The value of adjuvant radiotherapy on survival and recurrence in triple-negative breast cancer: a systematic review and meta-analysis of 5,507 patients

BACKGROUND: The value of adjuvant radiotherapy in triple negative breast cancer (TNBC) remains unclear. A systematic review and meta-analysis was conducted in TNBC patients to assess survival and recurrence outcomes associated with radiotherapy following either breast conserving therapy (BCT) or post-mastectomy radiotherapy (PMRT). METHODS: Four electronic databases were searched from January 2000 to November 2015 (PubMed, MEDLINE, EMBASE and Web of Science). Studies investigating overall survival and/or recurrence in TNBC patients according to radiotherapy administration were included. A random effects meta-analysis was conducted using mastectomy only patients as the reference.  RESULTS: Twelve studies were included. The pooled hazard ratio (HR) for locoregional recurrence comparing BCT and PMRT to mastectomy only was 0.61 (95% confidence interval [CI] 0.41-0.90) and 0.62 (95% CI 0.44-0.86), respectively. Adjuvant radiotherapy was not significantly associated with distant recurrence. The pooled HR for overall survival comparing BCT and PMRT to mastectomy only was 0.57 (95% CI 0.36-0.88) and HR 1.12 (95% CI 0.75, 1.69). Comparing PMRT to mastectomy only, tests for interaction were not significant for stage (p=0.98) or age at diagnosis (p=0.85). However, overall survival was improved in patients with late-stage disease (T3-4, N2-3) pooled HR 0.53 (95% CI 0.32-0.86), and women <40 years, pooled HR 0.30 (95% CI 0.11-0.82). CONCLUSIONS: Adjuvant radiotherapy was associated with a significantly lower risk of locoregional recurrence in TNBC patients, irrespective of the type of surgery. While radiotherapy was not consistently associated with an overall survival gain, benefits may be obtained in women with late-stage disease and younger patients. 

Diagnostic value of surgical lung biopsy: comparison with clinical and radiological diagnosis

OBJECTIVE: To determine overall and disease-related accuracy of the clinical/imagiological evaluation for pulmonary infiltrates of unknown aetiology, compared with the pathological result of the surgical lung biopsy (SLB) and to evaluate the need for the latter in this setting. METHODS: We conducted a retrospective review of the experiences of SLB in 366 consecutive patients during the past 5 years. The presumptive diagnosis was based on clinical, imagiological and non-invasive or minimally invasive diagnostic procedures and compared with the gold standard of histological diagnosis by SLB. We considered five major pathological groups: diffuse parenchymal lung disease (DPLD), primitive neoplasms, metastases, infectious disease and other lesions. Patients with previous histological diagnosis were excluded. RESULTS: In 56.0% of patients (n=205) clinical evaluation reached a correct diagnosis, in 42.6% a new diagnosis was established (n=156) by the SLB, which was inconclusive in 1.4% (n=5). The pre-test probability for each disease was 85% for DPLD, 75% for infectious disease, 64% for primitive neoplasms and 60% for metastases. Overall sensitivity, specificity, positive and negative predictive values for the clinical/radiological diagnosis were 70%, 90%, 62% and 92%, respectively. For DPLD: 67%, 90%, 76% and 85%; primitive neoplasms: 47%, 90%, 46% and 90%; metastases: 99%, 79%, 60% and 99%; infectious disease 38%, 98%, 53% and 96%. CONCLUSIONS: Despite a high sensitivity and specificity of the clinical and imagiological diagnosis, the positive predictive value was low, particularly in the malignancy group. SLB should be performed in pulmonary infiltrates of unknown aetiology because the clinical/imagiological assessment missed and/or misdiagnosed an important number of patients.

