Value and Quality of Care in Head and Neck Oncology

Purpose of ReviewThe concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an on-going process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging.Recent FindingsThis monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention.SummaryHealth care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value.Peer reviewe

Measurement of \Gamma(\eta -> \pi^+\pi^-\gamma)/\Gamma(\eta -> \pi^+\pi^-\pi^0) with the KLOE Detector

The ratio R_{\eta}=\Gamma(\eta -> \pi^+\pi^-\gamma)/\Gamma(\eta -> \pi^+\pi^-\pi^0) has been measured by analyzing 22 million \phi \to \eta \gamma decays collected by the KLOE experiment at DA\PhiNE, corresponding to an integrated luminosity of 558 pb^{-1}. The \eta \to \pi^+\pi^-\gamma proceeds both via the \rho resonant contribution, and possibly a non-resonant direct term, connected to the box anomaly. Our result, R_{\eta}= 0.1856\pm 0.0005_{stat} \pm 0.0028_{syst}, points out a sizable contribution of the direct term to the total width. The di-pion invariant mass for the \eta -> \pi^+\pi^-\gamma decay could be described in a model-independent approach in terms of a single free parameter, \alpha. The determined value of the parameter \alpha is \alpha = (1.32 \pm 0.08_{stat} +0.10/-0.09_{syst}\pm 0.02_{theo}) GeV^{-2}Comment: Paper in press, accepted by PL

Measurement of {\eta} meson production in {\gamma}{\gamma} interactions and {\Gamma}({\eta}-->{\gamma}{\gamma}) with the KLOE detector

We present a measurement of {\eta} meson production in photon-photon interactions produced by electron-positron beams colliding with \sqrt{s}=1 GeV. The measurement is done with the KLOE detector at the \phi-factory DA{\Phi}NE with an integrated luminosity of 0.24 fb^{-1}. The e^+e^- --> e^+e^-{\eta} cross section is measured without detecting the outgoing electron and positron, selecting the decays {\eta}-->{\pi}^+{\pi}^-{\pi}^0 and {\eta}-->{\pi}^0{\pi}^0{\pi}^0. The most relevant background is due to e^+e^- --> {\eta}{\gamma} when the monochromatic photon escapes detection. The cross section for this process is measured as {\sigma}(e^+e^- -->{\eta}{\gamma}) = (856 \pm 8_{stat} \pm 16_{syst}) pb. The combined result for the e^+e^- -->e^+e^-{\eta} cross section is {\sigma}(e^+e^- -->e^+e^-{\eta}) = (32.72 \pm 1.27_{stat} \pm 0.70_{syst}) pb. From this we derive the partial width {\Gamma}({\eta}-->{\gamma}{\gamma}) = (520 \pm 20_{stat} \pm 13_{syst}) eV. This is in agreement with the world average and is the most precise measurement to date.Comment: Version accepted by JHE

A new limit on the CP violating decay KS -> 3pi0 with the KLOE experiment

We have carried out a new direct search for the CP violating decay KS -> 3pi0 with 1.7 fb^-1 of e+e- collisions collected by the KLOE detector at the phi-factory DAFNE. We have searched for this decay in a sample of about 5.9 x 10^8 KS KL events tagging the KS by means of the KL interaction in the calorimeter and requiring six prompt photons. With respect to our previous search, the analysis has been improved by increasing of a factor four the tagged sample and by a more effective background rejection of fake KS tags and spurious clusters. We find no candidates in data and simulated background samples, while we expect 0.12 standard model events. Normalizing to the number of KS -> 2pi0 events in the same sample, we set the upper limit on BR(KS -> 3pi0 < 2.6 x 10^-8 at 90% C.L., five times lower than the previous limit. We also set the upper limit on the eta_000 parameter, |eta_000 | < 0.0088 at 90% C.L., improving by a factor two the latest direct measurement.Comment: Accepted for publication in Physics Letters B (15 pages, 13 figures

Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma : A review of the literature

The pattern of clinical behaviour and response to treatment of recurrent and/or metastatic head and neck squamous cell carcinoma is heterogeneous. Treatment strategies that can be employed vary from potentially curative salvage surgery and re-irradiation to palliative systemic therapies and best supportive care. The advent of new therapeutic options, in terms of more sophisticated surgical approaches and techniques, highly conformal and precise radiation techniques and immunotherapy may offer improved control of disease and longer survival. Moreover, the epidemiological changes during the last decades, including the increase of human papilloma virus-related oropharyngeal primary tumors, are also reflected in the recurrent and metastatic setting. In this complex context the identification of predictive and prognostic factors is urgently needed to tailor treatment, to increase its efficacy, and to avoid unnecessary toxicities. A better knowledge of prognosis may also help the patients and caregivers in decision making on the optimal choice of care. The purpose of our review is to highlight the current evidence and shortcomings in this field.Peer reviewe

