The US Great Plains, Change, and Place Development

This chapter presents the changing conditions of a subregion and a specific place embedded within the larger region (space) of the Great Plains. From a general overview of the Great Plains, through a discussion of a portion of its High Plains subregion, and ending with a specific Kansas community, the focus is on general economic and environmental conditions. While some places within the larger space of the North American Great Plains/prairie region may find the wherewithal to succeed in the longer term—by capitalizing on local features and local entrepreneurial strength—these are likely to be exceptional in a large and relatively sparsely populated region

Groundwater Depletion and Agricultural Land Use Change in Wichita County, Kansas

Though researchers have documented groundwater and land use changes in the High Plains, few studies have investigated their interactions. This paper examines the relationship between groundwater depletion and agricultural land use change in greater detail than previous studies. Water well measurements and satellite imagery were used to detect changes in groundwater and land cover in Wichita County, Kansas, between 1975 and 2001. Analysis of these changes using GIS indicated that areas experiencing the greatest decline in groundwater were indeed being removed from irrigation, while areas with limited groundwater decline were experiencing fewer land use changes

Lessons learned from professional development workshops on using GIS to teach geography and history in the K-12 classroom

A GIS oriented professional development activity engaged social studies teachers with the importance of maps and graphics in teaching geography and history. With an introduction to ArcGIS Online and National Geographic Map Maker, the activity provided teachers with the ability to make their own maps and identify GIS materials for their classrooms. Conducting the workshop reinforced our belief in the need for considerable hands-on activity with participants allowed to work at their own pace. Pre- and post-event surveys showed positive gains regarding the teachers’ likelihood to include GIS based maps and graphics in teaching. The activity provided teachers with enough knowledge of GIS that they were ready to use the technology immediately

Evidence-Based Treatment Options in Recurrent and/or Metastatic Squamous Cell Carcinoma of the Head and Neck.

The major development of the past decade in the first-line treatment of recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) was the introduction of cetuximab in combination with platinum plus 5-fluorouracil chemotherapy (CT), followed by maintenance cetuximab (the EXTREME regimen). This regimen is supported by a phase 3 randomized trial and subsequent observational studies, and it confers well-documented survival benefits, with median survival ranging between approximately 10 and 14 months, overall response rates between 36 and 44%, and disease control rates of over 80%. Furthermore, as indicated by patient-reported outcome measures, the addition of cetuximab to platinum-based CT leads to a significant reduction in pain and problems with social eating and speech. Conversely, until very recently, there has been a lack of evidence-based second-line treatment options, and the therapies that have been available have shown low response rates and poor survival outcomes. Presently, a promising new treatment option in R/M SCCHN has emerged: immune checkpoint inhibitors (ICIs), which have demonstrated favorable results in second-line clinical trials. Nivolumab and pembrolizumab are the first two ICIs that were approved by the US Food and Drug Administration. We note that the trials that showed benefit with ICIs included not only patients who previously received ≥1 platinum-based regimens for R/M SCCHN but also patients who experienced recurrence within 6 months after combined modality therapy with a platinum agent for locally advanced disease. In this review, we outline the available clinical and observational evidence for the EXTREME regimen and the initial results from clinical trials for ICIs in patients with R/M SCCHN. We propose that these treatment options can be integrated into a new continuum of care paradigm, with first-line EXTREME regimen followed by second-line ICIs. A number of ongoing clinical trials are comparing regimens with ICIs, alone and in combination with other ICIs or CT, with the EXTREME regimen for first-line treatment of R/M SCCHN. As we eagerly await the results of these trials, the EXTREME regimen remains the standard of care for the first-line treatment of R/M SCCHN

Efficacy and safety of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor in patients with stage IIIB/C and IVM1a melanoma: subanalysis of the Phase III OPTiM trial

