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Perianal Mucinous Adenocarcinoma (PMA) is a rare gastrointestinal malignancy, known to occur in patients with a long-standing history of recurrent perirectal abscesses or a chronic fistula. In this case report, we present a unique presentation of perianal mucinous adenocarcinoma, which began as a rectal abscess and progressed to a case of perianal mucinous adenocarcinoma, with a skip lesion present all the way up in the mid-rectal region. To the best of our knowledge, this is the first case in which PMA presented with skip lesions as opposed to a continuous lesion, and presented without a long standing history of fistulas and recurrent abscesses, but instead just a 4-day history of perianal burning, itching and tingling. The use of CT imaging, MRI’s and PET scans as diagnostic modalities for PMA are further elucidated in the report, along with a discussion of NCCN guidelines on using radiation therapy followed by an APR with inguinal node dissection for the management and treatment of PMA. Sharing this unique and atypical presentation of PMA with multimodality speciality groups and tumor boards helps in the development of various diagnostic and therapeutic approaches for PMA, as well as enhances our understanding of this rare malignant entity.

The use of DNA barcoding has revolutionized biodiversity science, but its application depends on the existence of comprehensive and reliable reference libraries. For many poorly known taxa, such reference sequences are missing even at higher-level taxonomic scales. We harvested the collections of the Smithsonian’s National Museum of Natural History (USNM) to generate DNA barcoding sequences for genera of terrestrial arthropods previously not recorded in one or more major public sequence databases. Our workflow used a mix of Sanger and Next-Generation Sequencing (NGS) approaches to maximize sequence recovery while ensuring affordable cost. In total, COI sequences were obtained for 5,686 specimens belonging to 3,888 genera and 202 families. Success rates varied widely according to collection data and focal taxon. NGS helped recover sequences of specimens that failed a previous run of Sanger sequencing. Success rates and the optimal balance between Sanger and NGS are the most important drivers to maximize output and minimize cost in future projects. The corresponding sequence and taxonomic data can be accessed through the Barcode of Life Data System, GenBank, the Global Biodiversity Information Facility, the Global Genome Biodiversity Network Data Portal and the NMNH data portal.

The Northern Review 44 (2017): 9–30 The participation of the Yukon in the First World War is a neglected part of northern history. For four years, the people of the Yukon, young and old, men and women, from all walks of life, became actively involved. A quarter of the population enlisted and fought in many of the major battles of the war; many came back as heroes, while others never came home at all. Those who remained at home were heavily committed to King and Empire. Women of the Yukon volunteered for service, raised funds for the war effort, and became socially active in such causes as prohibition and suffrage. Yukoner Joe Boyle distinguished himself in Russia during the war by financing a machine gun battery of fifty men, then volunteering to save the crown jewels and national treasury of Romania, negotiating an international treaty between Russia and Romania, and establishing a spy network. Robert Service, the Bard of the Yukon, volunteered as an ambulance driver and later penned the best-selling book of poetry of his long career. Individual acts of courage led to two men from the Yukon receiving the Victoria Cross, and many others receiving other honours. George Black, the commissioner of the Yukon, volunteered for service, bringing 250 Yukon men with him to the battlefields of France. Martha Black, his wife, accompanied him and became a mother figure to the men overseas and a Yukon goodwill ambassador. Many acts of commemoration and remembrance followed the war. This article is part of a special collection of papers originally presented at “The North and the First World War” conference held May 2016 in Whitehorse, Yukon. https://doi.org/10.22584/nr44.2017.002

We establish, under both theoretical conditions and empirical application, the separate roles of (1) market asset class exposure through index funds; (2) style factor exposure like value, momentum, and quality which have traditionally delivered higher and differentiated returns than market index exposure; and (3) pure alpha-seeking sources of return in excess of index and factor returns. We develop a new methodology to determine optimal allocations of index, factors, and alpha-seeking funds by imposing priors on the information ratios of factors and alpha strategies. We expect in most cases, prior standard deviations for factor funds should be smaller than alpha strategies, given the economic rationale and relatively long histories of factor strategies. The means and covariances from the predictive distribution can be used as inputs in standard optimization procedures.

