Outcomes following autologous hematopoietic stem cell transplant for patients with relapsed Wilms' tumor: a CIBMTR retrospective analysis.

Despite the marked improvement in the overall survival (OS) for patients diagnosed with Wilms' tumor (WT), the outcomes for those who experience relapse have remained disappointing. We describe the outcomes of 253 patients with relapsed WT who received high-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplant (HCT) between 1990 and 2013, and were reported to the Center for International Blood and Marrow Transplantation Research. The 5-year estimates for event-free survival (EFS) and OS were 36% (95% confidence interval (CI); 29-43%) and 45% (95 CI; 38-51%), respectively. Relapse of primary disease was the cause of death in 81% of the population. EFS, OS, relapse and transplant-related mortality showed no significant differences when broken down by disease status at transplant, time from diagnosis to transplant, year of transplant or conditioning regimen. Our data suggest that HDT followed by autologous HCT for relapsed WT is well tolerated and outcomes are similar to those reported in the literature. As attempts to conduct a randomized trial comparing maintenance chemotherapy with consolidation versus HDT followed by stem cell transplant have failed, one should balance the potential benefits with the yet unknown long-term risks. As disease recurrence continues to be the most common cause of death, future research should focus on the development of consolidation therapies for those patients achieving complete response to therapy

EFEKTIVITAS DESENTRALISASI PENDIDIKAN DALAM MENINGKATKAN PROFESIONALISME GURU DI SMA NEGERI 1 LAKEA

Skripsi ini membahas tentang efektivitas desentralisasi pendidikan dalammeningkatkan profesionalisme guru di SMA Negeri 1 Lakea dengan pokok pembahasana bagaimana deskripsi desentralisasi pendidikan dalam meningkatkan profesionalisme guru di SMA Negeri 1 Lakea? dan bagaimana implikasi desentralisasi pendidikan dalam meningkatkan profesionalisme guru di SMA Negeri 1 Lakea. Tujuan penelitian ini untuk mengetahuideskripsi dan implikasi desentralisasi pendidikan dalam meningkatkan prodfesionalisme guru di sekolah tersebut.Untuk menjawab permsalahan tersebut, penelitian ini menggunakan metode kualitatif dengan teknik pengumpulan data melalui observasi, wawancara dan dokumentasi, serta menggunakan teknik analisis data melalui reduksi data, penyajian data, verifikasi data dan penarikan kesimpulan.Hasil penelitian skripsi ini yaitu: deskripsi Desentralisasi Pendidikan dalam Meningkatkan Profesionalisme Guru di SMA Negeri 1 Lakea: (1) Desentralisasi pendidikan merupakan pemberian kewenangan kepada daerah untuk mengelola pendidikannya, lalu daerah melimpahkan kepada masing-masing sekolah (2) Pemerintah pusat tetap mengontrol pendidikan yang diselenggarakan oleh pemerintah daerah dan masing-masing sekolah melalui akreditasi nasional yang dilaksanakan oleh BAN-SM (3) Aspek-aspek yang menjadi kewenangan sekolah dalam melaksanakan desentralisai pendidikan yakni: (a) Perencanaan dan evaluasi program sekolah dalam hal ini sekolah berupaya meningkatkan mutu pendidikan dengan cara merencanakan kegiatan-kegiatan yang dapat meningkatkan profesionalisme guru, misalnya mengutus guru untuk mengikuti Musyawarah Guru Mata Pelajaran (MGMP) dan merencanakan bimbingan teknis untuk meningkatkan keterampilan guru dan mengevaluasi berbagai perencaan kegiatan program sekolah (b) Aspek pengelolaan proses belajar, memberikan kewenangan kepada masing-masing guru untuk mengelola proses pembelajaran pada mata pelajaran yang dipegangnya dan kepala sekolah melukan supervisi kepada guru untuk mengevaluasi dan membimbing pelaksanaan proses pembelajaran guru tersebut (c) Aspek pengelolaan ketenagaan, SMA Negeri 1 Lakea mengelola 25 orang guru dan 3 orang tenaga administrasi, pengelolaan yang dilakukan misalnya memberikan guru mata pelajaran yang sesuai dengan keahliannya, dan mengutus guru sebagai perwakilannya dalam kegiatan seminar mapun workshop (d) Aspek pengelolaan keuangan, sekolah mengelola dana BOS dengan prosedur sesuai dengan aturan penggunaan dana tersebut yakni sebagai operasional sekolah, misalnya mengupayakan pembayaran honor guru honorer yang tidak pernah terlambat dibayarkan. Implikasi Desentralisasi Pendidikan dalam Meningkatkan Profesionalisme Guru di SMA Negeri 1 Lakea: (1) Program sekolah dalam meningkatkan profesionalisme dapat terlaksana dengan baik (2) Masing-masing guru berupaya meningkatkan pengelolaan proses belajarnya sebagai implikasi dari pelaksanaan supervisi (3) Sekolah memiliki tenaga pendidik sesuai dengan kebutuhan dan (4) Pengelolaan keuangan yang dilaksanakan oleh sekolah dapat memotivasi guru untuk melaksanakan tugasnya dengan baik.Kata Kunci        :    Desentralisasi pendidikan, profesionalisme gur

