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Treatment completion by study arm

Purpose:Addition of carboplatin (Cb) to anthracycline chemotherapy improves pathologic complete response (pCR), and carboplatin plus taxane regimens also yield encouraging pCR rates in triple-negative breast cancer (TNBC). Aim of the NeoSTOP multisite randomized phase II trial was to assess efficacy of anthracycline-free and anthracycline-containing neoadjuvant carboplatin regimens.Patients and Methods:Patients aged ≥18 years with stage I–III TNBC were randomized (1:1) to receive either paclitaxel (P) weekly × 12 plus carboplatin AUC6 every 21 days × 4 followed by doxorubicin/cyclophosphamide (AC) every 14 days × 4 (CbP → AC, arm A), or carboplatin AUC6 + docetaxel (D) every 21 days × 6 (CbD, arm B). Stromal tumor-infiltrating lymphocytes (sTIL) were assessed. Primary endpoint was pCR in breast and axilla. Other endpoints included residual cancer burden (RCB), toxicity, cost, and event-free (EFS) and overall survival (OS).Results:One hundred patients were randomized; arm A (n = 48) or arm B (n = 52). pCR was 54% [95% confidence interval (CI), 40%–69%] in arm A and 54% (95% CI, 40%–68%) in arm B. RCB 0+I rate was 67% in both arms. Median sTIL density was numerically higher in those with pCR compared with those with residual disease (20% vs. 5%; P = 0.25). At median follow-up of 38 months, EFS and OS were similar in the two arms. Grade 3/4 adverse events were more common in arm A compared with arm B, with the most notable differences in neutropenia (60% vs. 8%; P < 0.001) and febrile neutropenia (19% vs. 0%; P < 0.001). There was one treatment-related death (arm A) due to acute leukemia. Mean treatment cost was lower for arm B compared with arm A (P = 0.02).Conclusions:The two-drug CbD regimen yielded pCR, RCB 0+I, and survival rates similar to the four-drug regimen of CbP → AC, but with a more favorable toxicity profile and lower treatment-associated cost.

Purpose: Addition of carboplatin (Cb) to anthracycline chemotherapy improves pathologic complete response (pCR), and carboplatin plus taxane regimens also yield encouraging pCR rates in triple-negative breast cancer (TNBC). Aim of the NeoSTOP multisite randomized phase II trial was to assess efficacy of anthracycline-free and anthracycline-containing neoadjuvant carboplatin regimens. Patients and Methods: Patients aged ≥18 years with stage I–III TNBC were randomized (1:1) to receive either paclitaxel (P) weekly × 12 plus carboplatin AUC6 every 21 days × 4 followed by doxorubicin/cyclophosphamide (AC) every 14 days × 4 (CbP → AC, arm A), or carboplatin AUC6 + docetaxel (D) every 21 days × 6 (CbD, arm B). Stromal tumor-infiltrating lymphocytes (sTIL) were assessed. Primary endpoint was pCR in breast and axilla. Other endpoints included residual cancer burden (RCB), toxicity, cost, and event-free (EFS) and overall survival (OS). Results: One hundred patients were randomized; arm A (n = 48) or arm B (n = 52). pCR was 54% [95% confidence interval (CI), 40%–69%] in arm A and 54% (95% CI, 40%–68%) in arm B. RCB 0+I rate was 67% in both arms. Median sTIL density was numerically higher in those with pCR compared with those with residual disease (20% vs. 5%; P = 0.25). At median follow-up of 38 months, EFS and OS were similar in the two arms. Grade 3/4 adverse events were more common in arm A compared with arm B, with the most notable differences in neutropenia (60% vs. 8%; P < 0.001) and febrile neutropenia (19% vs. 0%; P < 0.001). There was one treatment-related death (arm A) due to acute leukemia. Mean treatment cost was lower for arm B compared with arm A (P = 0.02). Conclusions: The two-drug CbD regimen yielded pCR, RCB 0+I, and survival rates similar to the four-drug regimen of CbP → AC, but with a more favorable toxicity profile and lower treatment-associated cost.