Hematopoietic cell transplantation (HCT) has become a standard treatment for many adult and pediatric conditions. Emerging evidence suggests that perturbations in the microbiota diversity increase recipients' susceptibilities to gut-mediated conditions such as diarrhea, infection and acute GvHD. Probiotics preserve the microbiota and may minimize the risk of developing a gut-mediated condition; however, their safety has not been evaluated in the setting of HCT. We evaluated the safety and feasibility of the probiotic, Lactobacillus plantarum (LBP), in children and adolescents undergoing allogeneic HCT. Participants received once-daily supplementation with LBP beginning on day -8 or -7 and continued until day +14. Outcomes were compliance with daily administration and incidence of LBP bacteremia. Administration of LBP was feasible with 97% (30/31, 95% confidence interval (CI) 83-100%) of children receiving at least 50% of the probiotic dose (median 97%; range 50-100%). We did not observe any case of LBP bacteremia (0% (0/30) with 95% CI 0-12%). There were not any unexpected adverse events related to LBP. Our study provides preliminary evidence that administration of LBP is safe and feasible in children and adolescents undergoing HCT. Future steps include the conduct of an approved randomized, controlled trial through Children's Oncology Group.

Neuroendocrine carcinomas (NECs) are malignancies most often found in the colon, lung, pancreas, or thyroid. We describe a rare case of an NEC found in the anal canal of a 68-year-old woman. We also explore a list of differential diagnoses that should be considered in a patient presenting with a rectal mass. Pathological slides with staining for chromogranin, synaptophysin and CDX2 confirm the diagnosis. We are hopeful that this patient is responsive to neoadjuvant chemotherapy and radiation as to allow for a sphincter preserving surgery to ultimately lead to a better quality of life.

Perianal mucinous adenocarcinoma (PMA) is a rare gastrointestinal malignancy that occurs in patients with a long-standing history of recurrent perirectal abscesses or a chronic fistula. We present a unique case of PMA, which began as a rectal abscess and progressed to PMA with a skip lesion present all the way up in the mid-rectal region. This is the first case in which PMA presented with skip lesions as opposed to a continuous lesion, and presented without fistulas and recurrent abscesses history but just a 4-day history of perianal burning, itching, and tingling. CT imaging, MRIs, and PET scans were done for the diagnosis of PMA. A discussion of the National Comprehensive Cancer Network (NCCN) guidelines on using radiation therapy followed by an abdominoperineal resection with inguinal node dissection for the management and treatment of PMA is reported. Sharing the presentation of PMA with multimodality specialty groups and tumor boards helps develop various diagnostic and therapeutic approaches for PMA, as well as enhances our understanding of this rare malignant entity.

Stress reactions resulting from participation in simulation scenarios are seldom reported in the literature but are often informally discussed by simulation faculty seeking guidance to manage the occurrences. Although simulation faculty members often describe events where a single learner's distress interrupted learning for all involved, no examples of policies to plan for this kind of occurrence are available in the simulation literature. This article offers suggested best practices for identifying and assisting students who exhibit uncontrolled stress in simulation and includes a sample policy for planning.

Practical Applications Summary In Model Portfolios, which appeared in the Spring 2019 issue of The Journal of Wealth Management, Debarshi Basu of BlackRock, Michael Gates of BlackRock, Vishal Karir of iHuddl, and Andrew Ang of BlackRock present a three-step framework for developing model portfolios: 1) create a performance benchmark that reflects an investor’s risk tolerance, 2) construct a strategic model portfolio that reflects long-term capital market expectations based on that benchmark, and 3) construct a final tactical model portfolio that rotates the holdings around the strategic model portfolio. The authors suggest that investors use this framework as a repeatable and verifiable process for model portfolio construction. To demonstrate the framework’s usefulness, the authors apply it to two examples: building a strategic model portfolio for multi-asset investing, and building a tactical factor timing portfolio. TOPICS:Portfolio construction, risk management, analysis of individual factors/risk premia, performance measurement

This paper provides new activity-based classifications for cultural differences and similarities, in contrast to the cultural dimensions of hierarchy, group behavior, uncertainty avoidance and timeorientation.\ud Cultural activity types have been classified by Lewis (1999) into linear-active, multiactive\ud and reactive cultures. Moving away from a country perspective based on political boundaries to\ud a cultural community approach, it is not only task-orientation, but also the way cultures communicate, negotiate, and contract that is dominated by activity types. This article conceptualize, hypothesize and test observations with a set-theoretic tool (fsQCA). Our analysis focuses primarily on British and Chinese cultural profiles to start with. This should give us an initial approach towards understanding the similarities, differences and overlaps of cultural behavior. The outcome shows that future managers from Britain and China have more similarities than so far portrayed. Cultural dynamics are at the centre of a cooperative outlook towards managing across cultures.

