34 research outputs found
Postoperative adjuvant chemotherapy in rectal cancer operated for cure
No full textBACKGROUND:
Colorectal cancer is one of the most common types of cancer in the Western world. Apart from surgery - which remains the mainstay of treatment for resectable primary tumours - postoperative (i.e., adjuvant) chemotherapy with 5-fluorouracil (5-FU) based regimens is now the standard treatment in Dukes' C (TNM stage III) colon tumours i.e. tumours with metastases in the regional lymph nodes but no distant metastases. In contrast, the evidence for recommendations of adjuvant therapy in rectal cancer is sparse. In Europe it is generally acknowledged that locally advanced rectal tumours receive preoperative (i.e., neoadjuvant) downstaging by radiotherapy (or chemoradiotion), whereas in the US postoperative chemoradiotion is considered the treatment of choice in all Dukes' C rectal cancers. Overall, no universal consensus exists on the adjuvant treatment of surgically resectable rectal carcinoma; moreover, no formal systematic review and meta-analysis has been so far performed on this subject.
OBJECTIVES:
We undertook a systematic review of the scientific literature from 1975 until March 2011 in order to quantitatively summarize the available evidence regarding the impact of postoperative adjuvant chemotherapy on the survival of patients with surgically resectable rectal cancer. The outcomes of interest were overall survival (OS) and disease-free survival (DFS).
SEARCH METHODS:
CCCG standard search strategy in defined databases with the following supplementary search. 1. Rect* or colorect* - 2. Cancer or carcinom* or adenocarc* or neoplasm* or tumour - 3. Adjuv* - 4. Chemother* - 5. Postoper*
SELECTION CRITERIA:
Randomised controlled trials (RCT) comparing patients undergoing surgery for rectal cancer who received no adjuvant chemotherapy with those receiving any postoperative chemotherapy regimen.
DATA COLLECTION AND ANALYSIS:
Two authors extracted data and a third author performed an independent search for verification. The main outcome measure was the hazard ratio (HR) between the risk of event between the treatment arm (adjuvant chemotherapy) and the control arm (no adjuvant chemotherapy). The survival data were either entered directly in RevMan or extrapolated from Kaplan-Meier plots and then entered in RevMan. Due to expected clinical heterogeneity a random effects model was used for creating the pooled estimates of treatment efficacy.
MAIN RESULTS:
A total of 21 eligible RCTs were identified and used for meta-analysis purposes. Overall, 16,215 patients with colorectal cancer were enrolled, 9,785 being affected with rectal carcinoma. Considering patients with rectal cancer only, 4,854 cases were randomized to receive potentially curative surgery of the primary tumour plus adjuvant chemotherapy and 4,367 to receive surgery plus observation. The mean number of patients enrolled was 466 (range: 54-1,243 cases). 11 RCTs had been performed in Western countries and 10 in Japan. All trials used fluoropyrimidine-based chemotherapy (no modern drugs - such as oxaliplatin, irinotecan or biological agents - were tested).Overall survival (OS) data were available in 21 RCTs and the data available for meta-analysis regarded 9,221 patients: of these, 4854 patients were randomized to adjuvant chemotherapy (treatment arm) and 4,367 patients did not receive adjuvant chemotherapy (control arm). The meta-analysis of these RCTs showed a significant reduction in the risk of death (17%) among patients undergoing postoperative chemotherapy as compared to those undergoing observation (HR=0.83, CI: 0.76-0.91). Between-study heterogeneity was moderate (I-squared=30%) but significant (P=0.09) at the 10% alpha level.Disease-free survival (DFS) data were reported in 20 RCTs, and the data suitable for meta-analysis included 8,530 patients. Of these, 4,515 patients were randomized to postoperative chemotherapy (treatment arm) and 4,015 patients received no postoperative chemotherapy (control arm). The meta-analysis of these RCTs showed a reduction in the risk of disease recurrence (25%) among patients undergoing adjuvant chemotherapy as compared to those undergoing observation (HR=0.75, CI: 0.68-0.83). Between-study heterogeneity was moderate (I-squared=41%) but significant (P=0.03).While analyzing both OS and DFS data, sensitivity analyses did not find any difference in treatment effect based on trial sample size or geographical region (Western vs Japanese). Available data were insufficient to investigate on the effect of adjuvant chemotherapy separately in different TNM stages in terms of both OS and DFS. No plausible source of heterogeneity was formally identified, although variability in treatment regimens and TNM stages of enrolled patients might have played a significant role in the difference of reported results.
