An Update on Grading of Salivary Gland Carcinomas

Histologic grade is a significant predictor of outcome in salivary gland carcinomas. However, the sheer variety of tumor type and the rarity of these tumors pose challenges to devising highly predictive grading schemes. As our knowledge base has evolved, it is clear that carcinoma ex pleomorphic adenoma is not automatically a high grade tumor as is traditionally suggested. These tumors should be further qualified as to type/grade of carcinoma and extent, since intracapsular and minimally invasive carcinomas ex pleomorphic adenoma behave favorably. The two carcinoma types for which grading schemes are common include adenoid cystic carcinoma and mucoepidermoid carcinoma. Adenoid cystic carcinomas are graded based solely on pattern with solid components portending a worse prognosis. Occasionally, adenoid cystic carcinomas may undergo transformation to pleomorphic high grade carcinomas. This feature confers a high propensity for lymph node metastasis and should thus be reported to alert the clinical team. Mucoepidermoid carcinomas are graded in a three tier fashion based on a constellation of features including cystic component, border, mitoses, anaplasia, and perineural invasion among others. All grading schemes are somewhat cumbersome, intimidating and occasionally ambiguous, but evidence suggests that using a scheme consistently shows greater reproducibility than using an intuitive approach. The intermediate grade category demonstrates the most variability between grading systems and thus the most controversy in management. In the AFIP system intermediate grade tumors cluster with high grade tumors, while in the Brandwein system, they cluster with low grade tumors

Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? : A Systematic Review and Meta-Analysis

Copyright: © 2014 Durand et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. Objective: To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities. Design: Systematic review and meta-analysis of randomised controlled trials and observational studies.Peer reviewe

Goldstone inflation

Identifying the inflaton with a pseudo-Goldstone boson explains the flatness of its potential. Successful Goldstone Inflation should also be robust against UV corrections, such as from quantum gravity: in the language of the effective field theory this implies that all scales are sub-Planckian. In this paper we present scenarios which realise both requirements by examining the structure of Goldstone potentials arising from Coleman-Weinberg contributions. We focus on single-field models, for which we notice that both bosonic and fermionic contributions are required and that spinorial fermion representations can generate the right potential shape. We then evaluate the constraints on non-Gaussianity from higher-derivative interactions, finding that axiomatic constraints on Goldstone boson scattering prevail over the current CMB measurements. The fit to CMB data can be connected to the UV completions for Goldstone Inflation, finding relations in the spectrum of new resonances. Finally, we show how hybrid inflation can be realised in the same context, where both the inflaton and the waterfall fields share a common origin as Goldstones

Phenotypic Variation and Bistable Switching in Bacteria

Microbial research generally focuses on clonal populations. However, bacterial cells with identical genotypes frequently display different phenotypes under identical conditions. This microbial cell individuality is receiving increasing attention in the literature because of its impact on cellular differentiation, survival under selective conditions, and the interaction of pathogens with their hosts. It is becoming clear that stochasticity in gene expression in conjunction with the architecture of the gene network that underlies the cellular processes can generate phenotypic variation. An important regulatory mechanism is the so-called positive feedback, in which a system reinforces its own response, for instance by stimulating the production of an activator. Bistability is an interesting and relevant phenomenon, in which two distinct subpopulations of cells showing discrete levels of gene expression coexist in a single culture. In this chapter, we address techniques and approaches used to establish phenotypic variation, and relate three well-characterized examples of bistability to the molecular mechanisms that govern these processes, with a focus on positive feedback.

Glaciotectonic deformation associated with the Orient Point–Fishers Island moraine, westernmost Block Island Sound : further evidence of readvance of the Laurentide ice sheet

This paper is not subject to U.S. copyright. The definitive version was published in Geo-Marine Letters 32 (2012): 279-288, doi:10.1007/s00367-012-0296-9.High-resolution seismic-reflection profiles collected across pro-glacial outwash deposits adjacent to the circa 18 ka b.p. Orient Point–Fishers Island end moraine segment in westernmost Block Island Sound reveal extensive deformation. A rhythmic seismic facies indicates the host outwash deposits are composed of fine-grained glaciolacustrine sediments. The deformation is variably brittle and ductile, but predominantly compressive in nature. Brittle deformation includes reverse faults and thrust faults that strike parallel to the moraine, and thrust sheets that extend from beneath the moraine. Ductile deformation includes folded sediments that overlie undisturbed deposits, showing that they are not drape features. Other seismic evidence for compression along the ice front consists of undisturbed glaciolacustrine strata that dip back toward and underneath the moraine, and angular unconformities on the sea floor where deformed sediments extend above the surrounding undisturbed correlative strata. Together, these ice-marginal glaciotectonic features indicate that the Orient Point–Fishers Island moraine marks a significant readvance of the Laurentide ice sheet, consistent with existing knowledge for neighboring coeval moraines, and not simply a stillstand as previously reported.This work was supported by the Connecticut Department of Environmental Protection, and the Atlantic Hydrographic Branch of the National Oceanic and Atmospheric Administration.2013-06-2

