Analytical and clinical validation of PATHWAY Anti-HER-2/neu (4B5) antibody to assess HER2-low status for trastuzumab deruxtecan treatment in breast cancer.

In DESTINY-Breast04 (DB-04), safety and efficacy of HER2-targeted antibody-drug conjugate (ADC) trastuzumab deruxtecan (T-DXd) in previously treated HER2-low unresectable/metastatic breast cancer were established. This manuscript describes the analytical validation of PATHWAY Anti-HER2/neu (4B5) Rabbit Monoclonal Primary Antibody (PATHWAY HER2 (4B5)) to assess HER2-low status and its clinical performance in DB-04. Preanalytical processing and tissue staining parameters were evaluated to determine their impact on HER2 scoring. The recommended antibody staining procedure provided the optimal tumor staining, and deviations in cell conditioning and/or antibody incubation times resulted in unacceptable negative control staining and/or HER2-low status changes. Comparisons between antibody lots, kit lots, instruments, and day-to-day runs showed overall percent agreements (OPAs) exceeding 97.9%. Inter-laboratory reproducibility showed OPAs of ≥97.4% for all study endpoints. PATHWAY HER2 (4B5) was utilized in DB-04 for patient selection using 1340 tumor samples (59.0% metastatic, 40.7% primary, (0.3% missing data); 74.3% biopsy, 25.7% resection/excisions). Overall, 77.6% (823/1060) of samples were HER2-low by both central and local testing, with the level of concordance differing by sample region of origin and collection date. In DB-04, the efficacy of T-DXd over chemotherapy of physician's choice was consistent, regardless of the characteristics of the sample used (primary or metastatic, archival, or newly collected, biopsy or excision/resection). These results demonstrate that PATHWAY HER2 (4B5) is precise and reproducible for scoring HER2-low status and can be used with multiple breast cancer sample types for reliably identifying patients whose tumors have HER2-low expression and are likely to derive clinical benefit from T-DXd.

Neurological patient and informal caregiver quality of life, and caregiver burden: A cross-sectional study of postdischarge community neurological nursing recipients.

Neurological conditions produce considerable disease burden.To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden.A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview.Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression.A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.

Evaluation of an Australian neurological nurse-led model of postdischarge care.

Neurological disorders are a leading cause of disease burden worldwide, placing a heavy demand on health systems. This study evaluated the impacts and cost savings of a community-based nursing service providing supported discharge for neurological patients deemed high-risk for unplanned emergency department presentations and/or hospital readmissions. It focused on adult patients with stroke, epilepsy, migraine/headache or functional neurological disorders discharged from a Western Australian tertiary hospital. An observational design was used comprising prospective enrolment of patients receiving nurse-led supported discharge and follow-up (Neurocare), 21 August 2018 to 6 December 2019 (N = 81), and hospital administrative data, 1 February 2016 to 31 January 2018, for patients in previous care model (N = 740). Healthcare utilisation and annualised cost savings from reduced rehospitalisation and/or emergency department presentations within 28 days post discharge were compared. Neurocare patients' postdischarge functional and health-related quality of life outcomes, and perceived involvement in self-management and integrated care were surveyed. The hospital's total cost savings are A$101,639 per annum and A$275/patient/year with a return on investment of 2.01. There was no significant difference in hospital length of stay (LOS) between models, but older age was associated with longer length of hospital stay and a predictor for non-neurological readmissions. Neurocare patients showed improved functional status, less equipment and/or service needs, improved health-related quality of life. They felt involved in self-managing their condition with well-integrated postdischarge care. This nurse-led model of transitional care for neurology patients discharged from hospital produced cost savings and a positive return on investment compared with usual care. With service maturity, earlier supported hospital discharge and reduced LOS may follow. Patients' reduced service needs and improved functional status and health-related quality of life may positively impact healthcare utilisation. Future research should include larger patient samples and multiple sites.

Artificial Intelligence-Assisted Amphiregulin and Epiregulin IHC Predicts Panitumumab Benefit in RAS Wild-Type Metastatic Colorectal Cancer.

