Methods and contexts: Challenges of planning with scenarios in a hospital's division

Scenario planning is presented as a well-suited approach in uncertain environments such as healthcare systems. In this article, we report a project aimed at defining scenarios in the cancer division of a large hospital. The approach chosen was based on La Prospective school of scenario planning. The project stopped before scenarios could be elaborated, for lack of knowledge available on contextual factors influencing the system. From the analysis of this case study, we elaborate on the adequacy of scenario planning in the context of small healthcare delivery organisations. We conclude that most forms of scenario planning are unlikely to work in these cases, especially in the La Prospective approach. Perspectives are drawn for scenario planning in hospitals, and for research on the fit between scenario approaches and application contexts, in order to understand what approaches work in which circumstances

Modified Signals for Supersymmetry in the NMSSM with a Singlino-like LSP

In the framework of the NMSSM with a singlino-like LSP, we study quantitatively the impact of the additional bino -> singlino cascade on the efficiencies in several search channels for supersymmetry of the ATLAS and CMS collaborations. Compared to the MSSM, the additional cascade reduces the missing transverse energy, but leads to additional jets or leptons. For the NMSSM benchmark lines which generalize cMSSM benchmark points, the efficiencies in the most relevant 2/3 jet + missing energy search channels can drop by factors ~1/3 to ~1/7, and can reduce the present lower bounds on M_{1/2} by as much as ~0.9 - 0.75 in the NMSSM for large bino-singlino mass differences. The larger efficiencies in multijet or multilepton search channels are not strong enough to affect this conclusion. In the fully constrained cNMSSM, sparticle decay cascades via the lightest stau can lead to signal cross sections in multilepton and 2tau search channels which are potentially visible at the LHC with 7 TeV center of mass energy.Comment: 24 pages, 9 Figures, misprint in Table 1 correcre

Immunohistochemical evaluation of human epidermal growth factor receptor 2 and estrogen and progesterone receptors in breast carcinoma in Jordan

INTRODUCTION: Although breast carcinoma (BC) is the most common malignancy affecting Jordanian females and the affected population in Jordan is younger than that in the West, no information is available on its biological characteristics. Our aims in this study are to evaluate the expression of estrogen receptor (ER) and progesterone receptor (PR) and Her-2/neu overexpression in BC in Jordan, and to compare the expression of these with other prognostic parameters for BC such as histological type, histological grade, tumor size, patients' age, and number of lymph node metastases. METHOD: This is a retrospective study conducted in the Department of Pathology at Jordan University of Science and Technology. A confirmed 91 cases of BC diagnosed in the period 1995 to 1998 were reviewed and graded. We used immunohistochemistry to evaluate the expression of ER, PR, and Her-2. Immunohistochemical findings were correlated with age, tumor size, grade and axillary lymph node status. RESULTS: Her-2 was overexpressed in 24% of the cases. The mean age of Her-2 positive cases was 42 years as opposed to 53 years among Her-2 negative cases (p = 0.0001). Her-2 expression was inversely related to ER and PR expression. Her-2 positive tumors tended to be larger than Her-2 negative tumors with 35% overexpression among T3 tumors as opposed to 22% among T2 tumors (p = 0.13). Her-2 positive cases tended to have higher rates of axillary metastases, but this did not reach statistical significance. ER and PR positive cases were seen in older patients with smaller tumor sizes. CONCLUSION: Her-2 overexpression was seen in 24% of BC affecting Jordanian females. Her-2 overexpression was associated with young age at presentation, larger tumor size, and was inversely related to ER and PR expression. One-fifth of the carcinomas were Her-2 positive and ER negative. This group appears to represent an aggressive form of BC presenting at a young age with large primary tumors and a high rate of four or more axillary lymph node metastases

Treating breast cancer through novel inhibitors of the phosphatidylinositol 3'-kinase pathway

