assessment of concussion (SAC) scores at the beginning of the season had the highest levels of miRNAs. The area under the curve (AUC) for predicting pre-season SAC scores were miR-195 (0.90), miR-20a (0.89), miR-151-5p (0.86), miR-505* (0.85), miR-9-3p (0.77), and miR-362-3p (0.76). In athletes with declining neurocognitive function over the season, concentrations of miRNAs increased over same period. There were significant negative correlations with miR-505* (p = 0.011), miR-30d (p = 0.007), miR-92 (p = 0.033), and (p = 0.008). The miRNAs correlating with balance problems were miR-505* (p = 0.007), miR-30d (p = 0.028), and miR-151-5p (p = 0.023). Those correlating with poor reaction times were miR-20a (0.043), miR-505* (p = 0.049), miR-30d (p = 0.031), miR-92 (p = 0.015), and miR-151-5p (p = 0.044). Select miRNAs were associated with baseline concussion assessments at the beginning of the season and with neurocognitive changes from pre to post-season in collegiate football players. Should these findings be replicated in a larger cohort of athletes, these markers could potentially serve as measures of neurocognitive status in athletes at risk for concussion and subconcussive injuries.

Ten-Year Outcomes and Toxicity with Moderately Hypofractionated (70 Gy in 28 fractions) Intensity-Modulated Radiation Therapy for Localized Prostate Cancer.

Long-term outcomes with hypofractionated radiation therapy for prostate cancer are limited. We report 10-year efficacy and toxicity outcomes of patients treated with intensity modulation radiation therapy (IMRT) for localized prostate cancer with 70 Gy in 28 fractions at 2.5 Gy/fraction. This IRB-approved study included all 854 consecutive patients with localized prostate cancer treated with moderately hypofractionated IMRT at a single institution between 1998 and 2012. The median follow-up was 11.3 years (maximum, 19 years). Patients were grouped into low-risk (LR, n=266); favorable intermediate-risk (FIR), defined as a single National Comprehensive Cancer Network (NCCN) intermediate-risk factor (n=238); unfavorable intermediate-risk (UIR), defined as ≥2 NCCN intermediate-risk factors (n=106), and high-risk (HR, n=244) groups. Biochemical relapse free survival (bRFS; defined as nadir + 2 ng/mL), clinical relapse free survival (cRFS), & overall survival (OS) were analyzed used Kaplan-Meier analysis. Prostate cancer specific mortality (PCSM) was analyzed using Fine and Gray regression. All grade ≥3 genitourinary (GU) and gastrointestinal (GI) toxicities were recorded using CTCAE version 4.03 and cumulative incidence rates of GU and GI toxicity were calculated. The 10-year bRFS was 71% (95% CI: 67-74%). For patients with LR, FIR, UIR, and HR disease the 10-year bRFS rates were 88%, 78%, 71%, and 42%, respectively (p <0.0001), while the 10-year cRFS rates were 95%, 91%, 85%, and 72%, respectively (p <0.0001). Overall, the 10-year actuarial OS rate was 69% (95% CI: 66-73%) and the 10-year PCSM was 7% (95% CI: 5-9%). For patients with LR, FIR, UIR and HR disease, the 10-year PCSM rates were 2%, 5%, 5% and 15%. Long-term grade ≥3 GU or GI toxicity remained low with 10-year cumulative incidences of 2% and 1%, respectively. High-dose moderately hypofractionated IMRT for localized prostate cancer continues to show excellent oncological outcome with a low incidence of toxicity over long-term follow up. This fractionation schedule appears to be acceptable for patients across all risk groups.

P3.15-15 ALI Could Be a One of Prognostic Survival Factor for Non-Small Cell Lung Cancer Patients

Patients with terminal non-small cell lung cancer become greatly concerned about where they will die. And the Advanced Lung Cancer Inflammation Index (ALI, body mass index × albumin/neutrophil-to-lymphocyte ratio) has been demonstrated to be a prognostic factor of survival in some solid cancers. We examined the survival times of such patients according to their place of death; i.e., whether they died at home, at a hospice, or at hospital and analysis with ALI. A retrospective cohort study of patients who were followed from their first chemotherapy session for non-small cell lung cancer until death was performed. Specifically, the study compared four groups, those that died at home, at a hospice, at hospital or alive. The study was based on mortality data from the single institute National Hospital in Japan, for the period between April 2010 and December 2015. Among the 313 patients recruited, 214 were analyzed in this study: 90, 49, and 75 received hospital-based, home-based, and hospice-based palliative care, respectively. The patients who died at a hospice exhibited significantly longer survival than those that died at hospital (estimated median survival time, 420 days [95% confidence interval (CI), 325-612 days] vs. 252 days [95% CI, 201-316 days]; P<0.0001), and the patients that died at home also demonstrated significantly longer survival than those that died at hospital (estimated median survival time, 420 days [95% CI, 325-612 days] vs. 341 days [95% CI, 293-460 days]; P<0.0001). No significant difference in survival was detected between the patients that died at home and those that died at a hospice. At the time of data cut-off, ALI before chemotherapy in 4 groups was evaluated. There was no significant difference in BMI and NLR. However, ALI assessment showed that ALI had a higher value in the surviving patient group with a statistically significant difference from the group who died in the hospital. Patients who died at a hospice or home exhibited significantly longer survival than those that died at hospital. Social background and spiritual factors are also taken into consideration, but ALI before treatment also considered factors that contribute to prognosis.

