Best in Class: Self-Determined College Students With Learning Disabilities

This presentations asks the following questions: What are the factors that supported the development of self-determination during secondary education? What are the factors that supported the transition from high school to college

A Retrospective Analysis of VeriStrat Status on Outcome of a Randomized Phase II Trial of First-Line Therapy with Gemcitabine, Erlotinib, or the Combination in Elderly Patients (Age 70 Years or Older) with Stage IIIB/IV Non–Small-Cell Lung Cancer

In a multicenter randomized phase II trial of gemcitabine (arm A), erlotinib (arm B), and gemcitabine and erlotinib (arm C), similar progression-free survival (PFS) and overall survival (OS) were observed in all arms. We performed an exploratory, blinded, retrospective analysis of plasma or serum samples collected as part of the trial to investigate the ability of VeriStrat (VS) to predict treatment outcomes.Ninety-eight patients were assessable, and the majority had stage IV disease (81%), adenocarcinoma histology (63%), reported current or previous tobacco use (84%), and 26% had a performance status (PS) of 2.In arm A, patients with VS Good ( = 20) compared with VS Poor status ( = 8) had similar PFS (hazard ratio [HR]: 1.21; = 0.67) and OS (HR: 0.82; = 0.64). In arm B, patients with VS Good ( = 26) compared with VS Poor ( = 12) had a statistically significantly superior PFS (HR: 0.33; = 0.002) and OS (HR: 0.40; = 0.014). In arm C, patients with VS Good ( = 17) compared with Poor ( = 1 5) had a superior PFS (HR: 0.42; = 0.027) and a trend toward superior OS (HR: 0.48; = 0.051). In the multivariate analysis for PFS, VS status was statistically significant ( = 0.011); for OS, VS status ( = 0.017) and PS ( = 0.005) were statistically significant. A statistically significant VS and treatment interaction (gemcitabine versus erlotinib) was observed for PFS and OS.Gemcitabine is the superior treatment for elderly patients with VS Poor status. First-line erlotinib for elderly patients with VS Good status may warrant further investigation

Self-rated health of primary care house officers and its relationship to psychological and spiritual well-being

<p/> <p>Background</p> <p>The stress associated with residency training may place house officers at risk for poorer health. We sought to determine the level of self-reported health among resident physicians and to ascertain factors that are associated with their reported health.</p> <p>Methods</p> <p>A questionnaire was administered to house officers in 4 residency programs at a large Midwestern medical center. Self-rated health was determined by using a health rating scale (ranging from 0 = death to 100 = perfect health) and a Likert scale (ranging from "poor" health to "excellent" health). Independent variables included demographics, residency program type, post-graduate year level, current rotation, depressive symptoms, religious affiliation, religiosity, religious coping, and spirituality.</p> <p>Results</p> <p>We collected data from 227 subjects (92% response rate). The overall mean (SD) health rating score was 87 (10; range, 40–100), with only 4 (2%) subjects reporting a score of 100; on the Likert scale, only 88 (39%) reported excellent health. Lower health rating scores were significantly associated (P < 0.05) with internal medicine residency program, post-graduate year level, depressive symptoms, and poorer spiritual well-being. In multivariable analyses, lower health rating scores were associated with internal medicine residency program, depressive symptoms, and poorer spiritual well-being.</p> <p>Conclusion</p> <p>Residents' self-rated health was poorer than might be expected in a cohort of relatively young physicians and was related to program type, depressive symptoms, and spiritual well-being. Future studies should examine whether treating depressive symptoms and attending to spiritual needs can improve the overall health and well-being of primary care house officers.</p

A Randomized Phase II Trial of First-Line Treatment with Gemcitabine, Erlotinib, or Gemcitabine and Erlotinib in Elderly Patients (Age ≥70 Years) with Stage IIIB/IV Non-small Cell Lung Cancer