The extent to which introduced weed biocontrol agents are subject to attack by generalist natural enemies within the area of introduction is believed to be an important determinant of program success. We monitored larval populations of a recently introduced weed biocontrol agent, Neomusotima conspurcatalis Warren, at field sites in Florida to investigate parasitism by native parasitoids and to assess the overall rate of parasitism. Of six native parasitoid species reared from wild larvae of N. conspurcatalis, five, Rhygoplitis choreuti (Viereck), Stantonia pallida (Ashmead), Elasmus apanteli Gahan, Hyphantrophaga sellersi (Sabrosky), and an unidentified Cotesia sp. were primary parasitoids of the biocontrol agent. The sixth species, Mesochorus apantelis Dasch, is likely a hyperparasitoid of R. choreuti. From 1,100 N. conspurcatalis larvae collected from three sites, adult parasitoids emerged from 6.8% of those larvae and 73.6% of the N. conspurcatalis developed to adulthood. R. choreuti was the most common parasitoid, accounting for 81% of adults reared. Photographs of parasitoid species are provided, aspects of their natural histories and host ranges are described, and accumulation of native parasitoids on introduced weed biocontrol agents is discussed.

The movement of Canadian nurses to the United States increased over the past decade and is an ongoing concern of health policy analysts. This study examines why Canadian nurses emigrate to the United States and whether there is interest in returning to work in Canada. A survey of Canadian-educated nurses in North Carolina showed that lack of full-time work opportunities played a key role in emigration. Focus groups of respondents revealed deep dissatisfaction with many aspects of nursing practice in Canada, particularly undervaluing of the profession. There is an urgent need for healthcare policy makers to explore what should be done to reduce the loss of this critical human resource.

Introduction: This article presents the scientific evidence for the merit of telemedicine interventions in the diagnosis and management of skin disorders (teledermatology) in the published literature. The impetus for this work derives from the high prevalence of skin disorders, the high cost, the limited availability of dermatologists in certain areas, and the promise of teledermatology to address unmet needs in this area. Materials and Methods: The findings are based on a targeted review of scientific studies published from January 2005 through April 2015. The initial search yielded some 5,020 articles in Google Scholar and 428 in PubMed. A review of the abstracts yielded 71 publications that met the inclusion criteria for this analysis. Evidence is organized according to the following: feasibility and acceptance; intermediate outcomes (use of service, compliance, and diagnostic and treatment concordance and accuracy); outcomes (health improvement and problem resolution); and cost savings. A special section is devoted to studies conducted at the Veterans Health Administration. Results: Definitions of teledermatology varied across a wide spectrum of skin disorders, technologies, diagnostic tools, provider types, settings, and patient populations. Outcome measures included diagnostic concordance, treatment plans, and health. Conclusions: Despite these complexities, sufficient evidence was observed consistently supporting the effectiveness of teledermatology in improving accessibility to specialty care, diagnostic and treatment concordance, and skin care provided by primary care physicians, while also reducing cost. One study reported suboptimal clinical results from teledermatology for patients with pigmented skin lesions. On the other hand, confocal microscopy and advanced dermoscopy improved diagnostic accuracy, especially when rendered by experienced teledermatologists.

© 2015 American Society for Blood and Marrow Transplantation. The presence of increasing host chimerism or persistent mixed chimerism (MC) after hematopoietic stem cell transplantation for leukemia in children is a predictor of relapse. To reduce the risk of relapse, we prospectively studied post-transplantation chimerism-based immunotherapy (IT) using fast withdrawal of immunosuppression (FWI) and donor lymphocyte infusions (DLI) in children with early post-transplantation MC. Forty-three children with hematologic malignancies at 2 institutions were enrolled prospectively in this study from 2009 until 2012 and were followed for a mean of 42 (SD, 10) months. Twelve patients (28%) were assigned to the observation arm based on the presence of graft-versus-host disease (GVHD) or full donor chimerism (FDC), and 5 (12%) sustained early events and could not undergo intervention. Twenty-six (60%) patients with MC were assigned to IT with FWI, which started at a median of 49 days (range, 35 to 85 days) after transplantation. Fourteen patients proceeded to DLI after FWI. Toxicities of treatment included GVHD, which developed in 19% of patients undergoing intervention, with 1 of 26 (4%) dying from GVHD and 1 (4%) still requiring therapy for chronic GVHD 21 months after DLI. Patients with MC undergoing IT had similar 2-year event-free survival (EFS) (73%; 95% confidence interval (CI), 55% to 91%) compared with patients who achieved FDC spontaneously (83%; 95% CI, 62% to 100%); however, because 50% of all relapses in the IT occurred later than 2 years after transplantation, the EFS declined to 55% (95% CI, 34% to 76%) at 42 (SD, 11) months. There were no late relapses in the observation group. EFS in the entire cohort was 58% (95% CI, 42% to 73%) at 42 (SD, 11) months after transplantation. Evidence of disease before transplantation remained a significant predictor of relapse, whereas development of chronic GVHD was protective against relapse.

