Enlarging neck masses in the elderly – Histological and surgical considerations

AbstractINTRODUCTIONAnaplastic carcinoma of the thyroid is a rare but aggressive malignancy which can present with a rapidly enlarging neck mass or compressive sequelae of cough, dyspnoea, dysphagia and hoarseness. Treatment of such tumours is commonly palliative however they occasionally represent surgical challenges due to their rapid growth, diagnostic difficulty and locoregional spread.PRESENTATION OF CASEA 75 year-old retired veterinary surgeon was referred with a 2 month history of a painless, enlarging neck mass. The patient denied any secondary compressive symptoms or general symptoms of malignancy. On examination a large right-sided neck mass measuring 7cm×5cm was appreciated which was fixed, hard and irregular with associated adenopathy.DISCUSSIONWe discuss the diagnostic challenges posed by anaplastic carcinoma of the thyroid and the difficulties in selecting the appropriate intervention in this aggressive disease process.CONCLUSIONAnaplastic carcinoma of the thyroid is encountered infrequently in clinical practice and can generate diagnostic and therapeutic challenges

The Five Factor Model of personality and evaluation of drug consumption risk

The problem of evaluating an individual's risk of drug consumption and misuse is highly important. An online survey methodology was employed to collect data including Big Five personality traits (NEO-FFI-R), impulsivity (BIS-11), sensation seeking (ImpSS), and demographic information. The data set contained information on the consumption of 18 central nervous system psychoactive drugs. Correlation analysis demonstrated the existence of groups of drugs with strongly correlated consumption patterns. Three correlation pleiades were identified, named by the central drug in the pleiade: ecstasy, heroin, and benzodiazepines pleiades. An exhaustive search was performed to select the most effective subset of input features and data mining methods to classify users and non-users for each drug and pleiad. A number of classification methods were employed (decision tree, random forest, $k$-nearest neighbors, linear discriminant analysis, Gaussian mixture, probability density function estimation, logistic regression and na{\"i}ve Bayes) and the most effective classifier was selected for each drug. The quality of classification was surprisingly high with sensitivity and specificity (evaluated by leave-one-out cross-validation) being greater than 70\% for almost all classification tasks. The best results with sensitivity and specificity being greater than 75\% were achieved for cannabis, crack, ecstasy, legal highs, LSD, and volatile substance abuse (VSA).Comment: Significantly extended report with 67 pages, 27 tables, 21 figure

Towards a quantum universe

In this short review we study the state of the art of the great problems in cosmology and their interrelationships. The reconciliation of these problems passes undoubtedly through the idea of a quantum universe.Comment: 7 pages, Accepted for publication in Astrophysics & Space Scienc

Identification of independent association signals and putative functional variants for breast cancer risk through fine-scale mapping of the 12p11 locus.

BACKGROUND: Multiple recent genome-wide association studies (GWAS) have identified a single nucleotide polymorphism (SNP), rs10771399, at 12p11 that is associated with breast cancer risk. METHOD: We performed a fine-scale mapping study of a 700 kb region including 441 genotyped and more than 1300 imputed genetic variants in 48,155 cases and 43,612 controls of European descent, 6269 cases and 6624 controls of East Asian descent and 1116 cases and 932 controls of African descent in the Breast Cancer Association Consortium (BCAC; http://bcac.ccge.medschl.cam.ac.uk/ ), and in 15,252 BRCA1 mutation carriers in the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). Stepwise regression analyses were performed to identify independent association signals. Data from the Encyclopedia of DNA Elements project (ENCODE) and the Cancer Genome Atlas (TCGA) were used for functional annotation. RESULTS: Analysis of data from European descendants found evidence for four independent association signals at 12p11, represented by rs7297051 (odds ratio (OR) = 1.09, 95 % confidence interval (CI) = 1.06-1.12; P = 3 × 10(-9)), rs805510 (OR = 1.08, 95 % CI = 1.04-1.12, P = 2 × 10(-5)), and rs1871152 (OR = 1.04, 95 % CI = 1.02-1.06; P = 2 × 10(-4)) identified in the general populations, and rs113824616 (P = 7 × 10(-5)) identified in the meta-analysis of BCAC ER-negative cases and BRCA1 mutation carriers. SNPs rs7297051, rs805510 and rs113824616 were also associated with breast cancer risk at P < 0.05 in East Asians, but none of the associations were statistically significant in African descendants. Multiple candidate functional variants are located in putative enhancer sequences. Chromatin interaction data suggested that PTHLH was the likely target gene of these enhancers. Of the six variants with the strongest evidence of potential functionality, rs11049453 was statistically significantly associated with the expression of PTHLH and its nearby gene CCDC91 at P < 0.05. CONCLUSION: This study identified four independent association signals at 12p11 and revealed potentially functional variants, providing additional insights into the underlying biological mechanism(s) for the association observed between variants at 12p11 and breast cancer risk.UK funding includes Cancer Research UK and NIH.This is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s13058-016-0718-

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Relationship marketing

This collection is a long-awaited one-stop resource that draws together all the important readings on the origins, development and future of Relationship Marketing. With classic and contemporary writings from influential figures in the field, this landmark work explores the theory and practice of Relationship Marketing. Papers map out past and present research and pose exciting questions about Relationship Marketing's future. This definitive collection includes 59 articles and is accompanied by an insightful introduction that draws together key issues. A concise rationale behind the selection of papers is also provided. The SAGE Library in Business and Management is a first-class series of major works that brings together the most influential and field-defining articles, both classical and contemporary, in a number of key areas of research and inquiry in Business and Management. Each multi-volume set represents a collection of the essential published works collated from the foremost publications in the field by an Editor or Editorial Team of renowned international stature. They include a full introduction, presenting a rationale for the selection and mapping out the discipline's past, present and likely future. This series is designed to be a 'gold standard' for university libraries throughout the world with a programme or interest in Business and Management Studies