Collision of ductal adenocarcinoma and neuroendocrine tumor of the pancreas: a case report and review of the literature

Background: Simultaneous occurrence of exocrine and neuroendocrine tumors of the pancreas is very infrequent. We report a patient with an endocrine tumor in the pancreatic-duodenal area and extensive exocrine carcinoma involving the whole pancreas. Case presentation: A 69-year-old woman was hospitalized in May 2016 for epigastric pain and weight loss. Her past medical history revealed an undefined main pancreatic duct dilation that was subsequently confirmed at CT scan (23 mm) and endoscopic ultrasound. There was no evidence of pancreatic masses, but the cephalic portion of the main pancreatic duct presented hypoechoic nodules. A diagnosis of the main-duct intraductal papillary mucinous neoplasm was made, and the patient underwent total pancreatectomy. Pathological examination showed a collision tumor constituted by a ductal adenocarcinoma involving the whole pancreas and a neuroendocrine tumor located in the duodenal peripancreatic wall and the head of the pancreas. There was one peripancreatic lymph node metastasis from the ductal adenocarcinoma and eight node metastases from the neuroendocrine tumor. These findings suggested a diagnosis of collision of neuroendocrine and ductal adenocarcinomas of the pancreas. The postoperative course was uneventful. Conclusions: The coexistence of pancreatic endocrine and exocrine tumors is very uncommon. When present, problems in differential diagnosis may arise between mixed exocrine-endocrine carcinoma or the collision of separate tumors

Building theory about theory building: what constitutes a theoretical contribution?

We distill existing literature on theoretical contribution into two dimensions, originality (incremental or revelatory) and utility (scientific or practical). We argue for a revision in the way scholars approach the utility dimension by calling for a view of theorizing that would enable theories with more “scope” (both scientific and practical utility). We also argue for an orientation toward “prescience” as a way of achieving scope and fulfilling our scholarly role of facilitating organizational and societal adaptiveness

Organizational identity, image, and adaptive instability

Organizational identity usually is portrayed as that which is core, distinctive, and enduring about the character of an organization. We argue that because of the reciprocal interrelationships between identity and image, organizational identity, rather than enduring, is better viewed as a relatively fluid and unstable concept. We further argue that instead of destabilizing an organization, this instability in identity is actually adaptive in accomplishing change. The analysis leads to some provocative, but nonetheless constructive, implications for theory, research, and practice

Evaluación mediata en la replicación del Programa de Capacitación en Comunicación no Verbal en Gerontología

OBJECTIVE Replicating the training program in non-verbal communication based on the theoretical framework of interpersonal communication; non-verbal coding, valuing the aging aspects in the perspective of active aging, checking its current relevance through the content assimilation index after 90 days (mediate) of its application. METHOD A descriptive and exploratory field study was conducted in three hospitals under direct administration of the state of São Paulo that caters exclusively to Unified Health System (SUS) patients. The training lasted 12 hours divided in three meetings, applied to 102 health professionals. RESULTS Revealed very satisfactory and satisfactory mediate content assimilation index in 82.9%. CONCLUSION The program replication proved to be relevant and updated the setting of hospital services, while remaining efficient for healthcare professionals.OBJETIVO Replicar o programa de capacitação em comunicação não verbal baseado no referencial teórico da comunicação interpessoal; da codificação não verbal, valorizando os aspectos próprios do envelhecimento na perspectiva do envelhecimento ativo, verificando sua pertinência na atualidade por meio do índice de assimilação do conteúdo após 90 dias (mediato) de sua aplicação. MÉTODO Estudo de campo descritivo e exploratório desenvolvido em três hospitais de administração direta do estado de São Paulo que atendem exclusivamente clientes do Sistema Único de Saúde (SUS). A capacitação teve duração de 12 horas, dividida em três encontros, aplicada em 102 profissionais de saúde. RESULTADOS Revelaram índice de assimilação mediato do conteúdo muito satisfatório e satisfatório em 82,9%. CONCLUSÃO A replicação do programa revelou-se pertinente e atualizada ao cenário dos serviços hospitalares, mantendo-se eficiente aos profissionais de saúde.OBJETIVO Replicar el programa de capacitación en comunicación no verbal basado en el marco de referencia teórico de la comunicación interpersonal; la codificación no verbal, valorando los aspectos propios del envejecimiento en la perspectiva del envejecimiento activo, verificando su pertinencia en la actualidad por medio del índice de asimilación del contenido luego de 90 días (mediato) de su aplicación. MÉTODO Estudio de campo descriptivo y exploratorio desarrollado en tres hospitales de administración directa del Estado de São Paulo que atienden exclusivamente a los clientes del Sistema Único de Salud (SUS). La capacitación tuvo duración de 12 horas, dividida en tres encuentros, aplicada a 102 profesionales de salud. RESULTADOS El 92,9% revelaron índice de asimilación mediato del contenido muy satisfactorio y satisfactorio. CONCLUSIÓN La replicación del programa se mostró pertinente y actualizada al escenario de los servicios hospitalarios, manteniéndose eficiente con respecto a los profesionales

