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Purpose Breast cancer (BC) is the most common malignancy among women and prognosis is strongly influenced by tumor subtype. Neoadjuvant chemotherapy (NAC) is the standard treatment for both locally advanced- and early-stage triple-negative and Her2-positive BC. Pathologic complete response (pCR) to NAC is an important predictor of patient outcomes. Neutrophil-to-lymphocyte-ratio (NLR) in peripheral blood is associated with prognosis in various malignancies. Here, we investigated the value of the pretreatment NLR as a response predictor in neoadjuvant-treated patients with BC. Methods A retrospective chart analysis of 862 patients with invasive BC treated with NAC at the Heidelberg University Hospital during 2003–2015 was conducted. NLR was calculated as the ratio of the absolute neutrophil and lymphocyte counts in peripheral blood, and pCR was defined as absence of invasive or in situ carcinoma in breast and axillary lymph nodes. Results A total of 151 patients with invasive BC who underwent NAC were included in this study. NLR tended to be higher in the pCR group than the non-pCR group (p p = 0.048) in patients with luminal B/Her2-negative tumors. Further, we found a significant difference in NLR according to remission status in postmenopausal patients (2.861 vs. 2.313, respectively; p = 0.043). Conclusion NLR was significantly higher only for patients achieving pCR in the Luminal B/Her2-negative and postmenopausal subgroups. Hence, NLR is a candidate additional predictive factor in patients with Luminal B/Her2-negative BC.

The increasing commercial relevance of automotive audio systems has led to an increased interest in the reliable evaluation of the sound quality of these systems. For this contribution, the sound quality of a wide range of different car audio systems was evaluated by means of acoustic measurements and listening tests based on binaural recordings of music. As human perception is influenced by a multitude of sensory impressions, the question arose whether these listening tests could be conducted in a laboratory or whether a more realistic environment is needed to obtain valid results. Accordingly, in a between-subjects-design, the same set of stimuli was evaluated in two test environments: a listening laboratory and a driving simulator. Aspects to be considered when selecting music material for perceptual evaluations in studies are presented. The relationship of acoustic measurements, the musical stimuli and the results of the perception experiments is discussed. No relevant differences between the results of the two test environments were observed. However, the results showed listener preferences concerning the music excerpts used as well as distinct interaction effects between the factors song and audio system.

Objective Measuring the success of molecularly guided therapies is a major challenge in precision oncology trials. A commonly used endpoint is an intra-patient progression-free survival (PFS) ratio, defined as the PFS interval associated with molecularly guided therapy (PFS2) divided by the PFS interval associated with the last prior systemic therapy (PFS1), above 1.3 or, in some studies, above 1.33 or 1.5. Methods To investigate if the concept of PFS ratios is in agreement with actual response evaluations by physicians, we conducted a survey among members of the MASTER (Molecularly Aided Stratification for Tumor Eradication Research) Programme of the German Cancer Consortium who were asked to classify the success of molecularly guided therapies in 194 patients enrolled in the MOSCATO 01 trial based on PFS1 and PFS2 times. Results A comparison of classification profiles revealed three distinct clusters of PFS benefit assessments. Only 29% of assessments were consistent with a PFS ratio threshold of 1.3, whereas the remaining 71% of participants applied a different classification scheme that did not rely on the relation between PFS times alone, but also took into account absolute PFS1 intervals. Based on these community-driven insights, we developed a modified PFS ratio that incorporates the influence of absolute PFS1 intervals on the judgement of clinical benefit by physicians. Application of the modified PFS ratio to outcome data from two recent precision oncology trials, MOSCATO 01 and WINTHER, revealed significantly improved concordance with physician-perceived clinical benefit and identified comparable proportions of patients who benefited from molecularly guided therapies. Conclusions The modified PFS ratio may represent a meaningful clinical endpoint that could aid in the design and interpretation of future precision oncology trials.

The authors attempt to simplify the key elements to the process of negotiating successfully with private physicians. From their experience, the business elements that have resulted in the most discussion center on the compensation including the incentive plan. Secondarily, how the issue of malpractice is handled will also consume a fair amount of time. What the authors have also learned is that the intangible issues can often be the reason for an unexpectedly large amount of discussion and therefore add time to the negotiation process. To assist with this process, they have derived a negotiation checklist, which seeks to help hospital leaders and administrators set the proper framework to ensure successful negotiation conversations. More importantly, being organized and recognizing these broad issues upfront and remaining transparent throughout the process will help to ensure a successful negotiation.