Recent studies indicate that constitutive signaling through the phosphatidylinositol 3'-kinase (PI3K) pathway is a cause of treatment resistance in breast cancer patients. This implies that patients with tumors that exhibit aberrant PI3K signaling may benefit from targeted pathway inhibitors. The first agents to make it to the clinic are the rapamycin analogs. These compounds inhibit the downstream PI3K effector mTOR (mammalian target of rapamycin). A study presented in this issue of Breast Cancer Research suggests that recently developed inhibitors of phosphoinositide-dependent protein kinase 1, a more proximal target of the PI3K pathway, may provide an alternative route to effective PI3K pathway inhibition for breast cancer treatment

Excess Higgs Production in Neutralino Decays

The ATLAS and CMS experiments have recently claimed discovery of a Higgs boson-like particle at ~5 sigma confidence and are beginning to test the Standard Model predictions for its production and decay. In a variety of supersymmetric models, a neutralino NLSP can decay dominantly to the Higgs and the LSP. In natural SUSY models, a light third generation squark decaying through this chain can lead to large excess Higgs production while evading existing BSM searches. Such models can be observed at the 8 TeV LHC in channels exploiting the rare diphoton decays of the Higgs produced in the cascade decay. Identifying a diphoton resonance in association with missing energy, a lepton, or b-tagged jets is a promising search strategy for discovery of these models, and would immediately signal new physics involving production of a Higgs boson. We also discuss the possibility that excess Higgs production in these SUSY decays can be responsible for enhancements of up to 50% over the SM prediction for the observed rate in the existing inclusive diphoton searches, a scenario which would likely by the end of the 8 TeV run be accompanied by excesses in the diphoton + lepton/MET and SUSY multi-lepton/b searches and a potential discovery in a diphoton + 2b search.Comment: 42 pages, 19 figure

Light-Dependant Biostabilisation of Sediments by Stromatolite Assemblages

For the first time we have investigated the natural ecosystem engineering capacity of stromatolitic microbial assemblages. Stromatolites are laminated sedimentary structures formed by microbial activity and are considered to have dominated the shallows of the Precambrian oceans. Their fossilised remains are the most ancient unambiguous record of early life on earth. Stromatolites can therefore be considered as the first recognisable ecosystems on the planet. However, while many discussions have taken place over their structure and form, we have very little information on their functional ecology and how such assemblages persisted despite strong eternal forcing from wind and waves. The capture and binding of sediment is clearly a critical feature for the formation and persistence of stromatolite assemblages. Here, we investigated the ecosystem engineering capacity of stromatolitic microbial assemblages with respect to their ability to stabilise sediment using material from one of the few remaining living stromatolite systems (Highborne Cay, Bahamas). It was shown that the most effective assemblages could produce a rapid (12–24 h) and significant increase in sediment stability that continued in a linear fashion over the period of the experimentation (228 h). Importantly, it was also found that light was required for the assemblages to produce this stabilisation effect and that removal of assemblage into darkness could lead to a partial reversal of the stabilisation. This was attributed to the breakdown of extracellular polymeric substances under anaerobic conditions. These data were supported by microelectrode profiling of oxygen and calcium. The structure of the assemblages as they formed was visualised by low-temperature scanning electron microscopy and confocal laser microscopy. These results have implications for the understanding of early stromatolite development and highlight the potential importance of the evolution of photosynthesis in the mat forming process. The evolution of photosynthesis may have provided an important advance for the niche construction activity of microbial systems and the formation and persistence of the stromatolites which came to dominate shallow coastal environments for 80% of the biotic history of the earth