A randomized study of pomalidomide vs placebo in persons with myeloproliferative neoplasm-associated myelofibrosis and RBC-transfusion dependence

RBC-transfusion dependence is common in persons with myeloproliferative neoplasm (MPN)-associated myelofibrosis. The objective of this study was to determine the rates of RBC-transfusion independence after therapy with pomalidomide vs placebo in persons with MPN-associated myelofibrosis and RBC-transfusion dependence. Two hundred and fifty-two subjects (intent-to-treat (ITT) population) including 229 subjects confirmed by central review (modified ITT population) were randomly assigned (2:1) to pomalidomide or placebo. Trialists and subjects were blinded to treatment allocation. Primary end point was proportion of subjects achieving RBC-transfusion independence within 6 months. One hundred and fifty-two subjects received pomalidomide and 77 placebo. Response rates were 16% (95% confidence interval (CI), 11, 23%) vs 16% (8, 26% P=0.87). Response in the pomalidomide cohort was associated with ⩽4 U RBC/28 days (odds ratio (OR)=3.1; 0.9, 11.1), age ⩽65 (OR=2.3; 0.9, 5.5) and type of MPN-associated myelofibrosis (OR=2.6; 0.7, 9.5). Responses in the placebo cohort were associated with ⩽4 U RBC/28 days (OR=8.6; 0.9, 82.3), white blood cell at randomization >25 × 10(9)/l (OR=4.9; 0.8, 28.9) and interval from diagnosis to randomization >2 years (OR=4.9; 1.1, 21.9). Pomalidomide was associated with increased rates of oedema and neutropenia but these adverse effects were manageable. Pomalidomide and placebo had similar RBC-transfusion-independence response rates in persons with MPN-associated RBC-transfusion dependence

Communicating curriculum reform to students: Advice in hindsight.....

BACKGOUND: In view of the changing health care needs of communities, curriculum reform of traditional curricula is inevitable. In order to allay the apprehension that may accompany such change, curriculum development and implementation should be an inclusive process, with both staff and students being well informed of the planned reform. In 2001, the Nelson R. Mandela School of Medicine implemented Year 1 of a problem-based learning curriculum. During the design phase, students and staff were invited to take part in the development and were kept abreast of developments through meetings and newsletters. METHOD: A survey of Years 1–5 students of the last intake into the traditional curriculum was undertaken a few months prior to the implementation of the new programme. RESULTS: Students were generally well informed about the impending change, having heard about it from fellow students and staff. The more senior the students, the less the perceived impact of the reform. Although most of what students had heard was correct, some, however, had misconceptions that were generally extreme views (e.g. all self-directed learning; no Anatomy) about the new programme. Others expressed valid concerns (e.g. underpreparedness of students from disadvantaged schools; overcrowding in hospitals). CONCLUSIONS: Advice offered to institutions considering curriculum reform include using various methods to inform internal and external affected parties, ensuring that the student representative body and staff is well informed, reiterating the need for the change, confirming that the new programme meets recognised standards and that the students most affected are reassured about their future studies

Improved structure and function in early detected second eye neovascular age-related macular degeneration; FASBAT/EDNA report 1

PURPOSE: Visual Acuity (VA) and structural biomarker assessment before and at 24-months after early detection and routine treatment of second eye involvement with neovascular age-related macular degeneration (nAMD) and additional comparison with the first eye affected. DESIGN: Prospective, 22-centre observational study of participants with unilateral nAMD in the Early Detection of Neovascular AMD (EDNA) study, co-enrolled into the Observing fibrosis, macular atrophy and subretinal highly reflective material, before and after intervention with anti-VEGF treatment (FASBAT) study for an additional 2-year follow-up. PARTICIPANTS: Older adults (>50 years) with new onset nAMD in the first eye. METHODS: Assessment of both eyes with optical coherence tomography (OCT), colour fundus photography (CFP), clinic-measured visual acuity (VA) and quality-of-life (QoL). MAIN OUTCOME MEASURES: Prevalence of Atrophy, Subretinal Hyperreflective Material (SHRM), Intraretinal fluid (IRF), Subretinal fluid (SRF) and changes in VA over the study duration in both the first and second eyes affected with nAMD. Composite QoL scores over time. RESULTS: Of 431 participants recruited to the FASBAT study, the second eye converted to nAMD in 100 participants at a mean of 18.9 months. VA was 18 letters better at the time of early diagnosis in the second eye compared with conventional diagnosis in the first eye (72.9 vs 55.6 letters). 24.9-months post-conversion in the second eye, VA was 69.5 letters compared with at a similar matched time point in the first eye (59.7 letters; 18.9 months). A greater proportion of participants had vision >70 letters in the second eye versus the first eye, 24.9-months post-conversion (61 vs 38). Prevalence of SHRM and IRF was lower in the second eye compared with the first eye at 24.9-months post-conversion to nAMD. However, SRF prevalence was greater in the second eye at 24.9-months post-conversion. The development and progression of total area of atrophy appears similar in both eyes. Mean composite QoL scores increased over time, with a significant correlation between VA for the second eye only 24.9 months post-conversion. CONCLUSION: This study has shown that early detection of exudative AMD in the second eye is associated with reduced prevalence of SHRM and IRF and greater visual acuity which is significantly correlated with maintained quality-of-life

