Risk Factors for Gastrointestinal Stromal Tumor Recurrence in Patients Treated With Adjuvant Imatinib

Peer reviewe

The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Effect of KIT and PDGFRA Mutations on Survival in Patients With Gastrointestinal Stromal Tumors Treated With Adjuvant Imatinib An Exploratory Analysis of a Randomized Clinical Trial

IMPORTANCE Little is known about whether the duration of adjuvant imatinib influences the prognostic significance of KIT proto-oncogene receptor tyrosine kinase (KIT) and platelet-derived growth factor receptor a (PDGFRA) mutations. OBJECTIVE To investigate the effect of KIT and PDGFRA mutations on recurrence-free survival (RFS) in patients with gastrointestinal stromal tumors (GISTs) treated with surgery and adjuvant imatinib. DESIGN, SETTING, AND PARTICIPANTS This exploratory study is based on the Scandinavian Sarcoma Group VIII/Arbeitsgemeinschaft Internistische Onkologie (SSGXVIII/AIO) multicenter clinical trial. Between February 4, 2004, and September 29, 2008, 400 patients who had undergone surgery for GISTs with a high risk of recurrence were randomized to receive adjuvant imatinib for 1 or 3 years. Of the 397 patients who provided consent, 341 (85.9%) had centrally confirmed, localized GISTs with mutation analysis for KIT and PDGFRA performed centrally using conventional sequencing. During a median follow-up of 88 months (completed December 31, 2013), 142 patients had GIST recurrence. Data of the evaluable population were analyzed February 4, 2004, through December 31, 2013. MAIN OUTCOMES AND MEASURES The main outcome was RFS. Mutations were grouped by the gene and exon. KIT exon 11 mutations were further grouped as deletion or insertion-deletion mutations, substitution mutations, insertion or duplication mutations, and mutations that involved codons 557 and/or 558. RESULTS Of the 341 patients (175 men and 166women; median age at study entry, 62 years) in the 1-year group and 60 years in the 3-year group), 274 (80.4%) had GISTs with a KIT mutation, 43 (12.6%) had GISTs that harbored a PDGFRA mutation, and 24 (7.0%) had GISTs thatwere wild type for these genes. PDGFRA mutations and KIT exon 11 insertion or duplication mutations were associated with favorable RFS, whereas KIT exon 9 mutations were associated with unfavorable outcome. Patients with KIT exon 11 deletion or insertion-deletion mutation had better RFS when allocated to the 3-year group compared with the 1-year group (5-year RFS, 71.0% vs 41.3%; P CONCLUSIONS AND RELEVANCE Patients with KIT exon 11 deletion mutations benefit most from the longer duration of adjuvant imatinib. The duration of adjuvant imatinib modifies the risk of GIST recurrence associated with some KIT mutations, including deletions that affect exon 11 codons 557 and/or 558.Peer reviewe

Enabling sustainable energy futures: Factors influencing green supply chain collaboration

In order to explore the relationship between sustainability strategies and future energy needs and demands (hence energy futures), supply chains (SCs) need to continue to reduce their CO2 emissions through developing their green credentials and improving overall performance; noting that the assimilation of such environmental aspects into production, SCs and logistics are considered as complex processes. Knowledge management (KM) has long been seen as an enabler to support intensive collaboration efforts – on which green initiatives are largely based. The supply chain management (SCM) and KM areas have largely focused on improving organisational performance. While the latter research has yielded successful outcomes in many different sectors, there is still a scarcity of research studies focusing on identifying influential factors that highlight those aspects which may enable green supply chain collaboration (GrSCC) to occur, thus leading to sustainable energy futures and carbon-efficient production. To increase inter-organisational synchronisation, organisations often call for SC partners to implement common business processes and sources of knowledge. This paper therefore aims to contribute to the research domain by examining the role of KM in facilitating GrSCC. Through the identification of key factors extrapolated from the normative literature, a model for implementing GrSCC using a futures-based perspective is proposed. This paper inductively demonstrates the relationship between identified GrSCC factors through the application of a fuzzy cognitive mapping (FCM) technique. Findings from this research support a futures-based perspective that enhances understanding and refines forward-looking strategies for GrSCC. Through the exploration of two GrSCC scenarios using the given technique, this paper reports a granular perspective of positive and negative causal factors that support enabling energy futures that enhance green supply credentials

The Human Capital Hoax: Work, Debt and Insecurity in the Era of Uberization

Human capital theory - developed by neoclassical economists like Gary Becker and Theodore Schultz – is widely considered a useful way to explain how employees might enhance their value in organizations, leading to improved skill, autonomy and socio-economic wellbeing. This essay argues the opposite. Human capital theory implies that employees should bear the costs (and benefits) of their investment. Highly individualized training and work practices are an inevitable corollary. Self-employment, portfolio careers, the ‘gig economy’ and ondemand business models (including Uber and Deliveroo) faithfully reflect the assumptions that inform human capital theory. I term this the radical responsibilization of the workforce and link it to growing economic insecurity, low productivity, diminished autonomy and worrying levels of personal debt. The essay concludes by proposing some possible solutions

Learning from Blackpool Promenade: Re-enchanting sterile streets

In this article, the authors contend that contemporary urban streets are over-regulated, preoccupied with surveillance, commercial requirements and rapid transit, aesthetically homogeneous and sensually sterile. As an exemplary site of contrast, the article focuses on the recently redesigned Blackpool Promenade. First, it argues that this redesign honours the resort’s popular traditions, its potent heritage and the importance of innovation. Second, it explores how the promenade fosters playful interactions, conviviality and lingering. Third, the article focuses on sensory attributes that enhance the experience of promenaders