Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis

Objectives: Palliative self-expandable metallic stent (SEMS) insertion is common in patients not suitable for resection of oesophagogastric (OG) cancer. Factors which may determine survival, however, are not clear. The present study examined the relationship between tumour and host factors, including the systemic inflammatory response and survival of patients undergoing palliative SEMS insertion. Methods: Patients with a diagnosis of OG cancer who were considered suitable for palliative SEMS only without systemic therapy were identified. Patient characteristics including Eastern Cooperative Oncology Group performance status, radiological stage and modified Glasgow Prognostic Score (mGPS: 0—C-reactive protein (CRP) ≤10 mg/L; 1—CRP >10 mg/L; 2—CRP >10 mg/L; albumin <35 g/L) were recorded prospectively. The relationship between such characteristics and 3-month survival was examined. Results: 203 patients were included in the final analysis. All patients died during follow-up, with median survival from diagnosis 75 days (IQR 47–157). 78% of patients were systemically inflamed (mGPS >1). On multivariate analysis, only poor performance status (HR 1.23, p=0.025), metastatic disease (HR 2.27, p<0.001) and mGPS (HR 1.25, p=0.021) were associated with shorter survival. The combination of performance status and mGPS stratified 3-month survival of patients without metastatic disease from 88% to 20% (p<0.001) and patients with metastases from 43% to 6% (p=0.059). Similar results were observed when analysis was restricted to patients with oesophageal and junctional cancer (M0: 83%–20%, p=0.008; M1: 33%–8%, p=0.082). Conclusion: Performance status, metastatic disease and mGPS are independent predictors of survival in patients with OG cancer undergoing palliative SEMS insertion. These routinely available markers provide a rational system on which to base decisions regarding prognosis and treatment

Directives and Academics: educational developers, technology and the right support

There can be ‘an army of people involved in the development of academics as teachers’ (Ling & CADAC, 2009) and the role of Educational Developers with technological expertise is vital to the uptake and creative use of educational technologies in learning contexts (Oliver, 2005). Even so, technology plays only a part in the teaching and learning experience and must be underpinned with pedagogical wherewithal. At Victoria University (VU) in Melbourne, a new VU Agenda expects the university to be known for educational programmes ‘that maximise opportunities for blended and eLearning’. This discussion examines the support available to staff using technologies for teaching. The discussion covers two examples from different faculties where teaching staff have needed to comply with Faculty or School directives to use particular university-supported technologies (Lectopia and GradeMark). The comments about staff uptake of technologies draw on general themes from evaluations administered in each faculty to gauge the effectiveness of the technologies for teaching and to identify further professional development needs. Unsurprisingly, the findings show that, without intensive and timely support tailored to the specific requirements of academics, without academics having both an understanding of the reason for the mandating of a technology as well as an ability to influence that uptake, academics are likely to find ways to resist authoritarian directives. The danger of encouraging academics’ uptake of educational technologies without broader educational development support to encourage good teaching practices that integrate technology and good curriculum design became clear from the dat

Digistain: a novel biomarker imaging platform for grading breast carcinoma using routinely processed paraffin sections

Objective: Digistain is a new technology platform that enables imaging and quantification of a newly conceived biomarker for grading breast carcinoma in routinely processed, unstained paraffin sections without the use of traditional stains or contrasting agents. By recording a unique optical signature to analyze the chemical make-up of a biopsy quantitatively, the technique is unaffected by the subjectivity of traditional grading. Within minutes of loading a slide it yields a highly reproducible and user independent numerical score reflecting the cellularity of the tumour and its nuclear: cytoplasmic ratio. We report here our findings using an objective technique to grade breast tumours using quantitative criteria. Method: H&E stained sections from excision biopsies of 105 cases of invasive breast carcinoma were reviewed and graded using the ElstonEllis grading system. Unstained sections from each case were loaded into the Digistain platform to yield a numerical score - the Digistain Index (DI). Results: The cases were grouped according to histological grading. Mean DIs was calculated for each grade (1,2 and 3) to be 0.56, 0.61, and 0.68 respectively with a maximum standard error of 0.02. The DI spread within each grade was less than that across the three grades, thus validating this index as a viable grading indicator within the context of this study. Conclusion: We believe the new Digistain approach provides for the first time a cost effective and quantitative measure of tumour grade. This can be developed to deliver an effective assessment of prognosis and recurrence risk beyond traditional qualitative measures based on H&E staining protocols

NREL Job Task Analysis: Energy Auditor

A summary of job task analyses for the position of energy auditor when evaluating a residence before and during weatherization work

4D Emittance Measurements Using Multiple Wire and Waist Scan Methods in the ATF Extraction Line.