AUTHORS' CONCLUSIONS:
The results of this meta-analysis support the use of 5-FU based postoperative adjuvant chemotherapy for patients undergoing apparently radical surgery for non-metastatic rectal carcinoma. Available data do not allow us to define whether the efficacy of this treatment is highest in one specific TNM stage. The implementation of modern anti-cancer agents in the adjuvant setting is warranted to improve the results shown by this meta-analysis. Randomized trials of adjuvant chemotherapy for patients receiving preoperative neoadjuvant therapy are also needed in order to define the role of postoperative chemotherapy in the multimodal treatment of resectable rectal cancer
A biography of John Eliot, 1604-1690
No full textThesis (Ph.D.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.The objective of this dissertation is to re-create, as thoroughly as possible, the life of John Eliot, 1604-1690. To accomplish this end, the author has used an historical and descriptive method.
The author began by gathering all the available material he could find which had direct bearing on the preacher's life. These materials were then critically evaluated in the light of scholarly knowledge of New England Puritanism. The result is an essay designed to reveal in an original manner the life of the "Apostle to the Indians," and the "Saint of the New England Way," within his historic, political, and social setting.
EARLY LIFE: John Eliot was the son of Bennett Eliot and Lettese Agar. He was baptized on August 24, 1604, in Nazing, England. He grew up in the villages of East Anglia. English Puritanism was vibrant during this period, and Eliot was strongly influenced by Puritan thinking. In 1630, Eliot migrated to Massachusetts.
THE THEOLOGICAL CLIMATE IN MASSACHUSETTS: The covenant or federalist theology was the dominating force in Puritan Massachusetts. This theology was so forceful that it intimately influenced the whole social, political, and ecclesiastical structure of the Bay Colony. The church polity of the covenant contained the leaven of democracy with its provision for voting and discussion amongst church members. Church and state were mutually supportive, but not in unity.
ELIOT AS TEACHER AND PASTOR: In 1632, John Eliot was ordained a teacher in the First Church, Roxbury, "to teach Doctrine & therein to Administer a word of knowledge." The young Puritants vigorous ascetic tendencies adapted him well to his role. John Eliot helped guide the church during the dangerous times of the balky Roger Williams and the winsome Anne Hutchinson. He was one of the leaders at all of the early synods that helped to farm Congregational polity. At these synods, he was deeply involved in the Half-Way Covenant controversy.
ELIOT'S EFFORTS FOR THE INDIANS: Eliot did his best to convert the Indians by making them conform to English patterns of life. He preached to them in their own tongue. He encouraged Indian publications, Indian towns, and Indian churches. The greatest single monument to Eliotts life was the translation of the Bible into Algonquin. The Bible was dedicated and presented to Charles II in 1664.
Eliot's sacred, dedicated mission was a failure. War, vice, drunkenness, and disease hastened the demise of the Massachusetts Indians. Why did he fail? Probably because he was more concerned for the Indians(1) sinful condition than he was interested in the Indians(1) culture. The integrative nature of his theology forced him to look at the Indian in terms of himself. He tried to offer the Indian a religion, ideal and experience that he believed he had achieved for himself. He was only able to see the savage Indian world in terms of the civilized Puritan Reality.
ELIOTIS OTHER LABORS: Eliot labored in a wide range of early Massachusetts life. For nearly sixty years he served a growing parish. He was their sole clergyman from 1642-1650, and 1674-1689. He served as "overseer" at Harvard College from 1642-1685. He established fourteen Indian towns, the Roxbury Latin School, and the Eliot School, Jamaica Plain. He printed fifteen Indian translations, including two entire editions of the Bible. He was the first to request funds for a college in North America. He was an editor of the first book printed in North America, The Bay Psalm Book.