PURPOSE: High tumor mRNA levels of the EGFR ligands amphiregulin (AREG) and epiregulin (EREG) are associated with anti-EGFR agent response in metastatic colorectal cancer (mCRC). However, ligand RNA assays have not been adopted into routine practice due to issues with analytic precision and practicality. We investigated whether AREG/EREG IHC could predict benefit from the anti-EGFR agent panitumumab. EXPERIMENTAL DESIGN: Artificial intelligence algorithms were developed to assess AREG/EREG IHC in 274 patients from the PICCOLO trial of irinotecan with or without panitumumab (Ir vs. IrPan) in RAS wild-type mCRC. The primary endpoint was progression-free survival (PFS). Secondary endpoints were RECIST response rate (RR) and overall survival (OS). Models were repeated adjusting separately for BRAF mutation status and primary tumor location (PTL). RESULTS: High ligand expression was associated with significant PFS benefit from IrPan compared with Ir [8.0 vs. 3.2 months; HR, 0.54; 95% confidence interval (CI), 0.37-0.79; P = 0.001]; whereas low ligand expression was not (3.4 vs. 4.4 months; HR, 1.05; 95% CI, 0.74-1.49; P = 0.78). The ligand-treatment interaction was significant (P interaction = 0.02) and remained significant after adjustment for BRAF-mutation status and PTL. Likewise, RECIST RR was significantly improved in patients with high ligand expression (IrPan vs. Ir: 48% vs. 6%; P < 0.0001) but not those with low ligand expression (25% vs. 14%; P = 0.10; P interaction = 0.01). The effect on OS was similar but not statistically significant. CONCLUSIONS: AREG/EREG IHC identified patients who benefitted from the addition of panitumumab to irinotecan chemotherapy. IHC is a practicable assay that may be of use in routine practice.

Immunohistochemical Detection of Synuclein Pathology in Skin in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinsonism.

BACKGROUND: Recent studies reported abnormal alpha-synuclein deposition in biopsy-accessible sites of the peripheral nervous system in Parkinson's disease (PD). This has considerable implications for clinical diagnosis. Moreover, if deposition occurs early, it may enable tissue diagnosis of prodromal PD. OBJECTIVE: The aim of this study was to develop and test an automated bright-field immunohistochemical assay of cutaneous pathological alpha-synuclein deposition in patients with idiopathic rapid eye movement sleep behavior disorder, PD, and atypical parkinsonism and in control subjects. METHODS: For assay development, postmortem skin biopsies were taken from 28 patients with autopsy-confirmed Lewy body disease and 23 control subjects. Biopsies were stained for pathological alpha-synuclein in automated stainers using a novel dual-immunohistochemical assay for serine 129-phosphorylated alpha-synuclein and pan-neuronal marker protein gene product 9.5. After validation, single 3-mm punch skin biopsies were taken from the cervical 8 paravertebral area from 79 subjects (28 idiopathic rapid eye movement sleep behavior disorder, 20 PD, 10 atypical parkinsonism, and 21 control subjects). Raters blinded to clinical diagnosis assessed the biopsies. RESULTS: The immunohistochemistry assay differentiated alpha-synuclein pathology from nonpathological-appearing alpha-synuclein using combined phosphatase and protease treatments. Among autopsy samples, 26 of 28 Lewy body samples and none of the 23 controls were positive. Among living subjects, punch biopsies were positive in 23 (82%) subjects with idiopathic rapid eye movement sleep behavior disorder, 14 (70%) subjects with PD, 2 (20%) subjects with atypical parkinsonism, and none (0%) of the control subjects. After a 3-year follow-up, eight idiopathic rapid eye movement sleep behavior disorder subjects phenoconverted to defined neurodegenerative syndromes, in accordance with baseline biopsy results. CONCLUSION: Even with a single 3-mm punch biopsy, there is considerable promise for using pathological alpha-synuclein deposition in skin to diagnose both clinical and prodromal PD. © 2020 International Parkinson and Movement Disorder Society.

