Retrospective chart analysis to determine the impact of a patient-facing digital risk stratification tool combined with a clinical screener for hereditary cancer genetic risk assessment triage in a community oncology clinic.

The purpose of this study was to evaluate the utility of adding a clinical screener to the patient-facing digital risk stratification tool triage process for the identification of patients eligible for a genetic risk assessment for hereditary cancer. Digital risk stratification entries were retrospectively reviewed to determine the overall number of patients eligible for genetic risk assessment. These were also analyzed to determine how many patients were re-contacted by the clinical screener, and how many of those recontacted patients met criteria after their personal and family history was revised by the clinical screener. There was an 89.9% digital risk stratification triage tool completion rate, with 22.6% requiring contact from the clinical screener. Of the 640 patients who completed the digital tool, 5.9% met criteria for testing after their personal and/or family history was revised by the clinical screener. Overall, 51.1% of patients met criteria for a genetic risk assessment. The addition of a clinical screener further increased identification of patients eligible for genetic risk assessment. About half of patients who met criteria after being contacted by the clinical screener met criteria based on their personal diagnosis of cancer alone. Incorporation of a clinical screener to the digital screening process may serve to reduce barriers to patient completion of the tool and increase rates of patient identification for cancer genetic services.

Insertion Torques of Self-Drilling Mini-Implants in Simulated Mandibular Bone: Assessment of Potential for Implant Fracture.

PURPOSE: Fracture of orthodontic mini-implants during insertion is a limiting factor for their clinical success. The purpose of this study was to determine the fracture potential of commonly used self-drilling orthodontic mini-implants when placed into simulated thick, dense mandibular bone. MATERIALS AND METHODS: Six mini-implant systems were assessed for the potential for fracture (Aarhus, Medicon; Dual-Top, Jeil Medical; OrthoEasy, Forestadent; tomas-pin, Dentaurum; Unitek, 3M; and VectorTAS, Ormco). First, mini-implants were inserted manually, without predrilling, into bone substitutes (Sawbones) with a 3-mm-thick, dense (1.64 g/cm(3)) cortical layer. A custom-made insertion device was used for placement of mini-implants. A sixaxis force/torque transducer was secured at the base of the bone blocks to measure the maximum torque experienced during insertion. Measured insertion torques were compared with previously reported fracture torques, yielding a torque ratio (insertion torque as a percentage of fracture torque), which was used as an indicator of the potential for mini-implant fracture. Mini-implants that experienced torque ratios ≥ 75% upon insertion underwent further testing, following the manufacturer's recommendations for predrilling in thick, dense bone conditions. RESULTS: Significant differences in torque ratios were found among all mini-implants, except between OrthoEasy and Dual-Top, and OrthoEasy and VectorTAS. Overall, Aarhus had the highest torque ratio (91% ± 3%), with Unitek showing the lowest ratio (37% ± 3%). Aarhus and tomas-pin mini-implants displayed torque ratios ≥ 75% and experienced fracture upon insertion. When the manufacturer's specific predrilling recommendations were followed, no changes in torque ratio were found for Aarhus and tomas-pin. However, while Aarhus continued to fracture upon insertion, all tomas-pin mini-implants were inserted fully without fracture following predrilling. CONCLUSION: These findings support the safe use of Unitek, VectorTAS, Dual-Top, and OrthoEasy self-drilling mini-implants in areas of 3-mm-thick, 1.64 g/cm(3) dense cortical bone without predrilling. Following predrilling, fractures did not occur with tomas-pin. For implants that continued to fracture after predrilling, other strategies may be required, such as the use of larger-diameter mini-implants in thick, dense bone conditions.

Alternate Metabolic Programs Define Regional Variation of Relevant Biological Features in Renal Cell Carcinoma Progression.