ESO Imaging Survey: Optical follow-up of 12 selected XMM-Newton fields

(Abridged) This paper presents the data recently released for the XMM-Newton/WFI survey carried out as part of the ESO Imaging Survey (EIS) project. The aim of this survey is to provide optical imaging follow-up data in BVRI for identification of serendipitously detected X-ray sources in selected XMM-Newton fields. In this paper, fully calibrated individual and stacked images of 12 fields as well as science-grade catalogs for the 8 fields located at high-galactic latitude are presented. The data covers an area of \sim 3 square degrees for each of the four passbands. The median limiting magnitudes (AB system, 2" aperture, 5\sigma detection limit) are 25.20, 24.92, 24.66, and 24.39 mag for B-, V-, R-, and I-band, respectively. These survey products, together with their logs, are available to the community for science exploitation in conjunction with their X-ray counterparts. Preliminary results from the X-ray/optical cross-correlation analysis show that about 61% of the detected X-ray point sources in deep XMM-Newton exposures have at least one optical counterpart within 2" radius down to R \simeq 25 mag, 50% of which are so faint as to require VLT observations thereby meeting one of the top requirements of the survey, namely to produce large samples for spectroscopic follow-up with the VLT, whereas only 15% of the objects have counterparts down to the DSS limiting magnitude.Comment: 24 pages, 10 figures, accepted for publication in Astronomy and Astrophysics. Accompanying data releases available at http://archive.eso.org/archive/public_datasets.html (WFI images), http://www.eso.org/science/eis/surveys/release_65000025_XMM.html (optical catalogs), http://www.aip.de/groups/xray/XMM_EIS/ (X-ray data). Full resolution version available at http://www.astro.uni-bonn.de/~dietrich/publications/3785.ps.g

Fatores socioeconómicos e algoritmos de machine learning aplicados à predição de risco de doenças negligenciadas.

Analisar a relação entre variáveis socioeconómicas e doenças tropicais negligenciadas pode auxiliar os gestores no desenvolvimento de políticas públicas para a redução de casos. O objetivo deste trabalho foi avaliar, com base em algoritmos de machine learning, quais as variáveis socioeconómicas mais importantes para a classificação de risco de três doenças negligenciadas: hanseníase, leishmaniose tegumentar e dengue. Foram avaliados três algoritmos baseados em árvores de decisão: Random Forest (RF), XGBoost e C5.0. Como área de estudo, delimitaram-se os municípios do Estado de Goiás e o Distrito Federal – Brasil. Para as classes de risco de dengue, tanto o algoritmo RF quanto o XGBoost apresentaram valores de exatidão acima de 0,6. Ambos destacaram como variáveis preditivas mais importantes as condições de baixa renda, alfabetização e raça. No caso das classes de risco de hanseníase, os três algoritmos apresentaram resultados de exatidão acima de 0,6 indicando como importantes as variáveis abastecimento de água, alfabetização, raça e moradia. No caso das classes de risco de leishmaniose tegumentar, os algoritmos apresentaram exatidão inferior a 0,4, inviabilizando a avaliação das possíveis variáveis preditivas ao modelo. Os três algoritmos avaliados apresentaram desempenho preditivo aproximado. No entanto, o RF foi ligeiramente superior. As variáveis socioeconómicas mais importantes para predição das classes de risco de dengue e hanseníase foram similares