Development of an Immunohistochemical Assay to Detect the Ataxia-Telangiectasia Mutated (ATM) Protein in Gastric Carcinoma.

Ataxia-telangiectasia mutated (ATM), a key activator of DNA damage response mechanisms, represents a potential biomarker for targeted gastric carcinoma therapies. A phase II study (Study 39; NCT01063517) designed to investigate the combination olaparib plus paclitaxel in patients with recurrent or metastatic gastric cancer did not meet its primary endpoint of progression-free survival; however, an improvement in the secondary endpoint of overall survival was recorded with a greater overall survival benefit noted in patients with ATM-negative tumors. An ATM immunohistochemical (IHC) diagnostic assay was developed to identify patients who may respond favorably to targeted therapies and deployed in the confirmatory phase III GOLD trial (NCT01924533). The VENTANA ATM (Y170) assay was developed for investigational use in formalin-fixed, paraffin-embedded gastric carcinoma samples using an anti-ATM rabbit monoclonal antibody (clone Y170) and was optimized with OptiView DAB IHC Detection Kit on a BenchMark ULTRA instrument. The assay was deployed in studies assessing sensitivity, specificity, robustness, precision, and determining optimal ATM staining cutoff to define ATM-deficiency (ATM-low). The ATM (Y170) assay met all predefined product development acceptance criteria. Multiple parameters were characterized, including repeatability, reproducibility, analytical sensitivity, specificity, robustness, and product stability. The scoring algorithm was defined; gastric carcinoma samples were considered ATM-negative or ATM-positive when <25% or ≥25%, respectively, of tumor cell nuclei expressed ATM at any IHC stain intensity and nuclei of immune and/or endothelial cells expressed ATM at a moderate stain intensity (internal positive control). Results highlight reproducibility of the assay, supporting suitability for investigational use for evaluation of gastric carcinoma samples using tumor cell staining cutoff of <25% to define ATM-deficiency. Using this ATM assay, phase III GOLD trial (NCT01924533) clinical trial did not meet its primary endpoint, only suggesting, but not demonstrating, that assessment of ATM levels by IHC could possibly be useful in assessing the degree of benefit that may be achieved by adding olaparib to paxitaxel when treating gastric carcinoma. The utility of ATM (Y170) assay as a companion diagnostic requires further clinical validation.

Exercise, fitness and musculoskeletal health of undergraduate nursing students: A cross-sectional study.

AIMS: To describe the exercise, physical fitness and musculoskeletal health of nursing students. BACKGROUND: Nursing students are prone to musculoskeletal disorders restricting work ability. Physical fitness and leisure-time exercise may affect responses to workplace exposures and risk for work-related musculoskeletal disorders. DESIGN: A cross-sectional study. METHOD: Between August 2013 and April 2015, a convenience sample of 111 nursing students performed submaximal exercise tests. Nursing work, exercise and musculoskeletal health were surveyed and analysed descriptively. RESULTS: Students' mean age was 30.0 years, 89.2% were female and 20.0% worked in nursing while studying. Highest annual prevalence of musculoskeletal trouble was in low back (45.6%), neck (32.0%) and shoulder (18.5%) regions. Most exercised regularly but did not meet weekly cardiorespiratory, resistance, neuromotor and flexibility exercise recommendations and had poor to average fitness levels. Approximately 40% were overweight or obese; 26.1% had risk for obesity-related disease. CONCLUSIONS: Interventions to improve nursing students' physical condition before entering the nursing workforce appear warranted. IMPACT: Imbalance between physical work capacity and demanding workloads increases musculoskeletal disorder risk amongst undergraduate nursing students. A large proportion studied reported recent musculoskeletal trouble (particularly low back, neck and shoulder). They exhibited modifiable characteristics of overweight/obese, poor fitness and inadequate leisure-time exercise, predisposing them to work-related musculoskeletal disorders. Undergraduate preparation should raise nursing students' health literacy about physical fitness and ways to achieve it, for their musculoskeletal health and work capacity. Improving nursing students' fitness may enhance their work preparedness and help them achieve longevity in this physically demanding occupation.