Práticas de gestão do design para o subsetor nacional de cerâmica utilitária e decorativa

O campo de análise do estudo compreende o subsetor de cerâmica utilitária e decorativa (CUD) nacional. Nesse contexto, o estudo analisa o papel atual do designer e propõe novas estratégias de gestão do design, como ferramentas estratégicas potenciadoras de inovação e de valor acrescentado, para o produto e para o desenvolvimento da empresa. A pertinência da investigação justifica-se pela necessidade premente da reestruturação estratégica das empresas do setor face ao cenário da crise atual. Os dados mais recentes disponibilizados do subsetor indicam que, de 2002 para 2008, encerraram 36,6% das empresas, o número de trabalhadores reduziu-se em 36,8% e o volume de negócios decresceu 32%. Acrescenta-se ainda que, do ano de 2008 para 2012, encerraram 15% das empresas da amostra. Pretende-se com este estudo não só definir o estado atual da arte e do subsetor mas, ir mais além, procurando respostas aos problemas detetados, através de ferramentas estratégicas para a gestão do design integrado nas estratégias de imagem, comercialização e produção. O estudo compreendeu as seguintes etapas: pesquisa, análise de dados e desenvolvimento dos resultados. A etapa da pesquisa correspondeu à recolha da documentação disponível para o contexto do subsetor e da gestão do design apresentado no estado da arte; a pesquisa de campo a seleção de empresas da amostra onde se realizaram questionários (em 2008 e 2012) e entrevistas (em 2008) no universo amostra. Na análise de dados, estes foram apresentados e analisados de forma quantitativa e qualitativa (com recurso a lugares estruturais e a palavras-chave) e relacionados com o estado de arte e desenvolvimento de resultados. A última etapa, desenvolvimento dos resultados, traduz-se pela idealização e construção de ferramentas sob a perspetiva da gestão do design nas empresas: em checklists da definição do trabalho do designer e da integração do designer nas estratégias de gestão do design, aplicadas ao subsetor; na definição das estratégias vigentes na amostra; na sugestão de uma estratégia de gestão de design direcionada para o subsetor e de planos de ação concordantes com a estratégia sugerida. A novidade do estudo está presente nas propostas de ferramentas estratégicas, onde se define o trabalho do designer, enuncia estratégias de gestão do design direcionadas ao subsetor, define campos de integração do designer nessas estratégias, caracteriza-se a aplicabilidade de práticas de gestão do design e sugere-se uma estratégia e planos de ação para aplicar ao subsetor de CUD. De modo a facilitar a aplicação da investigação e da análise aqui realizada, redigiu-se um manual de estratégias de gestão do design – Cerâmica design mais – para disponibilizar e apresentar futuramente ao subsetor e a todos os interessados no tema.

Extraction of added-value products from biomass using ionic liquids

The main purpose of this thesis is to investigate the potential of ionic liquids (ILs) as a new class of extractive solvents for added-value products from biomass. These include phenolic compounds (vanillin, gallic, syringic and vanillic acids), alkaloids (caffeine) and aminoacids (L-tryptophan). The interest on these natural compounds relies on the wide variety of relevant properties shown by those families and further application in the food, cosmetic and pharmaceutical industries. Aiming at developping more benign and effective extraction/purification techniques than those used, a comprehensive study was conducted using aqueous biphasic systems (ABS) composed of ILs and inorganic/organic salts. In addition, ILs were characterized by a polarity scale, using solvatochromic probes, aiming at providing prior indications on the ILs affinity for particular added-value products. Solid-liquid (S-L) extractions from biomass and using aqueous solution of ILs were also investigated. In particular, and applying and experimental factorial design to optimize the operational conditions, caffeine was extracted from guaraná seeds and spent coffee. With both types of extractions it was found that it is possible to recover the high-value compounds and to recycle the IL and salt solutions. Finally, aiming at exploring the recovery of added-value compounds from biomass using a simpler and more suistainable technique, the solubility of gallic acid, vanillin and caffeine was studied in aqueous solutions of several ILs and common salts. With the gathered results it was possible to demonstrate that ILs act as hydrotropes and that water can be used as an adequate antisolvent. This thesis describes the use of ILs towards the development of more effective and sustainable processes.

Boundary value problems for analytic functions in the class of Cauchy-type integrals with density in

We study the Riemann boundary value problem , for analytic functions in the class of analytic functions represented by the Cauchy-type integrals with density in the spaces with variable exponent. We consider both the case when the coefficient is piecewise continuous and it may be of a more general nature, admitting its oscillation. The explicit formulas for solutions in the variable exponent setting are given. The related singular integral equations in the same setting are also investigated. As an application there is derived some extension of the Szegö-Helson theorem to the case of variable exponents.