The perception and understanding of health professionals and undergraduate students regarding aging and the elderly

Estudio cualitativo desarrollado con 117 profesionales y estudiantes de salud que participaron de capacitación en comunicación no verbal en gerontología objetivando identificar la percepción y comprensión de graduados y estudiantes del área de salud acerca de la ancianidad y el envejecimiento humano. Los resultados respecto del entendimiento sobre envejecimiento permitieron construir las categorías: Evolución de la vida que acarrea experiencia; Natural, misteriosa y con experiencia acumulada; Pérdida de la alegría y ganancia de aislamiento; Época de valorización del cariño y respeto; Etapa inevitable con desgaste, prejuicios, limitaciones y exigencia de atención; Consecuencia de la vida y presencia de enfermedades y Proceso fisiológico global. Respecto a percepción del anciano, las respuestas fueron clasificadas en positivas, negativas, mixtas y neutras. Consideramos que la comprensión del anciano y del envejecimiento fue limitada y pesimista; es necesario tener conciencia de que la visión que se posee interfiere en la manera de relacionarnos.Estudo qualitativo desenvolvido com 117 profissionais e graduandos na área da saúde, que participaram da capacitação em comunicação não verbal em gerontologia, com objetivo de identificar a percepção e compreensão de graduandos e graduados da área da saúde, sobre o que é o idoso e o envelhecimento humano. Os resultados sobre o entendimento sobre envelhecimento humano permitiu a construção das categorias: evolução da vida que traz experiências; natural, misteriosa e com experiências acumuladas; perda da alegria e ganho do isolamento; época de valorização do carinho e respeito; etapa inevitável com desgaste, preconceito, limitações e exige atenção; consequência da vida e presença de doenças e processo fisiológico global. Quanto à percepção do idoso, as respostas foram classificadas em positivas, negativas, mistas e neutras. Consideramos que a compreensão do idoso e do envelhecimento foi limitada e pessimista, sendo necessário que tenhamos a consciência de que a visão que se possui interfere na maneira pela qual nos relacionamos.This qualitative study was developed with 117 healthcare professionals and undergraduate students who were participants of a non-verbal communication training program in gerontology, with the objective to identify the perception and understanding of healthcare undergraduates and graduates regarding aging and the elderly. The results allowed the construction of the following categories: an evolution of life that brings a variety of experiences; natural, mysterious and with accumulated experiences; a decrease in overall happiness due to an increase in isolation; a time of valuing affection and respect; an inevitable stage including distress, prejudice, and limitations worthy of attention; a natural consequence of life; and the presence of disease and the global physiological process. Regarding perceptions of the elderly, the answers were classified as positive, negative, mixed and neutral. We considered that the understanding regarding the elderly and aging was limited and pessimist, indicating a need to become aware that one's views affect the way we relate to others

Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial

Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 ± 4 years; 68 ± 12 kg; 154 ± 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small

Reconhecimento dos aspectos tacêsicos para o cuidado afetivo e de qualidade ao idoso hospitalizado