Rapid evidence assessment of approaches to community neurological nursing care for people with neurological conditions post-discharge from acute care hospital.

Neurological conditions represent leading causes of non-fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long-term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February-June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post-discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English-language studies published January 2000 to June 2016. Data were extracted using a purpose-designed protocol. Studies describing community neurological nursing care services post-discharge for adults with stroke, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self-management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post-discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology-generalist nurses to promote continuity of care for people with long-term or progressive, long-term neurological conditions post-discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care.

Issues impacting on enrolled nurse education for Aboriginal and Torres Strait Islander students: a discussion.

Background: Achieving increased participation of Aboriginal and Torres Strait Islander peoples in Australia's health workforce, particularly nursing, is federal government policy imperative. However, the uptake of Aboriginal and Torres Strait Islander students into nursing has stalled and their attrition from tertiary nursing courses is considerably higher than for other students. Aim: To alert the profession to issues impacting enrolled nursing education for Aboriginal and Torres Strait Islander students. Design: Discussion paper. Results: Studies of Aboriginal and Torres Strait Islander students mainly focus on tertiary education for registered nurses whereas vocational education and training (VET) for enrolled nurses is usually overlooked. It is generally assumed that the issues influencing the recruitment, attrition, and retention of Aboriginal and Torres Strait Islander students in higher education universities and other institutions similarly impact enrolled nursing students in the VET sector. Conclusion: Research that contributes robust evidence-based knowledge specifically on strategies addressing issues in enrolled nursing education for Aboriginal and Torres Strait Islander students and their employment uptake is required.

Adaptation and pretesting of the College Persistence Questionnaire V3 (Short Form) for measuring intention to persist among Aboriginal Diploma of Nursing students.

BACKGROUND: Culturally appropriate health care delivery is essential to improve health outcomes for Aboriginal peoples. There is a shortage of Aboriginal and Torres Strait Islander nurses partly due to disproportionately high non-completion rates among tertiary sector students. The College Persistence Questionnaire V3 (Short Form) provides scales for gauging major predictors of retention. OBJECTIVE: To adapt an instrument for measuring intention to persist among Aboriginal Diploma of Nursing students. DESIGN: Instrument adaptation and pretesting. PARTICIPANTS: A convenience sample of Aboriginal Diploma of Nursing students (N=21) at a registered training organisation in Australia. METHODS: The instrument was mapped against the domain of interest and modified. Ten experts reviewed its content validity; its reading ease and educational grade reading level were assessed. RESULTS: The expert panel endorsed individual items as valid (item-level Content Validity Index 0.90-1.00) and scale-level validation was acceptable (average scale-level Content Validity Index=0.98). The minimally-adapted instrument was 'fairly easy' to read and suitable for general adult audiences (Flesch Reading Ease score 71.3) and was below the United States 8th grade reading level (Flesch-Kincaid Grade Level 6.7). Students took <30min to complete the questionnaire. All understood its purpose, found instructions clear, and questions easy to answer. Most rated its length 'Just right'. CONCLUSION: The College Persistence Questionnaire - Registered Training Organisation Version appears suitable for assessing factors influencing retention/attrition among Aboriginal Diploma of Nursing students. Piloting and psychometric evaluation is recommended.

The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data.

OBJECTIVES: The aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data. DESIGN: Logistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury. SETTING: Eleven acute care metropolitan hospitals in Western Australia. SAMPLE: Patients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006-2007) and 130,540 in the post-test period (2009-2010). RESULTS: The results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia. CONCLUSION: The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored.

Barriers and enablers to retention of Aboriginal Diploma of Nursing students in Western Australia: An exploratory descriptive study.

