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BackgroundUnderstanding how changes in body mass index (BMI) relate to changes in mammographic density is necessary to evaluate adjustment for BMI gain/loss in studies of change in density and breast cancer risk. Increase in BMI has been associated with a decrease in percent density, but the effect on change in absolute dense area or volume is unclear.MethodsWe examined the association between change in BMI and change in volumetric breast density among 24,556 women in the San Francisco Mammography Registry from 2007 to 2013. Height and weight were self-reported at the time of mammography. Breast density was assessed using single x-ray absorptiometry measurements. Cross-sectional and longitudinal associations between BMI and dense volume (DV), non-dense volume (NDV), and percent dense volume (PDV) were assessed using multivariable linear regression models, adjusted for demographics, risk factors, and reproductive history.ResultsIn cross-sectional analysis, BMI was positively associated with DV [β, 2.95 cm(3); 95% confidence interval (CI), 2.69-3.21] and inversely associated with PDV (β, -2.03%; 95% CI, -2.09, -1.98). In contrast, increasing BMI was longitudinally associated with a decrease in both DV (β, -1.01 cm(3); 95% CI, -1.59, -0.42) and PDV (β, -1.17%; 95% CI, -1.31, -1.04). These findings were consistent for both pre- and postmenopausal women.ConclusionOur findings support an inverse association between change in BMI and change in PDV. The association between increasing BMI and decreasing DV requires confirmation.ImpactLongitudinal studies of PDV and breast cancer risk, or those using PDV as an indicator of breast cancer risk, should evaluate adjustment for change in BMI.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Thyroid Carcinoma focuses on anaplastic carcinoma because substantial changes were made to the systemic therapy recommendations for the 2015 update. Dosages and frequency of administration are now provided, docetaxel/doxorubicin regimens were added, and single-agent cisplatin was deleted because it is not recommended for patients with advanced or metastatic anaplastic thyroid cancer.

Stiff skin syndrome is a rare sclerotic condition that presents during infancy or early childhood. It has an insidious chronic course and may lead to significant co-morbidity and reduced quality of life. Often, affected individuals experience impaired ambulation and immobilization related to joint involvement. Clinically, it may resemble other sclerotic diseases, so histopathological evaluation is necessary to establish a diagnosis. As it is a condition with limited treatment options, prompt diagnosis and early initiation of physical therapy is crucial to prevent joint restriction and maintain quality of life. We describe a case of a 7-year-old with stiff skin syndrome, and review the literature to discuss the clinical presentation, histological findings, and management of this condition.

