Overtreatment of low-grade ductal carcinoma in situ

Importance: While the prevalence of ductal carcinoma in situ (DCIS) of the breast has increased substantially following the introduction of breast-screening methods, the clinical significance of early detection and treatment for DCIS remains unclear. Objective: To investigate the survival benefit of breast surgery for low-grade DCIS. Design, Setting, and Participants: A retrospective longitudinal cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from October 9, 2014, to January 15, 2015, at the Dana-Farber/Brigham and Women’s Cancer Center. Between 1988 and 2011, 57 222 eligible cases of DCIS with known nuclear grade and surgery status were identified. Exposures: Patients were divided into surgery and nonsurgery groups. Main: Outcomes and Measures Propensity score weighting was used to balance patient backgrounds between groups. A log-rank test and multivariable Cox proportional hazards model was used to assess factors related to overall and breast cancer–specific survival. Results: Of 57 222 cases of DCIS identified in this study, 1169 cases (2.0%) were managed without surgery and 56 053 cases (98.0%) were managed with surgery. With a median follow-up of 72 months from diagnosis, there were 576 breast cancer–specific deaths (1.0%). The weighted 10-year breast cancer–specific survival was 93.4% for the nonsurgery group and 98.5% for the surgery group (log-rank test, P < .001). The degree of survival benefit among those managed surgically differed according to nuclear grade (P = .003). For low-grade DCIS, the weighted 10-year breast cancer–specific survival of the nonsurgery group was 98.8% and that of the surgery group was 98.6% (P = .95). Multivariable analysis showed there was no significant difference in the weighted hazard ratios of breast cancer–specific survival between the surgery and nonsurgery groups for low-grade DCIS. The weighted hazard ratios of intermediate- and high-grade DCIS were significantly different (low grade: hazard ratio, 0.85; 95% CI, 0.21-3.52; intermediate grade: hazard ratio, 0.23; 95% CI, 0.14-0.42; and high grade: hazard ratio, 0.15; 95% CI, 0.11-0.23) and similar results were seen for overall survival. Conclusions and Relevance: The survival benefit of performing breast surgery for low-grade DCIS was lower than that for intermediate- or high-grade DCIS. A prospective clinical trial is warranted to investigate the feasibility of active surveillance for the management of low-grade DCIS

A model of quality determinants in Internet retailing

While there is a substantial body of literature relating to the activities of Internet marketers and the technology which drives E-Commerce, less attention has been given to consumer oriented research. To partially address this gap in marketing knowledge, a preliminary model of quality determinants in Internet retailing has been developed in this paper. In-depth interviews with 14 experienced Internet shoppers provided the data that was used to develop the model. Respondents discussed what they expected from Internet retailers and the quality of service that they have received. The analysis of results indicated that inherent differences between traditional and Internet environments increased the significance of some quality dimensions, resulted in the merging of others, and introduced new issues which were not accounted for by SERVQUAL. The resultant model identifies six potential determinants of quality; web site, product offering, company information, transaction system, product possession, and interaction with the firm

Establishing the comparative durability of African mahogany (Khaya senegalensis) in weather exposed above-ground applications

This study was established to evaluate the natural durability of ten- and twenty-year-old plantation-grown Khaya senegalensis (African mahogany) above ground. Whilst mature African mahogany heartwood is expected to last five to 15 years in ground, Australian natural durability standards and specifications do not currently provide information on the durability performance of African mahogany when used above ground. A ground proximity field test was installed at DAFF’s South Johnstone Research Facility in north Queensland and modified ground proximity tests were also installed in a fungal cellar at DAFF’s Salisbury Research Facility near Brisbane. Whilst the plantation African mahogany tested appears more durable than pine, it is not yet possible to determine if its’ durability is consistent with expectations for durability class 3 or durability class 2 timbers above ground. Minimal decay of test specimens had occurred after 12 months and more time is required before reliable conclusions can be drawn. Data gathered, however, are vital for any future durability modelling for plantation African mahogany, to calculate the lag for decay initiation and rates of decay

Quality implications of cryopreservation: Building a small-scale model to determine the shelf-life of cryopreserved blood products for drug product manufacturing

Cryopreservation of mobilized apheresis products could prove to be very important in the manufacture of scalable and more globally accessible cell-based gene therapies. However, it introduces a new challenge of how to assess the stability and shelf-life of these products in the context of advanced cell therapy products. The stability of cryopreserved mobilized apheresis products for direct transplantation has been established, but the challenges of separating and recovering the rare CD34+ hematopoietic stem and progenitor cell (HSPCs) population from other cells in the blood products after cryopreservation suggest that further work to assess stability is needed to understand the impact of storage on further cell processing. Typically, a stability study involves the generation of material using an at-scale manufacturing process that mirrors the clinical manufacturing process, storing the material and testing it at predetermined timepoints. As mobilized apheresis products are small, expensive and limited, it is not feasible to generate and test material at-scale. Therefore, a small-scale model was developed to inform the design of a stability study for cryopreserved apheresis products. First, we assessed two types of container closures, a rigid cryovial and flexible cryopreservation bag, that are similar to what is used clinically. Once the target vessel was determined, we identified the number of vessels that would be needed to complete characterization testing of the thawed apheresis and generate a representative drug product to assess process performance. Second, we assessed the cryopreservation configuration to ensure that all of the vessels had similar cryopreservation profiles as material during at-scale processing. Finally, healthy donor material was cryopreserved in several bags with our small-scale model, stored in vapor phase of liquid nitrogen, and then thawed at various intervals over a one-year period. We assessed multiple stability indicating parameters at thaw, including cell health and CD34+ cell recovery. The thawed apheresis product was forward processed through CD34+ cell enrichment and transduction to generate a representative drug product for further characterization, including cell health, CD34+ cell recovery, transgene expression and vector copy number. The results from these studies are reported herein and will inform the study design, including the cryopreservation process and best measures of stability, of a larger quality-controlled study performed at the manufacturing site