ELIOT'S LAST YEARS: Eliot's old age was mostly spent alone. He had buried his supportive wife and his five exemplary sons, three of whom were devoted to religious work. Only a daughter survived him. He watched the decline of the churches and the Indian mission. He saw the tyranny of Andros descend upon the colony and then lift again after the victory of William of Orange. A moment before death, at the age of eighty-six, he is recorded to have said, "Welcome joy!" He was not afraid to die. But the Massachusetts Indians had lost a great champion.2999-01-0
Customer feedback systems in tourism : a study of interdependent services of German travel agencies, tour operations and airlines
No full textA high level of service quality is being widely acknowledged among German tourism marketers as the strategy to survive in an increasingly competitive market. In tourism many independent suppliers contribute to the tourist experience. This concept is critical to the industry as poor performance within one sector may result in low tourist satisfaction and subsequently reflect poor on all providers.
Customer feedback systems have the potential to help management identify customers' expectations and causes of (dis)satisfaction in order to then communicate necessary service improvements back to the employees. Little knowledge exists how feedback systems can be applied to tourism systems. This exploratory study focuses on interdependent services of travel agents, tour operators and airlines. It investigates on the current extent of customer feedback systems in each sectors as well as the feedback information exchange between the three organisation types. Furthermore, it aims to identify barriers and improvement potential of such cooperation.
Results indicate that all organisations collect information. However, feedback systems as proposed in the literature exists in only a few companies. Most organisations do not use a combination of different feedback methods. They also lack communication channels/ procedures to implement improvement needs into the service delivery process. The researcher argues that such feedback information systems are not effective tools to increase an organisation's service quality. Findings further suggest that no established cooperation in terms of customer feedback information exists between the organisations.
The researcher recommends that, prior to investing in data collection methods, management should focus on the implementation of communication systems throughout the whole organisation using improvement procedures and employee research. The author suggests how the three organisation types can collect feedback information more effectively. Cooperative feedback systems should be established in a step-by-step approach. It is recommended to start with information exchange about current feedback systems and cooperative research on inter-organisational processes
Academic Perspectives on Agribusiness: An International Survey
No full textThe IFAMR is published by (IFAMA) the International Food and Agribusiness Management Review. www.ifama.orgpromotion and tenure, agribusiness, teaching, grantsmanship, research, Agribusiness, Institutional and Behavioral Economics, Productivity Analysis, Teaching/Communication/Extension/Profession, Q130,
Modulation of elastin by monocytes and their secretions
No full textPLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please log in with a valid BU account to access and click Download. If you are the author of this work and would like to make it publicly available, please contact [email protected] (M.Sc.D.)--Boston University, Henry M. Goldman School of Graduate Dentistry, 1994.Includes bibliographical references (leaves 41-45)Monocytes are functionally diverse cells that have the capacity to secrete several biologically active molecules that modulate the metabolism of other cell types. To determine the influence of monocyte secreted proteins or live monocytes on the metabolism of cultured smooth muscle cells, a sequence of experiments was designed. Monocyte conditioned medium (MCM) or freshly isolated monocytes were added to smooth muscle cell cultures of various ages. The focus of these studies was the extracellular matrix. Treatment of smooth muscle cell culture with MCM drastically decreased the elastin accumulation in the extracellular matrix. The decrease did not appear until the second or third week after the initial exposure of the cultures when compared to untreated smooth muscle cell cultures, was both dose and time dependent. Live monocytes, when freshly plated onto the smooth muscle cells were active in the solubilization of the existing matrix. Conditioned medium reduced the elastin to a greater extent than live cells under several experimental conditions, suggesting labile inhibitors might be closely associated with the phagocytes. These results show that exposure of the smooth muscle cells to monocyte products reduces the amount of elastin accumulation in the matrix. The mechanism responsible for this novel observation is unknown
Clinical deterioration during antituberculosis treatment in a high HIV-1 prevalence setting
No full textFrom Maine to Chiloé: the effects of social enterprises on marginalized experiences: a comparative study of Penobscot Bay Islands, Maine and Chiloe Islands, Chile
No full textAlthough the notion of islands contains a strong association or undertone of isolation and closure, islands are never closed environments. None the less, Islands are susceptible to exogenous factors and often exposed to development processes that can lead to inequality and inequity in society and space. Global change and the ongoing progression of globalization and processes of deregulation may deepen regional disparities and thus increase or position areas in a state of marginalization. Furthermore, on islands, while size itself matters in economic terms, topography and geographic location relative to major economic centers can also position them in a state of marginalization.