Adding value to performance measurement by using system dynamics and multicriteria analysis

Tese de dout., Filosofia, Department of Management Science, University of Strathclyde, 2004

A value chain analysis of tuna industry in Ghana

Every can of tuna purchased by the consumer has taken a long journey before reaching the supermarket shelves. For each can bought there is a lengthy process from sea to shelf. A large proportion of the tuna cans purchased in the European Union come all the way from West Africa; a developing region with a high dependency on fisheries. Amidst an ever-increasing demand for tuna products the global tuna fisheries are set to continue expanding, apparently one of the last natural resource based industries fit to do so in West Africa. Tuna is the biggest fisheries export and dominates the fisheries sector in Ghana, a country situated in West Africa. This thesis aims to understand how this globally important industrial fisheries functions in terms of procedures, practices, Governance and finance. Socioeconomic influences, in the setting of a developing country, were also examined. For these purposes a Value Chain Analysis was employed. A Value Chain Analysis is a tool commonly used to understand how different companies and organizations participate in a domestic policy environment, which directs conclusion in the global economy. This analysis has the potential to allow researchers to fully understand a commodity chain and hence identify realistic opportunities for consequential improvements. Interviews and questionnaires were employed in-field Ghana along with secondary data collection techniques. It was found that the fisheries functions at the production level under influences from large multinational companies and tends to operate with a certain degree of lawlessness. Governance over the value chain is well defined, however implementation is poor or non-existent. The processors, whom are also dominated by multinationals, exert some control over the producers and their sales, however the high value links which are highlighted occur at the retail stage. Socioeconomic dynamics acting in the chain included the lack of communication between the public and private sector, power imbalances amongst players at production, the role of local businesswomen as actors in the chain and the general characteristics of the workers in the industry. Value addition and upgrading are needed the most in Governance over the chain, especially within Monitoring, Control and Surveillance. The results of the study provide a wealth of material about the components of a cost-heavy fishing industry in a developing country; an industry on which many eyes have recently turned due to illegal fishing activities. It highlights clearly where funding and future focus are needed. This value chain can be used as a guide for those that need to comprehend the financial complexities and real life dynamics of the Ghanaian tuna fishing industry today.

Does Cost-Effectiveness Analysis Have a Role in US Managed Care Drug Formularies? An Empirical Study of Utilization, Costs, Outcomes, and Elasticity of Demand of a Value-Based Formulary

Thesis (Ph.D.)--University of Washington, 2015

Is there really a value in entrepreneurship education?

This paper considers whether entrepreneurship education has a value outside of the education institutions in which it takes place. The paper takes an indirect form of enquiry and argues that entrepreneurship education is driven by three factors; the growing emphasis on supply side policy interventions in the economy; the emphasis placed on the agency of management in the growing literature on globalisation and international reforms to public sector organisations. The paper concludes that there is a tension between the activity as descriptive and the activity as promotion and until this tension is resolved it is unlikely that there will be clarity about the value of this form of education.

Theorising and analysing digital labour: from global value chains to modes of production

This paper considers the following question—where do computers, laptops and mobile phones come from and who produced them? Specific cases of digital labour are examined—the extraction of minerals in African mines under slave-like conditions; ICT manufacturing and assemblage in China (Foxconn); software engineering in India; call centre service work; software engineering at Google within Silicon Valley; and the digital labour of internet prosumers/users. Empirical data and empirical studies concerning these cases are systematically analysed and theoretically interpreted. The theoretical interpretations are grounded in Marxist political economy. The term ‘global value chain’ is criticised in favour of a complex and multidimensional understanding of Marx’s ‘mode of production’ for the purposes of conceptualizing digital labour. This kind of labour is transnational and involves various modes of production, relations of production and organisational forms (in the context of the productive forces). There is a complex global division of digital labour that connects and articulates various forms of productive forces, exploitation, modes of production, and variations within the dominant capitalist mode of production.

