The prognostic impact of clinical and molecular features in hairy cell leukaemia variant and splenic marginal zone lymphoma.

Hairy cell leukaemia variant (HCL-variant) and splenic marginal zone lymphoma (SMZL) are disorders with overlapping features. We investigated the prognostic impact in these disorders of clinical and molecular features including IGH VDJ rearrangements, IGHV gene usage and TP 53 mutations. Clinical and laboratory data were collected before therapy from 35 HCL-variant and 68 SMZL cases. End-points were the need for treatment and overall survival. 97% of HCL-variant and 77% of SMZL cases required treatment (P = 0·009). Survival at 5 years was significantly worse in HCL-variant [57% (95% confidence interval 38-73%)] compared with SMZL [84% (71-91%); Hazard Ratio 2·25 (1·20-4·25), P = 0·01]. In HCL-variant, adverse prognostic factors for survival were older age (P = 0·04), anaemia (P = 0·01) and TP 53 mutations (P = 0·02). In SMZL, splenomegaly, anaemia and IGHV genes with >98% homology to the germline predicted the need for treatment; older age, anaemia and IGHV unmutated genes (100% homology) predicted shorter survival. IGHV gene usage had no impact on clinical outcome in either disease. The combination of unfavourable factors allowed patients to be stratified into risk groups with significant differences in survival. Although HCL-variant and SMZL share some features, they have different outcomes, influenced by clinical and biological factors.

A compendium of myeloma-associated chromosomal copy number abnormalities and their prognostic value.

To obtain a comprehensive genomic profile of presenting multiple myeloma cases we performed high-resolution single nucleotide polymorphism mapping array analysis in 114 samples alongside 258 samples analyzed by U133 Plus 2.0 expression array (Affymetrix). We examined DNA copy number alterations and loss of heterozygosity (LOH) to define the spectrum of minimally deleted regions in which relevant genes of interest can be found. The most frequent deletions are located at 1p (30%), 6q (33%), 8p (25%), 12p (15%), 13q (59%), 14q (39%), 16q (35%), 17p (7%), 20 (12%), and 22 (18%). In addition, copy number-neutral LOH, or uniparental disomy, was also prevalent on 1q (8%), 16q (9%), and X (20%), and was associated with regions of gain and loss. Based on fluorescence in situ hybridization and expression quartile analysis, genes of prognostic importance were found to be located at 1p (FAF1, CDKN2C), 1q (ANP32E), and 17p (TP53). In addition, we identified common homozygously deleted genes that have functions relevant to myeloma biology. Taken together, these analyses indicate that the crucial pathways in myeloma pathogenesis include the nuclear factor-κB pathway, apoptosis, cell-cycle regulation, Wnt signaling, and histone modifications. This study was registered at http://isrctn.org as ISRCTN68454111.

UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method

Introduction
Evaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.

Aim
To develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.

Methods
Using a modified version of the RAND/UCLA appropriateness method (Fitch et al., 2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.

Results
71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.

Conclusion
The final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.

Reference

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001. http://www.rand.org/pubs/monograph_reports/MR1269

The Acridian plagues, a new Holocene and Pleistocene palaeoclimatic indicator

[EN] Five palaeosols, intercalated within the Quaternary dune beds of Fuerteventura and Lanzarote (Canary Islands), off the Moroccan coast, mark wetter climatic episodes. In all of them, billions of calcified insect ootheca testify to past occurrences of Acridian plagues, such as those reaching the western Sahara following heavy rainfall events over the Sahel.

Ki-67 Proliferation Index in Gastric Cancer - Biologic Significance

Objectives/Introdution: Ki-67 protein has been used as an indicator of proliferation activity in tumor cells. In gastric cancer the prognostic value has not been fully understood. This study was designed to assess the biologic significance of Ki-67 proliferation index (PI) in gastric cancer. Material/Methods: Seventy-two patients with gastric cancer were evaluated. These patients underwent gastric resection, and the tumor tissue was stained immunohistochemically. Ki-67 PI was defined as the percentage of tumor cells positive for Ki-67. Ki-67 PI was correlated with clinicopathological characteristics and patient survival. Results: A low Ki-67 PI (less than or equal to 50%) was associated with poorly differentiated histology - diffuse type (p=0.009) and signet ring cells (p=0.004) - and younger age (p=0.022). A worse prognosis in patients with low Ki-67 PI was also found (a mean survival of 41.8 vs 63 months for high Ki-67 PI group), but not statistically significant (p=0.623, log rank test). Discussion/Conclusion: We found an inversely correlation between Ki-67 PI and histological differentiation grade. Patients in group with low Ki-67 PI are younger, with poorly differentiated histology and have a lower mean survival. Like other studies already suggested, we may have two different tumors phenotypes - highly invasive with low proliferative capability, and less invasive potential with higher proliferative ability. However, in this sample, no significant prognostic value was achieved between both.

