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1
Ferella, Francesco, Valentina Innocenzi, Nicold M. Ippolito, and Ida De Michelis. "Adsorption of CO2 by synthetic zeolites." E3S Web of Conferences 161 (2020): 01116. http://dx.doi.org/10.1051/e3sconf/202016101116.
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The paper reports on a possible way to recycle fluid catalytic cracking catalysts (FCCCs), widely used in oil refining operations. This research proposes a novel approach that leads to a near zero-waste process. The spent FCCC was leached by 1.5 mol/L of HNO3, HCl and H2SO4 solutions at 80°C, for 3 h with a solid to liquid ratio of 20 %wt/vol. The leaching yields for cerium and lanthanum were in the range 69-82 %. The solid residues from the leaching stage were used as base material for the synthesis of the zeolites by means of a combined thermal-hydrothermal treatment. The characterization of the zeolites demonstrated that the Na-A phase was predominant over the Na-X phase. The zeolites were tested as sorbent material for CO2 separation from CH4, in order to simulate the upgrading of biogas to biomethane. The maximum adsorption rate of CO2 was 0.778 mol CO2/kg of zeolite at 3 bar, with a resulting CH4 recovery of 62 % and purity of 97 %vol. The zeolites synthesized from spent FCCC represent a feasible solution to recover such industrial waste.
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Breidenich, Clare, Daniel Magraw, Anne Rowley, and James W. Rubin. "The Kyoto Protocol to the United Nations Framework Convention on Climate Change." American Journal of International Law 92, no. 2 (April 1998): 315–31. http://dx.doi.org/10.2307/2998044.
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In December 1997, in Kyoto, Japan, over 160 parties to the 1992 United Nations Framework Convention on Climate Change (FCCC or Convention) adopted the Kyoto Protocol, which, for the first time, establishes legally binding limits for industrialized countries on emissions of carbon dioxide and other “greenhouse gases.” The Kyoto Protocol (the Protocol) is quite complex, reflecting the complicated political, economic, scientific and legal issues raised by human-induced climate change. The result of more than two years of preparatory discussions and eleven days of often-intense negotiations in Kyoto, the Protocol will be opened for signature in March 1998 for one year, although countries may accede to it after that period. It will enter into force ninety days after at least fifty-five parties to the FCCC, encompassing FCCC Annex I parties that accounted in total for at least 55 percent of the total emissions for 1990 of carbon dioxide (CO2) of Annex I parties, have ratified, accepted, approved or acceded to the Protocol.
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Daly, John M., Alan G. Howald, Kelly Ann Filchner, Bonnie J. Miller, Leanne Lyons, Crystal Shereen Denlinger, Patrick O'Brien, Amanda Schlueter, Evelyn Gonzalez, and Jennifer Seggev. "Enhancing cancer survivorship through improved provider communication, care coordination, and professional education." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 104. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.104.
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104 Background: Care coordination among oncology and primary care physicians (PCPs) is an essential element of survivorship care. Providers at an NCI-designated comprehensive cancer center noted gaps in coordinating care with PCPs. We sought to develop a program that enhances communication and education between provider groups to ensure a seamless continuum of care thereby improving overall survivorship care. Methods: The Fox Chase Cancer Center (FCCC) Care Connect program was created to comprehensively connect PCPs in the regional service area with cancer center providers. Program participation requirements for PCP’s include attendance at 2 of 4 targeted professional education programs and participation in quality measures for breast, cervical, and colon cancer screening. Formalized processes to efficiently move patients between oncologists and PCP’s were established. Communication gaps were addressed by providing electronic access via a secure physician portal, access to FCCC disease navigation services, and establishment of designated referral navigators to coordinate clinical needs between provider groups. Results: FCCC initiated the Care Connect program with 5 PCP practices. During a 3 month pilot phase, FCCC directed 19 patients to Care Connect PCP’s to manage ongoing clinical needs and implement survivorship plans. Eight-six percent of referrals were classified as non-urgent. Median time from referral to PCP appointment was 16 days, 24% below regional average. One CME education program was conducted during the pilot phase. Of the attendees, 91% reported an intent to change current practice by implementing a new procedure, discussing new information or seek additional information. Attendees identified potential care barriers which will be included in future program development. Post-education, one practice referred 3 patients to the lung cancer screening program. Conclusions: A formal program that aligns PCPs and oncologists is an effective initiative to improve communication and awareness of cancer patient survivorship needs in oncology and primary care settings.
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Rajamani, Lavanya. "III. THE MAKING AND UNMAKING OF THE COPENHAGEN ACCORD." International and Comparative Law Quarterly 59, no. 3 (July 2010): 824–43. http://dx.doi.org/10.1017/s0020589310000400.
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The last two years have witnessed a flurry of diplomatic activity on climate change. In addition to the 16 weeks of scheduled inter-governmental negotiations under the auspices of the UN Framework Convention on Climate Change (FCCC), meetings, many at a Ministerial level, were convened by the G-8, the Major Economies Forum, the UN Secretary General, and Denmark, the host of the 15th Conference of Parties (COP-15) to the FCCC. Notwithstanding regular and intense engagement at the highest-level many fundamental disagreements remained in the lead up to COP-15, including on the future (or lack thereof) of the Kyoto Protocol, the legal form and architecture of the future legal regime, and the nature and extent of differential treatment between developed and developing countries.
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Goldstein, Lori J., Richard J. Bleicher, Steven J. Cohen, Elaine Sein, Margaret Anne O’Grady, Patricia A. Keeley, Bonnie J. Miller, Elyse Slater, and Tianyu Li. "Prospective quality review of breast care navigation and treatment: Fox Chase Cancer Center Partners’ (FCCCP) initiative." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 85. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.85.
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85 Background: There is increasing emphasis on quality metrics and process improvement for breast cancer treatment. FCCC designed a study to measure compliance with NCCN breast cancer guidelines at 11 FCCCP institutions. Methods: A relational data base was created to track indicators for operational timing, access, treatment modalities, and variance data in a population of breast cancer patients diagnosed and receiving first course of treatment at participating FCCCP institutions for 2009 calendar year. Pilot was conducted to ensure integrity of data collection tool in the previous year. Activation workshop, quarterly on site quality monitoring plan, real time quarterly reports to cancer committee, and benchmarking data were embedded in study. The primary objective was to benchmark participating institutions against each other and national benchmarks. Secondary objectives were to assess causes for variance and explore the role nurse navigation plays in real time quality metrics. Results: See Table. Conclusions: This novel prospective quality study demonstrated significant compliance with established breast cancer metrics across a large community hospital affiliate program. The impact of navigation appears greatest in reducing time between screening and diagnostic testing, demonstrating that navigation’s benefits extend beyond patient satisfaction to improvement of quality metrics. [Table: see text]
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Whitaker, Kristen Danielle, Ryan Bernhisel, John Kidd, Elisha Hughes, Eric Thomas Rosenthal, and Michael J. Hall. "A single-institution and commercial laboratory database analysis of BRIP1-associated cancer risks." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 1538. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.1538.