Background: Data are limited regarding the optimal dose and duration of amoxicillin treatment for community-acquired pneumonia in children. Objectives: To determine the efficacy, safety and impact on antimicrobial resistance of shorter (3-day) and longer (7-day) treatment with amoxicillin at both a lower and a higher dose at hospital discharge in children with uncomplicated community-acquired pneumonia. Design: A multicentre randomised double-blind 2 × 2 factorial non-inferiority trial in secondary care in the UK and Ireland. Setting: Paediatric emergency departments, paediatric assessment/observation units and inpatient wards. Participants: Children aged > 6 months, weighing 6–24 kg, with a clinical diagnosis of community-acquired pneumonia, in whom treatment with amoxicillin as the sole antibiotic was planned on discharge. Interventions: Oral amoxicillin syrup at a dose of 35–50 mg/kg/day compared with a dose of 70–90 mg/kg/day, and 3 compared with 7 days’ duration. Children were randomised simultaneously to each of the two factorial arms in a 1 : 1 ratio. Main outcome measures: The primary outcome was clinically indicated systemic antibacterial treatment prescribed for respiratory tract infection (including community-acquired pneumonia), other than trial medication, up to 28 days after randomisation. Secondary outcomes included severity and duration of parent/guardian-reported community-acquired pneumonia symptoms, drug-related adverse events (including thrush, skin rashes and diarrhoea), antimicrobial resistance and adherence to trial medication. Results: A total of 824 children were recruited from 29 hospitals. Ten participants received no trial medication and were excluded. Participants [median age 2.5 (interquartile range 1.6–2.7) years; 52% male] were randomised to either 3 (n = 413) or 7 days (n = 401) of trial medication at either lower (n = 410) or higher (n = 404) doses. There were 51 (12.5%) and 49 (12.5%) primary end points in the 3- and 7-day arms, respectively (difference 0.1%, 90% confidence interval –3.8% to 3.9%) and 51 (12.6%) and 49 (12.4%) primary end points in the low- and high-dose arms, respectively (difference 0.2%, 90% confidence interval –3.7% to 4.0%), both demonstrating non-inferiority. Resolution of cough was faster in the 7-day arm than in the 3-day arm for cough (10 days vs. 12 days) (p = 0.040), with no difference in time to resolution of other symptoms. The type and frequency of adverse events and rate of colonisation by penicillin-non-susceptible pneumococci were comparable between arms. Limitations: End-of-treatment swabs were not taken, and 28-day swabs were collected in only 53% of children. We focused on phenotypic penicillin resistance testing in pneumococci in the nasopharynx, which does not describe the global impact on the microflora. Although 21% of children did not attend the final 28-day visit, we obtained data from general practitioners for the primary end point on all but 3% of children. Conclusions: Antibiotic retreatment, adverse events and nasopharyngeal colonisation by penicillin-non-susceptible pneumococci were similar with the higher and lower amoxicillin doses and the 3- and 7-day treatments. Time to resolution of cough and sleep disturbance was slightly longer in children taking 3 days’ amoxicillin, but time to resolution of all other symptoms was similar in both arms. Future work: Antimicrobial resistance genotypic studies are ongoing, including whole-genome sequencing and shotgun metagenomics, to fully characterise the effect of amoxicillin dose and duration on antimicrobial resistance. The analysis of a randomised substudy comparing parental electronic and paper diary entry is also ongoing. Trial registration: Current Controlled Trials ISRCTN76888927, EudraCT 2016-000809-36 and CTA 00316/0246/001-0006. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 60. See the NIHR Journals Library website for further project information.

Abu Ghraib. The name conjures horrifying images of abuse, torture, and man's inhumanity to man. In one photograph, a pyramid of naked detainees huddles outside a jail cell; in another, a soldier holds the end of a dog leash which is attached at the neck to a prostrate prisoner; in another, a soldier gives the thumbs-up sign in front of a line of naked detainees. A constant barrage of images like these can often leave students shaking their heads and repeating a line from the Black Eyed Peas, "Where is the love, the love, the love?" In this article, assistant professor Elizabeth Sturgeon explores how professors can show their students the value of empathetic identification while still teaching critical thinking skills, without forcing them to adapt the professors' viewpoints, which often results in college professors being stigmatized as radicals. Further, she asks how teachers can empower their students to engage the political hot-spots around the globe and in their communities instead of turning away to turn the volume of their iPods up and tune out? Herein, Sturgeon discusses a two-tier approach to teaching freshman composition that she has been using regularly for the past eight years. Firstly, she introduces current subjects of social, cultural, and political significance to her class. In this article, she specifically discusses the controversy surrounding the discovery of the photographs in January 2004 which testify to the abuse and torture that occurred at Abu Ghraib Prison in Baghdad. Secondly, she has students analyze these current events--in this case, the abuse at Abu Ghraib--from the perspectives of major researchers, thinkers, and writers who, in the wake of the Holocaust, attempt to make sense of mankind's common (in)humanity.

