Alternative targeted therapy for early HER2 positive breast cancer

Her2 (erbB2) receptor is overexpressed in around twenty percent of early breast cancer and historically conferred a poorer prognosis (1). Targeted anti-Her2 therapy has significantly improved outcomes for these women.

Neuroendocrine neoplasms of the GI tract : the role of cytotoxic chemotherapy

Neuroendocrine neoplasms (NENs) comprise a heterogeneous group of neoplasms derived from peptide- and amine-secreting cells of the neuroendocrine system. NENs commonly arise in the GI tract but can arise in most organs of the body. NENs in different organs share many common pathologic features. Although the incidence of NENs is not high, the prevalence is not low because many patients may live relatively long periods without major symptoms from the disease. While many of these tumors lead an indolent clinical course, they constitute a therapeutic challenge when they progress, metastasize and become symptomatic. Treatment requires a multidisciplinary approach including cytotoxic chemotherapy. Almost all clinical trials investigating cytotoxic chemotherapy in NENs are small single-arm studies and guidelines are derived from expert opinion and from extrapolating results from small cell lung cancer studies. This article briefly reviews NENs before focusing on reviewing data on the role of cytotoxic chemotherapy studies in NENs.

IPMA : Indirect patterns mining algorithm

Indirect pattern is considered as valuable and hidden information in transactional database. It represents the property of high dependencies between two items that are rarely occurred together but indirectly appeared via another items. Indirect pattern mining is very important because it can reveal a new knowledge in certain domain applications. Therefore, we propose an Indirect Pattern Mining Algorithm (IPMA) in an attempt to mine the indirect patterns from data repository. IPMA embeds with a measure called Critical Relative Support (CRS) measure rather than the common interesting measures. The result shows that IPMA is successful in generating the indirect patterns with the various threshold values.

Parallax

Parallax is a live contemporary dance work that incorporates 3D animation, stereoscopic illusions and dance. This work was performed within the Melbourne Fringe Festival at the Substation, Newport. Within this work the stereoscopic illusion creates a new choreographic palette that can be used to manipulate human physicality via animated bodies that appear within the performance space. The stereoscopic image is released from the wall and placed within the dancing environment the image becomes another body within the dance space that can be manipulated in ways that would be impossible for a real physical body. In turn, the dancing body is positioned within the digital environment. The performer’s abilities have not changed, but the space around the dancer can be manipulated with imagery that transforms the place of the dancer within time and space. The stereoscopic illusion and live dance are melded creating a new experience of choreography one that takes the infinite possibilities of 3D animation and places them directly within choreography. Thematically this performance draws on the historical events revolving around the development of the stereoscope in the 1830s and the seminal ideas of the virtual that surfaced at this time. In the early 1830s Charles Wheatstone drew on the ideas and writings of Euclid and Leonardo da Vinci and discovered binocular vision through the use of his stereoscope box. It was this box that became the entertainment sensation of this time becoming a standard parlour entertainment. Unlike now where imagery of people are everywhere in the 1830s these types of imagery were novel. The stereoscopic pictures often showed content of people doing ordinary tasks such as chopping wood, doing the washing or simply standing in front of their house. In Parallax a Victorian woman is transported from her hallway to virtual worlds where she encounters, Euclid’s ancient Greek column, a di Vinci sphere and one of the first stereoscopic images drawn by Charles Wheatstone’s a stick figure cube.

Brain metastases in breast cancer

Despite therapeutic advances, the development of breast cancer brain metastases (BCBM) is still the harbinger of a dismal prognosis. Patient outcomes vary depending on factors, including tumor phenotype, extent of disease within and outside the brain, as well as patient performance status. Treatment includes surgery, radiation therapy and systemic therapy determined by patient and tumor characteristics. Despite these approaches, novel treatments are needed and there is growing interest in systemic therapies. However, the efficacy of pharmacologic agents is hampered by poor penetration of drugs across the blood–brain barrier. Therefore, there is a pressing need for a greater understanding of the natural history of BCBM to guide the development of further therapies. This review analyzes prognosis and treatment of BCBM by tumor phenotype and discusses ongoing research into new therapies.

A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency

Background
Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why?

Methods
The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use.

Results
24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents’ function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches.

Conclusion
This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.