Neoadjuvant and adjuvant strategies in renal cell carcinoma: more questions than answers.

The current standard treatment for early stage (I-III) renal cell cancer (RCC) is surgery. While the prognosis of stage I tumors is excellent, stage II and particularly stage III have a high risk of relapse. The adjuvant treatment of patients with RCC remains an area of investigation, with patient selection being a key aspect. There are currently two prognostic nomograms to establish the risk of relapse in patients with resected RCC. The results of earlier studies of adjuvant therapy, including the use chemotherapy and/or immunotherapy after nephrectomy have failed to show any benefit in the outcome of patients at risk of developing local recurrence or distant metastases. Two recent phase III trials with vaccines (autologous tumor cell vaccine and autologous tumor-derived heat shock protein peptide complex-96) have shown promising, albeit still preliminary, results. In the metastatic RCC setting, recent advances in the molecular understanding of oncogenic pathways have led to the development of new therapeutic strategies with the use of targeted therapies in the adjuvant setting. Neoadjuvant treatment is another treatment modality currently being evaluated for patients with early disease and in patients with metastatic RCC with inoperable primary tumors. The questions that remain unanswered include activity of these agents in early stages of the disease, patient selection, optimal start time of the adjuvant treatment, and finally, the optimal length of treatment.

Feasibility of Therapeutic Drug Monitoring (TDM) for Imatinib: Preliminary considerations on the dosage adjustment approach for CML patients enrolled in the Imatinib Concentration Monitoring (I-COME) study

Background: As imatinib pharmacokinetics are highly variable, plasma levels differ largely between patients under the same dosage. Retrospective studies in chronic myeloid leukemia (CML) patients showed significant correlations between low levels and suboptimal response, and between high levels and poor tolerability. Monitoring of plasma levels is thus increasingly advised, targeting trough concentrations of 1000 μg/L and above. Objectives: Our study was launched to assess the clinical usefulness of systematic imatinib TDM in CML patients. The present preliminary evaluation questions the appropriateness of dosage adjustment following plasma level measurement to reach the recommended trough level, while allowing an interval of 4-24 h after last drug intake for blood sampling. Methods: Initial blood samples from the first 9 patients in the intervention arm were obtained 4-25 h after last dose. Trough levels in 7 patients were predicted to be significantly away from the target (6 <750 μg/L, and 1 >1500 μg/L with poor tolerance), based on a Bayesian approach using a population pharmacokinetic model. Individual dosage adjustments were taken up in 5 patients, who had a control measurement 1-4 weeks after dosage change. Predicted trough levels were confronted to anterior model-based extrapolations. Results: Before dosage adjustment, observed concentrations extrapolated at trough ranged from 359 to 1832 μg/L (median 710; mean 804, CV 53%) in the 9 patients. After dosage adjustment they were expected to target between 720 and 1090 μg/L (median 878; mean 872, CV 13%). Observed levels of the 5 recheck measurements extrapolated at trough actually ranged from 710 to 1069 μg/L (median 1015; mean 950, CV 16%) and had absolute differences of 21 to 241 μg/L to the model-based predictions (median 175; mean 157, CV 52%). Differences between observed and predicted trough levels were larger when intervals between last drug intake and sampling were very short (~4 h). Conclusion: These preliminary results suggest that TDM of imatinib using a Bayesian interpretation is able to bring trough levels closer to 1000 μg/L (with CV decreasing from 53% to 16%). While this may simplify blood collection in daily practice, as samples do not have to be drawn exactly at trough, the largest possible interval to last drug intake yet remains preferable. This encourages the evaluation of the clinical benefit of a routine TDM intervention in CML patients, which the randomized Swiss I-COME study aims to.

The Epipalaeolithic (Iberomaurusian) at Grotte des Pigeons (Taforalt), Morocco: a preliminary study of the land Mollusca

Land snail middens occur widely throughout the circum-Mediterranean, particularly in the Maghreb and Libya, but are relatively understudied when compared with the better known coastal marine middens. The site of Taforalt (Grotte des Pigeons) in north east Morocco contains thick ashy deposits with considerable numbers of land snails, dating between 13,000 and 11,000 BP. The site has been excavated periodically since its discovery in 1908, but little attention has been paid to the land snail component. Recent excavations at the site as part of the Cemeteries and Sedentism Project has facilitated reinvestigation of the Iberomaurusian layers, including the upper ashy midden unit. This investigation addresses questions surrounding chronological variation in the lithic assemblage, subsistence strategies, population health and mortuary practices. Preliminary work on the land snails has identified a low species diversity in the grey series midden layers, characterised by the large edible species Alabastrina alabastrites, Helix cf aspersa, Dupotetia dupotetiana, Otala punctata and Cernuella sp, which appear to represent an abrupt intensification in the use of land snails as a food source. Significant quantities of associated plant material and animal bone suggest that land snails are part of a broader based diet which is adopted from around 13,000 BP.