Dedicated service improves the accuracy of Barrett’s oesophagus surveillance: a prospective comparative cohort study

ObjectivesStandards for Barrett’s oesophagus (BO) surveillance in the UK are outlined in the British Society of Gastroenterology (BSG) guidelines. This study aimed to assess the quality of current surveillance delivery...

Genomic data indicate ubiquitous evolutionary distinctiveness among populations of California metalmark butterflies

Conservation geneticists have argued that evolutionarily significant units (ESUs) must be both genetically distinct and adaptively significant to be recognized for conservation protection. High-throughput DNA approaches can greatly increase the power to identify genetic distinctiveness, even if inferring adaptive significance remains a challenge. Here we present the first genomic evaluation of Lange’s metalmark, Apodemia mormo langei (Lepidoptera: Riodinidae), a U.S. federally endangered subspecies restricted to sand dune habitats in a single National Wildlife Refuge in California. Previous work based on very few genetic markers detected little genetic distinction for Lange’s metalmark. We use several thousand genome-wide single nucleotide polymorphisms to characterize the population structure of the A. mormo complex across California and determine if Lange’s metalmark qualifies as an ESU. We found that Lange’s metalmark is genetically identifiable, but is no more distinct than many other isolated populations across the study area. It remains unclear whether this genetic variation is adaptive, and so conservation efforts would benefit from more ecological characterization to determine conservation priorities.

1296 Gender and racial differences in patient perception of pruritus: Evidence from a single institution and National Ambulatory Medical Care Survey data

1296 Gender and racial differences in patient perception of pruritus: Evidence from a single institution and National Ambulatory Medical Care Survey data

The importance of the therapeutic relationship when providing information to parents of children with long-term disabilities: The views and experiences of UK paediatric therapists.

The purpose of this study was to understand the views and experiences of paediatric therapists working in the United Kingdom regarding the importance of the therapeutic relationship when providing information for parents of children with long-term disabilities. The aim was to develop new perspectives, to encourage dialogue and reflection for change and to identify practical suggestions for health professionals when developing therapeutic relationships. This study employed an interpretive phenomenological methodology. Semi-structured, in-depth interviews were carried out with seven health professionals from a single National Health Service trust in the United Kingdom (children's physiotherapists, occupational therapists and speech therapists). Resultant data were analysed using a systematic process of thematic content analysis. One main theme 'The Importance of the Therapeutic Relationship: Balancing a Positive Relationship with Professional Responsibility' is presented and discussed. Paediatric therapists recognize that fostering a positive therapeutic relationship is vital to facilitate parental engagement with the information they provide. Despite this it was felt that efforts to maintain a positive relationship needed to be carefully balanced with discharging professional responsibility to the child. A preliminary model 'The Therapeutic Relationship Continuum' is presented, aiming to help health professionals self-assess and reflect on the dynamic interface between the therapeutic relationship and information provision.

Towards Robust, Authoritative Assessments of Environmental Impacts Embodied in Trade: Current State and Recommendations

SummaryGlobal multiregional input‐output databases (GMRIOs) became the standard tool for tracking environmental impacts through global supply chains. To date, several GMRIOs are available, but the numerical results differ. This paper considers how GMRIOs can be made more robust and authoritative. We show that GMRIOs need detail in environmentally relevant sectors. On the basis of a review of earlier work, we conclude that the highest uncertainty in footprint analyses is caused by the environmental data used in a GMRIO, followed by the size of country measured in gross domestic product (GDP) as fraction of the global total, the structure of the national table, and only at the end the structure of trade. We suggest the following to enhance robustness of results. In the short term, we recommend using the Single country National Accounts Consistent footprint approach, that uses official data for extensions and the national table for the country in question, combined with embodiments in imports calculated using a GMRIO. In a time period of 2 to 3 years, we propose work on harmonized environmental data for water, carbon, materials, and land, and use the aggregated Organization for Economic Cooperation and Development (OECD) Inter‐Country Input‐Output GMRIO as default in combination with detailing procedures developed in, for example, the EXIOBASE and Eora projects. In the long term, solutions should be coordinated by the international organizations such as the United Nations (UN) Statistical Division, OECD, and Eurostat. This could ensure that when input‐output tables and trade data of individual countries are combined, that the global totals are consistent and that bilateral trade asymmetries are resolved.

Role of the mass attenuation coefficient database in standardization of a silicon drift X‐ray detector for PIXE analysis

A simple, inexpensive procedure is described for calibrating a silicon drift detector‐based PIXE system for the analysis of geological and other “thick‐target” materials. It rests on the use of single element, chemical compound, and National Institute for Standards and Technology multielement standards. Much less effort has been focussed on the impact of mass attenuation coefficients on PIXE's analytical accuracy than on ionization cross sections and fluorescence yields. The calibrated system enables us to investigate the effects of inserting different mass attenuation coefficient datasets into the GUPIX database. For the K X‐rays of light elements, accuracy is significantly improved by replacing the formerly used XCOM self‐attenuation coefficients by the corresponding FFAST values; this effect decreases rapidly with increasing atomic number. Similar improvement was found for L X‐rays of medium‐Z, but not for high‐Z atoms.

Global Economic Challenges and Global Solutions 2016

Global Economic Challenges and Global Solutions 2016

A study of the relationship between resilience, burnout and coping strategies in doctors

Purpose of the studyThe aim of this study was to measure resilience, coping and professional quality of life in doctors.Study designA cross-sectional study using an online questionnaire in a single...