Despite numerous studies examining nursing wages, very little attention has focused on nursing wage differentials. We build on previous research by modeling nursing wages and examining male–female wage differences within the context of the current nursing shortage. Our results show that male nurses do earn a wage premium, largely explained by employment as a nurse anesthetist, job satisfaction, and experience. Whether or not this differential indicates discrimination toward females in the US nursing labor market is unclear. Since males represent a small proportion of the nursing workforce, the time required for males to become prevalent in the nursing labor market and help ease the nursing shortage is unknown. Consequently, one must ask whether the male wage premium is sufficient to attract substantial numbers of men into nursing, and whether wages, in general, are sufficient to attract the requisite numbers of males and females into nursing to address the shortage ‘crisis’.

Nurse turnover is a recurring problem for health care organizations. Nurse retention focuses on preventing nurse turnover and keeping nurses in an organization’s employment. However, decisions about nurse turnover and retention are often made without the support of full and complete knowledge of their associated costs and benefits. This article identifies common nurse turnover and retention costs and benefits, discusses the use of benefit-cost and cost-effectiveness analysis relevant to nurse turnover and retention, and calls for the construction of a business case for nurse retention. It also provides a foundation for including the costs and benefits of nurse turnover and retention in estimating the economic value of nursing.

A key component of a Joint Air Operation (JAO) environment is the planning and dynamic control of missions in the presence of uncertainties. This involves the assignment of resources (e.g., different aircraft types) to targets while taking into account and anticipating the effect of random future events and, subsequently, dynamic control in response to various controllable and uncontrollable events as missions are executed in a hostile and rapidly changing setting. The objective is to maximize the reward associated with targets while minimizing loss of resources. In this paper, we first formulate the problem of optimal mission assignment and identify the complexities involved due to combinatorial and stochastic characteristiscs. We then describe a discrete event simulation tool developed to model the JAO environment and all of its dynamics and stochastic elements and to provide a testbed for several methods we are developing to solve the problem of agile mission control. We describe some of these methods, including approximate dynamic programming using rollout algorithms and optimal resource allocation schemes, and present some numerical results.

Age at enrollment (years) Mean(SD) 7.7 (4.7) Median (range) 6.9 (2.2-17.3) Age at enrollment (years) 2-3.99 10 (33%) 4 or older 20 (67%) Stem Cell Source Cord blood 5 (16%) Marrow 21 (70%) Marrow and cord blood 1 (3%) PBSC 3 (10%) Stage of Acute GI GVHD for patients alive through Day 100 0 21 (78%) 1 2 (7%) 2 1 (4%) 3 3 (11%) Overall Grade of Acute GVHD for patients alive through Day 100 0 20 (74%) 2 4 (15%) 3 3 (11%) Abstracts / Biol Blood Marrow Transplant 21 (2015) S240eS265 S256

A phylogenetic study based on 25 species of Phasgonophorinae (Hymenoptera: Chalcididae) and 36 characters was carried out for ensuring the generic placement of three new species from Saudi Arabia. As a result of this study, the generaTrigonuraSichel, 1866,BactrochalcisKieffer, 1912,CentrochalcisCameron, 1913,CentrochalcidiaGahan & Fagan, 1923,ChalcidelliaGirault, 1924,UrochalcisNikol’skaya, 1952,TrigonurellaBouček, 1988, andMuhabbetellaKoçak & Kemal, 2008 are synonymized withPhasgonophoraWestwood, 1832. This genus is recorded in Saudi Arabia for the first time, represented here byP. rubens(Klug), and newly described speciesP. baiocchiiSoliman & Gul,sp. nov.,P. granulisDelvare,sp. nov., andP. magnaniiGadallah & Gul,sp. nov.An illustrated key to species of the Arabian Peninsula is provided. The relevant specimens were mostly reared from buprestid species infestingAcaciasp. andDodonaea viscosain Al-Baha, Asir and Riyadh regions, Saudi Arabia.