Laryngeal examinations, especially stroboscopic examinations, are increasingly recorded using digital video formats on computer media, rather than using analog formats on videotape. It would be useful to share these examinations with other medical professionals in formats that would facilitate reliable and high-quality playback on a personal computer by the recipients. Unfortunately, a personal computer is not well designed for reliable presentation of artifact-free video. It is particularly important that laryngeal video play without artifacts of motion or color because these are often the characteristics of greatest clinical interest. With proper tools and procedures, and with reasonable compromises in image resolution and the duration of the examination, digital video of laryngeal examinations can be reliably exchanged. However, the tools, procedures, and formats for recording, converting to another digital format ("transcoding"), communicating, copying, and playing digital video with a personal computer are not familiar to most medical professionals. Some understanding of digital video and the tools available is required of those wanting to exchange digital video. Best results are achieved by recording to a digital format best suited for recording (such as MJPEG or DV),judiciously selecting a segment of the recording for sharing, and converting to a format suited to distribution (such as MPEG1 or MPEG2) using a medium suited to the situation (such as e-mail attachment, CD-ROM, a "clip" within a Microsoft PowerPoint presentation, or DVD-Video). If digital video is sent to a colleague, some guidance on playing files and using a PC media player is helpful.

Objectives: to dimension abuse against vulnerable adults within the family and community environment in the Azores Islands, identify risk factors for abuse and describe the profile of an abused elder. Method: descriptive cross-sectional study. Random sampling. The instruments used were: clinical histories of the users, Mini-Mental State Examination, Index of Independence in Basic Activities of Daily Living, Family APGAR Scale, Elder Abuse Suspicion Index and Social Work Assessment Form. Descriptive statistical analysis was used for qualitative and quantitative variables and multiple logistic regression was used to identify factors associated with elder mistreatment. Results: abuse suspicion was identified in 24.5% of elderly participants. Psychological abuse was the most common type of abuse and sons were the main abusers. Conclusion: being a woman and belonging to a dysfunctional family is associated with an increased risk of becoming a victim of abuse; the high level of domestic violence against the elderly in the Azores Islands is in line with the rest of Portugal. RESUMO Objetivos: dimensionar os maus-tratos contra as pessoas idosas vulneráveis no ambiente familiar e comunitário nas Ilhas dos Açores, identificar fatores de risco para maus-tratos e definir o perfil do idoso maltratado. Método: estudo descritivo transversal. Amostragem aleatória. Os instrumentos utilizados foram: prontuários dos usuários, Mini Exame do Estado Mental, teste de autonomia para as Atividades Básicas da Vida Diária, Escala APGAR Familiar, Índice de Suspeição de Abuso no Idoso e Formulário de Avaliação de Trabalho Social. Análise estatística descritiva foi usada para as variáveis qualitativas e quantitativas e regressão logística múltipla foi usada para identificar os fatores associados aos maus-tratos. Resultados: suspeita de maus-tratos foi identificada em 24,5% dos idosos participantes. O abuso psicológico foi o tipo de maus-tratos mais comum e os responsáveis por esses maus-tratos foram principalmente os filhos. Conclusão: ser mulher e pertencer a uma família disfuncional está associado com uma maior probabilidade de sofrer maus-tratos; o alto nível de violência doméstica contra os idosos nas Ilhas dos Açores segue o mesmo padrão do resto de Portugal. RESUMEN Objetivos: dimensionar el maltrato a personas mayores vulnerables en el entorno familiar y comunitario de las Islas Azores, identificar factores de riesgo de maltrato y definir el perfil del anciano maltratado. Método: estudio descriptivo de corte transversal. Muestreo aleatorio. Los instrumentos utilizados fueron: historias clínicas de los usuarios, Mini-Examen Cognitivo, test de autonomía para las Actividades Básicas de la Vida Diaria, Test de APGAR Familiar, Índice de Sospecha de Maltrato hacia Personas Mayores y Formulario de Evaluación de Trabajo Social. El análisis estadístico fue descriptivo para las variables cualitativas y cuantitativas y una regresión logística múltiple para identificar los factores asociados al maltrato. Resultados: se identificó sospecha de maltrato en el 24,5% de los ancianos participantes. El maltrato psicológico fue el tipo de maltrato más común y los desencadenantes de ese maltrato fueron principalmente los hijos. Conclusión: se asocia ser mujer y pertenecer a familia disfuncional con mayor probabilidad de padecer maltrato; el alto nivel de la violencia domestica a los ancianos en las Islas Azores sigue la línea que en el resto de Portugal.