Fee Arrangements and Fee Shifting: Lessons From the Experience in Ontario

About one-third of oestrogen receptor alpha-positive breast cancer patients treated with tamoxifen relapse. Here we identify the nuclear receptor retinoic acid receptor alpha as a marker of tamoxifen resistance. Using quantitative mass spectrometry-based proteomics, we show that retinoic acid receptor alpha protein networks and levels differ in a tamoxifen-sensitive (MCF7) and a tamoxifen-resistant (LCC2) cell line. High intratumoural retinoic acid receptor alpha protein levels also correlate with reduced relapse-free survival in oestrogen receptor alpha-positive breast cancer patients treated with adjuvant tamoxifen solely. A similar retinoic acid receptor alpha expression pattern is seen in a comparable independent patient cohort. An oestrogen receptor alpha and retinoic acid receptor alpha ligand screening reveals that tamoxifen-resistant LCC2 cells have increased sensitivity to retinoic acid receptor alpha ligands and are less sensitive to oestrogen receptor alpha ligands compared with MCF7 cells. Our data indicate that retinoic acid receptor alpha may be a novel therapeutic target and a predictive factor for oestrogen receptor alpha-positive breast cancer patients treated with adjuvant tamoxifen

Interobserver Variability of Histopathological Prognostic Parameters in Cutaneous Malignant Melanoma : Impact on Patient Management

Clinical management of primary cutaneous melanomas is based on histopathological staging of the tumour. The aim of this study was to investigate, in a non-selected population in clinical practice, the agreement rate between general pathologists and pathologists experienced in melanoma in terms of the evaluation of histopathological prognostic parameters in cutaneous malignant melanomas, and to what extent the putative variability affected clinical management. A total of 234 cases of invasive cutaneous malignant melanoma were included in the study from the Stockholm-Gotland Healthcare Region in Sweden. Overall interobserver variability between a general pathologist and an expert review was 68.8-84.8%. Approximately 15.5% of melanomas <= 1 mm were re-classified either as melanoma in situ or melanomas >1 mm after review. In conclusion, review by a pathologist experienced in melanoma resulted in a change in recommendations about surgical excision margins and/or sentinel node biopsy in subgroups of Ti melanomas

Playing as an early-childhood promotion of communication skills

Darba autore: Agita Kaža Darba tēma: Rotaļa kā saskarsmes prasmju sekmētāja agrās bērnības vecumā Darba vadītājs: Prof. Dr. psych.Tija Zīriņa Pētījuma mērķis: Pētīt 2 – 3 gadīgu bērnu saskarsmes prasmes rotaļās Pētījuma saturs: darba teorētiskās daļas pirmajā nodaļā tiek aplūkotas un analizētas dažādu pedagogu, psihologu atziņas par saskarsmi, kā veidojas saskarsme pirmsskolā. Darba otrajā nodaļā tiek pētīta agrās bērnības saskarsmju prasmju sekmēšanā rotaļās. Nodaļas saturs lielākoties balstās uz praktisko pētījumu. Pētījumā piedalās agrās bērnības vecuma 16 bērni. Pētījumā tiek organizētas rotaļas ar kuru palīdzību bērni veicina sekmīgu saskarsmes prasmju veidošanos. Secinājumos apkopota nozīmīgākā informācija saskarsmes prasmju attīstību rotaļā. Atslēgas vārdi: saskarsme, saskarsmes prasmju attīstība, rotaļa, pirmsskola, bērni. Darba apjoms: darbs sastāv no 4 nodaļām un 5 apakšnodaļām, tam ir 55 lapas. Darbā aplūkojamas 2 tabulas, 2 attēli un pielikums, kurā ir redzams 21 attēls, izmantotās literatūras saraksts sastāv no 45 avotiem.Author of the work: Agita Kaza Theme of the work: Playing as an early-childhood promotion of communication skills Supervisor of the work: Prof. Dr. psych. Tija Zirina The aim of the research: To study 2-3-year-olds' skills in games Study content: the first chapter of the theoretical part of the work looks at and analyzes the knowledge of various educators, psychologists, about how they come into contact in preschool. The second section of work examines the promotion of early childhood communication skills in games. The content of the chapter is largely based on the practical study. 16 children of the age of early childhood are involved in the study. The study organizes games to help children develop successful communication skills. The conclusions summarise key information on the development of communication skills in play. Keywords: communication, development of communication skills, playing, preschool, children. Scope of the work: the work consists of 4 chapters and 5 subdivisions, with 55 pages. The work includes 2 tables, 2 pictures and an attachment showing 21 figures, a list of authorities used consisting of 45 sources

Validation of data quality in the Swedish National Register for Breast Cancer

Abstract Background The National Breast Cancer Register (NBCR) of Sweden was launched in 2008 and is used for quality assurance, benchmarking, and research. Its three reporting forms encompass Notification, Adjuvant therapy and Follow-up. Target levels are set by national and international guidelines. This national validation assessed data quality of the register. Methods Data recorded through the Notification form were evaluated for completeness, timeliness, comparability and validity. Completeness was assessed by cross-linkage to the Swedish Cancer Register (SCR). Comparability was analyzed by comparing registration routines in NBCR with national and international guidelines. Timeliness was defined as the difference between the earliest date of diagnosis and the reporting date to NBCR. Validity was assessed by re-abstraction of medical chart data for 800 randomly selected patients diagnosed in 2013. Results The completeness of the NBCR was high with a coverage across regions and years (2010–2014) of 99.9%. Of all incident cases reported to the NBCR in 2013 (N = 8654), 98.5% were included within 12 months and differences between health regions were essentially negligible. Coding procedures followed guidelines and were uniformly adhered to. The proportion of missing values was  90%). Conclusions Completeness of data, comparability and agreement in the NBCR was high. For clinical quality purposes and benchmarking, improved timeliness is warranted. Assessment of validity has resulted in a thorough review of all variables included in the Notification form with clarifications and revision of selected variables

Retinoic acid receptor alpha is associated with tamoxifen resistance in breast cancer

About one-third of oestrogen receptor alpha-positive breast cancer patients treated with tamoxifen relapse. Here we identify the nuclear receptor retinoic acid receptor alpha as a marker of tamoxifen resistance. Using quantitative mass spectrometry-based proteomics, we show that retinoic acid receptor alpha protein networks and levels differ in a tamoxifen-sensitive (MCF7) and a tamoxifen-resistant (LCC2) cell line. High intratumoural retinoic acid receptor alpha protein levels also correlate with reduced relapse-free survival in oestrogen receptor alpha-positive breast cancer patients treated with adjuvant tamoxifen solely. A similar retinoic acid receptor alpha expression pattern is seen in a comparable independent patient cohort. An oestrogen receptor alpha and retinoic acid receptor alpha ligand screening reveals that tamoxifen-resistant LCC2 cells have increased sensitivity to retinoic acid receptor alpha ligands and are less sensitive to oestrogen receptor alpha ligands compared with MCF7 cells. Our data indicate that retinoic acid receptor alpha may be a novel therapeutic target and a predictive factor for oestrogen receptor alpha-positive breast cancer patients treated with adjuvant tamoxifen