BACKGROUND: Nursing education appropriate to the learning needs of Aboriginal and Torres Strait Islander students is essential to prepare them for registration as nurses. Despite incentives to encourage the recruitment and retention of such students, a disproportionate number commence but do not finish their nursing studies. OBJECTIVES: To describe the barriers and enablers to the retention of Aboriginal students in a Diploma of Nursing course (Enrolled/Division 2) in Western Australia. DESIGN: An exploratory descriptive design was used. SETTINGS: One metropolitan educational facility catering for Aboriginal people offering an 18-month course in a block release format. PARTICIPANTS: A convenience sample of 16 students aged 18+years. METHODS: Newly enrolled students (n=10) participated in an investigator-developed survey to explore their motivation for entering the course. Nine of these students and a further seven students who were nearing the end of their course participated in focus groups to explore their experiences of nursing education. RESULTS: Survey respondents had a mean age of 32.7years; most were female, had nominated family as influential in the decision to enroll, and commenced with a friend. Regarding recruitment and retention, the qualitative data highlighted the importance of students': perceptions of the training organisation, characteristics, experiences of nursing education, and sources of support. CONCLUSIONS: Strategies that develop individual's resilience and engage supportive networks can assist Aboriginal students to negotiate tertiary nursing study. Academic skills assessments supplemented with tailored educational support at entry can resource students to navigate increasingly complex course content. Flexibility throughout the course enables students to negotiate study in a context of ongoing family and financial obligations.

Validity and reliability of an online extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E2) to measure nurses' fitness.

AIMS AND OBJECTIVES: To describe modifications to a second extended version of the Nordic Musculoskeletal Questionnaire for online use in nursing populations, and check validity and reliability. BACKGROUND: The Nordic Musculoskeletal Questionnaire has been used to assess the severity and impact of musculoskeletal symptoms in occupational groups. The reliability of a previous extended version was established for paper-based, self-administration among nursing students. This current study extended the questionnaire to collect more information regarding musculoskeletal symptoms in all nine body regions and their work-relatedness, as an instrument is needed to gather evidence about the impact of fitness levels on occupational musculoskeletal disorders among nurses. DESIGN: Psychometric evaluation. METHOD: Sixty-five undergraduate nurses completed the online extended Nordic Musculoskeletal Questionnaire twice. Content validity was examined by expert review and construct validity by exploratory factor analysis of 90 responses from the first completion. Reliability was checked by examining internal consistency, kappa statistics, proportions of observed, and positive and negative agreements, intra-class correlation coefficient and standard error of measurement. RESULTS: The instrument had high internal consistency and exploratory factor analysis revealed it was a relatively homogenous (unidimensional) measure of musculoskeletal symptom severity. Age of onset of symptoms questions were reliable, with high mean intra-class correlation coefficients and low mean standard errors of measurement. Overall, questions showed high mean strengths of agreement and proportions of observed agreement: three-quarters of the prevalence questions and 99% of the severity/impact questions had 10% or fewer disagreements. CONCLUSIONS: Modifications to the Nordic Musculoskeletal Questionnaire and online administration did not diminish its validity or reliability for obtaining information about the severity of nurses' musculoskeletal symptoms. RELEVANCE TO CLINICAL PRACTICE: Occupational musculoskeletal disorders are an issue for nurses. This questionnaire can be used to monitor nurses' musculoskeletal health, and in musculoskeletal disorder prevention studies.

Impact and costs of home-based trial of void compared with the day care setting.