Lessons Learned from a Decade of Sudden Oak Death in California: Evaluating Local Management

Sudden Oak Death has been impacting California’s coastal forests for more than a decade. In that time, and in the absence of a centrally organized and coordinated set of mandatory management actions for this disease in California’s wildlands and open spaces, many local communities have initiated their own management programs. We present five case studies to explore how local-level management has attempted to control this disease. From these case studies, we glean three lessons: connections count, scale matters, and building capacity is crucial. These lessons may help management, research, and education planning for future pest and disease outbreaks

Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians

<p>Abstract</p> <p>Background</p> <p>It is uncertain whether the range and frequency of Diagnostic Thinking Processes (DTP) and pieces of information (concepts) involved in dental restorative treatment planning are different between students and expert clinicians.</p> <p>Methods</p> <p>We video-recorded dental visits with one standardized patient. Clinicians were subsequently interviewed and their cognitive strategies explored using guide questions; interviews were also recorded. Both visit and interview were content-analyzed, following the Gale and Marsden model for clinical decision-making. Limited tests used to contrast data were t, χ², and Fisher's. Scott's π was used to determine inter-coder reliability.</p> <p>Results</p> <p>Fifteen dentists and 17 senior dental students participated in visits lasting 32.0 minutes (± 12.9) among experts, and 29.9 ± 7.1 among students; contact time with patient was 26.4 ± 13.9 minutes (experts), and 22.2 ± 7.5 (students). The time elapsed between the first and the last instances of the clinician looking in the mouth was similar between experts and students. Ninety eight types of pieces of information were used in combinations with 12 DTPs. The main differences found in DTP utilization had dentists conducting diagnostic interpretations of findings with sufficient certainty to be considered definitive twice as often as students. Students resorted more often to more general or clarifying enquiry in their search for information than dentists.</p> <p>Conclusions</p> <p>Differences in diagnostic strategies and concepts existed within clearly delimited types of cognitive processes; such processes were largely compatible with the analytic and (in particular) non-analytic approaches to clinical decision-making identified in the medical field. Because we were focused on a clinical presentation primarily made up of non-emergency treatment needs, use of other DTPs and concepts might occur when clinicians evaluate emergency treatment needs, complex rehabilitative cases, and/or medically compromised patients.</p

Tyrosine kinase inhibitor SU6668 represses chondrosarcoma growth via antiangiogenesis in vivo

BACKGROUND: As chondrosarcomas are resistant to chemotherapy and ionizing radiation, therapeutic options are limited. Radical surgery often cannot be performed. Therefore, additional therapies such as antiangiogenesis represent a promising strategy for overcoming limitations in chondrosarcoma therapy. There is strong experimental evidence that SU6668, an inhibitor of the angiogenic tyrosine kinases Flk-1/KDR, PDGFRbeta and FGFR1 can induce growth inhibition of various primary tumors. However, the effectiveness of SU6668 on malignant primary bone tumors such as chondrosarcomas has been rarely investigated. Therefore, the aim of this study was to investigate the effects of SU6668 on chondrosarcoma growth, angiogenesis and microcirculation in vivo. METHODS: In 10 male severe combined immunodeficient (SCID) mice, pieces of SW1353 chondrosarcomas were implanted into a cranial window preparation where the calvaria serves as the site for the orthotopic implantation of bone tumors. From day 7 after tumor implantation, five animals were treated with SU6668 (250 mg/kg body weight, s.c.) at intervals of 48 hours (SU6668), and five animals with the equivalent amount of the CMC-based vehicle (Control). Angiogenesis, microcirculation, and growth of SW 1353 tumors were analyzed by means of intravital microscopy. RESULTS: SU6668 induced a growth arrest of chondrosarcomas within 7 days after the initiation of the treatment. Compared to Controls, SU6668 decreased functional vessel density and tumor size, respectively, by 37% and 53% on day 28 after tumor implantation. The time course of the experiments demonstrated that the impact on angiogenesis preceded the anti-tumor effect. Histological and immunohistochemical results confirmed the intravital microscopy findings. CONCLUSION: SU6668 is a potent inhibitor of chondrosarcoma tumor growth in vivo. This effect appears to be induced by the antiangiogenic effects of SU6668, which are mediated by the inhibition of the key angiogenic receptor tyrosine kinases Flk-1/KDR, PDGFRbeta and FGFR1. The experimental data obtained provide rationale to further develop the strategy of the use of the angiogenesis inhibitor SU6668 in the treatment of chondrosarcomas in addition to established therapies such as surgery

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO) : 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods: The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations: Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion: This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.Peer reviewe