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1538 Background: BRIP1/ FANCJ participates in DNA replication and repair via interactions with BRCA1 and possibly MLH1. Previous studies have reported that pathogenic variants (PV) in BRIP1 are associated with an ~2-fold increase in risk for ovarian cancer (OC) and triple-negative breast cancer (TNBC). Although multigene panel testing for hereditary cancer (CA) has identified BRIP1 PV and uncertain variants (VUS) in patients with diverse CAs including breast (BC), colorectal (CRC) and melanoma (Mel), association with these CA types has not been established. Methods: We examined BRIP1 risks in two independent populations: Fox Chase Cancer Center (FCCC) and Myriad Genetics (MGL). At FCCC, pedigrees of BRIP1 PV ( N= 10) and VUS families ( N= 47) were reviewed. The MGL population included patients referred for testing by multigene panel (9/2013-12/2019) ( N= 586,740). Multivariable logistic regression analysis estimated BRIP1 CA risks as odds ratios (ORs) and 95% confidence intervals (CIs). Models were adjusted for age, sex, ancestry, personal CA history (PHX), and family CA history. Results: In the FCCC cohort, BRIP1 PV carriers ( N= 12) reported PHX of early-onset ( < 50) BC, CRC, and bladder CA. BRIP1 VUS were also identified among several patients with striking PHX and negative panel testing: BC < 40 ( N= 3), bilateral BC ( N= 4), TNBC ( N= 2), CRC < 40 ( N= 3), and a patient with 3 CAs < 40 (CRC, BC, and Mel). All FCCC families with a BRIP1 PV and select VUS families ( N= 6) are seen in the Table. In the MGL population, 0.3% (1,678/586,740) carried a BRIP1 PV. Logistic regression analyses found that female BRIP1 PV carriers have significantly increased risk for OC (OR 2.40, 95% CI 1.93-2.98) and TNBC (OR 1.93, 95% CI 1.52-2.46). Data were insufficient for testing risk of bladder or prostate CA. Findings did not support associations of BRIP1 with CRC, melanoma, endometrial, pancreatic or gastric CA. Conclusions: BRIP1 PV and VUS may be identified in patients with diverse CA histories. These results confirm studies showing that BRIP1 PV are associated with an ~2-fold increased risk of OC and TNBC, but do not support increased risks of CRC, melanoma or endometrial CA in BRIP1 PV carriers. [Table: see text]
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Varbanov, Petar, Jiří Klemeš, Ramesh K. Shah, and Harmanjeet Shihn. "Power Cycle Integration and Efficiency Increase of Molten Carbonate Fuel Cell Systems." Journal of Fuel Cell Science and Technology 3, no. 4 (December 15, 2005): 375–83. http://dx.doi.org/10.1115/1.2349515.
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A new view is presented on the concept of the combined cycle for power generation. Traditionally, the term “combined cycle” is associated with using a gas turbine in combination with steam turbines to better utilize the exergy potential of the burnt fuel. This concept can be broadened, however, to the utilization of any power-generating facility in combination with steam turbines, as long as this facility also provides a high-temperature waste heat. Such facilities are high temperature fuel cells. Fuel cells are especially advantageous for combined cycle applications since they feature a remarkably high efficiency—reaching an order of 45–50% and even close to 60%, compared to 30–35% for most gas turbines. The literature sources on combining fuel cells with gas and steam turbines clearly illustrate the potential to achieve high power and co-generation efficiencies. In the presented work, the extension to the concept of combined cycle is considered on the example of a molten carbonate fuel cell (MCFC) working under stationary conditions. An overview of the process for the MCFC is given, followed by the options for heat integration utilizing the waste heat for steam generation. The complete fuel cell combined cycle (FCCC) system is then analyzed to estimate the potential power cost levels that could be achieved. The results demonstrate that a properly designed FCCC system is capable of reaching significantly higher efficiency compared to the standalone fuel cell system. An important observation is that FCCC systems may result in economically competitive power production units, comparable with contemporary fossil power stations.
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Ferella, Francesco, Idiano D’Adamo, Simona Leone, Valentina Innocenzi, Ida De Michelis, and Francesco Vegliò. "Spent FCC E-Cat: Towards a Circular Approach in the Oil Refining Industry." Sustainability 11, no. 1 (December 26, 2018): 113. http://dx.doi.org/10.3390/su11010113.
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Every year the oil refining industry consumes thousand tons of fluid catalytic cracking zeolite from the E-cat generated in the fluid catalytic cracking (FCC) unit. In the present paper, a new process for recycling of fluid catalytic cracking catalysts (FCCCs) is presented. The process, previously tested at laboratory scale, was simulated by SuperPro Designer catalysts (FCCCs, also known as equilibrium catalysts, E-cat), which are mainly landfilled. Their intrinsic value is quite low and the content of rare earth elements (REEs), as lanthanum and cerium oxides, is around 3%wt. Moreover, their reuse in other industrial processes as raw material is very scarce. For each metric ton of spent FCCC treated for recovery of REEs, nearly the same amount of waste is generated from the process, the majority of which is represented by the solid residue resulting from the leaching stage. The manuscript presents a technological study and an economic analysis for the recovery of REEs, as well as the production of synthetic © software package. The plant was designed for a capacity of 4000 metric tons per year. The discounted cash flow (DCF) method was applied and Net Present Value (NPV) equal to about two-million € and Discounted Payback Time (DPBT) equal to two years defined the profitability of the process for recycling of FCCCs. This result depends on the selling price of zeolite. Consequently, a break-even point (BEP) analysis was conducted on this critical variable and the condition of economic feasibility was verified with a price of 1070 €/ton. This study tried to implement recycling strategies towards circular economy models.
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Meshman, Jessica, Benjamin Farnia, Radka Stoyanova, Isildinha Reis, Matthew Abramowitz, Alan Dal Pra, Eric M. Horwitz, and Alan Pollack. "Biopsy positivity in prostate cancer patients undergoing mpMRI-targeted radiation dose escalation." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 336. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.336.
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336 Background: Radiation (RT) dose escalation improves prostate cancer outcomes, but when the whole gland is treated to high doses complications can arise. We used prostate multiparametric MRI (mpMRI) findings for targeted dose escalation (MTDE) in prospective clinical trials in which prostate biopsy at 2-3 years after completion of RT was planned. Biopsy positivity is a known predictor of biochemical failure. These findings are compared to those in another cohort in which standard whole gland RT doses were used. Methods: Patients enrolled on three investigator initiated clinical trials incorporating MTDE (n=30) were eligible for inclusion. All patients were assessed for response by prostate biopsy 2-3 years after RT. Patients were compared to a reference group treated with standard RT doses to the whole prostate on a randomized trial at Fox Chase Cancer Center (FCCC trial). Univariable and multivariable analysis (MVA) was performed to assess for correlation with biopsy positivity, defined as carcinoma with or without RT effect. Results: Of those treated with MTDE: 3 (10%) were low, 23 (77%) intermediate, and 4 (13%) high risk. Assuming an α/β ratio of 1.5, MTDE patients received an equivalent dose (EQD2) of 76 Gy to the prostate, with focal dose escalation to an EQD2 of 98-122 Gy to mpMRI lesions. The MTDE cohort was compared with 115 patients from the FCCC trial, where 23 (20%) were low, 74 (64%) intermediate, and 18 (16%) high risk. The FCCC trial patients received an EQD2 of 76 Gy (n=64) or 84.24 Gy (n=51) without boost. Median time from RT to biopsy was 2 years (range, 1.6-3.3). The post-treatment biopsy results were negative in 50% (n=73), atypical in 12% (n=17), carcinoma with RT effect in 31% (n=45) and frank carcinoma in 7% (n=10). On MVA, patients with tumor volume >20% were more likely to have positive post-RT biopsies (OR: 3.21, 95% CI: 1.34-7.68, p= 0.009). MTDE patients were less likely to have positive post-RT biopsies, 10% vs. 45%, (OR: 0.13, 95% CI: 0.03-0.46, p=0.002). Conclusions: Focal dose-escalation to mpMRI-defined lesions significantly reduces biopsy positivity, a measure associated with long term outcomes including distant metastasis.
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Eslami-Farsani, Reza. "Modeling and Optimization of Carbon Fiber Processing: A RSM-FCCC Experimental Design Approach." Journal of Macromolecular Science, Part A 52, no. 1 (November 18, 2014): 69–75. http://dx.doi.org/10.1080/10601325.2014.976756.
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Vijayvergia, Namrata, Patrick McKay Boland, Steven J. Cohen, Karen S. Gustafson, Harry S. Cooper, Igor A. Astsaturov, and Paul F. Engstrom. "Molecular profiling of neuroendocrine tumors (NETs): The Fox Chase Cancer Center (FCCC) experience." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 245. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.245.