The oral mucosal and salivary microbial community of Behçet's syndrome and recurrent aphthous stomatitis.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Behçet's syndrome (BS) is a multisystem immune-related disease of unknown etiology. Recurrent aphthous stomatitis (RAS) is characterized by the presence of idiopathic oral ulceration without extraoral manifestation. The interplay between the oral microbial communities and the immune response could play an important role in the etiology and pathogenesis of both BS and RAS

Low grade Ductal Carcinoma in situ (DCIS): how best to describe it?

BACKGROUND: In the absence of definitive data about the natural history of DCIS the appropriateness of describing DCIS as cancer is controversial. METHODS: We conducted a survey amongst British Breast Group (BBG) members, to determine which descriptions of DCIS were deemed most accurate and appropriate. RESULTS: 54/73 (74%) attendees completed the survey: A majority (34/54; 63%) said they would be comfortable using the description that explained DCIS as abnormal cells in the milk ducts that had not spread into other breast tissue and which did not need urgent treatment as if it was breast cancer and this description was overall the most preferred (24/54; 44%). CONCLUSIONS: Little consensus exists regarding how best to explain low grade DCIS to patients

Reviews

The following publications have been reviewed by the mentioned authors;Taste by Stephen Bayley, reviewed by Stephen R. BlundellDesign and Technology by A. Yarwood and A. H. Orme, reviewed by David JonesAnimal Forms by Nigel Billington and John Jeffrey, reviewed by Lesley LordTechnical Graphics Book 1 by A. Bedford and K. Pyne, reviewed by David JonesScrewcutting in the Lathe by Martin Cleeve, reviewed by David JonesUnderstanding Industry by Alasdair Hogarth, reviewed by Iolo RobertsCase in Hand by Alun Phillips and Geoffrey Stuttard, reviewed by Iolo RobertsGood Practice in Industrial Education by Gordon J. H. Vincent, reviewed by Iolo RobertsStarting Technology by G. Mills and J. Aitken, reviewed by Keith SimmondsDrawing and Painting: A Complete Study Course by Elva Bett, reviewed by John LancasterEarthworks as Sculpture by Peter Jobling, reviewed by Francis CelonaDesign Policy: The Proceedings of an International Conference held at the Royal College of Art, London, 20-23 July 1982. Design and Society, Design and Industry, Design Theory and Practice, Design Evaluation, Design Education, Design and Information Technology reviewed by Bernard MyersAn Introduction to Graphic Design by J. Park, R. De Silva, F. Thomson and C. Tudor, reviewed by F. B. Maycoc

Why we should understand the patient experience: clinical empathy and medicines optimisation

Objectives To critically discuss the need for pharmacists to underpin their consultations with appropriate ‘clinical empathy’ as part of effective medicines optimisation. Methods Use of literature around empathy, consultation and pharmacy practice to develop a case for greater clinical empathy in pharmacy consultations. Key findings Clinical empathy is defined from the literature and applied to pharmacy consultations, with a comparison to empathy in other clinical professions. Historical barriers to the embedding of clinical empathy into pharmacy consultations are also explored. Conclusions We challenge the pharmacy profession to consider how clinical empathy should underpin consultations with a series of introspective questions and provide some sample questions to support pharmacy consultations. We also make the case for appropriate education and professional development of consultation skills at undergraduate and postgraduate level. We contend that patients’ relationships with practitioners are critical, and a lack of empathy can impact the effectiveness of care

Electrophysiological and behavioral responses of female African rice gall midge, Orseolia oryzivora Harris and Gagné, to host plant volatiles

African rice gall midge, Orseolia oryzivora Harris and Gagné, is a major pest of rice in Africa. Depsite its economic importance, its chemical ecology is not well understood. Here, we assessed behavioral and electrophysiological responses of O. oryzivora to host plant volatiles. In olfactometer bioassays, mated female O. oryzivora were attracted to volatiles emitted from intact rice plants but were repelled by volatiles collected from plants infested by conspecifics. In a choice test, there was a preference for volatiles from uninfested plants over those from infested plants. Coupled gas chromatography-electroantennography analyses of panicle volatiles isolated four electrophysiologically active components: (S)-linalool, 4,8-dimethyl-1,3,7-nonatriene, (E)-caryophyllene, and (R/S)-(E)-nerolidol. A synthetic blend of volatiles at the same concentration and ratio as that from an intact plant was attractive to mated females, whereas a blend based on the ratio of volatiles from an infested plant was repellent. This suggests that O. oryzivora uses olfaction for host plant recognition. The identification of blends of volatiles emitted by plants that can both attract and repel O. oryzivora may aid the development of sustainable control measures