INTRODUCTION: Single-agent gemcitabine is a standard of care for elderly patients with advanced non-small cell lung cancer, but novel therapies are needed for this patient population. METHODS: We performed a noncomparative randomized phase II trial of gemcitabine, erlotinib, or the combination in elderly patients (age ≥70 years) with stage IIIB or IV non-small cell lung cancer. Patients were randomized to arms: A (gemcitabine 1200 mg/m on days 1 and 8 every 21 days), B (erlotinib 150 mg daily), or C (gemcitabine 1000 mg/m on days 1 and 8 every 21 days and erlotinib 100 mg daily). Arms B and C were considered investigational; the primary objective was 6-month progression-free survival. RESULTS: Between March 2006 and May 2010, 146 eligible patients received protocol therapy. The majority of the patients (82%) had stage IV disease, 64% reported adenocarcinoma histology, 90% reported current or previous tobacco use, and 28% had a performance status of 2. The 6-month progression-free survival rate observed in arms A, B, and C was 22% (95% confidence interval [CI] 11-35), 24% (95% CI 13-36), and 25% (95% CI 15-38), respectively; the median overall survival observed was 6.8 months (95% CI 4.8-8.5), 5.8 months (95% CI 3.0-8.3), and 5.6 months (95% CI 3.5-8.4), respectively. The rate of grade ≥3 hematological and nonhematological toxicity observed was similar in all three arms. The best overall health-related quality of life response did not differ between treatment arms. CONCLUSIONS: Erlotinib or erlotinib and gemcitabine do not warrant further investigation in an unselected elderly patient population

Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma

Introduction: A common neurosurgical condition, chronic subdural haematoma (cSDH) typically affects older people with other underlying health conditions. The care of this potentially vulnerable cohort is often, however, fragmented and suboptimal. In other complex conditions, multidisciplinary guidelines have transformed patient experience and outcomes, but no such framework exists for cSDH. This paper outlines a protocol to develop the first comprehensive multidisciplinary guideline from diagnosis to long-term recovery with cSDH. Methods: The project will be guided by a steering group of key stakeholders and professional organisations and will feature patient and public involvement. Multidisciplinary thematic working groups will examine key aspects of care to formulate appropriate, patient-centered research questions, targeted with evidence review using the GRADE framework. The working groups will then formulate draft clinical recommendations to be used in a modified Delphi process to build consensus on guideline contents. Conclusions: We present a protocol for the development of a multidisciplinary guideline to inform the care of patients with a cSDH, developed by cross-disciplinary working groups and arrived at through a consensus-building process, including a modified online Delphi.</p

TBCRC 018: phase II study of iniparib in combination with irinotecan to treat progressive triple negative breast cancer brain metastases

Nearly half of patients with advanced triple negative breast cancer (TNBC) develop brain metastases (BM) and most will also have uncontrolled extracranial disease. This study evaluated the safety and efficacy of iniparib, a small molecule anti-cancer agent that alters reactive oxygen species tumor metabolism and penetrates the blood brain barrier, with the topoisomerase I inhibitor irinotecan in patients with TNBC-BM. Eligible patients had TNBC with new or progressive BM and received irinotecan and iniparib every 3weeks. Time to progression (TTP) was the primary end point; secondary endpoints were response rate (RR), clinical benefit rate (CBR), overall survival (OS), toxicity, and health-related quality of life. Correlative endpoints included molecular subtyping and gene expression studies on pre-treatment archival tissues, and determination of germline BRCA1/2 status. Thirty-seven patients began treatment; 34 were evaluable for efficacy. Five of 24 patients were known to carry a BRCA germline mutation (4 BRCA1, 1 BRCA2). Median TTP was 2.14months and median OS was 7.8months. Intracranial RR was 12%, while intracranial CBR was 27%. Treatment was well-tolerated; the most common grade 3/4 adverse events were neutropenia and fatigue. Grade 3/4 diarrhea was rare (3%). Intrinsic subtyping revealed 19 of 21 tumors (79%) were basal-like, and intracranial response was associated with high expression of proliferation-related genes. This study suggests a modest benefit of irinotecan plus iniparib in progressive TNBC-BM. More importantly, this trial design is feasible and lays the foundation for additional studies for this treatment-refractory disease.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-014-3039-y) contains supplementary material, which is available to authorized users

TBCRC 018: phase II study of iniparib in combination with irinotecan to treat progressive triple negative breast cancer brain metastases