Concomitant with an increase in the global illegal wildlife trade has been a substantial increase in research within traditional conservation-based sciences and conservation and green criminology. While the integration of criminological theories and methods into the wildlife conservation context has advanced our understanding of and practical responses to illegal wildlife trade, there remain discrepancies between the number of empirical vs. conceptual studies and a disproportionate focus on a few select theories, geographical contexts, and taxonomic groups. We present three understudied or novel applications of criminology and criminal justice research within the fields of fisheries, forestry, and wildlife conservation. First, we highlight criminological research on the application of corruption prevention in combating the illegal wildlife trade. Corruption has increasingly been getting attention from the non-governmental sector; however, there has been limited research aimed at understanding institutional opportunity structures, local conceptualizations of corruption, and the corresponding prevention strategies within conservation contexts. Second, we discuss the pre-emptive application of compliance theories when designing and monitoring Community-Based Conservation (CBC) programs such as community forestry, non-timber forest products, and community patrol programs. Applying opportunity theory and social development strategies are two suggestions to improve the effectiveness of CBCs in forestry and beyond. Finally, we present a discussion on recidivism (i.e., repeat offending) and non-instrumental or novel responses, utilizing illegal fishing as a case study. We present two alternative methods to traditional forms of punishment: restorative justice and community-based approaches. Lastly, we will present a diversity of priority research agendas within each of these topics.

Abstract Six sample preparation procedures were evaluated for selective extraction of Cr(VI) from commercial samples of chromium oxide green (Cr2O3) pigments prior to formation of its diphenylcarbazone complex [CrDPCO]- for determination by visible spectrophotometry: (I) water-soluble chromium; (II) EPA method 3060A without Mg2+; (III) EPA method 3060A with Mg2+; (IV) Na3PO4 based extraction; (V) method IRSA16 based on acidic extraction and; (VI) Na2CO3 based extraction. Evaluation of the influence of concomitant Cr(III) ions, time and stability of the [CrDPCO]- complex was investigated. Recoveries of soluble and insoluble Cr(VI) species were 86% and 80%, respectively, using procedure (VI). Direct calibration against aqueous standards prepared in the extraction medium was successful for Cr(VI) in the concentration range 0.05-1.50 μg L-1. Limits of detection and quantitation were 0.3 µg g-1 and 1.0 µg g-1, respectively, for 250 mg subsamples/25 mL. Procedure (VI) was applied to the analysis of four commercial samples of Cr2O3 pigments, three determined to have Cr(VI) within compliance limits below 1.0 µg g-1, but one at 16.6 ± 0.6 µg g-1, prohibiting use of this pigment in cosmetic formulations. This sample was conveniently employed to evaluate the accuracy of the method. The recommended procedure is simple and accurate and has been adopted by Tecpar’s laboratory of Parana Institute of Technology (Curitiba, Brazil).

These NCCN Guidelines Insights focus on some of the major updates to the 2014 NCCN Guidelines for Thyroid Carcinoma. Kinase inhibitor therapy may be used to treat thyroid carcinoma that is symptomatic and/or progressive and not amenable to treatment with radioactive iodine. Sorafenib may be considered for select patients with metastatic differentiated thyroid carcinoma, whereas vandetanib or cabozantinib may be recommended for select patients with metastatic medullary thyroid carcinoma. Other kinase inhibitors may be considered for select patients with either type of thyroid carcinoma. A new section on "Principles of Kinase Inhibitor Therapy in Advanced Thyroid Cancer" was added to the NCCN Guidelines to assist with using these novel targeted agents.

These NCCN Guidelines Insights focus on some of the major updates to the 2014 NCCN Guidelines for Thyroid Carcinoma. Kinase inhibitor therapy may be used to treat thyroid carcinoma that is symptomatic and/or progressive and not amenable to treatment with radioactive iodine. Sorafenib may be considered for select patients with metastatic differentiated thyroid carcinoma, whereas vandetanib or cabozantinib may be recommended for select patients with metastatic medullary thyroid carcinoma. Other kinase inhibitors may be considered for select patients with either type of thyroid carcinoma. A new section on "Principles of Kinase Inhibitor Therapy in Advanced Thyroid Cancer" was added to the NCCN Guidelines to assist with using these novel targeted agents.

