Fulvestrant plus vandetanib versus placebo for the treatment of patients with metastatic breast cancer resistant to aromatase inhibitor therapy (FURVA): a multicentre, Phase 2, randomised controlled trial

Background: FURVA, a randomised, double-blind Phase II trial, investigated whether the addition of vandetanib to fulvestrant improved progression-free survival (PFS) in patients with an aromatase inhibitor(AI)-resistant advanced breast cancer. Methods: Postmenopausal women with oestrogen receptor-positive (ER+ve)/HER2-negative advanced breast cancer, who experienced disease progression on an AI, were randomised (1:1) to fulvestrant 500 mg (Q28) with vandetanib 300 mg od (f + v) or placebo (f + p) until disease progression or discontinuation. The primary endpoint was PFS; secondary endpoints included overall survival (OS) and the influence of REarranged during Transfection (RET) signalling on outcomes. Results: In total, 165 participants were randomised to f + v (n = 80) or f + p (n = 85). Median PFS was 5.5 months (m) for f + v compared to 5.5 m for f + p (hazard ratio (HR) 0.88; 95% CI: 0.62–1.23; P = 0.22). Unexpectedly, high total RET expression was associated with a PFS advantage of 8.87 m vs 3.94 with low RET (HR 0.493: 95% CI 0.32–0.77; P = 0.002) independent of the treatment arm, supported by an OS advantage 21.95 m vs 18.04 (HR 0.584; 95% CI 0.34–1.00; P = 0.051) in the high-RET group. Conclusion: The addition of vandetanib to fulvestrant does not improve PFS. However, high total RET expression was associated with improved PFS, suggesting RET may have a prognostic role in patients treated with fulvestrant. Clinical trial registration: ClinicalTrials.gov, NCT02530411

The Institutionalization of Implicit and Explicit CSR in a Developing Country Context: The Case of Lebanon

This article presents a qualitative study pertaining to the interface between business and society that primarily focuses on the prominent institutional factors that are influencing organizations to adopt explicit and implicit forms of corporate social responsibility in a developing country context. This is a pertinent subject because developing countries contain a large proportion of the world’s population and, subsequently, a large proportion of salient issues in the social, economic, and environmental arena. This study identifies that, in the country context chosen namely Lebanon, explicit social responsibility initiatives are driven by predominantly normative and mimetic institutional pressures emanating from both local and international institutions. This study also identifies that implicit social responsibility initiatives are driven by normative institutional pressures emanating from elements in the national business system. Contributions of this study include a conceptual model to aid future research, identifying the importance of the duality of corporate social responsibility, the importance of international institutions in facilitating explicit social responsibility proliferation, and the importance for managers to include explicit social responsibility initiatives in their organizational mandate. Future research can use a different sampling technique, conduct interviews with employees that are not directly involved with social responsibility initiatives, or use other perspectives, such as agency theory or theory of institutional logics, to gain more insight on the topic

Depressive symptoms and trust of healthcare provider in rural adolescents: Relationships and predictors

The purpose of this study was to evaluate associations among depressive symptoms, trust of healthcare provider, and health behavior in adolescents who live in a rural area. Two hundred twenty-four adolescents aged 14-19 years old attending public high school in the Midwestern United States were surveyed. Results showed a diagnosis of depression, trust of healthcare provider, health awareness, and stress management predicted depressive symptoms in adolescents living in a rural area. Healthcare providers should take extra care to promote trust in the healthcare provider-patient relationship with adolescents and to follow guidelines for annual screening of adolescents for depressive symptoms. Nursing implications include adolescent psychoeducation to improve health awareness and stress management.National Institutes of Health; Rural Nurses Organizatio

Global Cost and Carbon Impact Assessment Methodology for Electric Vehicles’ PV-Powered Charging Station

