Interobserver reproducibility of histopathologic prognostic variables in primary cutaneous melanomas

Background: The prognosis for patients with localized primary cutaneous melanoma is known to depend principally on tumor thickness, and to a lesser extent on ulcerative state and Clark level. We have recently found in an analysis of 3661 patients that tumor mitotic rate (TMR) is also an important prognostic parameter, ranking second only to tumor thickness. However, few studies have assessed the accuracy and reproducibility with which these features of a melanoma are recorded by histopathologists.
Aim: To assess interobserver reproducibility of major pathologic prognostic parameters in cutaneous melanoma.
Methods: Single hematoxylin and eosin-stained slides of 69 dermally invasive primary cutaneous melanomas were circulated among six pathologists with differing experience in the assessment of melanocytic tumors. The observers independently determined the tumor thickness, Clark level of invasion, ulcerative state, and TMR for each lesion. Intraclass correlation coefficients and kappa scores for multiple ratings per subject were calculated.
Results: The intraclass correlation coefficients were 0.96 for tumor thickness and 0.76 for TMR. The kappa scores were 0.83 for ulcerative state and 0.60 for Clark level. These results indicated excellent agreement among the pathologists for measurements of tumor thickness, ulcerative state, and TMR and fair to good agreement for Clark level.
Conclusions: Appropriately trained and experienced histopathologists can assess prognostically important features of melanomas accurately and reproducibly. Given our recent finding of the significance of TMR in determining prognosis, it is important that this feature be assessed by a standardized method and documented for all primary cutaneous melanomas.

Neurally-derived nitric oxide regulates vascular tone in pulmonary and cutaneous arteries of the toad, Bufo marinus

In this study, the role of nitric oxide (NO) in regulation of the pulmocutaneous vasculature of the toad, Bufo marinus was investigated. In vitro myography demonstrated the presence of a neural NO signaling mechanism in both arteries. Vasodilation induced by nicotine was inhibited by the soluble guanylyl cyclase (GC) inhibitor, 1H-(1,2,4)oxadiazolo(4,3-a)quinoxalin-1-one, and the NO synthase (NOS) inhibitor, N^ω-nitro-_L-arginine (_L-NNA). Removal of the endothelium had no significant effect on the vasodilation. Furthermore, pretreatment with N⁵-(1-imino-3-butenyl)-_L-ornithine (vinyl-_L-NIO), a more specific inhibitor of neural NOS, caused a significant decrease in the nicotine-induced dilation. In the pulmonary artery only, a combination of _L-NNA and the calcitonin gene-related peptide (CGRP) receptor antagonist, CGRP(_8-37), completely blocked the nicotine-induced dilation. In both arteries, the vasodilation was also significantly decreased by glibenclamide, an ATP-sensitive K⁺ (K⁺_ATP) channel inhibitor. Levcromakalim, a K⁺_ATP channel opener, caused a dilation that was blocked by glibenclamide in both arteries. In the pulmonary artery, NO donor-mediated dilation was significantly decreased by pretreatment with glibenclamide. The physiological data were supported by NADPH-diaphorase histochemistry and immunohistochemistry, which demonstrated NOS in perivascular nerve fibers but not the endothelium of the arteries. These results indicate that the pulmonary and cutaneous arteries of B. marinus are regulated by NO from nitrergic nerves rather than NO released from the endothelium. The nitrergic vasodilation in the arteries appears to be caused, in part, via activation of K⁺_ATP channels. Thus, NO could play an important role in determining pulmocutaneous blood flow and the magnitude of cardiac shunting.