Talimogene laherparepvec is the first oncolytic immunotherapy to receive approval in Europe, the USA and Australia. In the randomized, open-label Phase III OPTiM trial (NCT00769704), talimogene laherparepvec significantly improved durable response rate (DRR) versus granulocyte-macrophage colony-stimulating factor (GM-CSF) in 436 patients with unresectable stage IIIB-IVM1c melanoma. The median overall survival (OS) was longer versus GM-CSF in patients with earlier-stage melanoma (IIIB-IVM1a). Here, we report a detailed subgroup analysis of the OPTiM study in patients with IIIB-IVM1a disease.The patients were randomized (2:1 ratio) to intralesional talimogene laherparepvec or subcutaneous GM-CSF and were evaluated for DRR, overall response rate (ORR), OS, safety, benefit-risk and numbers needed to treat. Descriptive statistics were used for subgroup comparisons.Among 249 evaluated patients with stage IIIB-IVM1a melanoma, DRR was higher with talimogene laherparepvec compared with GM-CSF (25.2% versus 1.2%; P<0.0001). ORR was also higher in the talimogene laherparepvec arm (40.5% versus 2.3%; P<0.0001), and 27 patients in the talimogene laherparepvec arm had a complete response, compared with none in GM-CSF-treated patients. The incidence rates of exposure-adjusted adverse events (AE) and serious AEs were similar with both treatments.The subgroup of patients with stage IIIB, IIIC and IVM1a melanoma (57.1% of the OPTiM intent-to-treat population) derived greater benefit in DRR and ORR from talimogene laherparepvec compared with GM-CSF. Talimogene laherparepvec was well tolerated

Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer.

SummaryGiven the complexities of multimodality treatment for patients with head and neck cancer, the rationale for the use of multidisciplinary teams (MDTs) to define individual optimal treatment strategies on a per-patient basis is apparent. Increased use of guideline-directed approaches, reduced time to treatment and improved outcomes, which result from use of an MDT approach in head and neck cancer, have been documented. A discussion of these recent advances, as well as presentation of available country-specific guidance on the roles and responsibilities of team members, supports the creation of similar local-language recommendations for the treatment of patients with head and neck cancer. Finally, expert practical advice on the implementation of MDTs may enable the establishment of the MDT approach more universally around the world

Assessing Addictions in a Spiritual World: Using Confirmatory Factor Analysis and Structural Equations Modeling to Develop the Life Interests Questionnaire

This study uses the thoughts and writings of Evagrius of Ponticus to provide a measure useful in assessing addictions in relation to spirituality. Evagrius (1972) theorizes that there are eight tempting thoughts that can form the basis of disordered attachments, and that these deadly thoughts could lead one to a life of addictions. These thoughts formed the foundation of the Life Interests Questionnaire (LIQ). This self-report survey consists of 170 items, all of which are scored on a Likert scale (1 = strongly agree and 5 = strongly disagree). The LIQ was paired with an interest survey containing 43 items taken from previously tested measures. These questions asked about one’s religious identification, locus of control, and beliefs about the world. In a pilot study, each attachment item group was examined through confirmatory factor analysis which allowed the substructure of the questionnaire to be examined and the overall fit of the model was found to be marginally adequate (GFI 0.8889). Reliability and validity of this measure were attained primarily through construct validity and it found both a valid and reliable measure of Evagrius’s underlying theory. Future plans include correlational studies between religious identification/practices and level of disordered attachments

Efficacy and safety of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor in patients with stage IIIB/C and IVM1a melanoma: subanalysis of the Phase III OPTiM trial

Talimogene laherparepvec is the first oncolytic immunotherapy to receive approval in Europe, the USA and Australia. In the randomized, open-label Phase III OPTiM trial ({"type":"clinical-trial","attrs":{"text":"NCT00769704","term_id":"NCT00769704"}}NCT00769704), talimogene laherparepvec significantly improved durable response rate (DRR) versus granulocyte-macrophage colony-stimulating factor (GM-CSF) in 436 patients with unresectable stage IIIB–IVM1c melanoma. The median overall survival (OS) was longer versus GM-CSF in patients with earlier-stage melanoma (IIIB–IVM1a). Here, we report a detailed subgroup analysis of the OPTiM study in patients with IIIB–IVM1a disease