Carbon stable isotope analysis of cereal remains as a way to reconstruct water availability: preliminary results

Reconstructing past water availability, both as rainfall and irrigation, is important to answer questions about the way society reacts to climate and its changes and the role of irrigation in the development of social complexity. Carbon stable isotope analysis of archaeobotanical remains is a potentially valuable method for reconstructing water availability. To further define the relationship between water availability and plant carbon isotope composition and to set up baseline values for the Southern Levant, grains of experimentally grown barley and sorghum were studied. The cereal crops were grown at three stations under five different irrigation regimes in Jordan. Results indicate that a positive but weak relationship exists between irrigation regime and total water input of barley grains, but no relationship was found for sorghum. The relationship for barley is site-specific and inter-annual variation was present at Deir ‘Alla, but not at Ramtha and Khirbet as-Samra.

Attribution of extreme weather events in Africa: A preliminary exploration of the science and policy implications

At the most recent session of the Conference of the Parties (COP19) in Warsaw (November 2013) the Warsaw international mechanism for loss and damage associated with climate change impacts was established under the United Nations Framework Convention on Climate Change (UNFCCC). The mechanism aims at promoting the implementation of approaches to address loss and damage associated with the adverse effects of climate change. Specifically, it aims to enhance understanding of risk management approaches to address loss and damage. Understanding risks associated with impacts due to highly predictable (slow onset) events like sea-level rise is relatively straightforward whereas assessing the effects of climate change on extreme weather events and their impacts is much more difficult. However, extreme weather events are a significant cause of loss of life and livelihoods, particularly in vulnerable countries and communities in Africa. The emerging science of probabilistic event attribution is relevant as it provides scientific evidence on the contribution of anthropogenic climate change to changes in risk of extreme events. It thus provides the opportunity to explore scientifically-backed assessments of the human influence on such events. However, different ways of framing attribution questions can lead to very different assessments of change in risk. Here we explain the methods of, and implications of different approaches to attributing extreme weather events with a focus on Africa. Crucially, it demonstrates that defining the most appropriate attribution question to ask is not a science decision but needs to be made in dialogue with those stakeholders who will use the answers.

Preliminary data on the feeding habits of the freshwater stingrays Potamotrygon falkneri and Potamotrygon motoro (Potamotrygonidae) from the Upper Paraná River basin, Brazil

As raias da família Potamotrygonidae representam um grupo singular da ictiofauna Neotropical. Apesar de serem antigos os relatos sobre o grupo, ainda são muitas as questões que permanecem sem resposta, sobretudo no que diz respeito à biologia das espécies que ocorrem na Bacia do Paraná-Paraguai. No presente trabalho foi analisada a dieta de Potamotrygon falkneri e Potamotrygon motoro, capturadas no Alto Rio Paraná, a jusante da Usina Hidrelétrica Engenheiro Souza Dias (UHE Jupiá). As duas espécies de raias apresentaram dieta diversificada, ingerindo 14 itens, entre moluscos, crustáceos, insetos e peixes, porém com predominância de insetos aquáticos em diversidade e abundância. Somente um indivíduo de cada espécie ingeriu peixe. Potamotrygon motoro consumiu principalmente Ephemeroptera, enquanto P. falkneri, principalmente Mollusca, Hemiptera e Trichoptera. Os dados aparentemente indicam uma dieta mais especializada de P. motoro, com maior consumo de Ephemeroptera (Baetidae), e uma dieta mais generalizada de P. falkneri. A análise dos indivíduos capturados em três micro-hábitats, que diferem quanto ao tipo de substrato e presença de vegetação marginal, sugere diferenças nos tipos de alimentos consumidos.

Preliminary Overview of the Economies of Latin America and the Caribbean 2010

Includes bibliography

A Preliminary Study: Body Dysmorphic Disorder in Division I Women’s Collegiate Soccer Players

The prevalence of Body Dysmorphic Disorder (BDD) among collegiate athletes has not been clearly determined. The purpose of this study was to determine if there are symptoms of body dysmorphic disorder found in Division I women’s soccer players. The researcher hypothesized that there would be some symptoms found within the participants of sport and that there was a need to research this area further. The study consisted of four participants who participated in semi-structured interviews. The subjects were asked a series of questions from the Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) to determine if they indicated any symptoms of BDD. The prevalence of symptoms of BDD found among these four participants was very low. There was only one athlete who scored high on the questions that could be questionable of whether the indicators or symptoms of BDD were present. In conclusion there was not enough evidence to support the research hypothesis. The sample used was not a clear representation of all Division I women’s soccer players. Further research is needed to determine if BDD symptoms are found among Division I women’s soccer players.