The IJK Ride Indicator, 1976

State highway engineers realized a need for a numerical quality index and began planning for a research project of this type in 1951. The Present Serviceability Index was developed through the AASHO (now AASHTO) Road Test near Ottawa, Illinois, from 1956 to 1962.1 longitudinal profile and physical deterioration such as cracking, patching, and rut depth (for flexible pavements) were considered in deriving these Present Serviceability Index (PSI) equations

Validation Française de l’Échelle de la Personnalité Temporelle (French Validation of the Time Personality Indicator)

RÉSUMÉ Certains auteurs ont développé un intérêt pour la compréhension des aptitudes associées à la gestion du temps. Ainsi, plusieurs définitions théoriques ont été proposées afin de mieux cerner ce concept et une multitude de questionnaires a été développée afin de le mesurer. La présente étude visait à valider la traduction française d’un de ces outils, soit le Time Personality Indicator (TPI). Des analyses exploratoires et confirmatoires ont été effectuées sur l’ensemble des données recueillies auprès de 1 267 étudiants et employés de l’Université Laval ayant complété la version française du TPI ainsi que d’autres mesures de la personnalité. Les résultats ont révélé qu’une solution à huit facteurs permet de mieux décrire les données de l’échantillon. La discussion présente les raisons pour lesquelles la version française du TPI est valide, identifie certaines limites de la présente étude et souligne l’utilité de cet outil pour la recherche sur la gestion du temps. (ABSTRACT: Numerous authors have developed an interest towards the understanding of the abilities related to time management. As a consequence, multiple theoretical definitions have been proposed to explain time management. Likewise, several questionnaires have been developed in order to measure this concept. The aim of this study was to validate a French version of one of these tools, namely the Time Personality Indicator (TPI). The French version of the TPI and other personality questionnaires were completed by 1267 students and employees of Université Laval. The statistical approach used included exploratory and confirmatory analyses. Results revealed that an eight factor model provided a better adjustment to the data. The discussion provides arguments supporting the validity of the French version of the TPI and underlines the importance of such a tool for the research on time management)

Eosinophilia is a favourable prognostic marker in oral squamous cell carcinoma

Suusyöpä on yleisin pään ja kaulan alueen pahanlaatuisista kasvaimista. Niistä yli 90 % on levyepiteelikarsinoomia. Koska suusyöpäpotilaan viisivuotisennuste on vain noin 50 %, on jatkuva tarve löytää keinoja ennustamaan potilaan selviytymistä ja ohjaamaan hoitoa. Suun levyepiteelikarsinooman ympäristössä havaitaan säännöllisesti eosinofiilejä. Eosinofiili on ihmisen immuunijärjestelmän erikoistunut solu, joiden määrä lisääntyy sekä tulehdusreaktioissa että syöpien läheisyydessä. Toistaiseksi ei tiedetä, miten eosinofiilit liittyvät suun levyepiteelikarsinoomaan, mutta oletuksena on, että suusyöpään liittyvällä eosinofilialla, TATE (tumor-associated tissue eosinophilia), voisi olla vaikutusta suun levyepiteelikarsinoomapotilaan ennusteeseen. Tämän tutkimuksen tarkoituksena oli selvittää TATE:n ilmenemistä ja vaikutusta potilaan ennusteeseen suun levyepiteelikarsinoomassa. Lisäksi tutkimus käsittelee potilaan ennusteen kannalta optimaalista eosinofiilimäärän raja-arvoa, jota voitaisiin käyttää patologin työkaluna ennusteen arvioinnissa. Tutkimusaineisto koostui Turun yliopiston Suupatologian laitoksella vuosina 2002-2010 tutkituista 122 suuontelon ja huulen limakalvokoepalasta, jotka oli otettu diagnostisia tarkoituksia varten 99 potilaalta. Tutkimuksen potilaista 44 oli naisia ja 55 miehiä, ja heidän keski-ikänsä oli 65,3 vuotta. Seuranta-aika oli keskimäärin 40,7 kk. Kaksi tutkijaa analysoivat hematoksyliini-eosiinilla värjätyt näytteet suurentamalla ne 400-kertaisiksi valomikroskoopilla. Eosinofiilien määrä laskettiin yhteensä kuudelta edustavimmalta syövän ja strooman alueelta. TATE:n suhde potilaan kliinispatologisiin piirteisiin ja selviytymiseen selvitettiin Turun yliopistollisen keskussairaalan potilastiedoistoista ja analysoitiin tilastollisesti käyttämällä Fischerin testiä. Työllä oli Varsinais-Suomen sairaanhoitopiirin eettisen toimikunnan lupa (nro T10/2011, päätös O31/11). Levyepiteelikarsinooman kliininen kuva vaihteli haavaisen muutoksen ollessa yleisin. Yleisin sijainti levyepiteelikarsinoomalle oli kieli. TATE:a löydettiin 61,5 %:sta (78/122) levyepiteelikarsinoomanäytteitä. Mikäli TATE:a ei löydetty tai sen määrä oli korkea, oli potilaan selviytyminen tilastollisesti merkitsevästi parempi kuin potilailla, joilla TATE oli matala. Lisäanalyyseissä havaittiin, että potilaan ennuste oli tilastollisesti merkitsevästi huonompi, mikäli TATE:n raja-arvo oli vähemmän kuin neljä eosinofiiliä per tutkittu mikroskooppinäkymä (HPF). TATE on täten merkki suun levyepiteelikarsinoomapotilaan paremmasta ennusteesta erityisesti, kun havaitaan enemmän kuin neljä eosinofiiliä/HPF. Tutkimustulosten varmistamiseksi tarvitaan kuitenkin jatkossa laajempia tutkimuksia.