BackgroundA higher body mass index (BMI) is associated with more advanced stages of thyroid cancer. Screening obese patients for thyroid cancer has been proposed but has yet to be examined for cost-effectiveness. The objective of this study was to assess the cost-effectiveness of ultrasound (US) screening of obese patients for thyroid cancer.MethodsA decision-tree model compared cost savings for the following: (i) base case scenario of an obese patient with thyroid nodule found by palpation, (ii) universal US screening of all obese patients, and (iii) risk-based US screening in obese patients. Risk-based screening consisted of patients who had at least one of four major identified risk factors for thyroid cancer (family history of thyroid cancer, radiation exposure, Hashimoto's thyroiditis, and/or elevated thyrotropin). Patients with nodules underwent established treatment and management guidelines. The model accounted for recurrence, complications, and long-term treatment/follow-up for five years. Outcome probabilities were identified from a literature review. Costs were estimated using a third-party payer perspective. Sensitivity analyses were performed to examine the impact of risk factor prevalence and US cost on the model.ResultsThe resulted costs per patient were $210.73 in the base case scenario, $434.10 in the universal US screening arm, and $166.72 in the risk-based screening arm. Risk-based screening remained cost-effective until more than 14% of obese patients had risk factors and with a wide variation of US costs ($0-$1113).ConclusionRisk-based US screening in selected obese patients with risk factors for thyroid cancer is cost-effective. Recommendations for screening this subgroup will result in cost savings and a likely decreased morbidity and mortality in this subpopulation with more aggressive disease.

There is an ongoing debate in the United States and elsewhere on the effects of outsourcing and offshoring on employment and wages, yet little is known how U.S. enterprises have restructured their organizations by externalizing business functions domestically and internationally. This paper presents the results from a pilot survey that uses a business function framework to collect information about the domestic and international sourcing practices of United States organizations. Our results suggest that offshoring is not as pervasive as might be expected and appears to be most common in large goods - producing companies. Offshoring is spread across all business functions and international sourcing is more commonly from foreign affiliates than in dependent contractors. Perhaps most surprisingly, most offshoring is to countries with costs that are the similar to the United States. About two thirds of internal domestic employment is in the primary business function, and the distribution of employment by business function is roughly similar across industry groupings. Wages show clear variation across business functions. We find that international sourcing is positively related to percentage of workers in high wage jobs, suggesting that offshoring is complementary to domestic activities and may substitute for low wage jobs.

A liquid sampling-atmospheric pressure glow discharge (LS-APGD) ionization source operating at a nominal power of 30 W and solution flow rate of 30 µL min−1 and supported in a He sheath gas flow rate of 500 mL min−1 was interfaced to an Orbitrap mass spectrometer and assessed for use in rapid identification of inorganic and organic arsenic species, including As(III), As(V), monomethylarsonic acid, dimethylarsinic acid, and arsenobetaine in a 2% (v/v) nitric acid medium. Mass spectral acquisition in low-resolution mode, using only the ion trap analyzer, provided detection of protonated molecular ions for AsBet (m/z 179), DMA (m/z 139), MMA (m/z 141), and As(V) (m/z 143). As(III) is oxidized to As(V), likely due to in-source processes. Typical fragmentation of these compounds resulted in the loss of either water or methyl groups, as appropriate, i.e., introducing DMA also generated ions corresponding to MMA and As(V) as dissociation products. Structure assignments were also confirmed by high-resolution Orbitrap measurements. Spectral fingerprint assignments were based on the introduction of solutions containing 5 µg mL−1 of each arsenic compound. [ABSTRACT FROM AUTHOR]