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245 Background: The rarity of NETs can limit clinical trial accrual to develop new therapies. Given fewer approved treatments, a better understanding of underlying biology is critical to development of and assignment of patients (pts) to clinical trials. Methods: Pts with NETs (excluding small/large cell lung cancer) of all grades at FCCC were enrolled onto a prospective IRB approved protocol that utilized an NGS platform to detect somatic mutations (SM) in 50 cancer-related genes (Cancer Code) on archived tissue from primary or metastatic sites. Genes tested included ABL1, AKT1, ALK, APC, ATM, BRAF, CDH1, CDKN2A, CSF1R, CTNNB1, EGFR, ERBB2, ERBB4, EZH2, FBXW7, FGFR1, FGFR2, FGFR3, FLT3, GNA11, GNAQ, GNAS, HNF1A, HRAS, IDH1, IDH2, JAK2, JAK3, KDR, KIT, KRAS, MET, MLH1, MPL, NOTCH1, NPM1, NRAS, PDGFRA, PIK3CA, PTEN, PTPN11, RB1, RET, SMAD4, SMARCB1, SMO,SRC, STK11, TP53 and VHL. Review of pathology specimens for grade and Ki -67 was also performed. Results: Thirty-nine pts (median age 59 y, males 46%) were enrolled from October 2013 to July 2014. Gene profiling results are available on thirty-five pts. Ki-67 score was reviewed for 31/35 tumors. 6 (20%) pts had high grade (HG) tumors (Ki-67 > 20%) and 25 (80%) had low/intermediate grade (LIG) tumors (Ki-67 ≤20%). Thirteen (37%) pts were found to have SMs and 22 (63%) did not, with 4 (12%) pts’ tumors having >1 SMs (2 HG and 2 LIG tumors). Incidence of SM was 41% (12/29) in Caucasians, 16% (1/6) in other races, 46% (6/13) in smokers and 30% (6/20) in non-smokers. Incidence of SM was 24% (6/25) in LIG NETs and 84% (5/6) in the HG NETs. Among HG tumors, 66% (4/6) harbored TP53 gene mutation and 33% (2/6) were BRAF mutation positive. Conclusions: Tumor-specific mutations are seen in a minority of low grade NETs but are common in high grade tumors. Interestingly, no mutations were identified in pts with unknown primary. Analysis of clinical outcomes based on treatment received is ongoing to assess for possible prognostic/therapeutic implications of these mutations. [Table: see text]
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Wilkinson Cross, Kate. "Comparing the transformative potentials of the FCCC and the CCD: An ecofeminist exploration." Denning Law Journal 30, no. 1 (December 6, 2018): 5–54. http://dx.doi.org/10.5750/dlj.v30i1.1583.
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This article undertakes a critical comparison and analysis of two environmental regimes – the UN Framework Convention on Climate Change and the UN Convention to Combat Desertification, Particularly in Africa – to explore their transformative potential. Drawing on Karen Warren’s ecofeminist ethics, the author compares and contrasts the ways in which these two regimes engage with the underlying institutional, structural, social and conceptual frameworks which ecofeminists argue contribute to the environmental degradation and the exploitation suffered by marginalised groups. She examines how marginalised communities have been involved in the evolution of the two regimes, the differing approaches towards science and technology, as well as the integration of differentiation within the two regimes. The author concludes that while both regimes have transformative potential, they both continue to affirm an ideological perspective that disembeds humanity from the environment, while at the same time commodifying nature in order to protect it.
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Curley, B., M. A. O'Grady, S. Litwin, K. Stitzenberg, H. Armitage, A. Bapat, E. R. Sigurdson, N. J. Meropol, P. F. Engstrom, and S. J. Cohen. "Assessing the impact of a targeted educational initiative on colorectal cancer lymph node retrieval: A Fox Chase Cancer Center Partners' quality initiative." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 6524. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6524.
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6524 Background: The retrieval of ≥12 lymph nodes in a colorectal cancer surgical specimen is an established quality metric. The impact of targeted education to improve nodal yield at community hospitals has not been studied. We initiated an intensive educational program through the Fox Chase Cancer Center Partner (FCCCP) hospitals to improve nodal retrieval in colon cancer specimens. Methods: At 12 FCCCP community hospitals from 2004–05, educational initiatives were conducted by FCCC staff and included group presentations at hospital tumor boards, cancer and quality committees, and regional CME. Individual presentations to pathologists and surgeons were held. Tumor registry data were retrospectively collected from FCCCP from 2003 (pre-intervention) to 2006 (post-intervention) for patients undergoing curative colon cancer surgery. Data abstracted were age, sex, race, stage, surgical procedure, and total number of nodes examined. The primary end point was % surgical specimens with ≥12 lymph nodes. Obtaining at least 250 records per year would allow ≥90% power to detect a change from a baseline level of ∼40% to ≥50% after intervention. Results: Data from 4,208 patients from 12 FCCCP hospitals were collected. Overall characteristics: male/female (48%/52%), race (W 83%, AA 7%, other 10%), age (<50:6%, 50–70: 34%, >70:60%), node ± (39%/61%). The % of colon cancer operations with ≥12 nodes significantly increased over the four years of the study (Table, p<.00001). This difference persisted when pooling years before and after the intervention (2003–04 vs. 2005–06, p <0.0001). There was no difference in nodal yield between two pre-intervention years (2003 vs. 2004, p=0.1). No differences in other characteristics such as age, sex, race, or % lymph node positive were noted between years. Conclusions: A multi-intervention targeted educational initiative in a large community cancer network is feasible and associated with increased colon cancer nodal retrieval. [Table: see text] No significant financial relationships to disclose.
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Campins Eritja, Mar, Xavier Fernández Pons, and Laura Huici Sancho. "Compliance Mechanisms in the Framework Convention on Climate Change and the Kyoto Protocol." Revue générale de droit 34, no. 1 (November 7, 2014): 51–105. http://dx.doi.org/10.7202/1027235ar.
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Multilateral environmental agreements usually provide for mechanisms to monitor and ensure compliance. This paper focuses on the analysis of two of the most singular mechanisms under the FCCC and the KP: the Multilateral Consultative Process and the new Compliance Procedure. The authors analyse how the European bubble plays a role in the application of such mechanisms. Those mechanisms search for a balance between facilitation and enforcement, which should be reflected at the institutional and procedural levels. In cases of noncompliance, specific consequences are associated to the concrete nature of the obligations foreseen in such international instruments.
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Whooley, Peter D., Fumei Cerecino, Joy Kaye Weaver, Maria Market, Marie Riehl, Lauren Ellis, Andrew Beothy, et al. "Implementation of an oral chemotherapy adherence tool at an NCCN comprehensive cancer center." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 265. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.265.
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265 Background: Adherence to oral chemotherapy (OC) is a critical factor in achieving optimal oncologic outcomes. Correct dosing, education, and symptom management are essential to maximizing adherence. As part of the 2020 Quality Oncology Practice Initiative Certification Program Fox Chase Cancer Center (FCCC), a NCCN Comprehensive Cancer Center, learned that only 33% of patients on OC had a documented OC plan, 7% were assessed for adherence, and 0% had documentation reflecting efforts to address non-adherence. Methods: Our goal was to create and implement an electronic medical record (EMR) tool (Oral Chemo Smart Form) to address the variance and deficiencies in monitoring adherence to OC. The Smart Form (SF) was designed to include fields to document the OC plan (drug, indication, dose, schedule, duration of cycle, initial start/end date) as well as provide a standard for documentation of education, management of toxicity and non-adherence. We integrated the SF into nursing, pharmacy, and physician workflows to capitalize on shared EMR tools. A series of Plan-Do-Study-Act cycles were conducted over 8 weeks within pilot clinics. Weekly review of the SF and feedback forms generated real-time progress reports which were serially appraised and shared with stakeholders. Results: Two oncologists (piloted in Genitourinary and Breast Cancer clinics), two pharmacists, and several nurses used the SF March 15, 2021 to May 7, 2021. Over these 8 weeks, 223 patients on OC were seen in clinic. If the OC was dispensed from FCCC, pharmacists were to complete the SF at the time of initial OC prescription, 7 days after dispensing, and with each refill. Pharmacists also identified patients receiving OC through a specialty pharmacy and routed a message to clinic nurses via an EMR message pool. The message became the trigger for nurses to call patients within two weeks to troubleshoot dispensing issues and/or complete the SF. Oncologists were to complete the SF with each clinic visit for a patient on OC. Feedback from the clinical and pharmacy teams motivated changes in the content fields of the SF and workflow. Ultimately, 45% of patients on OC had the SF completed. An OC plan was documented in 41% of patients, compared to 33% at baseline; 87% had an administration schedule compared to 81%. There was an increase in the number of patients contacted following start of OC, 35% from 4%. Medication adherence was assessed in 35% of patients, up from 7%. Documented discussions addressing medication adherence increased to 78%, from 0%. Conclusions: Introduction of the Oral Chemo SF in pilot clinics improved documented OC plans and administration schedules. Its use introduced a standard process for monitoring safety, assessing and addressing non-adherence, while troubleshooting specialty pharmacy dispensing issues. The SF will be implemented throughout FCCC and further evaluated with efforts focused on adopting and streamlining this as standard work.
