Approaches to decision-making among late-stage melanoma patients: a multifactorial investigation.

PurposeThe treatment decisions of melanoma patients are poorly understood. Most research on cancer patient decision-making focuses on limited components of specific treatment decisions. This study aimed to holistically characterize late-stage melanoma patients' approaches to treatment decision-making in order to advance understanding of patient influences and supports.Methods(1) Exploratory analysis of longitudinal qualitative data to identify themes that characterize patient decision-making. (2) Pattern analysis of decision-making themes using an innovative method for visualizing qualitative data: a hierarchically-clustered heatmap. Participants were 13 advanced melanoma patients at a large academic medical center.ResultsExploratory analysis revealed eight themes. Heatmap analysis indicated two broad types of patient decision-makers. "Reliant outsiders" relied on providers for medical information, demonstrated low involvement in decision-making, showed a low or later-in-care interest in clinical trials, and expressed altruistic motives. "Active insiders" accessed substantial medical information and expertise in their networks, consulted with other doctors, showed early and substantial interest in trials, demonstrated high involvement in decision-making, and employed multiple decision-making strategies.ConclusionWe identified and characterized two distinct approaches to decision-making among patients with late-stage melanoma. These differences spanned a wide range of factors (e.g., behaviors, resources, motivations). Enhanced understanding of patients as decision-makers and the factors that shape their decision-making may help providers to better support patient understanding, improve patient-provider communication, and support shared decision-making

Recognition of a Cause of Action for Abusive Discharge in Maryland

In recent years, courts in other jurisdictions have created certain exceptions to the general rule that an at-will employee may be terminated without cause. The Court of Appeals of Maryland, in the recent case of Adler v. American Standard Corp., limited the at-will rule by recognizing a cause of action for abusive discharge. In this article, the authors trace the development of the at-will rule and exceptions to it carved out by courts and legislatures. After reviewing certain facets of the law of abusive discharge in other jurisdictions, the authors examine the Adler case and discuss the possible ramifications of this decision

Targeting colorectal cancer via its microenvironment by inhibiting IGF-1 receptor-insulin receptor substrate and STAT3 signaling.

The tumor microenvironment (TME) exerts critical pro-tumorigenic effects through cytokines and growth factors that support cancer cell proliferation, survival, motility and invasion. Insulin-like growth factor-1 (IGF-1) and signal transducer and activator of transcription 3 (STAT3) stimulate colorectal cancer development and progression via cell autonomous and microenvironmental effects. Using a unique inhibitor, NT157, which targets both IGF-1 receptor (IGF-1R) and STAT3, we show that these pathways regulate many TME functions associated with sporadic colonic tumorigenesis in CPC-APC mice, in which cancer development is driven by loss of the Apc tumor suppressor gene. NT157 causes a substantial reduction in tumor burden by affecting cancer cells, cancer-associated fibroblasts (CAF) and myeloid cells. Decreased cancer cell proliferation and increased apoptosis were accompanied by inhibition of CAF activation and decreased inflammation. Furthermore, NT157 inhibited expression of pro-tumorigenic cytokines, chemokines and growth factors, including IL-6, IL-11 and IL-23 as well as CCL2, CCL5, CXCL7, CXCL5, ICAM1 and TGFβ; decreased cancer cell migratory activity and reduced their proliferation in the liver. NT157 represents a new class of anti-cancer drugs that affect both the malignant cell and its supportive microenvironment

Multi-objective engineering shape optimization using differential evolution interfaced to the Nimrod/O tool

This paper presents an enhancement of the Nimrod/O optimization tool by interfacing DEMO, an external multiobjective optimization algorithm. DEMO is a variant of differential evolution – an algorithm that has attained much popularity in the research community, and this work represents the first time that true multiobjective optimizations have been performed with Nimrod/O. A modification to the DEMO code enables multiple objectives to be evaluated concurrently. With Nimrod/O’s support for parallelism, this can reduce the wall-clock time significantly for compute intensive objective function evaluations. We describe the usage and implementation of the interface and present two optimizations. The first is a two objective mathematical function in which the Pareto front is successfully found after only 30 generations. The second test case is the three-objective shape optimization of a rib-reinforced wall bracket using the Finite Element software, Code_Aster. The interfacing of the already successful packages of Nimrod/O and DEMO yields a solution that we believe can benefit a wide community, both industrial and academic

Scheduling aircraft landings - the static case

This is the publisher version of the article, obtained from the link below.In this paper, we consider the problem of scheduling aircraft (plane) landings at an airport. This problem is one of deciding a landing time for each plane such that each plane lands within a predetermined time window and that separation criteria between the landing of a plane and the landing of all successive planes are respected. We present a mixed-integer zero–one formulation of the problem for the single runway case and extend it to the multiple runway case. We strengthen the linear programming relaxations of these formulations by introducing additional constraints. Throughout, we discuss how our formulations can be used to model a number of issues (choice of objective function, precedence restrictions, restricting the number of landings in a given time period, runway workload balancing) commonly encountered in practice. The problem is solved optimally using linear programming-based tree search. We also present an effective heuristic algorithm for the problem. Computational results for both the heuristic and the optimal algorithm are presented for a number of test problems involving up to 50 planes and four runways.J.E.Beasley. would like to acknowledge the financial support of the Commonwealth Scientific and Industrial Research Organization, Australia