Comprehensive adverse event (AE) surveillance programs in interventional radiology (IR) are rare. Our aim was to develop and validate a retrospective electronic surveillance model to identify outpatient IR procedures that are likely to have an AE, to support patient safety and quality improvement. We identified outpatient IR procedures performed in the period from October 2017 to September 2019 from the Veterans Health Administration (n = 135,283) and applied electronic triggers based on posyprocedure care to flag cases with a potential AE. From the trigger-flagged cases, we randomly sampled n = 1,500 for chart review to identify AEs. We also randomly sampled n = 600 from the unflagged cases. Chart-reviewed cases were merged with patient, procedure, and facility factors to estimate a mixed-effects logistic regression model designed to predict whether an AE occurred. Using model fit and criterion validity, we determined the best predicted probability threshold to identify cases with a likely AE. We reviewed a random sample of 200 cases above the threshold and 100 cases from below the threshold from October 2019 to March 2020 (n = 20,849) for model validation. In our development sample of mostly trigger-flagged cases, 444 of 2,096 cases (21.8%) had an AE. The optimal predicted probability threshold for a likely AE from our surveillance model was >50%, with positive predictive value of 68.9%, sensitivity of 38.3%, and specificity of 95.3%. In validation, chart-reviewed cases with AE probability >50% had a positive predictive value of 63% (n = 203). For the period from October 2017 to March 2020, the model identified approximately 70 IR cases per month that were likely to have an AE. This electronic trigger-based approach to AE surveillance could be used for patient-safety reporting and quality review. [ABSTRACT FROM AUTHOR]

Purpose: Higher pre-diagnosis physical activity (PA) is associated with lower all-cause mortality in breast cancer (BCa) patients. However, the association with pathological complete response (pCR) is unclear. We investigated the association between pre-diagnosis PA level and chemotherapy completion, dose delay, and pCR in BCa patients receiving neoadjuvant chemotherapy (NACT). Methods: 180 stage I–III BCa patients receiving NACT (mean [SD] age of diagnosis: 60.8 [8.8] years) in the Sister Study were included. Self-reported recreational and total PA levels were converted to metabolic equivalent of task-hours per week (MET-hrs/wk). The pCR was defined as no invasive or in situ residual in breast or lymph node (ypT0 ypN0). Multivariable logistic regression analyses estimated odds ratios (ORs) and 95% confidence intervals (CIs) for treatment outcomes. Results: In this sample, 45 (25.0%) BCa patients achieved pCR. Higher pre-diagnosis recreational PA was not associated with lower likelihood of chemotherapy completion (highest vs. lowest tertile: OR = 0.87, 95% CI = 0.30–2.56; Ptrend = 0.84), greater dose delay (OR = 1.45, 95% CI = 0.54–3.92; Ptrend = 0.46), or greater odds of pCR (OR = 1.28, 95% CI = 0.49–3.34; Ptrend = 0.44). Associations were similar for pre-diagnosis total PA. Meeting the recommended level of recreational PA was not associated with pCR overall (≥ 7.5 vs. < 7.5 MET-hrs/wk: OR = 1.33, 95% CI = 0.59–3.01). Conclusions: Although small sample size and limited information on exercise closer to time of diagnosis limit interpretation, pre-diagnosis PA was not convincingly associated with treatment tolerance or treatment efficacy in BCa patients receiving NACT. Future investigations are needed to better understand the impact of pre-diagnosis PA on BCa treatment. [ABSTRACT FROM AUTHOR]

Endocrine therapy (ET) for breast cancer treatment is associated with cognitive complaints, but their etiology is poorly understood. To address this, we developed and implemented an ambulatory assessment protocol consisting of wearable activity monitors, brief surveys of affect, context, and perceived impairments, and ultra-brief performance-based measures of cognition. Newly diagnosed, ER/PR+, stage 0-III, female breast cancer patients, were recruited. Ambulatory assessments were conducted on smart phones and wearable activity monitors were used to monitor sleep and physical activity. Participants were asked to complete five 7-day measurement bursts (one before starting ET and one each month for 4 consecutive months while on ET). We observed a consent rate of 36%, 27 women completed the study. Of the women that withdrew, 91% dropped prior to the midpoint of follow up. There were no significant differences in demographics, clinical breast cancer characteristics, sleep or physical activity patterns, or measures of cognition between women who completed versus withdrew. Women who did not complete the study provided fewer valid days of baseline data. In conclusion, while some women may be overwhelmed with their cancer diagnosis, we did not identify any predictive characteristics of women whom did not complete the study. This novel method enables the prospective study of psychological changes associated with cancer treatment, capturing a wide array of information about behavior, experience, and cognition, thus providing a picture of the lived experiences of cancer patients before and during exposure to ET. [ABSTRACT FROM AUTHOR]