TUPC087International audienceEmittance measurements performed in the diagnostic section of the ATF extraction line since 1998 lead to ver- tical emittances three times larger than the expected ones, with a strong dependence on intensity. An experimental program is pursued to investigate potential sources of emit- tance growth and find possible remedies. This requires ef- ficient and reliable emittance measurement techniques. In the past, several phase-space reconstruction methods devel- oped at SLAC and KEK have been used to estimate the ver- tical emittance, based on multiple location beam size mea- surements and dedicated quadrupole scans. These methods have been shown to be very sensitive to measurement er- rors and other fluctuations in the beam conditions. In this context new emittance measurements have been performed revisiting these methods and newly developed ones with a systematic approach to compare and characterise their per- formance in the ATF extraction line

The Globular Cluster Systems around NGC 3311 and NGC 3309

We present extensive new photometry in (g',i') of the large globular cluster (GC) system around NGC 3311, the central cD galaxy in the Hydra cluster. Our GMOS data cover a 5.5' field of view and reach a limiting magnitude i' = 26, about 0.5 magnitude fainter than the turnover point of the GC luminosity function. We find that NGC 3311 has a huge population of ~16, 000 GCs, closely similar to the prototypical high specific frequency Virgo giant M87. The color-magnitude distribution shows that the metal-poor blue GC sequence and the metal-richer red sequence are both present, with nearly equal numbers of clusters. Bimodal fits to the color distributions confirm that the blue sequence shows the same trend of progressively increasing metallicity with GC mass that has previously been found in many other large galaxies; the correlation we find corresponds to a scaling of GC metallicity with mass of Z ~ M^0.6 . By contrast, the red sequence shows no change of mean metallicity with mass, but it shows an upward extension to much higher than normal luminosity into the UCD-like range, strengthening the potential connections between massive GCs and UCDs. The GC luminosity function, which we measure down to the turnover point at M_I = -8.4, also has a normal form like those in other giant ellipticals. Within the Hydra field, another giant elliptical NGC 3309 is sitting just 100" from the cD NGC 3311. We use our data to solve simultaneously for the spatial structure and total GC populations of both galaxies at once. Their specific frequencies are S_N (NGC 3311) = 12.5 +/- 1.5 and S_N (NGC 3309) = 0.6 +/-0.4. NGC 3311 is completely dominant and entirely comparable with other cD-type systems such as M87 in Virgo.Comment: 15 pages, 15 figures. Accepted to the Astrophysical Journal. Version with higher resolution figures is available at http://www.thewehners.net/astro/papers/wehner_n3311_highres.pd

Anatomy of the long head of biceps femoris: An ultrasound study

Hamstring strains, particularly involving the long head of biceps femoris (BFlh) at the proximal musculotendinous junction (MTJ), are commonly experienced by athletes. With the use of diagnostic ultrasound increasing, an in-depth knowledge of normal ultrasonographic anatomy is fundamental to better understanding hamstring strain. The aim of this study was to describe the architecture of BFlh, using ultrasonography, in young men and cadaver specimens. BFlh morphology was examined in 19 healthy male participants (mean age 21.6 years) using ultrasound. Muscle, tendon and MTJ lengths were recorded and architectural parameters assessed at four standardised points along the muscle. Measurement accuracy was validated by ultrasound and dissection of BFlh in six male cadaver lower limbs (mean age 76 years). Intra-rater reliability of architectural parameters was examined for repeat scans, image analysis and dissection measurements. Distally the BFlh muscle had significantly (P

Whey- vs Casein-Based Enteral Formula and Gastrointestinal Function in Children With Cerebral Palsy.

Objectives: Children with severe cerebral palsy (CP) commonly have gastrointestinal (GI) dysfunction. Whey-based enteral formulas have been postulated to reduce gastroesophageal reflux (GOR) and accelerate gastric emptying (GE). The authors investigated whether whey-based (vs casein-based) enteral formulas reduce GOR and accelerate GE in children who have severe CP with a gastrostomy and fundoplication. Methods: Thirteen children received a casein-based formula for 1 week and either a 50% whey whole protein (50% WWP) or a 100% whey partially hydrolyzed protein (100% WPHP) formula for 1 week. Reflux episodes, gastric half-emptying time (GE t1/2), and reported pain and GI symptoms were measured. Results: Whey formulas emptied significantly faster than casein (median [interquartile range (IQR)] GE t1/2, 33.9 [25.3-166.2] min vs 56.6 [46-191] min; P = .033). Reflux parameters were unchanged. GI symptoms were lower in children who received 50% WWP (visual analog symptom score, median [IQR], 0[0-11.8]) vs 100% WPHP (13.0 [2.5-24.8]) (P = .035). Conclusion: This pilot study shows that in children who have severe CP with a gastrostomy and fundoplication, GE of the whey-based enteral formula is significantly faster than casein. The acceleration in GE does not alter GOR frequency, and there appears to be no effect of whey vs casein in reducing acid, nonacid, and total reflux episodes. The results indicate that enteral formula selection may be particularly important for children with severe CP and delayed GE. (JPEN J Parenter Enteral Nutr. 2012;36:118S-123S