For whom the Bellwether polls : the electorate of Eden-Monaro as an indicator of Australian electoral trends

Validation and Characterization of the Novel, Putative Prognostic Biomarkers CHAC1 and NFE2L2 in Breast Cancer

Arbeit an der Bibliothek noch nicht eingelangt - Daten nicht geprüft

Obstruction and infiltration: a proposal of a quality indicator.

Background The quest for continuous improvement of the quality of provided care is the objective of nursing care. However, the insertion and permanence of a peripheral venous catheter has been associated to complications, thus making a systematic evaluation of the performance of professionals and the management of health services important. Objective: Analyse complications that caused removal of intravenous catheters. Methods A prospective study with 64 patients of a health service of Portugal, from July to September/2015. Included patients with age 18 years, with a peripheral venous catheter. Descriptive analysis using SPSS. Ethical requirements were met. Results Two hundred three (203) intravenous catheters, in 64 patients, most elderly (section 95.3 %), with mean age of 80 years were evaluated. The catheters remained inserted between one and 12 days (mean 2 days), 66 % of the devices were removed because of complications, such as: removal by the patient (17.7 %), obstruction (17.2 %), infiltration (14.8 %), phlebitis (9.4 %) and fluid exiting the insertion site (6.4 %). The prevalence of obstruction and infiltration per patient was respectively 36 % and 39 %. Conclusions Obstruction and infiltration were the complications of higher prevalence that led to the removal and reinsertion of a new peripheral venous catheter with the possibility of increased pain, infection and hospital costs. Faced with the risk of compromising patient safety and being able to contribute to the improvement of health care, we suggest the inclusion of obstruction and infiltration in the indicators of quality of care, in order to have systematic evaluation of results, (re)plan and implement preventive measures.

THE USE OF THE EARLY WARNING INDICATOR REPORT TO IMPACT NINTH GRADE PROMOTION RATES IN A LARGE URBAN SCHOOL DISTRICT

Abstract The purpose of this study was to examine how four high schools used an Early Warning Indicator Report (EWIR) to improve ninth grade promotion rates. Ninth grade on-time promotion is an early predictor of a student’s likelihood to graduate (Bornsheuer, Polonyi, Andrews, Fore, & Onwuegbuzie, 2011; Leckrone & Griffith, 2006; Roderick, Kelley-Kemple, Johnson, & Beechum, 2014; Zvoch, 2006). The analysis revealed both similarities and differences in the ways that the four schools used the EWIR. The research took place in a large urban school district in the Mid-Atlantic. Sixteen participants from four high schools and the district’s central office voluntarily participated in face-to-face interviews. The researcher utilized a qualitative case study method to examine the implementation of the EWIR system in Wyatt School District. The interview data was transcribed and analyzed, along with district documents, to identify categories in this cross case analysis. Three primary themes emerged from the data: (1) targeted school structures for EWIR implementation, (2) the EWIR identified necessary supports for students, and (3) the central office support for school staff. The findings revealed the various ways that the target schools implemented the EWIR in their buildings and the level of support that they received from the central office that aided them in using the EWIR to improve ninth grade promotion rates. Based on the findings of this study, the researcher provided a number of key recommendations: (1) Districts should provide professional development to schools to ensure that schools have the support they need to implement the EWIR successfully; (2) There should be increased accountability from the central office for schools using the EWIR to identify impactful interventions for ninth graders; and (3) The district needs to assign dedicated central office staff to support the implementation of the EWIR in high schools across the district. As schools continue to face the challenge of improving ninth grade promotion rates, effective use of an Early Warning Indicator Report is recommended to provide school and district staff with data needed to impact overall student performance.