KLOE results in kaon physics and prospects for KLOE-2

The phi-factory DAPHNE offers a possibility to select pure kaon beams, charged and neutral ones. In particular, neutral kaons from phi->KS KL are produced in pairs and the detection of a KS (KL) tags the presence of a KL (KS). This allows to perform precise measurements of kaon properties by means of KLOE detector. Another advantage of a phi-factory consists in fact that the neutral kaon pairs are produced in a pure quantum state (J^(PC) = 1^(--)), which allowsto investigate CP and CPT symmetries via quantum interference effects, as well as the basic principles of quantum mechanics.A review of the most recent results of the KLOE experiment at DAPHNE using pure kaon beams or via quantum interferometry is presented together with prospects for kaon physics at KLOE-2.Comment: 5 pages, 4 figures, From Phi To Psi 2011 conference, to be published in Nuclear Physics B (Proceedings Supplements

Gene Expression Clustering and Selected Head and Neck Cancer Gene Signatures Highlight Risk Probability Differences in Oral Premalignant Lesions

BACKGROUND: Oral premalignant lesions (OPLs) represent the most common oral precancerous conditions. One of the major challenges in this field is the identification of OPLs at higher risk for oral squamous cell cancer (OSCC) development, by discovering molecular pathways deregulated in the early steps of malignant transformation. Analysis of deregulated levels of single genes and pathways has been successfully applied to head and neck squamous cell cancers (HNSCC) and OSCC with prognostic/predictive implications. Exploiting the availability of gene expression profile and clinical follow-up information of a well-characterized cohort of OPL patients, we aim to dissect tissue OPL gene expression to identify molecular clusters/signatures associated with oral cancer free survival (OCFS). MATERIALS AND METHODS: The gene expression data of 86 OPL patients were challenged with: an HNSCC specific 6 molecular subtypes model (Immune related: HPV related, Defense Response and Immunoreactive; Mesenchymal, Hypoxia and Classical); one OSCC-specific signature (13 genes); two metabolism-related signatures (3 genes and signatures raised from 6 metabolic pathways associated with prognosis in HNSCC and OSCC, respectively); a hypoxia gene signature. The molecular stratification and high versus low expression of the signatures were correlated with OCFS by Kaplan-Meier analyses. The association of gene expression profiles among the tested biological models and clinical covariates was tested through variance partition analysis. RESULTS: Patients with Mesenchymal, Hypoxia and Classical clusters showed an higher risk of malignant transformation in comparison with immune-related ones (log-rank test, p = 0.0052) and they expressed four enriched hallmarks: "TGF beta signaling" "angiogenesis", "unfolded protein response", "apical junction". Overall, 54 cases entered in the immune related clusters, while the remaining 32 cases belonged to the other clusters. No other signatures showed association with OCFS. Our variance partition analysis proved that clinical and molecular features are able to explain only 21% of gene expression data variability, while the remaining 79% refers to residuals independent of known parameters. CONCLUSIONS: Applying the existing signatures derived from HNSCC to OPL, we identified only a protective effect for immune-related signatures. Other gene expression profiles derived from overt cancers were not able to identify the risk of malignant transformation, possibly because they are linked to later stages of cancer progression. The availability of a new well-characterized set of OPL patients and further research is needed to improve

Invasive meningococcal disease in three siblings with hereditary deficiency of the 8th component of complement: Evidence for the importance of an early diagnosis

Deficiency of the eighth component of complement (C8) is a very rare primary immunodeficiency, associated with invasive, recurrent infections mainly caused by Neisseria species. We report functional and immunochemical C8 deficiency diagnosed in three Albanian siblings who presented with severe meningococcal infections at the age of 15 years, 4 years and 17 months, respectively. The youngest suffered serious complications (necrosis of fingers and toes requiring amputation). METHODS: Functional activity of the classical, alternative and mannose-binding lectin complement pathways was measured in serum from the 3 siblings and their parents (37-year-old woman and 42-year-old man). Forty healthy subjects (20 males and 20 females aged 4-38 years) served as normal controls. Serum complement factors were measured by haemolytic assays and immunoblotting. Sequence DNA analysis of the C8B gene was performed. RESULTS: Analyses of the three complement pathways revealed no haemolytic activity and also absence of C8beta in serum samples from all three siblings. The genetic analysis showed that the three siblings were homozygous for the p.Arg428* mutation in the C8B gene on chromosome 1p32 (MIM 120960). The parents were heterozygous for the mutation and presented normal complement activities. A 2-year follow-up revealed no further infective episodes in the siblings after antibiotic prophylaxis and meningococcal vaccination. CONCLUSIONS: Complement deficiencies are rare and their occurrence is often underestimated. In presence of invasive meningococcal infection, we highlight the importance of complement screening in patients and their relatives in order to discover any genetic defects which would render necessary prophylaxis to prevent recurrent infections and severe complications