Satisfaction with the treatment, confidence and 'naturalness' in engaging in sexual activity in men with psychogenic erectile dysfunction: preliminary results of a randomized controlled trial of three therapeutic approaches

OBJECTIVE To assess the efficacy of group psychotherapy (GTP) and/or sildenafil for psychogenic erectile dysfunction (ED). PATIENTS AND METHODS A randomized controlled single-blind trial was performed at the Institute of Psychiatry of the Medical School of at Universidade de Sao Paulo, Sao Paulo, Brazil. In all, 30 men with mild and moderate psychogenic ED were randomized to receive for 6 months: GPT plus 50 mg sildenafil on-demand, or 50 mg sildenafil on-demand exclusively, or GPT exclusively. Changes in score from baseline for three questions of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were evaluated at endpoint and after 3-months follow-up. RESULTS Satisfaction with the treatment, confidence and 'naturalness' increased in the GPT plus sildenafil and GPT exclusively groups (P = 0.001) from baseline to endpoint. The treatment-by-time comparison was not significant at endpoint vs the 3-month follow-up, in the three groups. There was no difference in the sildenafil group in the three study periods (P > 0.05) CONCLUSION Men with mild and moderate psychogenic ED had higher treatment satisfaction, confidence and naturalness in engaging in sexual activity when receiving GPT plus sildenafil or GP exclusively, when compared with sildenafil exclusively, as assessed by these three EDITS questions after 6-months treatment.

Re-Evaluating Vietnam’s Nghe-Tinh Soviets (1930-1931) using a Historical GIS: Some Preliminary Observations

The Nghe-Tinh Soviets of 1930-1931, a rebellion against colonial authority in north-central and central colonial Vietnam, has received extensive analysis by a variety of commentators and scholars, both Vietnamese and not. Most scholars, Vietnam and internationally, settled on some view of immiseration combined with the presence of pro-communist organizers as the motive forces for the rebellion, but a few have favored questions of political dissatisfaction and local empowerment as underlying motivations for revolt. Until recently, examining the rebellion on a gross scale in order to test either theory has proven difficult, with a surfeit of information but no easy way to process it in order to underwrite large-scale analyses. Del Testa is using a historical GIS (geographical information system) analysis, which blends statistics with digitized maps, in order to display correlations between factors, such as wealth, religion, and so on of those who rebelled in order to reexamine the Nghe-Tinh Soviets movement on a grand scale. His presentation will illustrate some initial findings as well as the techniques used.

Development of the Heat and Energy Concept Inventory: Preliminary Results on the Prevalence and Persistence of Engineering Students' Misconceptions

BACKGROUND Students frequently hold a number of misconceptions related to temperature, heat and energy. There is not currently a concept inventory with sufficiently high internal reliability to assess these concept areas for research purposes. Consequently, there is little data on the prevalence of these misconceptions amongst undergraduate engineering students. PURPOSE (HYPOTHESIS) This work presents the Heat and Energy Concept Inventory (HECI) to assess prevalent misconceptions related to: (1) Temperature vs. Energy, (2) Temperature vs. Perceptions of Hot and Cold, (3) Factors that affect the Rate vs. Amount of Heat Transfer and (4) Thermal Radiation. The HECI is also used to document the prevalence of misconceptions amongst undergraduate engineering students. DESIGN/METHOD Item analysis, guided by classical test theory, was used to refine individual questions on the HECI. The HECI was used in a one group, pre-test-post-test design to assess the prevalence and persistence of targeted misconceptions amongst a population of undergraduate engineering students at diverse institutions. RESULTS Internal consistency reliability was assessed using Kuder-Richardson Formula 20; values were 0.85 for the entire instrument and ranged from 0.59 to 0.76 for the four subcategories of the HECI. Student performance on the HECI went from 49.2% to 54.5% after instruction. Gains on each of the individual subscales of the HECI, while generally statistically significant, were similarly modest. CONCLUSIONS The HECI provides sufficiently high estimates of internal consistency reliability to be used as a research tool to assess students' understanding of the targeted concepts. Use of the instrument demonstrates that student misconceptions are both prevalent and resistant to change through standard instruction.