Influence of temperature on evaporative water loss and cutaneous resistance to water vapour diffusion in the orange-thighed frog (Litoria xanthomera)

We evaluated the effect of ambient temperatures between 25 and 43°C on the rate of evaporative water loss (EWL) in eight adult Litoria xanthomera (average body mass = 7.3 ± 0.6 g). Frogs were placed in a cylindrical chamber that permitted them to fully conceal their ventral surfaces using a water-conserving posture. Their EWL was 7.1 ± 0.7 mg g^–1 h^–1 at 25°C and reached 28.0 ± 2.5 mg g^–1 h^–1 at 43°C. Agar replicas of the frogs were used to evaluate boundary-layer resistances associated with the EWL measurements and, thus, to permit evaluation of cutaneous resistance to vapour diffusion (r_c) in live frogs. The r_c of L. xanthomera was stable over the temperature range of 25–35°C, averaging about 28 s cm^–1, and then declined stepwise with ambient temperatures above 37°C. The highest r_c recorded for each individual over the range of temperatures studied averaged 32.0 ± 1.2 s cm^–1. The thermolabile nature of r_c demonstrates a well developed thermoregulatory control of EWL in this species, a trait very similar in pattern and extent to that previously measured in the closely related Litoria chloris.

Drivers, impediments and manifestations of brand orientation in museums : an international museum study

Purpose - While the body of work exploring brand orientation has grown, there has been a general failure to build on extant research and generate a holistic conceptualization of brand orientation. This paper aims to develop a model of the key drivers, impediments and manifestations of brand orientation in a museum context.

Design/methodology/approach - A collective case study design was used, consisting of key informant interviews using a semi-structured interview protocol and analysis of institutional documents and observational research. Interviews took place with well-known museums across three countries: the United Kingdom, the United States of America and Australia. This paper demonstrates the richness of qualitative case studies as a method of theory building and as a precursor to further empirical research.

Findings - The case study findings reveal both a philosophical and behavioral aspect of brand orientation. Thus, six attributes are presented that include brand orientation as an organizational culture and compass for decision-making and four brand behaviors (distinctiveness, functionality, augmentation and symbolism). The conceptual model also depicts the critical antecedents to brand orientation in a museum context.

Research limitations/implications - This study provides a foundation for future brand research by offering a holistic conceptualization of brand orientation and identifying the primary antecedents in a museum context. Future research may wish to empirically establish a valid and reliable scale of brand orientation and examine its explanatory potential. Future research may also consider other contexts to provide further insight into the drivers and inhibitors of brand orientation.

Practical implications - If organizations seek to establish a strong brand orientation they must devote resources to establishing the brand as a dominant organizational philosophy that guides decision-making. In addition, brand oriented organizations must establish the brand as a distinctive asset that communicates relevance and accessibility and invest in augmenting initiatives that enable the organization to connect with customers on a personal and emotional level.

Originality/value - Using an exploratory method we are able to reconcile a number of approaches to brand orientation and provide a conceptualization that incorporates the philosophical and behavioral approaches to business orientations. Museums face substantial resource constraints, competing needs of multiple stakeholders and increasing market turbulence. If museums can achieve such significant organizational change then the sector presents an interesting exemplar for many other non-profit organizations.

Stressors, Recovery Processes, and Manifestations of Training Distress in Dance

Abstract
Dancers are expected to maintain consistently high levels of performance capability and to perform on demand. To meet these expectations, they subject their bodies to long hours of intensive physical training. Such training regimens are often combined with tight rehearsal and performance schedules, which over time, can lead to persistent fatigue, psychological distress, performance decrements, and injury. A similar process has been observed as a consequence of high-intensity training in many different sports, and considerable sport-related research has been devoted to identifying the antecedents, the symptoms that are experienced, and the most cost-effective ways of monitoring symptom development. This paper presents a general heuristic framework for understanding this “training distress process” and discusses the framework with specific reference to dance.

Postauricular cutaneous mastoid fistula

Postauricular cutaneous mastoid fistula is a rare condition. The cutaneous mastoid fistula is a very rare complication of chronic suppurative otitis media. The fistula tracts are typically difficult to manage because of the surrounding necrotic skin edges. We describe an unusual case of a postauricular cutaneous mastoid fistula and outline the surgical technique used for closure.