Stress-Induced Reinstatement of Drug Seeking: 20 Years of Progress

In human addicts, drug relapse and craving are often provoked by stress. Since 1995, this clinical scenario has been studied using a rat model of stress-induced reinstatement of drug seeking. Here, we first discuss the generality of stress-induced reinstatement to different drugs of abuse, different stressors, and different behavioral procedures. We also discuss neuropharmacological mechanisms, and brain areas and circuits controlling stress-induced reinstatement of drug seeking. We conclude by discussing results from translational human laboratory studies and clinical trials that were inspired by results from rat studies on stress-induced reinstatement. Our main conclusions are (1) The phenomenon of stress-induced reinstatement, first shown with an intermittent footshock stressor in rats trained to self-administer heroin, generalizes to other abused drugs, including cocaine, methamphetamine, nicotine, and alcohol, and is also observed in the conditioned place preference model in rats and mice. This phenomenon, however, is stressor specific and not all stressors induce reinstatement of drug seeking. (2) Neuropharmacological studies indicate the involvement of corticotropin-releasing factor (CRF), noradrenaline, dopamine, glutamate, kappa/dynorphin, and several other peptide and neurotransmitter systems in stress-induced reinstatement. Neuropharmacology and circuitry studies indicate the involvement of CRF and noradrenaline transmission in bed nucleus of stria terminalis and central amygdala, and dopamine, CRF, kappa/dynorphin, and glutamate transmission in other components of the mesocorticolimbic dopamine system (ventral tegmental area, medial prefrontal cortex, orbitofrontal cortex, and nucleus accumbens). (3) Translational human laboratory studies and a recent clinical trial study show the efficacy of alpha-2 adrenoceptor agonists in decreasing stress-induced drug craving and stress-induced initial heroin lapse

Identifying hazardousness of sewer pipeline gas mixture using classification methods: a comparative study

In this work, we formulated a real-world problem related to sewer pipeline gas detection using the classification-based approaches. The primary goal of this work was to identify the hazardousness of sewer pipeline to offer safe and non-hazardous access to sewer pipeline workers so that the human fatalities, which occurs due to the toxic exposure of sewer gas components, can be avoided. The dataset acquired through laboratory tests, experiments, and various literature sources was organized to design a predictive model that was able to identify/classify hazardous and non-hazardous situation of sewer pipeline. To design such prediction model, several classification algorithms were used and their performances were evaluated and compared, both empirically and statistically, over the collected dataset. In addition, the performances of several ensemble methods were analyzed to understand the extent of improvement offered by these methods. The result of this comprehensive study showed that the instance-based learning algorithm performed better than many other algorithms such as multilayer perceptron, radial basis function network, support vector machine, reduced pruning tree. Similarly, it was observed that multi-scheme ensemble approach enhanced the performance of base predictors

Design of a Trichromatic Cone Array

Cones with peak sensitivity to light at long (L), medium (M) and short (S) wavelengths are unequal in number on the human retina: S cones are rare (<10%) while increasing in fraction from center to periphery, and the L/M cone proportions are highly variable between individuals. What optical properties of the eye, and statistical properties of natural scenes, might drive this organization? We found that the spatial-chromatic structure of natural scenes was largely symmetric between the L, M and S sensitivity bands. Given this symmetry, short wavelength attenuation by ocular media gave L/M cones a modest signal-to-noise advantage, which was amplified, especially in the denser central retina, by long-wavelength accommodation of the lens. Meanwhile, total information represented by the cone mosaic remained relatively insensitive to L/M proportions. Thus, the observed cone array design along with a long-wavelength accommodated lens provides a selective advantage: it is maximally informative

The deuteron: structure and form factors

A brief review of the history of the discovery of the deuteron in provided. The current status of both experiment and theory for the elastic electron scattering is then presented.Comment: 80 pages, 33 figures, submited to Advances in Nuclear Physic

Vouchers for scaling up insecticide-treated nets in Tanzania: Methods for monitoring and evaluation of a national health system intervention

BACKGROUND: The Tanzania National Voucher Scheme (TNVS) uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs) to pregnant women. The system began operation in October 2004 and by May 2006 was operating in all districts in the country. Evaluating complex public health interventions which operate at national level requires a multidisciplinary approach, novel methods, and collaboration with implementers to support the timely translation of findings into programme changes. This paper describes this novel approach to delivering ITNs and the design of the monitoring and evaluation (M&E). METHODS: A comprehensive and multidisciplinary M&E design was developed collaboratively between researchers and the National Malaria Control Programme. Five main domains of investigation were identified: (1) ITN coverage among target groups, (2) provision and use of reproductive and child health services, (3) "leakage" of vouchers, (4) the commercial ITN market, and (5) cost and cost-effectiveness of the scheme. RESULTS: The evaluation plan combined quantitative (household and facility surveys, voucher tracking, retail census and cost analysis) and qualitative (focus groups and in-depth interviews) methods. This plan was defined in collaboration with implementing partners but undertaken independently. Findings were reported regularly to the national malaria control programme and partners, and used to modify the implementation strategy over time. CONCLUSION: The M&E of the TNVS is a potential model for generating information to guide national and international programmers about options for delivering priority interventions. It is independent, comprehensive, provides timely results, includes information on intermediate processes to allow implementation to be modified, measures leakage as well as coverage, and measures progress over time