Over recent decades, some islands have experienced improvements in terms of their infrastructure, transportation and communication systems. Yet they still struggle with certain aspects such as the cost for daily operation of services, and the overall aspects of development and decision making processes that affect their day to day livelihoods. This research revealed a series of day to day challenges that people on remote islands face. A social enterprise (SE) is a distinctive form of entity that is rapidly gaining recognition from policy makers worldwide. The SEs are seen as unique entities that are changing relationships among those engaged in the market place, civil society and public institutions. They are able to do this through the pursuit of goals that go beyond mere profit acquisition. V
This study compares SEs located on islands in the Penobscot Bay, off the coast of Maine on the United States’ eastern sea board, and the Islands of Chiloé, off the southwest coast of Chile. This study of SEs offers an opportunity to understand people’s experiences with SEs and whether, how, and under what circumstances SEs affect the lives of those experiencing marginalization. Furthermore, it explores the effect on the level of inclusion of individuals within island society and their communities and how SEs aid their members in improving their quality of life
Is the lack of smartphone data skewing wealth indices in low-income settings?
No full textBackground Smartphones have rapidly become an important marker of wealth in low- and middle-income countries, but international household surveys do not regularly gather data on smartphone ownership and these data are rarely used to calculate wealth indices. Methods We developed a cross-sectional survey module delivered to 3028 households in rural northwest Burkina Faso to measure the effects of this absence. Wealth indices were calculated using both principal components analysis (PCA) and polychoric PCA for a base model using only ownership of any cell phone, and a full model using data on smartphone ownership, the number of cell phones, and the purchase of mobile data. Four outcomes (household expenditure, education level, and prevalence of frailty and diabetes) were used to evaluate changes in the composition of wealth index quintiles using ordinary least squares and logistic regressions and Wald tests. Results Households that own smartphones have higher monthly expenditures and own a greater quantity and quality of household assets. Expenditure and education levels are significantly higher at the fifth (richest) socioeconomic status (SES) quintile of full model wealth indices as compared to base models. Similarly, diabetes prevalence is significantly higher at the fifth SES quintile using PCA wealth index full models, but this is not observed for frailty prevalence, which is more prevalent among lower SES households. These effects are not present when using polychoric PCA, suggesting that this method provides additional robustness to missing asset data to measure underlying latent SES by proxy. Conclusions The lack of smartphone data can skew PCA-based wealth index performance in a low-income context for the top of the socioeconomic spectrum. While some PCA variants may be robust to the omission of smartphone ownership, eliciting smartphone ownership data in household surveys is likely to substantially improve the validity and utility of wealth estimates.
Keywords
Author Keywords:Wealth index; Smartphones; Socioeconomic status; Principal components analysis; Burkina Fasopublished_or_final_versio
Predicting adherence to antiretroviral therapy and retention to HIV care : effects of baseline biopsychosocial status and neuropsychological functioning
No full textThese drugs have demonstrated efficacy in improving immune function and reducing HIV-related morbidity and mortality, and while a cure is not available, patients on treatment may live longer, healthier lives. However, early optimism has been tempered by the growing recognition that meticulous adherence is a prerequisite for optimal clinical response and prevention of drug resistance
Interactions Between Delia platura and Erwinia amylovora Associated with Insect-Mediated Transmission of Shoot Blight
No full textErwinia amylovora is a bacterial pathogen of rosaceous plants that can be devastating to commercial apple and pear production worldwide. Exopolysaccharide (EPS) production is essential for pathogenicity, aiding in biofilm production, and plant defense protection. EPS also plays an epidemiological role in the form of bacterial ooze, which is generated when E. amylovora builds to such high levels within the parenchyma that it ruptures the plant epidermis and a mixture of bacteria encased in EPS exudes from the injury. Insects such as Delia platura feed on the ooze and become potential vectors in the process. The goal of this study was to investigate interactions between D. platura and E. amylovora to better understand how insects facilitate shoot blight. We demonstrate for the first time that D. platura can successfully transmit pathogen cells that initiate new infections in mechanically damaged apple shoots and that EPS aids in adherence of E. amylovora to the insect surface. We show that flies can carry the bacteria externally for at least 5 days and that they shed a constant daily rate. We also show that E. amylovora strains differing in virulence do not behave differently when associated with D. platura and that consumption of E. amylovora has no effect on insect survival. Our data demonstrate that flies can be efficient facilitators of new shoot blight infections, but the field conditions that make this type of transmission possible require further investigation.[Figure: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license