Dark sectors 2016 Workshop: community report

This report, based on the Dark Sectors workshop at SLAC in April 2016, summarizes the scientific importance of searches for dark sector dark matter and forces at masses beneath the weak-scale, the status of this broad international field, the important milestones motivating future exploration, and promising experimental opportunities to reach these milestones over the next 5-10 years

Data acquisition and monitoring for the KLOE detector

none77siThe Data Acquisition system for the KLOE experiment, presently running at the Laboratori Nazionali di Frascati DAPhiNE collider, has been designed to sustain an acquisition throughput of 50 Mbyte/s for an event rate of 10 kHz. its two major components are the front end data readout, based on custom buses, and a complex network of computers and storage devices hosting a set of distributed processes. The end result is a seamless data transport from the readout system to the storage library, accompanied by concurrent on line calibrations and data quality control.openA. ALOISIO; F. AMBROSINO; S. CAVALIERE; F. CEVENINI; C. DI DONATO; A. DORIA; D. FIORE; L. MEROLA; G. PIROZZI; G. SARACINO; M. ANTONELLI; F. BOSSI; P. CIAMBRONE; P. DE SIMONE; S. DELL'AGNELLO; M.L. FERRER; G. FINOCCHIARO; C. FORTI; C. GATTI; S. GIOVANNELLA; W. GRANDEGGER; G. LANFRANCHI; B. MARTINI; W. MEI; S. MISCETTI; M. MOULSON; F. MURTAS; M. PALUTAN; L. PASSALACQUA; F. PELUCCHI; P. SANTANGELO; B. SCIASCIA; I. SFILIGOI; J. SHAN; T. SPADARO; P. VALENTE; Y ZHOU; C. BINI; V. BOCCI; G. CABIBBO; R. CALOI; A. CARDINI; E. DE LUCIA; A. DI DOMENICO; P. GAUZZI; E. PASQUALUCCI; M. PASSASEO; D. PICCA; L. PONTECORVO; E. VALENTE; S. VENEZIANO; P. BRANCHINI; E. GRAZIANI; A. PASSERI; A. FERRARI; E. SPIRITI; C. STANESCU; L. TORTORA; M. CASARSA; G. CATALDI; E. GORINI; M. PRIMAVERA; A. VENTURA; G. DE ROBERTIS; P. GUARNACCIA; A. DENIG; CHEN-CHENG KUO; S. MULLER; B. VALERIANI; S. DI FALCO; M. INCAGLI; G. VENANZONI; R. MESSI; L. PACCIANI; E. SANTOVETTI; J. LEE-FRANZINI; M. MARTEMIANOVA., Aloisio; F., Ambrosino; S., Cavaliere; F., Cevenini; C., DI DONATO; A., Doria; D., Fiore; L., Merola; G., Pirozzi; G., Saracino; M., Antonelli; F., Bossi; P., Ciambrone; P., DE SIMONE; S., Dell'Agnello; M. L., Ferrer; G., Finocchiaro; C., Forti; C., Gatti; S., Giovannella; W., Grandegger; G., Lanfranchi; B., Martini; W., Mei; S., Miscetti; M., Moulson; F., Murtas; M., Palutan; L., Passalacqua; F., Pelucchi; P., Santangelo; B., Sciascia; I., Sfiligoi; J., Shan; T., Spadaro; P., Valente; Y., Zhou; C., Bini; V., Bocci; G., Cabibbo; R., Caloi; A., Cardini; E., DE LUCIA; A., DI DOMENICO; P., Gauzzi; E., Pasqualucci; M., Passaseo; D., Picca; L., Pontecorvo; E., Valente; S., Veneziano; P., Branchini; E., Graziani; A., Passeri; A., Ferrari; E., Spiriti; C., Stanescu; L., Tortora; M., Casarsa; G., Cataldi; Gorini, Edoardo; Primavera, Margherita; Ventura, Andrea; G., DE ROBERTIS; P., Guarnaccia; A., Denig; CHEN CHENG, Kuo; S., Muller; B., Valeriani; S., DI FALCO; M., Incagli; G., Venanzoni; R., Messi; L., Pacciani; E., Santovetti; J., LEE FRANZINI; M., Martemiano