Search

Osteosarcoma is the most common bone sarcoma and is typically found in the distal femur, proximal tibia, and proximal humerus. While several factors are known to influence survival, less is known regarding the influence of primary tumor location. This study describes the clinical features and prognosis of mandibular osteosarcoma. The SEER database was utilized to identify cases of mandibular osteosarcoma diagnosed between 2004 and 2015. Sex, age, grade, histological subtype, tumor size, tumor extension, presence of metastasis at diagnosis, and therapeutic intervention were determined. Osteosarcomas originating from other sites were assessed for comparison. There were 164 cases of mandibular osteosarcoma identified, representing 5.5% of all surveyed osteosarcomas. The 2-, 5-, and 10-year overall survival rates were 79.9%, 65.6% and 58.5%, respectively. Survival was worse for patients with older age, larger tumor size, metastatic disease, and absence of surgical resection. Compared to other sites, mandibular osteosarcomas were significantly smaller tumors and were far less likely to metastasize. Mandibular osteosarcoma manifested at an older age than the more common extremity osteosarcomas and presented with smaller tumors. Rates of metastasis of jaw osteosarcoma were much lower than osteosarcoma found in the extremities, while mortality rates were comparable.

Brain metastases are rarely observed in urothelial cancers but confer a uniformly poor prognosis. We sought to evaluate the clinical characteristics and course of brain metastases in four patients with primary urothelial cancer with secondary molecular brain tumor characterization available in 3 patients. Mean age was 68 years. Three of the patients were men. Two patients had both primary upper tract and bladder urothelial cancers, and two had bladder cancer alone. Three patients had initial nephroureterectomy and/or radical cystectomy, with subsequent development of initial distant metastasis at a median of 7.9 months. All four patients received platinum-based systemic therapy following initial metastasis. Median onset of brain metastasis from initial distant metastasis was 11.5 months. Median overall survival (OS) from the diagnosis of brain metastasis was 6 months (range: 3.1 – 12.8 months). Three patients who had comprehensive somatic tumor profiling of the brain metastasis using the Oncomine® panel showed mutations in the APC, TP53, and FGFR3 genes, loss of function in TP53 and BRCA-2, and deletion of MHS2. Our findings suggest brain metastases is a uniformly fatal diagnosis and a need for future exploration of primary tumor and metastatic sequencing in order to better define the role of current therapies for metastatic brain urothelial cancers which remains an area of increased unmet need.

Economic inequality is seen as fair when people believe it to be the result of fair processes, or in other words, in accordance with normative rules about resource allocation. As a result, people may support substantial inequalities of outcome as fair. There is broad agreement, within and across societies, on the normative rules that govern resource allocation. However, when people use these rules to evaluate specific instances of inequality, their conclusions are systematically affected by available information, self-interest and group-interest, and system justification. This causes divided opinions regarding the fairness of specific inequalities. Recent evidence suggests that growing economic inequality does not directly impact perceptions of fairness, but may reduce perceptions of meritocracy, thereby indirectly reducing the legitimacy of inequality.

Resilience is increasingly recognized as a factor that improves the functioning and performance of individuals and communities; however, it is underexamined in smaller groups or teams. We performed a comprehensive literature review to examine how resilience is defined, measured and used in small teams. Additionally, we evaluated the effectiveness of trainings or interventions on teams towards increasing unit resilience and performance. Following a literature review, 74 measures across 37 articles were assessed. Study eligibility criteria include English-language publications between 1980 and 2017 that included output from a research trial or survey on military or civilian groups pertaining to their resiliency to adverse events. Resilience of units/teams was assessed across the four phases of resilience defined by NAS: prepare, absorb, recover, adapt. Our review found that while the concept of resilience is not often studied in small groups empirically, the focus of available studies is on recovery with limited attention given to absorption and adaptation. This work reveals a potential mechanism to improve team/unit performance via unit resilience training and improved unit cohesion. Training had small but significant effects on the preparation (r = 0.03, k = 5) and recover (r = 0.05, k = 6) phases of unit resilience. In order to improve resilience in small groups, training programs and other interventions must be appropriately focused on the essential phases of resilience associated with mission execution.