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Sieradzki, Gregory, Helene Esperou, and Anne De Jesus. "Sharing experiences and building collective projects in quality management: The strength of UNICANCER group." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 226. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.226.
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226 Background: UNICANCER is a hospital group entirely devoted to fighting cancer. UNICANCER groups together 20 French Comprehensive Cancer Centers (FCCC), which are private, non-profit establishments with a threefold mission of patient care, research and oncology teaching. They share the same organizational model to take care the patients and they have organized an informal network of quality and risk management In 2005, the FCCC federation (former Unicancer group) was created a Quality department in order to build a common approach to improve the quality of care and patient management in Cancer Centers. One the most important tools to set up this shared works were comparative analysis and feedback system. Methods: Every year, the quality department of Unicancer group coordinated the results of several indicators recorded by each centers. These results were summarized in the benchmarks dashboards to identify the priority actions for the group. Results: Between 2006 and 2014, some collaborative projects have been carried out in various fields: (1) development of the culture of continuous improvement, (2) involvement to the national implementationof hospital quality and safety indicators in France, (3) development of specific indicators of cancer care, (4) implementation of questionnaire survey to assess the in- or outpatient satisfaction. As far as concerned the different results of external assessment (1) the values of quality and safety indicators are above the national average, (2) the Cancer Centers have the best level of “certification” for the French National Authority for Health. Conclusions: The teamwork and benchmarking is an innovative way of working. The level of quality of care and patient management increases steadily in Cancer Centers in France. The next step consists of developing a common standard to keep competitive edge. [Table: see text]
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Wang, Earl Juei. "Assessing Fuel Substitution from Coal to Natural Gas for Power Plants in Compliance with FCCC Provisions." Energy Sources 22, no. 8 (September 2000): 683–712. http://dx.doi.org/10.1080/00908310050120254.
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Wirth, David A. "The Sixth Session (Part Two) and Seventh Session of the Conference of the Parties to the Framework Convention on Climate Change." American Journal of International Law 96, no. 3 (July 2002): 648–60. http://dx.doi.org/10.2307/3062168.
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The reconvened sixth session of the Conference of the Parties (COP-6bis) to the UN Framework Convention on Climate Change (FCCC) took place in Bonn from July 16 to 27, 2001, under the presidency of Jan Pronk, Netherlands minister of housing, spatial planning, and the environment. The meeting was noteworthy as the occasion for adopting the Bonn Agreements on the Kyoto Protocol rules, a crucial juncture for entry into force of the principal international instrument for reducing emissions of greenhouse gases. The rules were adopted in final form as the Marrakesh Accords at the seventh session of the Conference of the Parties (COP-7), held in Marrakesh, Morocco, from October 29 to November 9, 2001.
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Hall, Michael J., Paul D'Avanzo, Yana Chertock, Jesse A. Brajuha, and Sarah Bauerle Bass. "Impact of medical mistrust (MM) on perceptions of tumor genomic profiling (TGP) among African American (AA) cancer patients: Application of perceptual mapping (PM)." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e22527-e22527. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e22527.
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e22527 Background: TGP is widely used to identify targetable mutations for precision cancer treatment and clinical trials. Many patients have poor understanding of TGP and are unaware of possible secondary hereditary risks. Lack of clarity regarding the relevance of informed consent and genetic counseling further magnify risks for patients. AA patients have lower genetic knowledge and health literacy and higher MM than Caucasian patients, making them especially vulnerable in the clinical setting. Perceptions of TGP in AA cancer patients have not been well-characterized. Methods: 120 AA pts from 1 suburban and 1 urban site (Fox Chase Cancer Center[FCCC] and Temple University Hospital[TUH]) were surveyed. A k-means cluster analysis using a modified MM scale was conducted; chi-square analysis assessed demographic differences. Perceptual mapping (PM)/multidimensional scaling and vector modeling was used to create 3-dimensional maps to study how TGP barriers/facilitators differed by MM group and how message strategies for communicating about TGP may also differ. Results: Data from 112 analyzable patients from FCCC (55%) and TUH (45%) were parsed into less MM (MM-L, n = 42, 37.5%) and more MM (MM-H, n = 70, 72.5%) clusters. MM-L and MM-H clusters were demographically indistinct with no significant associations by sex (p = 0.49), education (p = 0.3), income (p = 0.65), or location (p = 0.43); only age was significant (older = higher MM, p = 0.006). Patients in the MM-H cluster reported higher concerns about TGP, including cost (p < 0.001), insurance discrimination (p < 0.001), privacy breaches (p = 0.001), test performance/accuracy (p = 0.001), secondary gain by providers (p < 0.001) and provider ability to explain results (p = 0.04). Perceptual mapping identified both shared and contrasting barriers between MM clusters (Table). Conclusions: More than 2/3 of AA patients comprised a MM-H cluster. Communication strategies should focus on concerns about family and how to discuss TGP with an oncologist. PM can identify distinct and shared information needs of vulnerable populations undergoing TGP. [Table: see text]
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McSweeny, Michelle J., Susan Montgomery, Kristen Danielle Whitaker, Mary Beryl Daly, and Michael J. Hall. "The protean phenotype of MSH6 pathogenic variants (PV) in Lynch syndrome (LS) patients (pts)." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 10537. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.10537.
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10537 Background: LS is among the most common hereditary cancer (CA) syndromes. PVs in MSH6 are 2-4 fold more common in the population (1/758) than those in MLH1 (1/1946) or MSH2 (1/2841), and are increasingly regarded as lower penetrance for CRC due to published data supporting later mean age of CRC onset and lower CRC risk. Unlike for MLH1/MSH2, NCCN 2020 CA risk estimates recognize only endometrial CA (EC) and CRC risks in MSH6+ carriers as clearly above SEER population estimates. Further, risks of other LS manifestations such as skin disease/Muir-Torre, ovarian CA (OC), and possible rare tumors in LS like sarcoma, have been minimally characterized in MSH6+ carriers. Methods: Pedigree data for 44 MSH6+ index (first-evaluated family member by our program) pts consecutively ascertained since 2009 at Fox Chase (FCCC) were reviewed. 1 pt w/a rare MSH6 uncertain variant w/personal history (PHx) of MSH6-expression deficient EC (age 50) and MSH6-deficient sebaceous skin CA (age 50) and a strong family history (FHx) c/w LS is also included here. 34% (15/44) index pts were referred to FCCC for cascade testing due to a known MSH6 PV in the family. Of the remaining 29 index pts, ascertainment included: 14% w/positive universal LS tumor screening, 21% w/early-onset or synchronous LS CA, 14% w/multi-gene panel for PHx of OC, 10% w/incidental MSH6+ result (2 had testing for PHx breast CA, 1 tumor genomic profiling), and 28% w/PHx and/or FHx of LS CA warranting genetic testing. Age of CA onset and path data were verified in > 90% index pts. Results: Index pts had a mean age of 55.5 yrs, and 77% were female. Overall, 11% (5/44) of MSH6+ index pts were found to have LS at diagnosis of synchronous primary CAs (3 EC/OC, 1 CRC/CRC, 1 CRC/EC), and 4/5 of these occurred <50 yrs. An additional 20% (9/44) index pts reported PHx of >2 metachronous LS CAs. OC was the presenting CA in 14% (6/44) female index pts; 2 additional index pts had rarer OC variants (Mullerian duct @ 41, primary peritoneal CA @ 50). Skin manifestations of LS were documented in 9.1% (4/44) index pts (3 sebaceous, 1 SCC in-situ/Bowen’s disease); 1 other family had documented sebaceous CAs in an FDR (father) but the 2 daughters seen @FCCC (both 30s) had yet to develop skin lesions. 2 index pts were found to have LS after developing early-onset breast CA (age 39) and contralateral breast CA (ages 50 and 54). Finally, 7% (3/44) index pts had a PHx of sarcoma: 2 were liposarcomas (ages 57 and 67), and 1 was a dermatofibrosarcoma. 2 other index pts had siblings w/childhood sarcomas. Conclusions: Our data, encompassing 44 MSH6+ pts evaluated in our clinic and consecutively ascertained, suggest MSH6 PV carriers develop synchronous primaries (11%), common and rare OC histologic types (18%), sarcomas (7%) and skin disease/Muir-Torre (9%). While common in the population and lower penetrance for CRC, MSH6 PV can behave in uncommon ways and may have significant extra-colonic CA risks such as OC, sarcoma and skin manifestations.