A Preliminary Impact Assessment of Doha Round Results on Agricultural Policies in Turkey

Turkish agriculture has been experiencing a period of unique policy experiment over the last couple years. A World Bank-initiated project, called the Agricultural Reform Implementation Project (ARIP), has been at the forefront of policy change. It was initially promoted by the Bank as an exemplary reform package which could also be adopted by other developing countries. It was introduced in 2001 as part of a major International Monetary Fund (IMF)/World Bank-imposed program of “structural adjustment” after the country had been hit by a major financial crisis. The project has finally come to an end in 2009, and there is now an urgent need for a retrospective assessment of its overall impact on the agricultural sector. Has it fulfilled its ambitious objective of reforming and restructuring Turkish agriculture? Or should it be recorded as a failure of the neo-liberal doctrine? This book aims at finding answers to these questions by investigating the legacy of ARIP from a multi-disciplinary perspective.

Caste, land, and migration : a preliminary analysis of a village survey in an underdeveloped state in India

This paper explores migration from Bihar, one of the most underdeveloped states in India, by paying particular attention to social class (caste) and landholdings. After describing details of individual migrants, we present our preliminary findings on the determinants of migration, based on our field survey of 200 households in four villages in 2011. In terms of social class, Muslims are more likely to migrate, but Scheduled Castes do not show a high propensity to migrate as is stated in some of the existing literature where the underclass is said to be more mobile. In terms of landholdings, the probability that someone will migrate is high among the landless and smaller landholders but it decreases as the size of the landholding increases. However, as the size of the landholding increases still further, a reverse effect of landholding on decisions regarding migration moves in, with the decline in probability becoming less and less. This result confirms a non-linear relationship between landholdings and the decision to migrate. Some further research questions are raised in the paper.

Continuous Off-the-Job Training in East Germany After Unification: Preliminary Results of an Evaluation of the Effects for Individual Workers, CES Germany & Europe Working Papers, No. 05.9, 19 July, 1995

Retraining the labor force to match the demands of a modem economy is seen as an important task during the transition process from a centrally-planned to a market economy. This need was particularly pressing in East Germany, because the transition process has proceeded much faster than in the rest of Eastern Europe. Therefore, substantial resources have been devoted to this purpose. This paper analyzes the impact of continuous off-the-job training in East Germany from the point of view of individuals who were part of the labor force before German unification in 1990. It tries to answer questions about the average gains from participating in a specific type of training. Typical outcomes considered to measure those gains are income, employment status, job security, and expected future changes in job position. The methodology used for the evaluation is the potential outcome approach to causality. This approach has received considerable attention in the statistical literature over the last fifteen years and it has recently been rediscovered by the econometric literature as well. It is adapted to allow for important permanent and transitory shocks, such as unemployment, which influence the decision to participate in the training as well as future labor market outcomes. The empirical part is based on the first four waves of the Socio-Economic Panel (GSOEP)-East (1990-1993). This panel data set has the advantage that the fourth wave contains a special survey on continuous training and that it allows keeping track of individual behavior on a monthly, respectively yearly, basis. The econometric analysis focuses on off-the-job training courses that began after unification and were completed not later than in early 1993. Although it is obviously too early to evaluate the long-term implications, the results suggest that there are no positive effects in the short run.

Development and preliminary psychometric properties of the Care Experience Feedback Improvement Tool (CEFIT).

Objective To develop a structurally valid and reliable, yet brief measure of patient experience of hospital quality of care, the Care Experience Feedback Improvement Tool (CEFIT). Also, to examine aspects of utility of CEFIT. Background Measuring quality improvement at the clinical interface has become a necessary component of healthcare measurement and improvement plans, but the effectiveness of measuring such complexity is dependent on the purpose and utility of the instrument used. Methods CEFIT was designed from a theoretical model, derived from the literature and a content validity index (CVI) procedure. A telephone population surveyed 802 eligible participants (healthcare experience within the previous 12 months) to complete CEFIT. Internal consistency reliability was tested using Cronbach's α. Principal component analysis was conducted to examine the factor structure and determine structural validity. Quality criteria were applied to judge aspects of utility. Results CVI found a statistically significant proportion of agreement between patient and practitioner experts for CEFIT construction. 802 eligible participants answered the CEFIT questions. Cronbach's α coefficient for internal consistency indicated high reliability (0.78). Interitem (question) total correlations (0.28–0.73) were used to establish the final instrument. Principal component analysis identified one factor accounting for 57.3% variance. Quality critique rated CEFIT as fair for content validity, excellent for structural validity, good for cost, poor for acceptability and good for educational impact. Conclusions CEFIT offers a brief yet structurally sound measure of patient experience of quality of care. The briefness of the 5-item instrument arguably offers high utility in practice. Further studies are needed to explore the utility of CEFIT to provide a robust basis for feedback to local clinical teams and drive quality improvement in the provision of care experience for patients. Further development of aspects of utility is also required.