Mesenchymal chondrosarcoma: prognostic factors and outcome in 113 patients. A European Musculoskeletal Oncology Society study

BACKGROUND: Mesenchymal chondrosarcoma (MCS) is a distinct, very rare sarcoma with little evidence supporting treatment recommendations. PATIENTS AND METHODS: Specialist centres collaborated to report prognostic factors and outcome for 113 patients. RESULTS: Median age was 30 years (range: 11-80), male/female ratio 1.1. Primary sites were extremities (40%), trunk (47%) and head and neck (13%), 41 arising primarily in soft tissue. Seventeen patients had metastases at diagnosis. Mean follow-up was 14.9 years (range: 1-34), median overall survival (OS) 17 years (95% confidence interval (CI): 10.3-28.6). Ninety-five of 96 patients with localised disease underwent surgery, 54 additionally received combination chemotherapy. Sixty-five of 95 patients are alive and 45 progression-free (5 local recurrence, 34 distant metastases, 11 combined). Median progression-free survival (PFS) and OS were 7 (95% CI: 3.03-10.96) and 20 (95% CI: 12.63-27.36) years respectively. Chemotherapy administration in patients with localised disease was associated with reduced risk of recurrence (P=0.046; hazard ratio (HR)=0.482 95% CI: 0.213-0.996) and death (P=0.004; HR=0.445 95% CI: 0.256-0.774). Clear resection margins predicted less frequent local recurrence (2% versus 27%; P=0.002). Primary site and origin did not influence survival. The absence of metastases at diagnosis was associated with a significantly better outcome (P<0.0001). Data on radiotherapy indications, dose and fractionation were insufficiently complete, to allow comment of its impact on outcomes. Median OS for patients with metastases at presentation was 3 years (95% CI: 0-4.25). CONCLUSIONS: Prognosis in MCS varies considerably. Metastatic disease at diagnosis has the strongest impact on survival. Complete resection and adjuvant chemotherapy should be considered as standard of care for localised disease.

Is land condition a useful indicator of soil organic carbon stock in Australia?

The grazing lands of northern Australia contain a substantial soil organic carbon (SOC) stock due to the large land area. Manipulating SOC stocks through grazing management has been presented as an option to offset national greenhouse gas emissions from agriculture and other industries. However, research into the response of SOC stocks to a range of management activities has variously shown positive, negative or negligible change. This uncertainty in predicting change in SOC stocks represents high project risk for government and industry in relation to SOC sequestration programs. In this paper, we seek to address the uncertainty in SOC stock prediction by assessing relationships between SOC stocks and grazing land condition indicators. We reviewed the literature to identify land condition indicators for analysis and tested relationships between identified land condition indicators and SOC stock using data from a paired-site sampling experiment (10 sites). We subsequently collated SOC stock datasets at two scales (quadrat and paddock) from across northern Australia (329 sites) to compare with the findings of the paired-site sampling experiment with the aim of identifying the land condition indicators that had the strongest relationship with SOC stock. The land condition indicators most closely correlated with SOC stocks across datasets and analysis scales were tree basal area, tree canopy cover, ground cover, pasture biomass and the density of perennial grass tussocks. In combination with soil type, these indicators accounted for up to 42% of the variation in the residuals after climate effects were removed. However, we found that responses often interacted with soil type, adding complexity and increasing the uncertainty associated with predicting SOC stock change at any particular location. We recommend that caution be exercised when considering SOC offset projects in northern Australian grazing lands due to the risk of incorrectly predicting changes in SOC stocks with change in land condition indicators and management activities for a particular paddock or property. Despite the uncertainty for generating SOC sequestration income, undertaking management activities to improve land condition is likely to have desirable complementary benefits such as improving productivity and profitability as well as reducing adverse environmental impact.