Research shows that medical providers who care for seriously ill patients encounter a high risk for diminished well-being that can include burnout, moral distress, and compassion fatigue.1 The dail...

In this paper, we discuss the role of public parks in telling the nation’s story via statues, memorials, and monuments. We ground our discussion in affect theory, which addresses the affective responses statues, memorials, and monuments elicit in visitors. Of particular note is affective dissonance, which suggests that a statue, memorial, or monument may evoke a variety of conflicting affective responses. The way in which visitors reconcile these conflicting affective responses shapes their public memory of significant events in our nation’s history. As more is learned about the checkered past of individuals venerated in statues, memorials, and monuments, how should public park administrators respond? We provide several examples of statues, memorials, and monuments that are controversial in nature, and discuss how public park administrators have responded to the challenge of telling the nation’s story through the reinterpretation of events. We also consider the complexity of the management implications, focusing in particular on who should be driving the decisions made. We then discuss the Edmund Pettus Bridge in Selma, Alabama, as a good object lesson in how to deal with the affective dissonance involved in recasting public spaces. In so doing, we underscore the importance of frame theory in educating visitors about the preservation, modification, or removal of existing statues, memorials, or monuments.Subscribe to JPRA

Taking vacations in sunny locations is associated with the development of skin cancer. This study tested a multi-component sun protection intervention based on diffusion of innovations theory and transportation theory designed to increase vacationers' comprehensive sun protection, i.e., use of clothing, hats, and shade, and use, pre-application, and reapplication of sunscreen. The trial enrolled 41 warm weather resorts in North America in a pair-matched group randomized pretest-posttest design and assessed samples of adult vacationers at resort outdoor recreation venues regarding sun protection at pretest (n = 3,531) and posttest (n = 3,226). While results showed no overall effect of the intervention on comprehensive sun protection across venues, the intervention produced statistically significant improvements in sun protection at waterside venues (pools and beaches). The intervention's overall effects may have been impeded by a lack of uniformly robust implementation, low interest in skin cancer prevention by guests, or shortcomings of the theories used to create prevention messages. The intervention may have worked best with guests in the highest-risk recreation venue, i.e., waterside recreation where they exposed the most skin. Alternative approaches that alter resort organizations, such as through changes in policy, environmental features, or occupational efforts might be more effective than targeting vacationers with behavior-change messages.

Background: Triple negative breast cancer is defined by lack of expression of ER/PR (immunohistochemistry expression Table 1. Demographic, clinical, pathologic, and treatment characteristicsCharacteristics - N (%)All N=516TNBC (ER & PR Citation Format: Rachel Yoder, Bruce F Kimler, Joshua M Staley, Kelsey Schwensen, Yen Y Wang, Karissa Finke, Anne O'Dea, Lauren Nye, Manana Elia, Gregory Crane, Richard McKittrick, Robert Pluenneke, Sheshadri Madhusudhana, Larry Beck, Roberto Rodriguez, Anuj Shrestha, Larry Corum, Mark Marsico, Andrew K Godwin, Qamar Khan, Priyanka Sharma. Impact of low versus negative estrogen/progesterone receptor status on clinico-pathologic characteristics and survival outcomes in HER2 negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-04.