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Al-Zubaidi, Isam, and Congning Yang. "Waste Management of Spent Petroleum Refinery Catalyst." European Journal of Engineering Research and Science 5, no. 8 (August 31, 2020): 938–47. http://dx.doi.org/10.24018/ejers.2020.5.8.1929.
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Petroleum refinery uses many catalysts such as hydroprocessing catalyst HPC, fluid catalytic cracking catalyst FCCC, reforming catalyst RC, etc. During the refining processes, the catalysts are deactivated; the spent catalysts are regarded as hazardous toxic materials due to heavy metals, coke, other poisonous compounds, and hydrocarbons. Huge amount of spent catalysts SC is generated which is expected to increase with expansion capacities of available refineries processes. This paper is reviewing the mechanisms of refining catalyst and the deactivation processes and focusing on spent catalysts management. Management of spent catalyst includes four main options; select the catalysts which reduce the generation of SC by switching to more environment friendly, longer lifetime and less toxic catalyst during the refining process; regenerate the SC; and precious metal recovery should be explored and reuse for other applications. The selection can be based on many factors such as safety, environment, mobility, etc.
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WATANABE, NOBUHISA. "Going Back to “Limits of Growth” from Framework Convention on Climate Change (FCCC) Will Tell the Meaning of “Sustainable”." Sen'i Gakkaishi 75, no. 9 (September 10, 2019): P—484—P—488. http://dx.doi.org/10.2115/fiber.75.p-484.
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Paralkar, V., T. Li, and C. J. Langer. "Population characteristics and prognostic factors in metastatic non-small cell lung cancer (NSCLC): The Fox Chase Cancer Center (FCCC) experience." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 7644. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.7644.
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7644 Background: With increasing use of MRI and PET to stage NSCLC, the demographics, performance status and distribution of metastases at diagnosis in this patient (pt) population are changing; it is important to reassess the prognostic roles played by baseline clinical variables in the modern therapeutic era. Methods: We retrospectively evaluated the charts of 189 consecutive, unselected pts with stage IV NSCLC seen and followed at the Fox Chase Cancer Center between Oct 2000 and Aug 2003. Data on a variety of pt variables including demographics, histology, metastases, key laboratory tests and treatment were compiled. We intended to identify those that played statistically significant prognostic roles. Results: Median age at diagnosis was 62 years; 77% of pts had PS 0–1 at first presentation. 58% had single organ metastasis; 35% had metastases to the brain (half of these had brain only and a third had solitary brain metastasis). 51% of all pts received palliative radiation to the brain at some point after dx. Overall median survival was 10.8 months. The 1-yr, 2-yr, 3-yr and 4-yr overall survival rates were 44.2%, 21.9%, 11.6% and 7.8% respectively. On multivariate analysis, statistically significant negative prognostic factors included PS ≥ 2 (HR: 1.9, 95% CI: 1.1–3.3), serum albumin ≤ 3 (HR: 1.7, 95% CI: 1.1–2.8) and metastases to > 1 organ (HR: 1.6, 95% CI: 1.03–2.3). Bone and liver metastases, though associated with worse survival in univariate analysis, were not found to be independent predictors of survival. Gender had no bearing on outcome. Conclusions: Survival rates in this advanced NSCLC cohort equal or exceed contemporaneous ECOG figures. PS, serum albumin and number of organs with metastases are independent prognostic factors in NSCLC. The increasing detection of brain metastases at 1st presentation of metastatic NSCLC suggests that the role of prophylactic cranial irradiation in the management of early NSCLC should be explored. No significant financial relationships to disclose. [Table: see text]
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Cooper, Harry S., Wen-Chi L. Chang, Renata Coudry, Monique A. Gary, Lynette Everley, Cynthia S. Spittle, Hao Wang, Sam Litwin, and Margie L. Clapper. "Generation of a unique strain of multiple intestinal neoplasia (Apc+/Min-FCCC) mice with significantly increased numbers of colorectal adenomas." Molecular Carcinogenesis 44, no. 1 (2005): 31–41. http://dx.doi.org/10.1002/mc.20114.
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Movva, Sujana, Margaret von Mehren, Elizabeth Handorf, Eric Daniel Tetzlaff, Anjali Albanese, Kathleen Murphy, and Marcin Chwistek. "Characterizing the end-of-life period in young patients with sarcomas." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 11027. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.11027.
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11027 Background: There is a paucity of data surrounding the end-of life transition (EOLT) in young adult (YA) patients with sarcoma. Discussions surrounding prognosis, goals of care (GOC), hospice and death can be challenging in these patients as they may be at a particularly hopeful stage of their life. The purpose of this study is to better understand the EOLT in YA patients with sarcoma by determining the survival and number of lines of treatment at different periods in the disease course. In addition, the study aims to determine what impacts the decision to discontinue anti-cancer therapy. Methods: Fox Chase Cancer Center (FCCC) patients, 18-39 years old who died from sarcoma between January 2013 and December 2016 were included in this study. Patient demographics, tumor specific data, treatment and treatment decisions were collected from electronic medical records and retrospectively analyzed. Results: 38 FCCC patients who were diagnosed between the ages of 18-39 died between January 2013 and December 2016. Of these 21 patients were between the ages of 18-39 at the time of their death. Median age at death was 30 (range: 22-40). The most common histologies were Ewing Sarcoma, GIST (n = 3) and osteosarcoma, synovial sarcoma (n = 2). Median time from diagnosis of metastatic disease to death was 21.4 months. Median time from metastatic disease to discussion of GOC and hospice by any provider was 9.6 and 16.7 months respectively. The hospice discussion was held by the treating oncologist 87.5% (n = 16) of the time (outpatient 35.7% and inpatient 64.3%). 60% (n = 15) of patients/family selected hospice when it was originally presented to them (multi-organ failure, unarousable, paralysis). The hospice discussion was held at a median of 21 days prior to death and median time on hospice was 13 days (range: 1-63). Patients were treated a median of 54 days prior to their death (range: 6-1823). Median times on first, 2ndto last and last treatments were 273, 67 and 22.5 days respectively (P = 0.002). Conclusions: Focusing on this particular group of patients will generate benchmark data that can help counsel them about their specific expected survival and changes in clinical status as their disease progresses. We plan to compare this data with that of older patients.
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Seedor, Rino S., Michelle J. Savage, Waleed Iqbal, Sanjeevani Arora, Kim Rainey, Andrea Forman, Steven Lincoln, et al. "The prevalence of hereditary pancreatitis mutations in families with pancreatic cancer." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e15728-e15728. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e15728.