AIMS: This paper presents the relative merits and comparative costs of conducting trial of void using Hospital-In-The-Home vs. the Day Procedure Unit. BACKGROUND: Hospitals increasingly discharge patients with acute urinary retention with indwelling urinary catheters. For these to be removed and patients supported to return to normal urinary function, outpatient or in-home services are used. To date, the relative effectiveness and costs of Hospital-In-The-Home care and Day Procedure Unit care for trial of void have not been examined. DESIGN: This retrospective study used a static-group comparison design. METHODS: Hospital administrative data from 1 February 2009-30 March 2011 for patients having trial of void in the Day Procedure Unit (n = 107) and Hospital-In-The-Home (n = 163) of a tertiary hospital in Western Australia were compared in terms of patient outcomes and costs. RESULTS: Day Procedure Unit patients had longer wait times than Hospital-In-The-Home patients; there was no difference between the two groups for average per patient days of service or successful first trials. Hospital-In-The-Home care did not increase the overall period of care. Per patient average ward-equivalent cost in the Day Procedure Unit was A$396 higher than the Hospital-In-The-Home ward-equivalent cost. The average cost saving per patient for Hospital-In-The-Home care including trial of void cost and emergency department visits was A$117. CONCLUSION: Patient outcomes from Hospital-In-The-Home trial of void in low-risk patients were comparable to those of Day Procedure Unit care and less costly. Hospital-In-The-Home care for this well-defined procedure could permit more efficient management of patient throughput.

Feasibility of intensity-modulated and image-guided radiotherapy for locally advanced esophageal cancer.

BACKGROUND: In this study the feasibility of intensity-modulated radiotherapy (IMRT) and tomotherapy-based image-guided radiotherapy (IGRT) for locally advanced esophageal cancer was assessed. METHODS: A retrospective study of ten patients with locally advanced esophageal cancer who underwent concurrent chemotherapy with IMRT (1) and IGRT (9) was conducted. The gross tumor volume was treated to a median dose of 70 Gy (62.4-75 Gy). RESULTS: At a median follow-up of 14 months (1-39 months), three patients developed local failures, six patients developed distant metastases, and complications occurred in two patients (1 tracheoesophageal fistula, 1 esophageal stricture requiring repeated dilatations). No patients developed grade 3-4 pneumonitis or cardiac complications. CONCLUSIONS: IMRT and IGRT may be effective for the treatment of locally advanced esophageal cancer with acceptable complications.

The Use of Unregulated Staff: Time for Regulation?

Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes.

Feldenkrais method empowers adults with chronic back pain.

A phenomenological approach was used to explore the experiences of 11 adults attending Awareness Through Movement lessons in the Feldenkrais Method to manage chronic-episodic back pain. Semistructured interviews were analyzed. The results suggest improving self-efficacy through somatic education and awareness potentially offers a way forward given the back pain epidemic.

Enhanced visibility of colonic neoplasms using formulaic ratio imaging of native fluorescence.

BACKGROUND AND OBJECTIVES: Colonoscopy is the preferred method for colon cancer screening, but can miss polyps and flat neoplasms with low color contrast. The objective was to develop a new autofluorescence method that improves image contrast of colonic neoplasms. STUDY DESIGN/MATERIALS AND METHODS: We selected the three strongest native fluorescence signals and developed a novel method where fluorescence images are processed in a ratiometric formula to represent the likely cellular and structural changes associated with neoplasia. Native fluorescence images of fresh surgical specimens of the colon containing normal mucosa, polypoid and flat adenomas as well as adenocarcinoma were recorded using a prototype multi-spectral imager. Sixteen patients, with a mean age of 62 years (range 28-81) undergoing elective resection for colonic neoplasms were enrolled. High contrast images were seen with fluorescence from tryptophan (Tryp), flavin adenine dinucleotide (FAD) and collagen. RESULTS: When the image intensity of Tryp was divided pixel by pixel, by the intensities of FAD and collagen, the resulting formulaic ratio (FR) images were of exceptionally high contrast. The FR images of adenomas and adenocarcinomas had increased Weber contrast. CONCLUSIONS: FR imaging is a novel imaging process that represents the likely metabolic and structural changes in colonic neoplasia that produces images with remarkably high contrast.

Small cell carcinoma of the ovary of the hypercalcemic type presenting in a 5-year-old girl.

Small cell carcinoma of the ovary, hypercalcemic type is a very rare, highly aggressive tumor associated with a poor prognosis. Diagnosis is typically challenging secondary to undifferentiated cells and the rarity of the tumor. We report our experience with a 5-year-old girl who presented with stage IV disease.