Background Vacationing at sunny, warm weather locations is a risk factor for excessive solar ultraviolet (UV) radiation exposure and skin cancer. Objectives This study examined the association of environmental variables related to UV levels with vacationers' sun protection. Methods Vacationers at 41 summer resorts in 17 states and 1 Canadian Province were interviewed (n=3531) and observed (N=4347) during 2012 and 2013. Clothing coverage, sunglasses, and shade use were observed. Use of sunscreen and sunburns were self-reported. Environmental information was recorded by research staff or acquired from ground stations and the weather service. Results Temperature was positively associated with sun protection behaviors; however clothing coverage was negatively associated with temperature. Cloud cover was negatively associated with sun protection, with the exception of clothing coverage which was positively associated with it. Elevation showed a mixed pattern of associations with vacationer's sun protection. Latitude of a resort was negatively associated with most sun protection behaviors, such that sun protection increased at more southerly resorts. Similarly, the farther south a vacationer traveled to the resort, the less sun protection they employed. The UV index showed a weak, positive relationship with some sun protection behaviors even when controlling for temperature. Conclusions Vacationers appeared aware that UV is higher at southern latitudes and may learn UV is intense when living in southern regions. However, many used temperature, an unreliable cue, to judge UV intensity and seemed to adjust clothing for warmth not UV protection. Efforts are needed to help individuals make more accurate sun safety decisions.

Introduction Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluated an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations. Materials and methods Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012–14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun. protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits. Results Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees = 30 to 900; latitude = 24° 78′ N to 50° 52′ N; elevation = 2 ft. to 9726 ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/lawn games, golf courses, common areas, and chairlifts). At pretest, 4347 vacationers were observed and 3531 surveyed. More females were surveyed (61%) than observed (50%). Vacationers were mostly 35–60 years old, highly educated (college education = 68%) and non-Hispanic white (93%), with high-risk skin types (22%). Vacationers reported covering 60% of their skin with clothing. Also, 40% of vacationers used shade; 60% applied sunscreen; and 42% had been sunburned. Conclusions The trial faced challenges recruiting resorts but result showed that the large, multi-state sample of vacationers were at high risk for solar UV exposure.

The field of interpretation is increasingly acknowledging the potential for strategic health promotion. The purpose of this paper is to introduce Go Sun Smart (GSS) Resorts, a sun safety program directed to guests recreating outdoors at destination resorts and parks in the United States and Canada. This paper aims to present a sun safety intervention that was designed to promote advanced sun safety practices to the field of interpretation. With a foundation in Diffusion of Innovations Theory and Transportation Theory this paper will present the intervention materials and strategies developed by GSS to showcase the potential to promote health behaviors. Intervention materials that were developed include posters, tip cards, a Public Service Announcement (PSA) video, additional electronic and print materials, employee trainings, GSS certification, and an interpretive script for use prior to various outdoor activities.

Exposure to solar ultra violet radiation (UVR) is a primary risk factor for skin cancer. Vacationers often fail to protect themselves from harmful UVR.The study assessed the sun protection practices of resort guests in various outdoor leisure and recreation venues during warm-weather seasons.41 North American resorts were enrolled in a quasi-experimental randomized controlled trial. Adult guests were observed (n=4091) and surveyed (n=3694) in a cross sectional sample. Data collection was conducted in recreation and leisure venues with outdoors commons/reception areas acting as the comparison condition.The mean percent of vacationers at pools and beaches were more likely (p0.001) to wear sunscreen than in commons areas but less likely (p0.001) to wear cover-up clothing or use shade. In both samples, the combined sun protection scores were higher in commons areas compared to all venues except for outdoor dining (p0.001).Sun safety was suboptimal in all venues and was potentially mitigated by venue type.Approaches are needed to encourage vacationers to practice comprehensive sun protection and to work with resorts to construct built environments that facilitate rather than act as barriers to sun safety.

Rapidly changing business conditions make it difficult to see the future with any degree of certainty. Consequently, many firms have undertaken a thorough self‐examination and reworking of procedures and methods to position themselves to compete in the global marketplace of the 1990s. A crucial element in the changing and improving processes is raising the quality of the product or service the firm provides. Lockheed Martin Tactical Aircraft Systems has a vested interest in changing to meet the new requirements of the aerospace industry and decided to re‐evaluate its business practices, with the goal of increasing productivity while simultaneously increasing quality. Management decided to conduct a large‐scale quality survey throughout the company to understand the company’s current level of quality and the quality perceptions among employees. Reports on the results of that study, with a brief description of the development of the quality survey instrument and the information discovered during the data analysis.