The significance of Marx's value for strategy theory: competitive advantage and the issue of tautology within the resource-based view of the firm

Marxian thinking following the TSSI (Temporal Single System Interpretation) of Marx is applied to refute the allegation of a tautology in the resource-based view of the firm--paired with providing an explanation of how and why resources create value--, where resources are synonymous with Marx's categories of constant and variable capital. Refuting the allegation naturally leads to the holy grail of resource-based thinking, i.e. the question of what, conceptually, constitutes a firm's competitive advantage within the industry context. The article achieves its objectives by tying the resource-based view into Marx's theory value.

Diagnostic value of H3F3A mutations in giant cell tumour of bone compared to osteoclast-rich mimics

Driver mutations in the two histone 3.3 (H3.3) genes, H3F3A and H3F3B, were recently identified by whole genome sequencing in 95% of chondroblastoma (CB) and by targeted gene sequencing in 92% of giant cell tumour of bone (GCT). Given the high prevalence of these driver mutations, it may be possible to utilise these alterations as diagnostic adjuncts in clinical practice. Here, we explored the spectrum of H3.3 mutations in a wide range and large number of bone tumours (n 5 412) to determine if these alterations could be used to distinguish GCT from other osteoclast-rich tumours such as aneurysmal bone cyst, nonossifying fibroma, giant cell granuloma, and osteoclast-rich malignant bone tumours and others. In addition, we explored the driver landscape of GCT through whole genome, exome and targeted sequencing (14 gene panel). We found that H3.3 mutations, namely mutations of glycine 34 in H3F3A, occur in 96% of GCT. We did not find additional driver mutations in GCT, including mutations in IDH1, IDH2, USP6, TP53. The genomes of GCT exhibited few somatic mutations, akin to the picture seen in CB. Overall our observations suggest that the presence of H3F3A p.Gly34 mutations does not entirely exclude malignancy in osteoclast-rich tumours. However, H3F3A p.Gly34 mutations appear to be an almost essential feature of GCT that will aid pathological evaluation of bone tumours, especially when confronted with small needle core biopsies. In the absence of H3F3A p.Gly34 mutations, a diagnosis of GCT should be made with caution.

Introduction to the Special Section Value Development from Middle Childhood to Early Adulthood: New Insights from Longitudinal and Genetically Informed Research

Research into values at an early age has only started recently, although it has expanded quickly and dynamically in the past years. The purpose of this article is twofold: First, it provides an introduction to a special section that aims to help fill the gap in value development research. The special section brings together four new longitudinal and genetically informed studies of value development from the beginning of middle childhood through early adulthood. Second, this article reviews recent research from this special section and beyond, aiming to provide new directions to the field. With new methods for assessing children's values and an increased awareness of the role of values in children's and adolescents' development, the field now seems ripe for an in-depth investigation. Our review of empirical evidence shows that, as is the case with adults, children's values are organized based on compatibilities and conflicts in their underlying motivations. Values show some consistency across situations, as well as stability across time. This longitudinal stability tends to increase with age, although mean changes are also observed. These patterns of change seem to be compatible with Schwartz's (1992) theory of values (e.g., if the importance of openness to change values increases, the importance of conservation values decreases). The contributions of culture, family, peers, significant life events, and individual characteristics to values are discussed, as well as the development of values as guides for behavior.

Reciprocal relations across time between basic values and value-expressive behaviors: A longitudinal study among children

Tracing children’s values and value-expressive behavior over a sixth-month period, we examined stability and change of values and behavior and the reciprocal relations between them. Three hundred and ten sixth-grade students in Italy completed value and value-expressive behavior questionnaires three times in three-month intervals during the scholastic year. We assessed Schwartz's (1992) higher-order values of conservation, openness to change, self-enhancement, and self-transcendence, as well as their respective expressive behaviors. Reciprocal relations over time between values and behaviors were examined using a cross-lagged longitudinal design. Results showed that values and behaviors had reciprocal longitudinal effects on one another, after the stability of the variables was taken into account (i.e., values predicted change in behaviors, but also behaviors predicted change in values). Our findings also revealed that: (1) values were more stable over time than behaviors, and (2) the longitudinal effect of values on behaviors tended to be stronger than the longitudinal effect of behaviors on values. Findings are discussed in light of the recent developmental literature on value change.