The aim of the present study was to verify the important factors of tacesics that should be observed while touching the elderly. This qualitative and exploratory field of study was developed using 117 undergraduate students and healthcare professionals who participated in a training course regarding nonverbal communication in gerontology. The results revealed that the majority of the participants were able to identify at least one care factor that must be respected when touching the elderly. The discourses allowed for the construction of nine categories indicating the conditions that are necessary for high-quality affective care provided within the tacesics context; these conditions included the authorization for the touch to occur, location of the touch, intensity of the touch, condition of the elderly person, intentionality and type of touch, duration of the touch, gender and age of the person who touches and of the person being touched, frequency of the touch, and characteristics of the hands that touch. Touch is part of the quotidian practice of healthcare professionals and expresses their dedication and its related emotions, thereby revealing the quality of the care that is provided.Verificar aspectos importantes del lenguaje táctil a ser observados al tocar al anciano. Estudio de campo, cualitativo, exploratorio, desarrollado con 117 estudiantes y profesionales de salud participantes de capacitación en comunicación no verbal en gerontología. Los resultados demostraron que la mayoría consiguió identificar al menos un factor de atención a respetarse al tocar al anciano. Los discursos permitieron construir nueve categorías tomando nota de condiciones necesarias para el cuidado afectivo y de calidad brindado en el marco del lenguaje del tacto, que fueron: autorización para que ocurra el toque; localización del toque; intensidad del toque; condición del anciano; intencionalidad y tipo de toque; duración del toque; sexo y edad de quien toca y de quien es tocado; frecuencia del toque y características de las manos que tocan. El tocar forma parte del cotidiano de los profesionales de salud y expresa cuidado y sentimientos; consecuentemente, revela la calidad de atención prestada.Verificar os aspectos tacêsicos importantes para serem observados ao tocar o idoso. Estudo de campo, qualitativo e exploratório desenvolvido com 117 graduandos e profissionais de saúde participantes da capacitação em comunicação não verbal em gerontologia. Os resultados revelam que a maioria conseguiu identificar, pelo menos, um fator de atenção que precisa ser respeitado ao tocar o idoso. Os discursos permitiram a construção de nove categorias apontando condições necessárias ao cuidado afetivo e de qualidade prestado no âmbito da tacêsica; quais sejam: autorização para que o toque ocorra; localização do toque; intensidade do toque; condição do idoso; intencionalidade e tipo de toque; duração do toque; sexo e idade de quem toca e quem é tocado; frequência do toque e características das mãos que tocam. O tocar faz parte do cotidiano dos profissionais da saúde e expressa zelo e sentimentos consequentemente, revela a qualidade da assistência prestada

Reconstructing the recent West Nile virus lineage 2 epidemic in Europe and Italy using discrete and continuous phylogeography

West Nile virus lineage 2 (WNV-2) was mainly confined to sub-Saharan Africa until the early 2000s, when it was identified for the first time in Central Europe causing outbreaks of human and animal infection. The aim of this study was to reconstruct the origin and dispersion of WNV-2 in Central Europe and Italy on a phylodynamic and phylogeographical basis. To this aim, discrete and continuous space phylogeographical models were applied to a total of 33 newly characterised full-length viral genomes obtained from mosquitoes, birds and humans in Northern Italy in the years 2013-2015 aligned with 64 complete sequences isolated mainly in Europe. The European isolates segregated into two highly significant clades: a small one including three sequences and a large clade including the majority of isolates obtained in Central Europe since 2004. Discrete phylogeographical analysis showed that the most probable location of the root of the largest European clade was in Hungary a mean 12.78 years ago. The European clade bifurcated into two highly supported subclades: one including most of the Central/East European isolates and the other encompassing all of the isolates obtained in Greece. The continuous space phylogeographical analysis of the Italian clade showed that WNV-2 entered Italy in about 2008, probably by crossing the Adriatic sea and reaching a central area of the Po Valley. The epidemic then spread simultaneously eastward, to reach the region of the Po delta in 2013, and westward to the border area between Lombardy and Piedmont in 2014; later, the western strain changed direction southward, and reached the central area of the Po valley once again in 2015. Over a period of about seven years, the virus spread all over an area of northern Italy by following the Po river and its main tributaries