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e15728 Background: Germline pathogenic variants (PV) in hereditary cancer risk genes are found in ~10-15% of pancreatic adenocarcinomas/cancers (PC), but most cases of familial PC have no identifiable genetic cause. Chronic pancreatitis is an established risk factor for PC, with a lifetime risk of PC of 10-30%, and has been associated with germline mutations in several genes: PRSS1, SPINK1, CASR, CTRC, and CFTR. Few studies have examined the prevalence of PV in the pancreatitis risk genes among patients reporting a personal or family history (FHx) of PC. Methods: The FCCC Risk Assessment Program (RAP) database was queried to identify patients tested for PRSS1, SPINK1, CASR, CTRC, and CFTR as part of risk assessment. Pedigrees, demographic and cancer history data were reviewed. De-identified data from Invitae on patients found to be CFTR+ on hereditary pancreatitis testing were also reviewed for personal/FHx of PC. Results: 26 patients with PC and 48 patients with a FHx of PC underwent germline testing for the pancreatitis genes at FCCC. 7 of 26 (26.9%) patients with PC carried at least one CFTR mutation, while 3 of 48 (6.3%) patients with a FHx of PC carried a CFTR mutation. Interestingly, 8 patients carried an intronic variant in the CFTR gene. No patients with PC and 2 of 48 (4.2%) patients with a FHx of PC carried a SPINK1 mutation. The CFTR mutation rate in PC patients exceeded the expected carrier rate (2.6-3.6%)(p < 0.001). The SPINK1 mutation rate in PC patients also exceeded the expected carrier rate but was not statistically significant (1.9%)(p = 0.23). CaSR, PRSS1, and CTRC mutations were not identified in our population. Personal/FHx data were available to review for 175 of the 496 CFTR+ patients tested through Invitae. 49 of 175 (28%) had a personal history of PC and 105 of 175 (60%) had a reported FHx of PC. Strikingly, 23% of CFTR+ patients carried pathogenic mutations in other genes (most commonly SPINK1). Conclusions: In our select sample, CFTR mutations, and in particular a known intronic variant, were highly enriched in a population of patients undergoing risk assessment for hereditary PC. Commercial data suggest a substantial minority of CFTR+ carriers with a personal/FHx of PC may also carry SPINK1 mutations.
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Bakaeva, Natalia, Maria Suvorova, Roman Sheps, and Alexandra Kormina. "Adaptation techniques of an urban planning due to climate change." E3S Web of Conferences 263 (2021): 05013. http://dx.doi.org/10.1051/e3sconf/202126305013.
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In this paper there is reviewed a concept of adaptation of an urban planning to the changing climate conditions. The statements of the Framework Convention on Climate Change, UN FCCC, which are actively discussed these days in conditions of new challenges, determine a necessity of applying scientifically reasoned approaches to the landscape development and city transformation considering the climate change in the urban environment. There are discussed statements of climate change adapted concept of the urban planning and are reviewed examples of urban solutions corresponding to these statements. The authors are convinced that problem solving of the climate change adapted urban planning requires an interdisciplinary approach, embracing multiple scientific directions such as ecological, urban, social, technical and technological. In this aspect the concept of adaptation the urban planning to volatile climate conditions represent a long-term strategy of the urban development, which is, first of all, requires a preparation of a roadmap and then decision making, which would conduce to forming a fully comfortable and safe urban environment.
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Brown, K. M., W. J. Scott, C. Langer, S. Feigenberg, E. King, and M. Goldberg. "Pneumonectomy following induction chemoradiotherapy (CRT) in NSCLC at Fox Chase Cancer Center (FCCC): Peri-operative mortality rate is lower than expected." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 7107. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.7107.
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7107 Background: Induction CRT is used commonly prior to resection for NSCLC. Selected data cite increased operative mortality in patients (pts) requiring pneumonectomy following induction CRT (> 25% in RTOG 9309). We reviewed the FCCC experience with pneumonectomy for NSCLC and compared operative outcomes in pts who had induction CRT to those who had surgery (S) as initial treatment. Methods: Retrospective review of pts undergoing pneumonectomy for NSCLC from 1993–2005. Perioperative variables were analyzed for impact on operative mortality and complications. Results: 169 pts were analyzed: 110 (65%) were male; median age was 64 (range 39–84). 39 had induction CRT; 16 had preoperative chemo only and 3 had preoperative radiation only. Overall operative mortality was 13/169 (7.7%); for CRT pts, mortality was 5/39 (12.8%) compared to 7/111 (6.3%) for S pts (p = NS). In the CRT group, one pt died from respiratory failure due to radiation pneumonitis of the remaining lung; one pt died from complications of pneumonia, and the remainder died of respiratory failure. In the S group, 3 pts died of respiratory failure, 2 died after discharge of unknown causes, and one each died of pulmonary hypertension and empyema. Complications occurred in 19/39 (48.7%) of CRT pts compared to 39/111 (35%) in S patients (p = NS). Cardiac arrhythmias and pneumonia were the most common complications in both groups. A pre-op DLCO <60% predicted was associated with increased operative death (p = 0.045) and complications (p = 0.066) in the CRT group; this association was not present in the S group. There was no difference in DLCO between the groups. Age, diabetes, tobacco, laterality of surgery, and pre-op FEV1 did not predict operative complications or death in any group. Conclusions: Induction chemoradiotherapy pre-pneumonectomy is not associated with a statistically significant increase in perioperative morbidity or mortality vs those undergoing surgery alone. Mortality rate for CRT appears lower than that seen in RTOG 9309. DLCO <60% is a risk factor in pts with induction CRT, but not in our pts undergoing surgery alone. No significant financial relationships to disclose.
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Davella, Christopher, Peter Whooley, Emily Milano, Brian L. Egleston, Martin Edelman, James Helstrom, Kenneth Patrick, and Jessica Ruth Bauman. "Impact of oncology urgent care center on healthcare utilization." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 7. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.7.
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7 Background: Studies suggest that many Emergency Department (ED) visits and hospitalizations for cancer patients may be preventable. CMS has made changes to the hospital outpatient reporting program (OP-35) targeting ED visits and admissions in treatment patients for preventable conditions. Oncologic urgent care centers aim to streamline care for this population. Fox Chase Cancer Center (FCCC) developed an urgent care center called the Direct Referral Unit (DRU) in July 2011. We sought to assess the impact of the DRU on care utilization. Methods: We abstracted visits to our adjacent hospital (Jeanes) ED and the DRU from January 2014-June 2018. Visit rates represent the ratio of visits over the total number of patients with a clinic visit at FCCC per year. ED and DRU visits were associated with both a cancer and visit diagnosis per the International Classification of Disease (ICD). Patient demographics were abstracted. We also analyzed visit charges, inpatient admission and 30-day therapy utilization (chemotherapy, immunotherapy, radiation). Results: A total of 13,210 visits were analyzed including 5,789 ED visits and 7,421 DRU visits. Visits to the Jeanes ED increased over time. The average age of patients at time of first visit was 63 and visits were most common in females and Caucasians. Hispanic and African American (AA) patients were more likely to visit the ED compared to the DRU (OR: 7.54 and 1.30). Patients with GI (27%) and thoracic (15%) malignancies had the most visits. Commercial insurance use was most common (48%) followed by Medicare (34%) and Medicaid (16%). DRU use was most frequent on Mondays (22%), while ED use occurred the most on Sundays (17%). The most common DRU visit diagnoses in order of prevalence were dehydration, nausea/vomiting, abdominal pain, fever, shortness of breath, fatigue, diarrhea, cellulitis/rash, constipation and anemia. Inpatient admission rates were similar between the two settings (p=.8176). Patients on active cancer treatment more frequently presented to the DRU in comparison to the ED (p<.0001). The average charges were $2226.22 for a DRU visit vs. $10,253.44 for an ED visit. Conclusions: The increase in ED visits over time as well the more frequent ED use in Hispanic and AA patients both suggest a need for greater urgent care access. Many of the most common visit diagnoses to the DRU align with CMS’s list of preventable conditions, demonstrating the DRU’s success as a triage center targeting these conditions. DRU visits were associated with considerable cost savings, supporting the use of cancer urgent care centers as a cost-effective method to reduce acute care.