PURPOSE: Clear cell renal cell carcinoma (ccRCC) has recently been redefined as a highly heterogeneous disease. In addition to genetic heterogeneity, the tumor displays risk variability for developing metastatic disease, therefore underscoring the urgent need for tissue-based prognostic strategies applicable to the clinical setting. We have recently employed the novel PET/magnetic resonance (MR) image modality to enrich our understanding of how tumor heterogeneity can relate to gene expression and tumor biology to assist in defining individualized treatment plans. EXPERIMENTAL DESIGN: ccRCC patients underwent PET/MR imaging, and these images subsequently used to identify areas of varied intensity for sampling. Samples from 8 patients were subjected to histologic, immunohistochemical, and microarray analysis. RESULTS: Tumor subsamples displayed a range of heterogeneity for common features of hypoxia-inducible factor expression and microvessel density, as well as for features closely linked to metabolic processes, such as GLUT1 and FBP1. In addition, gene signatures linked with disease risk (ccA and ccB) also demonstrated variable heterogeneity, with most tumors displaying a dominant panel of features across the sampled regions. Intriguingly, the ccA- and ccB-classified samples corresponded with metabolic features and functional imaging levels. These correlations further linked a variety of metabolic pathways (i.e., the pentose phosphate and mTOR pathways) with the more aggressive, and glucose avid ccB subtype. CONCLUSIONS: Higher tumor dependency on exogenous glucose accompanies the development of features associated with the poor risk ccB subgroup. Linking these panels of features may provide the opportunity to create functional maps to enable enhanced visualization of the heterogeneous biologic processes of an individual's disease. Clin Cancer Res; 22(12); 2950-9. ©2016 AACR.

Fracture resistance of commonly used self-drilling orthodontic mini-implants.

OBJECTIVE: To investigate the fracture resistance of six commonly used self-drilling orthodontic mini-implants by comparing their respective fracture torques during insertion. MATERIALS AND METHODS: Ninety self-drilling mini-implants from six manufacturers (Aarhus, Dual-Top, OrthoEasy, Tomas-pin, Unitek, and VectorTAS), with diameters ranging from 1.4 to 1.8 mm, were inserted into acrylic blocks using a custom-made insertion device. Insertion torques were measured using a 6-degree-of-freedom load cell fixed to the base of the acrylic blocks, and peak torques experienced at the time of fracture for each of the mini-implants were recorded. One-way analysis of variance (α  =  .05) was used to compare the fracture torques among the six different groups. RESULTS: Statistical analysis revealed significant differences (P < .05) in the peak fracture torques among mini-implant groups. Mean fracture torques ranked as follows: Unitek (72 Ncm) > Tomas-pin (36 Ncm) > Dual-Top (32 Ncm) ≈ VectorTAS (31 Ncm) > OrthoEasy (28 Ncm) > Aarhus (25 Ncm), with significant differences found between all manufacturers, except for Dual-Top and VectorTAS. CONCLUSIONS: Mini-implants tested showed a wide range of torque at fracture depending on the manufacturer, with only a weak correlation between mini-implant diameter and fracture resistance. This torque should be considered at the time of mini-implant insertion to minimize the risk of implant fracture, especially in areas of high-density bone without predrilling.

Developing a service user designed tool for the assessment of student mental health nurses in practice: a collaborative process.

In this article we describe and critically analyse the process of developing an assessment tool designed by users of mental health services to assess student nurses in practice. The developmental process raised a number of complex and unexpected issues. The findings suggest that rather than "assess" student nurses in practice, service users should have a role in reviewing student's practice. Whilst there was a consensus amongst stake-holders that engaging in this feedback process is beneficial to both the student and service user, it is the manner in which it is sought which requires further investigation.

The practice assessment of student nurses by people who use mental health services.

This paper reports on a participatory action research project focusing upon service-user involvement in the assessment of student mental health nurses in practice. The principle of student nurses being assessed by service-users was found to be desirable in theory. However, its implementation proved to be fraught with difficulty especially with regard to the concerns about increased workload and feelings of vulnerability amongst students. It is recommended that the model of assessment should be adjusted to that of review and that a program of service-users reviewing student nurses on placement be implemented and evaluated.

Weighed in the balance? The corporation of apothecaries in Bordeaux, 1690-1790.

Based on a collective biography of apothecaries, surgeons, and physicians in Bordeaux between 1690 and 1790, this article offers a counterbalance to the prevailing view of apothecaries. It suggests that, although numbers may have been falling and corporations failing elsewhere in France, the favourable situation of Bordeaux aided the survival of the corporation of apothecaries in that city. It suggests that apothecaries were important in providing a wide range of goods and services to patients, and traces their involvement in retail, wholesale, and international trade. Control of numbers is shown to be linked to a desire to exploit their monopoly of the market, which led to increases in wealth for individual practitioners. A change in traditional inheritance strategies is linked to a new emphasis on merit, and to knowledge obtained through training outside the confines of the apprenticeship system. The 'secrets of the craft' are seen to be undermined by the public nature of the emerging science of chemistry. The corporation of apothecaries in Bordeaux was transformed through its absorption of three new types of practitioner-entrepreneurs, pharmacists, and scientists-yet it survived due to the substantial and continuing presence of traditional, locally born, and locally trained apothecaries.