Compared to the attention that gay male, lesbian, and even transgender employees have received in the last 30 years, research focused solely on bisexual employees is lacking. With the exception of a handful of studies, there have been surprisingly few attempts to both understand the potentially unique characteristics associated with a bisexual sexual orientation and also develop related psychological theory. The current study focuses on this often invisible and understudied population and examines both individual and organizational characteristics that theoretically and practically influence bisexual employees' workplace experiences. Our data reveal several important findings, the most striking of which is the divergence of experiences, attitudes, and outcomes between men and women who are bisexual. First, we found evidence of more bias against bisexual men than bisexual women. Second, our data show that bisexual men are less likely to disclose their sexual orientation at work both prior to and during employment. Third, bisexual men report experiencing more workplace discrimination than do bisexual women, and they also report increased minority stress, psychological distress, and substance use. Finally, we conducted a moderated mediation analysis for this population, examining employee gender, psychological distress, and substance use. We ultimately concluded that sexual orientation moderates these relations (with the exception of substance use), which are also serially mediated by “outness,” workplace discrimination, and minority stress. These findings suggest that the distinct experiences of bisexual employees, particularly men, may contribute to more negative work- and health-related outcomes for this invisible group as compared to their gay male and lesbian counterparts. We conclude with directions for future research, as well as theoretical and practical implications.

Patient engagement in medical decision-making improves patient related outcomes through compliance and patient satisfaction. The Inova Schar Cancer Institute has a weekly molecular tumor board (MTB) to match comprehensive genomic sequencing results with targeted therapies for patients. Primary oncologists extended MTB invitations to their patients. Ultimately, 20 of the 139 patients attended and completed pre- and post MTB surveys. There was a statistically significant change from the pre- to post- survey for the question "I am satisfied with how well informed I am about targeted therapy" with P = 0.016. Patients who attended MTB reported higher levels of satisfaction with their knowledge of targeted therapy after MTB as compared to before. A more holistic method of studying this practice would include sampling a larger patient population and a formal evaluation of the physicians' experience with patients attending.

We discuss eight randomized evaluations intended to increase vaccination uptake conducted by the US General Services Administration’s Office of Evaluation Sciences (OES). These evaluations had a median sample size of 55,000, deployed a variety of behaviorally-informed direct communications, and used administrative data to measure vaccination uptake. The confidence interval from an internal meta-analysis shows changes in vaccination rates ranging from -0.004 to 0.394 percentage points. Two studies yielded statistically significant increases, of 0.59 and 0.16 percentage points. The other six were not statistically significant, although the studies were powered to detect effect sizes in line with published research. This work highlights the likely effects of government communications and demonstrates the value of conducting rapid evaluations to support COVID-19 vaccination efforts.

The vitamin D receptor is expressed in most tissues of the body – and the cancers that arise from those tissues. The vitamin D signaling pathway is active in those tissues and cancers. This is at least consistent with the hypothesis that perturbing this signaling may have a favorable effect on the genesis and growth of cancers. Epidemiologic data indicate that vitamin D signaling may be important in the initiation and outcome of a number of types of cancer. Many studies have shown that calcitriol (1,25 dihydroxycholecalciferol) and other vitamin D compounds have antiproliferative, pro-apoptotic, anti-cell migration and antiangiogenic activity in a number of preclinical studies in many different cancer types. Unfortunately, the assessment of the activity of calcitriol or other vitamin D analogues in the treatment of cancer, as single agents or in combination with other anticancer agents has been stymied by the failure to adhere to commonly accepted principles of drug development and clinical trials conduct., Highlights • Many studies indicate that vitamin D compounds have cancer prevention and treatment properties in vitro and in vivo cancer models and epidemiologic studies note the association between low vitamin D levels and cancer occurrence and unfavorable outcome. • Many clinical trials in cancer patients have been done to define safety and efficacy of calcitriol and analogues and several trials suggest clinical benefit. • Two randomized trials of calcitriol + chemotherapy (docetaxel) in men with prostate cancer entered >1150 patients. • These trials did not adhere to principles of optimal trial design (choice of optimal dose of drug and balanced randomization) and the failure to execute on these findings is a missed opportunity.

When dealing with public policy in the field of safety, security, and environmental health, legitimacy or illegitimacy is often evoked as a challenge that determines whether a policy will be embraced over time. Scholarly literature points to key variables of public support as well as the use of subject matter experts to build legitimacy in the policy process, yet few articles unpack the meaning and application of legitimacy in a manner that accounts for unique political, institutional, and cultural considerations. This article offers a holistic understanding of the various drivers and challenges behind the legitimacy principle. Specifically, this article reviews how policy successes and failures in France were driven at least in part by a perception of policy legitimacy by policymakers, stakeholders, and the general public.