Patient-Reported Outcomes Measurement Information System physical function correlates with Toronto Extremity Salvage Score in an orthopaedic oncology population

Background: The National Institute of Health\u27s Patient-Reported Outcomes Measurement Information System (PROMIS) uses computerised-adaptive testing to reduce survey burden and improve sensitivity. PROMIS is being used across medical and surgical disciplines but has not been studied in orthopaedic oncology. Questions/purposes: The aim of the study was to compare PROMIS measures with upper extremity (UE) and lower extremity (LE) Toronto Extremity Salvage Score (TESS) by assessing the following: (1) responder burden, (2) correlation between scores and (3) floor/ceiling effects. Patients and methods: This cross-sectional trial analysed all 97 adult patients treated surgically for a bone or soft tissue tumour at a tertiary institution between November 2015 and March 2016. TESS (UE or LE) and PROMIS (Physical Function, Pain Interference and Depression) surveys were administered preoperatively. Pearson correlations between each PROMIS domain and TESS were calculated, as were floor/ceiling effects of each outcome measure. Results: (1) Completion of three PROMIS questionnaires required a mean total of 16.8 (+/- 5.8 standard deviation) questions, compared with 31 and 32 questions for the LE and UE TESS questionnaires, respectively. (2) The PROMIS Physical Function scores demonstrated a strong positive correlation with the LE TESS (r = 0.84; 95% confidence interval [CI], 0.72-0.91; p \u3c 0.001) and moderate positive correlation with the UE TESS (r = 0.64; 95% CI, 0.34-0.83; p = 0.055). The PROMIS Depression scores demonstrated a weak negative correlation with both the LE TESS (r = -0.38; 95% CI, -0.61 to -0.10; p = 0.010) and with UE TESS (r = -0.38; 95% CI, -0.67 to -0.01; p = 0.055). The PROMIS Pain Interference scores demonstrated a strong negative correlation with the LE TESS (r = -0.71; 95% CI, -0.83 to -0.52; p \u3c 0.001) and a moderate negative correlation with the UE TESS (r = -0.62; 95% CI, -0.81 to -0.30; p = 0.001). (3) The UE TESS had a range of scores from 16 to 100 with a 27% ceiling effect and no floor effect, and the LE TESS had a range from 10 to 98 with no floor or ceiling effect. There was no floor or ceiling effect for any PROMIS measures. Conclusions: In an orthopaedic oncology population, the PROMIS Physical Function and Pain Interference scores correlate with the TESS and have the benefit of reduced survey burden and ceiling effect. The PROMIS Depression scores may provide additional information regarding patient outcomes not captured by the TESS. Level of Evidence: Level III. The translational potential of this article: Patient reported outcome measures asses patients\u27 symptoms, function and health-related quality of life and are designed to capture more clinical information than can be gathered by objective medial testing alone. As reimbursements and the understanding of patient outcomes are becoming tied to performance on PROMIS measures, it is an important step to establish how PROMIS measures correlate and compare to traditional legacy measures

Work-Unit Absenteeism: Effects of Satisfaction, Commitment, Labor Market Conditions, and Time

Prior research is limited in explaining absenteeism at the unit level and over time. We developed and tested a model of unit-level absenteeism using five waves of data collected over six years from 115 work units in a large state agency. Unit-level job satisfaction, organizational commitment, and local unemployment were modeled as time-varying predictors of absenteeism. Shared satisfaction and commitment interacted in predicting absenteeism but were not related to the rate of change in absenteeism over time. Unit-level satisfaction and commitment were more strongly related to absenteeism when units were located in areas with plentiful job alternatives

On the faintest solar coronal hard X-rays observed with FOXSI

Solar nanoflares are small eruptive events releasing magnetic energy in the quiet corona. If nanoflares follow the same physics as their larger counterparts, they should emit hard X-rays (HXRs) but with a rather faint intensity. A copious and continuous presence of nanoflares would deliver enormous amounts of energy into the solar corona, possibly accounting for its high temperatures. To date, there has not been any direct observation of such sustained and persistent HXRs from the quiescent Sun. However, Hannah et al. in 2010 constrained the quiet Sun HXR emission using almost 12 days of quiescent solar-off-pointing observations by RHESSI. These observations set upper limits at $3.4\times 10^{-2}$ photons$^{-1}$ s$^{-1}$ cm$^{-2}$ keV$^{-1}$ and $9.5\times 10^{-4}$ photons$^{-1}$ s$^{-1}$ cm$^{-2}$ keV$^{-1}$ for the 3-6 keV and 6-12 keV energy ranges, respectively. Observing feeble HXRs is challenging because it demands high sensitivity and dynamic range instruments in HXRs. The Focusing Optics X-ray Solar Imager (FOXSI) sounding rocket experiment excels in these two attributes. Particularly, FOXSI completed its third successful flight (FOXSI-3) on September 7th, 2018. During FOXSI-3's flight, the Sun exhibited a fairly quiet configuration, displaying only one aged non-flaring active region. Using the entire $\sim$6.5 minutes of FOXSI-3 data, we constrained the quiet Sun emission in HXRs. We found $2\sigma$ upper limits in the order of $\sim 10^{-3}$ photons$^{-1}$ s$^{-1}$ cm$^{-2}$ keV$^{-1}$ for the 5-10 keV energy range. FOXSI-3's upper limit is consistent with what was reported by Hannah et al., 2010, but FOXSI-3 achieved this result using $\sim$1/2640 less time than RHESSI. A possible future spacecraft using FOXSI's concept would allow enough observation time to constrain the current HXR quiet Sun limits further or perhaps even make direct detections