Nearly half of patients with advanced triple negative breast cancer (TNBC) develop brain metastases (BM) and most will also have uncontrolled extracranial disease. This study evaluated the safety and efficacy of iniparib, a small molecule anti-cancer agent that alters reactive oxygen species tumor metabolism and penetrates the blood brain barrier, with the topoisomerase I inhibitor irinotecan in patients with TNBC-BM. Eligible patients had TNBC with new or progressive BM and received irinotecan and iniparib every 3 weeks. Time to progression (TTP) was the primary end point; secondary endpoints were response rate (RR), clinical benefit rate (CBR), overall survival (OS), toxicity, and health-related quality of life. Correlative endpoints included molecular subtyping and gene expression studies on pre-treatment archival tissues, and determination of germline BRCA1/2 status. Thirty-seven patients began treatment; 34 were evaluable for efficacy. Five of 24 patients were known to carry a BRCA germline mutation (4 BRCA1, 1 BRCA2). Median TTP was 2.14 months and median OS was 7.8 months. Intracranial RR was 12 %, while intracranial CBR was 27 %. Treatment was well-tolerated; the most common grade 3/4 adverse events were neutropenia and fatigue. Grade 3/4 diarrhea was rare (3 %). Intrinsic subtyping revealed 19 of 21 tumors (79 %) were basal-like, and intracranial response was associated with high expression of proliferation-related genes. This study suggests a modest benefit of irinotecan plus iniparib in progressive TNBC-BM. More importantly, this trial design is feasible and lays the foundation for additional studies for this treatment-refractory disease. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10549-014-3039-y) contains supplementary material, which is available to authorized users

Factors Influencing College Readiness: Supports and Barriers Experienced by Academically Resilient First-Generation Hispanic Males

This qualitative multiple-case study explored the supports and barriers experienced by nine first-generation Hispanic male high school students who met the college entrance requirements for the University of California and California State University systems. Research indicates that Hispanic males lag behind other underrepresented populations when it comes to college readiness, application, and enrollment rates. Given that parent education level is a strong predictor of degree attainment and that Hispanics have some of the lowest parent education levels, it is essential to examine how first-generation college-bound Hispanic males experience supports that help mitigate the barriers they face when pursuing college enrollment. Particularly in California, where the Hispanic population continues to rise exponentially, it is important for educational practitioners to develop a better understanding of how to support first-generation Hispanic students. This study aims to contribute to the research on improving college access for underrepresented populations using resiliency theory as the lens through which to examine this issue. Rather than look through a deficit-oriented lens, resiliency theory focuses on the protective factors or supports that help mitigate risk factors or barriers. Using data collected through interviews and document analysis, the findings here showed the significant role of supports such as academic capital and college knowledge, a systematic focus on college readiness, college readiness and bridge programs, and a strong counseling program for these students. In addition, it was evident that the students’ familial connections to college had a significant impact on the level of academic capital of each of them, reinforcing the need to look beyond the label of “first-generation”

Factors Influencing College Readiness: Supports and Barriers Experienced by Academically Resilient First-Generation Hispanic Males

This qualitative multiple-case study explored the supports and barriers experienced by nine first-generation Hispanic male high school students who met the college entrance requirements for the University of California and California State University systems. Research indicates that Hispanic males lag behind other underrepresented populations when it comes to college readiness, application, and enrollment rates. Given that parent education level is a strong predictor of degree attainment and that Hispanics have some of the lowest parent education levels, it is essential to examine how first-generation college-bound Hispanic males experience supports that help mitigate the barriers they face when pursuing college enrollment. Particularly in California, where the Hispanic population continues to rise exponentially, it is important for educational practitioners to develop a better understanding of how to support first-generation Hispanic students. This study aims to contribute to the research on improving college access for underrepresented populations using resiliency theory as the lens through which to examine this issue. Rather than look through a deficit-oriented lens, resiliency theory focuses on the protective factors or supports that help mitigate risk factors or barriers. Using data collected through interviews and document analysis, the findings here showed the significant role of supports such as academic capital and college knowledge, a systematic focus on college readiness, college readiness and bridge programs, and a strong counseling program for these students. In addition, it was evident that the students’ familial connections to college had a significant impact on the level of academic capital of each of them, reinforcing the need to look beyond the label of “first-generation”