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Turaka, A., R. Cattaneo, N. Nicos, M. Lango, B. Burtness, J. Ridge, and S. Feigenberg. "SU-GG-T-180: Intensity-Modulated Radiation Therapy (IMRT) for the Para-Nasal Sinus (PNS) Malignancies: Outcomes from Fox Chase Cancer Center (FCCC)." Medical Physics 37, no. 6Part18 (June 2010): 3226. http://dx.doi.org/10.1118/1.3468570.
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Ghatalia, Pooja, Kyungsuk Jung, Samuel Litwin, and Marijo Bilusic. "Small cell carcinoma of the bladder: Comparison of survival in various treatment modalities at Fox Chase Cancer Center (FCCC) from 1995 to 2015." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 465. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.465.
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465 Background: Small cell carcinoma of the bladder (SCBC) is a rare but aggressive neuroendocrine neoplasm. It accounts for only 0.35-0.70% of all bladder tumors. Because of its low incidence, there has been no consensus on the standard treatment of SCBC. We hypothesized that patients (pts) treated over the past 10 years would have better outcomes than those treated earlier, given recent treatment advances in oncology. Methods: We performed retrospective analysis of pts treated at FCCC with confirmed pathologic diagnosis of either SCBC or mixed urothelial and SCBC from 1995 to 2015. Kaplan-Meier estimates were made of the median times and log rank tests were used to compare OS and PFS. Results: We identified 38 pts, 10 women and 28 men who met inclusion criteria. The mean age at diagnosis was 68.2 years, all were Caucasians and 26 pts were smokers. Three pts (8%) had Stage I, 22 (58%) had Stage II, 6 (16%) had Stage III and 7 pts (18%) had Stage IV disease. Radical cystectomy was performed in 26 pts, 3 pts underwent surgery followed by radiation therapy, and 5 pts received primary radiation therapy alone. All but 1 pt received chemotherapy: 32 pts received neoadjuvant chemotherapy, 3 pts received adjuvant chemotherapy and 2 pts received both adjuvant and neoadjuvant chemotherapy. The number of prior lines of therapy, including perioperative chemotherapy as a line, was 1 in 25 pts, 2 in 7, 3 in 2 and 4 in 3 pts. Sixteen pts progressed after the primary treatment with the median time to progression of 7.7 months. The median OS was 397 days (95% CI: (309,633)), and median PFS was 332 days (95% CI: (427,608)). OS estimates are based on all 38 pts; PFS are based on 21 pts. There was no difference in OS (p = 0.752) in 19 pts who were treated before 12/31/2010 vs 19 pts treated after 12/31/2010. No difference was detected in PFS (p = 0.37) based on the earliest 10 (up to February 2010) vs final 11 pts (after February 2010) for whom data was available. Conclusions: No significant improvement in the treatment of SCBC or pt outcomes over the past 10 years was observed. Further data analysis will be aimed at comparing different treatment modalities and pt outcomes.
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Gupta, Joyeeta, and King Yip Wong. "China’s Evolving Development Dilemma in the Context of the North-South Climate Governance Debate." Perspectives on Global Development and Technology 13, no. 5-6 (October 8, 2014): 699–727. http://dx.doi.org/10.1163/15691497-12341324.
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This paper examines China’s policy and position in relation to the evolving climate change negotiations in order to explain how China is dealing with the dilemma of meeting its growing development needs while reducing ghg emissions. It argues that global climate governance requires steering and leadership to deal with the interlocked political process; that the developing countries (dcs) right to develop is challenged by the need for ecosystemic standards especially as climate change is seen as a zero-sum game as the more one country emits the less another one can. This is especially problematic as Industrialized countries (ics) appear to be both unwilling and unable to increase growth without increasing emissions. This explains China’s policy of insisting on its right to develop, of demanding that ics reduce their emissions and that they fulfil their obligations under the fccc, while expressing its willingness to take on a voluntary target. The paper argues that China’s state-led transition has eight unique characteristics that may allow it to lead as it moves beyond a no-regrets policy to a circular and green economy, cooperating with other dcs and mobilizing conscious green values in citizens. The question remains—will the initial success and scale of state-led transition lead the global green transition to a sustainable world?
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Scott, W. J., C. Aggarwal, A. Lebenthal, B. Egleston, H. Borghaei, R. Mehra, N. Somaiah, A. Turaka, and G. R. Simon. "Influence of surgical interventions on survival in patients with stage IIIb non-small cell lung cancer (NSCLC): The Fox Chase Cancer Center (FCCC) experience." Journal of Clinical Oncology 28, no. 15_suppl (May 20, 2010): 7067. http://dx.doi.org/10.1200/jco.2010.28.15_suppl.7067.
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Jacobson, Harold K. "International Cooperation in the Twenty-first Century: Familiar Problems and New Challenges." International Studies Review 1, no. 1 (October 15, 1997): 51–68. http://dx.doi.org/10.1163/2667078x-00101003.
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The creation and proliferation of international organizations of various sorts, increasing economic interdependence, the spread of democracy. and the strong leadership played by the United States all worked positively together to facilitate international cooperation during the second half of the twentieth century, overcoming to a great extent the familiar problem of 'cooperation under anarchy. 'But humankind is confronting new challenges as well, arising from the shift in power relations among nation-states and the rise of new issues that call for global. attention. One of the most prominent issues is the protection of environment. It is unclear how easily the formulas that have proved to be so successful in bringing about international cooperation in the twentieth century can be applied to the new challenges. If a series of organised responses to the issue of climate change as shown in the completion and implementation of the Framework Convention on Climate Change (FCCC) is any indication, however, the international. community seems to have successfully begun to confront them. The relative promptness of action taken by the international community. the manner in which the issue is negotiated where the principle of equity was directly addressed, the comprehensiveness of the Treaty's scope, and responsible behaviour of the states of the world, all point to broad optimism about international cooperation in the twenty-first century.
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Hall, Michael J., Kathleen Q. Martin, Christina Rybak, Harry S. Cooper, Karen S. Gustafson, Jeff Boyd, and Mary Beryl Daly. "Evaluating the impact of a clinical universal mismatch repair screening initiative." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 194. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.194.
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194 Background: Immunohistochemistry (IHC)-based universal mismatch repair (UMMR) screening of incident colorectal (CRC) and endometrial (EC) tumors for deficient MMR (dMMR) associated with Lynch syndrome (LS) is supported by expert recommendations and is cost-effective. Heterogeneity in the approach to implementation of UMMR screening nationwide has been observed, suggesting knowledge gaps that could adversely impact anticipated outcomes. Studies of clinical UMMR screening can inform efforts to optimize implementation in the real world setting. Methods: In September 2011, Fox Chase Cancer Center (FCCC) began UMMR screening of incident (surgical) CRC/EC tumors. Providers were emailed a tailored UMMR Results letter intended to facilitate discussion of hereditary cancer risks and for distribution to patients. Content supported genetics consultation for an abnormal UMMR screen or for high-risk history (Hx) regardless of MMR status (i.e., personal Hx of any cancer; or 1st/2nd degree relative with a LS cancer and/or cancer <50). For comparison, clinical data on all CRC/EC surgical cases 3 months prior to implementation of UMMR screening were extracted from the medical record. Results: 55 surgeries for CRC/EC occurred in the 3 months pre-implementation (PRE) and 130 in the 9 months post-implementation (POST). 1 yr PRE and POST data will be presented at the 2012 Quality Symposium. Conclusions: The UMMR screening initiative greatly improved patient outcomes. Provider referral and documentation behavior was highly responsive to an abnormal screening result, but not high-risk cancer history alone. [Table: see text]
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Hoffman-Censits, J. H., Y. Wong, T. Li, S. Boorjian, V. N. Giri, R. Uzzo, R. E. Greenberg, G. Hudes, and D. Y. Chen. "Dose intensity of cisplatin and gemcitabine (CG) for muscle invasive urothelial bladder cancer (MIUBC) in the neoadjuvant versus adjuvant settings: The Fox Chase Cancer Center (FCCC) experience." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e16012-e16012. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e16012.