The Bcl-2 repertoire of mesothelioma spheroids underlies acquired apoptotic multicellular resistance

Three-dimensional (3D) cultures are a valuable platform to study acquired multicellular apoptotic resistance of cancer. We used spheroids of cell lines and actual tumor to study resistance to the proteasome inhibitor bortezomib in mesothelioma, a highly chemoresistant tumor. Spheroids from mesothelioma cell lines acquired resistance to bortezomib by failing to upregulate Noxa, a pro-apoptotic sensitizer BH3-only protein that acts by displacing Bim, a pro-apoptotic Bax/Bak-activator protein. Surprisingly, despite their resistance, spheroids also upregulated Bim and thereby acquired sensitivity to ABT-737, an inhibitor of anti-apoptotic Bcl-2 molecules. Analysis using BH3 profiling confirmed that spheroids acquired a dependence on anti-apoptotic Bcl-2 proteins and were ‘primed for death'. We then studied spheroids grown from actual mesothelioma. ABT-737 was active in spheroids grown from those tumors (5/7, ∼70%) with elevated levels of Bim. Using immunocytochemistry of tissue microarrays of 48 mesotheliomas, we found that most (33, 69%) expressed elevated Bim. In conclusion, mesothelioma cells in 3D alter the expression of Bcl-2 molecules, thereby acquiring both apoptotic resistance and sensitivity to Bcl-2 blockade. Mesothelioma tumors ex vivo also show sensitivity to Bcl-2 blockade that may depend on Bim, which is frequently elevated in mesothelioma. Therefore, mesothelioma, a highly resistant tumor, may have an intrinsic sensitivity to Bcl-2 blockade that can be exploited therapeutically

On the Ethics of Trade Credit: Understanding Good Payment Practice in the Supply Chain

In spite of its commercial importance and signs of clear concern in public policy arenas, trade credit has not been subjected to systematic, extended analysis in the business ethics literature, even where suppliers as a stakeholder group have been considered. This paper makes the case for serious consideration of the ethics of trade credit and explores the issues surrounding slow payment of debts. It discusses trade debt as a kind of promise, but— noting that not all promises are good ones—goes on to develop an analysis of the ethics of trade credit grounded in an understanding of its fundamental purpose. Making a distinction between ‘‘operating’’ trade credit and ‘‘financial’’ trade credit, the paper provides an account of the maximum period for which it is appropriate for one company to delay payment to another from which it has purchased goods or services. The concern of commentators and policy makers that companies should not take too long to pay their debts is affirmed, but the understanding of what timely payment means is significantly finessed, with one conclusion being that, if debts have not already been settled according to acceptable standard terms of trade, cash should pass quickly back along the supply chain once the customer in the final product market has paid. The analysis has implications not only for companies that take credit but also for external parties that seek to rate companies or set regulations according to speed of payment—an approach that is shown to be misleadingly simplistic, albeit well intentioned. A corresponding important responsibility for suppliers, not to extend excessive credit (and thus act as a quasi-bank), also follows from the analysis developed. Having provided a novel analysis of an important business problem, the paper then discusses some of the related practical issues and makes suggestions for further research

Cargo Cults in Information Systems Development: a Definition and an Analytical Framework

Organizations today adopt agile information systems development methods (ISDM), but many do not succeed with the adoption process and in achieving desired results. Systems developers sometimes fail in efficient use of ISDM, often due to a lack of understanding the fundamental intentions of the chosen method. In many cases organizations simply imitate the behavior of others without really understanding why. This conceptual paper defines this phenomenon as an ISDM cargo cult behavior and proposes an analytical framework to identify such situations. The concept of cargo cults originally comes from the field of social anthropology and has been used to explain irrational, ritualistic imitation of certain behavior. By defining and introducing the concept in the field of information systems development we provide a diagnostic tool to better understand one of the reasons why ISDM adoption sometimes fail