To deal with the issue of climate change by moving towards sustainable development, electric mobility is one of the most beneficial approaches, offering users relatively low-carbon transport means. Based on a life cycle assessment, this paper investigates a calculation methodology of carbon impact and global cost for a photovoltaic-powered charging station (PVCS) for electric vehicles (EVs). The PVCS is equipped with a PV system, stationary storage, charging terminals, and connection with the power grid. This methodology has two main objectives. The first one is the estimation of the global cost of the PVCS under 30 years of lifespan, including the costs of investment, exploitation, maintenance, and externalities. The second one is the calculation and assessment of the carbon impact of the PVCS and comparing it with a grid-powered charging station (PGCS). According to the analysis of the results obtained, the carbon impact of the PV system is largely responsible for the global carbon impact of PVCS. Thus, levers of action and scenarios are proposed to reduce the global carbon impact by using more recent data and recycled materials for the most emitting elements of CO2. The proposed scenarios allowed a reduction in the carbon impact of the PVCS compared to the PGCS, where scenario 4 has the lowest carbon impact. For recent PV panels having a greatly reduced emission coefficient of 0.012 kgCO2,eq/kWh, and a recycled infrastructure, the PVCS has a 32.1% lower carbon impact than that of the PGCS

Usual interstitial pneumonia in asbestos-exposed cohorts - concurrent idiopathic pulmonary fibrosis or atypical asbestosis?

Aims: To determine if usual interstitial pneumonia pattern fibrosis is seen in asbestosis METHODS AND RESULTS: The occurrence of usual interstitial pneumonia pattern fibrosis was studied in 4 asbestos cohorts systematically referred following post mortem to the U.K. Pneumoconiosis Unit, Cardiff. The combined exposed workforce was over 25,000 persons. Over the 17 year period 233 subjects were identified, 210 had degrees of interstitial fibrosis with a fibrotic non-specific interstitial pneumonia pattern and sub-pleural accentuation and 3 cases showed usual interstitial pneumonia pattern fibrosis. All 3 cases showed grade 4 fibrosis (honeycombing) with no asbestos fibre dose-response correlation. Poisson distribution of probability analysis indicated that the observed cases of usual interstitial pneumonia in this workforce could be wholly accounted for by the prevalence of idiopathic pulmonary fibrosis in the population CONCLUSIONS: Usual interstitial pneumonia pattern fibrosis is rarely observed in asbestos exposed subjects, shows no dose-response correlation with asbestos fibres on mineral analysis and this points to the alternate disease such as idiopathic pulmonary fibrosis. The results indicate that usual interstitial pneumonia pattern fibrosis should not be regarded as bonafide asbestosis, irrespective of the status of asbestos biomarkers and this impacts upon the post mortem handling of asbestos related deaths. This article is protected by copyright. All rights reserved

Whole Slide Imaging Integration with Lab Information Systems, a Study of the Requirements, Processes and Procedures Enabling a Reporting-Based Workflow

Fouad S Alchami,1,2 Zafar Iqbal,3 Carl Niclas Björkhammer,1 Mohammed O Saeed,3 Ramachandran Ramakrishnan,3 Colin Clelland,1 Fareed Ahmad,3 Adrian Charles1 1Department of Pathology, Sidra Medicine, Doha, Qatar; 2Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Qatar, Doha, Qatar; 3Imaging Information Systems, Sidra Medicine, Doha, QatarCorrespondence: Fouad S Alchami, Department of Pathology, Sidra Medicine, Doha, 26999, Qatar, Tel +974 40033034, Email [email protected]: Significant advances have been achieved in the clinical implementation of digital pathology (DP) whole slide imaging (WSI). However, the workflow of the reporting process and the full integration of this technology into the lab and hospital information system have not been sufficiently addressed. There is not sufficient vendor and industry consideration for this in the development and implementation process.Methods: Exploring the requirements of direct integration of WSI with the lab and hospital information systems, demonstrating the workflow, challenges and best practices. Mapping and refining the process of movement of the digital slides. The anatomical pathology team, in collaboration with information technology and the vendor, establish the required scripts in order to enable direct integration, therefore allowing the laboratory a highly automated system of case, slide, and report movement.Results: Direct integration was achieved fulfilling the required goals specified by the workflow mapping. An automated case movement process was established in order to enable the pathologist a work management process from the digital platform. The integration errors and challenges were audited and reported.Conclusion: WSI digital pathology integration is achievable; however, it requires significant resource allocation adding to the technology acquirement.Keywords: digital pathology, whole slide imaging, lab information systems, integratio