Tuan, Yi-Fu. 1993. Passing Strange and Wonderful. Washington, DC: Island Press, ISBN 1-55963-209-7, $25.00 cloth, 288 pp.Yi-Fu Tuan is a professor of geography at the University of Wisconsin at Madison. His vast work links together the landscape of nature with the landscape of the human mind. His thinking is philosophical in its depth and his writing contains the flair of poetry. Perhaps the best known of Tuan's eight other books is Topophilia.Passing Strange and Wonderful, as the subtitle of the book reveals, is about aesthetics, nature, and culture. While Tuan does not ignore human folly, he does not dwell on the dark side of things--exploitation, greed, pollution--as many recent works on environment and society do. He summarizes, "By contrast, the outlook presented here is predominantly sunny."Conventional research, such as that by Abraham Maslow, suggests that aesthetic experiences are sought only after more basic needs have been met. In this far-reaching book, Tuan advances the idea that beauty is essential to individual life and is the driving force and ultimate goal of culture.The pervasive role of the aesthetic is reflected by its root meaning of "feeling" and is suggested even more by its opposite, anesthetic, "lack of feeling." Tuan reminds us, "The more attuned we are to the beauties of the world, the more we come to life and take joy in it."Passing Strange and Wonderful is divided into five parts. The chapters of Part I lay a foundation for the book. The aesthetic impulse is rooted in nature (biology), but it is directed and colored by culture. The aesthetic mode is "a mood, a feeling, an emotion." However, it cannot take extreme forms like drowsy indolence or visceral states such as rage.Aestheticism, ultimately, is a sophisticated response. It is a cultivated posture toward life and the world. Tuan explains, "Every society nurtures this impulse in its young, encouraging it to grow in scope, power, and subtlety." Of course, expressions of the aesthetic range widely from culture to culture. Less varying are the developmental stages of aesthetic competence and appreciation. Children, in general, tend to dwell in an expansive, timeless present. They are open to sensory delight and have an immense capacity for wonder. Preschoolers are enthralled by bright colors and things that sparkle, while older children begin to "apprehend the world more fully and discriminately, discerning in it a subtleness and range of beauty, an expressiveness, an emotional and psychological depth that lie beyond the competence of the young child."Part II is titled "Sensory Delights" and the chapters consider the different human senses--smell, touch, taste, hearing, and sight--the building blocks of aesthetic experience. This section of the book is similar in format and content to Diane Ackerman's A Natural History of the Senses.Tactile aesthetics contribute to the pleasures of being alive and to our sense of well-being, especially for children. Tuan laments that people are literally losing touch with nature. Although children still strive for intimate contact with the land, adults mostly enjoy nature by simply looking at it. The account of taste aesthetics includes a discussion of Chinese cuisine and etiquette where harmony in food is the desideratum, as it is in others areas of Chinese life--extremes and excess are to be avoided. Next, Tuan explores the olfactory sense: "Robbed of scent, life and the world become gray and passionless." He addresses fragrances in nature, the countryside, and the city. In a similar format, Tuan considers the sounds in our lives. He provides a relatively long discourse on music which "in its exalted form, elevates the soul." The last chapter in this part is about visual delight and splendor. Although a good deal of territory is covered from composition and pattern to color, the section on "ice" is especially intriguing while revealing the broad scope of the book. …

(1993). Willers, Bill (Ed.). Learning to Listen to the Land. Journal of Leisure Research: Vol. 25, No. 4, pp. 405-407.

The reaction of pentaerythritol and tetraethylorthocarbonate at 260 degrees C for 12 h yields a white crystalline material that was characterized by 13C CPMAS NMR, CHN analysis, FT-IR, electron and X-ray powder diffraction, and Rietveld analysis. The white crystalline material was found to have the formula C6H8O4 and a crystal structure with a monoclinic cell [a = 9.167 A, b = 5.681 A, c = 5.880 A, beta = 90.0 degrees , space group I2] of hexagonally arranged spiro-oligomeric chains.