Dark Matter in the MSSM

We have recently examined a large number of points in the parameter space of the phenomenological MSSM, the 19-dimensional parameter space of the CP-conserving MSSM with Minimal Flavor Violation. We determined whether each of these points satisfied existing experimental and theoretical constraints. This analysis provides insight into general features of the MSSM without reference to a particular SUSY breaking scenario or any other assumptions at the GUT scale. This study opens up new possibilities for SUSY phenomenology both in colliders and in astrophysical experiments. Here we shall discuss the implications of this analysis relevant to the study of dark matter.Comment: 27 pages, 19 figs; Journal version in NJP issue "Focus on Dark Matter and Particle Physics". Previous version had 26 pages, 19 figures. Text and some figures have been update

Cyclin A as a marker for prognosis and chemotherapy response in advanced breast cancer

We wanted to study cyclin A as a marker for prognosis and chemotherapy response. A total of 283 women with metastatic breast cancer were initially enrolled in a randomised multicentre trial comparing docetaxel to sequential methotrexate-fluorouracil (MF) in advanced breast cancer after anthracycline failure. Paraffin-embedded blocks of the primary tumour were available for 96 patients (34%). The proportion of cells expressing cyclin A was determined by immunohistochemistry using a mouse monoclonal antibody to human cyclin A. Response evaluation was performed according to WHO recommendations. The median cyclin A positivity of tumour cells was 14.5% (range 1.2–45.0). Cyclin A correlated statistically significantly to all other tested proliferation markers (mitotic count, histological grade and Ki-67). A high cyclin A correlated significantly to a shorter time to first relapse, risk ratio (RR) 1.94 (95% CI 1.24–3.03) and survival from diagnosis, RR 2.49 (95% CI 1.45–4.29), cutoff point for high/low proliferation group 10.5%. Cyclin A did not correlate to chemotherapy response or survival after anthracycline, docetaxel or MF therapy. Of all tumour biological factors tested (mitotic count, histological grade and Ki-67), cyclin A seemed to have the strongest prognostic value. Cyclin A is a good marker for tumour proliferation and prognosis in breast cancer. In the present study, cyclin A did not predict chemotherapy response

Evaluation of genome-wide loci of iron metabolism in hereditary hemochromatosis identifies PCSK7 as a host risk factor of liver cirrhosis

Genome-wide association studies (GWAS) have revealed genetic determinants of iron metabolism, but correlation of these with clinical phenotypes is pending. Homozygosity for HFE C282Y is the predominant genetic risk factor for hereditary hemochromatosis (HH) and may cause liver cirrhosis. However, this genotype has a low penetrance. Thus, detection of yet unknown genetic markers that identify patients at risk of developing severe liver disease is necessary for better prevention. Genetic loci associated with iron metabolism (TF, TMPRSS6, PCSK7, TFR2 and Chr2p14) in recent GWAS and liver fibrosis (PNPLA3) in recent meta-analysis were analyzed for association with either liver cirrhosis or advanced fibrosis in 148 German HFE C282Y homozygotes. Replication of associations was sought in additional 499 Austrian/Swiss and 112 HFE C282Y homozygotes from Sweden. Only variant rs236918 in the PCSK7 gene (proprotein convertase subtilisin/kexin type 7) was associated with cirrhosis or advanced fibrosis (P = 1.02 × 10−5) in the German cohort with genotypic odds ratios of 3.56 (95% CI 1.29-9.77) for CG heterozygotes and 5.38 (95% CI 2.39-12.10) for C allele carriers. Association between rs236918 and cirrhosis was confirmed in Austrian/Swiss HFE C282Y homozygotes (P = 0.014; ORallelic = 1.82 (95% CI 1.12-2.95) but not in Swedish patients. Post hoc combined analyses of German/Swiss/Austrian patients with available liver histology (N = 244, P = 0.00014, ORallelic = 2.84) and of males only (N = 431, P = 2.17 × 10−5, ORallelic = 2.54) were consistent with the premier finding. Association between rs236918 and cirrhosis was not confirmed in alcoholic cirrhotics, suggesting specificity of this genetic risk factor for HH. PCSK7 variant rs236918 is a risk factor for cirrhosis in HH patients homozygous for the HFE C282Y mutatio