Constructing Mutually Unbiased Bases in Dimension Six

The density matrix of a qudit may be reconstructed with optimal efficiency if the expectation values of a specific set of observables are known. In dimension six, the required observables only exist if it is possible to identify six mutually unbiased complex 6x6 Hadamard matrices. Prescribing a first Hadamard matrix, we construct all others mutually unbiased to it, using algebraic computations performed by a computer program. We repeat this calculation many times, sampling all known complex Hadamard matrices, and we never find more than two that are mutually unbiased. This result adds considerable support to the conjecture that no seven mutually unbiased bases exist in dimension six.Comment: As published version. Added discussion of the impact of numerical approximations and corrected the number of triples existing for non-affine families (cf Table 3

Planning for Long‐Term Recovery Before Disaster Strikes: Case Studies of 4 US Cities: A Final Project Report

Among the four phases along the hazard continuum -- preparedness, response, recovery, and mitigation -- the sub‐field of long‐term recovery has long been an outlier, an "orphan" when it comes to concerted policy attention and pre‐disaster planning. It's not that community residents or municipal and state government officials are unaware of the potential long‐term residual consequences of natural disasters. Since the attacks of September 11, 2001 and the subsequent creation of the Department of Homeland Security, the U.S. government has spent billions of dollars to upgrade and enhance the country's ability to detect and respond to major catastrophic events, whether man‐made or natural in origin. The country experienced catastrophic wildfires in 2003, 2007‐2008, and 2011, a regional electrical blackout affecting 9 states and part of Canada in 2003, major Midwest flooding in 2008 and again this year, Category 3 or greater hurricanes in 2004, 2005, and 2008, and significant tornado clusters in 2011 that claimed 529 lives and caused over $17 billion in damages. These hazards have struck virtually every region of the country, and the consequences are readily evident to emergency managers and local city and county. Although the ratio of uncovered to covered losses has declined over this three‐decade timeframe, from approximately 8:1 to 4:1, absolute dollar losses have escalated tremendously. This may represent gains in mitigation efforts to insure against losses in high‐risk areas, but the size and growth of uncovered losses suggest a growing recovery challenge. This difference between covered and uncovered losses reflects the absolute minimum investment required for affected areas to return to pre‐event conditions, much less build back to a better or higher standard. Furthermore, what this trend line cannot capture are those disaster consequences not so easily monetized -- diminished physical and mental health among an affected citizenry, loss of a sense of community and attachment to place, or large scale social disruptions or population displacements. Given the magnitude of the social investment needed to pursue long‐term recovery after a disaster, and the attention that other phases in the hazard continuum have experienced, why is recovery still a policy orphan, and what are the local implications for pre‐disaster planning for long‐term recovery

The Grism Lens-Amplified Survey from Space (GLASS). XII. Spatially Resolved Galaxy Star Formation Histories and True Evolutionary Paths at z > 1

Modern data empower observers to describe galaxies as the spatially and biographically complex objects they are. We illustrate this through case studies of four, $z\sim1.3$ systems based on deep, spatially resolved, 17-band + G102 + G141 Hubble Space Telescope grism spectrophotometry. Using full spectrum rest-UV/-optical continuum fitting, we characterize these galaxies' observed $\sim$kpc-scale structures and star formation rates (SFRs) and reconstruct their history over the age of the universe. The sample's diversity---passive to vigorously starforming; stellar masses $\log M_*/M_\odot=10.5$ to $11.2$---enables us to draw spatio-temporal inferences relevant to key areas of parameter space (Milky Way- to super-Andromeda-mass progenitors). Specifically, we find signs that bulge mass-fractions ($B/T$) and SF history shapes/spatial uniformity are linked, such that higher $B/T$s correlate with "inside-out growth" and central specific SFRs that peaked above the global average for all starforming galaxies at that epoch. Conversely, the system with the lowest $B/T$ had a flat, spatially uniform SFH with normal peak activity. Both findings are consistent with models positing a feedback-driven connection between bulge formation and the switch from rising to falling SFRs ("quenching"). While sample size forces this conclusion to remain tentative, this work provides a proof-of-concept for future efforts to refine or refute it: JWST, WFIRST, and the 30-m class telescopes will routinely produce data amenable to this and more sophisticated analyses. These samples---spanning representative mass, redshift, SFR, and environmental regimes---will be ripe for converting into thousands of sub-galactic-scale empirical windows on what individual systems actually looked like in the past, ushering in a new dialog between observation and theory.Comment: 18 pp, 15 figs, 3 tables (main text); 5 pp, 5 figs, 1 table (appendix); Submitted to AAS Journals 1 October 201