Understand the correlates of ultra-processed food (UPF) intake and examine the association of UPF on body mass index in children aged 3–5 years. Secondary analysis of a prospective cohort of 3–5-year-olds/parent, followed 1-year between March 2014 and October 2016. Usual UPF intake from 2 3-day food records completed 1 year apart, a standardized nutrient database customized with child-specific foods, and a NOVA food classification system was used. Child/parent characteristics and media use were measured via parent-reported surveys. Child weight/height objectively measured. New Hampshire community. Six hundred and sixty-seven parent-child dyads were screened, and 624 were enrolled with 90% follow-up. Primary outcome: identify correlates of UPF intake. Secondary outcome: determine if UPF intake is associated with body mass index change. Adjusted β linear regression, linear regression, P <0.05. Ultra-processed food accounted for 67.6% of total caloric intake. In adjusted models, children's UPF intake was positively associated with increasing child age, greater hours watching television, and more frequent parent soda/fast-food intake. Ultra-processed food intake was negatively associated with higher parent education and reported race/ethnicity other than non-Hispanic White. There was no association between UPF intake and weight. There are several predictors of UPF intake in young children. Family-level interventions could be implemented to encourage the intake of minimally processed foods before and during preschool years. [ABSTRACT FROM AUTHOR]

This scoping literature review explored specific themes connected to the evolving nature of academic business librarianship (career paths and educational backgrounds, services and job roles, self-assessment, and professional development) with the goal to determine the state of existing literature. Following careful review, two areas of business librarianship—self-assessment and professional development—were identified as lacking in overall research literature. Literature regarding career paths and educational backgrounds, as well as services and job roles demonstrated notable gaps and need for timely revision. Future directions for research in emerging areas of academic business librarianship are also identified. [ABSTRACT FROM AUTHOR]

Three natural assumptions about rationality lead to conflict when they are formalized in natural ways. The paper examines how the assumptions are built into formal frameworks and why they lead to conflict. Several lessons are learned for the type of rationality ordinary people manifest in everyday life. [ABSTRACT FROM AUTHOR]

Purpose of Review: A wellspring of new research has offered varying models of resilience in chronic pain populations; however, resilience is a multifaceted and occasionally nebulous construct. The current review explores definitional and methodological issues in existing observational and clinical studies and offers new directions for future studies of pain resilience. Recent Findings: Definitions of pain resilience have historically relied heavily upon self-report and from relatively narrow scientific domains (e.g., positive psychology) and in narrow demographic groups (i.e., Caucasian, affluent, or highly educated adults). Meta-analytic and systematic reviews have noted moderate overall quality of resilience-focused assessment and treatment in chronic pain, which may be attributable to these narrow definitions. Summary: Integration of research from affiliated fields (developmental models, neuroimaging, research on historically underrepresented groups, trauma psychology) has the potential to enrich current models of pain resilience and ultimately improve the empirical and clinical utility of resilience models in chronic pain. [ABSTRACT FROM AUTHOR]

Exercise oncology clinical trials contribute to the advancement of our scientific knowledge and to the safety and care of patients diagnosed with cancer. Nevertheless, regulatory reviewers and committees may not be familiar with the well-documented long-term health benefits and safety of the regular practice of physical activity. Moreover, they may not see how the benefits outweigh the risks in the context where patients diagnosed with cancer are typically seen as vulnerable. Therefore, we would like to provide a purpose-built overview of exercise oncology clinical trials for members involved in institutional review committees, including the Scientific Review Committee (SRC), the Institutional Review Board (IRB), and the Data Safety Monitoring Committee (DSMC) to facilitate a greater understanding of the safety and benefits of physical activity during cancer treatments. Communication is key to improve the success of exercise oncology clinical trials, which are vital for patients diagnosed with cancer. [ABSTRACT FROM AUTHOR]