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e16012 Background: Despite radical cystectomy (RC), subjects with MIUBC remain at risk of recurrence and optimal timing of chemotherapy remains unclear. Historically, we offered adjuvant (ADJ) CG to patients (pts) with T≥3 or node positive tumors. Since Dec 2005, neoadjuvant (NEO) CG treatment has been our preferred approach for pts with ≥T2 tumors. We compare our results with NEO and ADJ CG, including pathologic response after NEO CG. Methods: We reviewed records of patients who underwent RC for MIUBC and received at least 2 cycles of perioperative CG between Jan 2002 and Dec 2008at FCCC. We used Fisher's exact and Wilcoxon tests, as well as Generalized Estimating Equations (GEE), to compare baseline patient characteristics, dose intensity, completion, and complication rates in the ADJ and NEO groups. Results: Results of 22 ADJ and 17 NEO patients are shown below. Characteristics of age, gender, race, preop T stage and ECOG performance status (PS) ≤1 were similar. There was no significant difference in preoperative T stage between groups (p=0.2). The delivery of full doses (C 70mg/m2,G 1000 mg/m2) of GC were similar in the NEO vs the ADJ group. The delay between RC and chemotherapy may be shorter in the patients treated preoperatively, and trended toward significance (p=0.06). Reasons for dose modifications and delays are also shown in the Table . Of pts treated with NEO CG, 10/17 (55.7%) were ≤pT1 with 9 of those 10 pts also pN0 (52.9% of 17 pts) . 5/17 (29.4%) had positive lymph nodes at RC. Conclusions: CG for MIUBC is well tolerated in the NEO setting, with dose intensity comparable to that delivered adjuvantly. NEO pathologic downstaging with CG appears comparable to historical results with MVAC, and should be confirmed in larger, prospective studies. [Table: see text] No significant financial relationships to disclose.
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Shashi, Shashi, Roberto Cerchione, Rajwinder Singh, Piera Centobelli, and Amir Shabani. "Food cold chain management." International Journal of Logistics Management 29, no. 3 (August 13, 2018): 792–821. http://dx.doi.org/10.1108/ijlm-01-2017-0007.
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Purpose Since last few years, cold chain management (CCM) has gained growing interest among practitioners, policymakers, researchers and academicians. The purpose of this paper is to provide a review focused on food cold chain management (FCCM) over the last 16 years to identify state of the art in the literature, highlight research gaps and define appropriate research questions (RQs) for future research. Design/methodology/approach The paper analyzes the content of 89 research articles published on the topic of food cold chain (FCC) from 2001 to 2016 within different journals. The Scopus and Web of Science databases were taken into consideration to shortlist research articles. Henceforth, the authors scrutinized the FCC industry to offer some effective strategies to tackle the chain complexities. The authors also draw interwoven between FCC infrastructure, integration, stakeholders’ interest, value addition, partners’ performance and overall food cold chain performance (FCCP) into a conceptual framework. Findings This paper identifies four research gaps in the literature of FCC concerning the most popular approaches used for the FCCP measurement, the performance measurement metrics, the factors which negatively affect the FCCP and the main sustainability issues in FCC. Originality/value This study identifies RQs which represent possible areas of investigation to improve the body of the FCCP evaluation and management. Furthermore, the FCC practitioners, food authorities and researchers might find this review useful, as it draws a clear picture of research in the respective domain.
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Chang, Wen-Chi L., Christina Jackson, Stacy Riel, Harry S. Cooper, Karthik Devarajan, Harvey H. Hensley, Yan Zhou, Lisa A. Vanderveer, Minhhuyen T. Nguyen, and Margie L. Clapper. "Differential preventive activity of sulindac and atorvastatin in Apc+/Min-FCCCmice with or without colorectal adenomas." Gut 67, no. 7 (November 9, 2017): 1290–98. http://dx.doi.org/10.1136/gutjnl-2017-313942.
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ObjectiveThe response of subjects to preventive intervention is heterogeneous. The goal of this study was to determine if the efficacy of a chemopreventive agent differs in non-tumour-bearing animals versus those with colorectal tumours. Sulindac and/or atorvastatin was administered to Apc+/Min-FCCC mice with known tumour-bearing status at treatment initiation.DesignMale mice (6–8 weeks old) underwent colonoscopy and received control chow or chow with sulindac (300 ppm), atorvastatin (100 ppm) or sulindac/atorvastatin. Tissues were collected from mice treated for 14 weeks (histopathology) or 7 days (gene expression). Cell cycle analyses were performed on SW480 colon carcinoma cells treated with sulindac, atorvastatin or both.ResultsThe multiplicity of colorectal adenomas in untreated mice bearing tumours at baseline was 3.6-fold higher than that of mice that were tumour free at baseline (P=0.002). Atorvastatin completely inhibited the formation of microadenomas in mice that were tumour free at baseline (P=0.018) and altered the expression of genes associated with stem/progenitor cells. Treatment of tumour-bearing mice with sulindac/atorvastatin led to a 43% reduction in the multiplicity of colorectal adenomas versus untreated tumour-bearing mice (P=0.049). Sulindac/atorvastatin increased the expression of Hoxb13 and Rprm significantly, suggesting the importance of cell cycle regulation in tumour inhibition. Treatment of SW480 cells with sulindac/atorvastatin led to cell cycle arrest (G0/G1).ConclusionsThe tumour status of animals at treatment initiation dictates response to therapeutic intervention. Atorvastatin eliminated microadenomas in tumour-free mice. The tumour inhibition observed with Sul/Atorva in tumour-bearing mice was greater than that achieved with each agent.
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Langer, C., R. Hudes, B. Movsas, J. Schol, E. Keenan, D. Kilpatrick, C. Yeung, and W. Curran. "284 Induction paclitaxel (TAXOL) and carboplatin (CBDCA) followed by concurrent chemoradiotherapy (TRT-CT) in unresectable, locally advanced non-small cell lung carcinoma (NSCLC): Report of FCCC 94-001." Lung Cancer 18 (August 1997): 74. http://dx.doi.org/10.1016/s0169-5002(97)89664-x.
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Hudes, R. S., C. Langer, B. Movsas, N. Nicolaou, S. Litwin, J. Schol, E. Keenan, and W. J. Curran. "184 Induction paclitaxel-carboplatin followed by concurrent radiotherapy & dose escalation of paclitaxel-carboplatin in unresectable, locally advanced non-small cell lung CA: Report of FCCC 94-001." International Journal of Radiation Oncology*Biology*Physics 45, no. 3 (January 1999): 243. http://dx.doi.org/10.1016/s0360-3016(99)90202-x.
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Adams, Richard D., and Bo Qu. "Insertion of bis-ferrocenylbutadiyne into an osmium hydride bond. The synthesis, structure and electrochemical response of Os4(CO)11(μ-η-Z-FcCC(H)C2Fc)(μ-H)3." Journal of Organometallic Chemistry 619, no. 1-2 (January 2001): 271–74. http://dx.doi.org/10.1016/s0022-328x(00)00664-1.
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Devlin, J. G., and C. J. Langer. "Salvage vinorelbine (VNR) in the 2nd to 4th line setting in advanced non-small cell lung cancer (NSCLC): A retrospective review at the Fox Chase Cancer Center (FCCC)." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 17072. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.17072.
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17072 Background: Published literature has demonstrated minimal activity for VNR in the salvage treatment of NSCLC, with response rates of only 0.8% (Fossella, et al, JCO 2000; 18(12), 2354–2362). However, in our clinical experience, we have observed a number of patients (pts) with clinical benefit. Methods: Retrospective evaluation was performed of all pts with NSCLC who had received VNR at FCCC from 6/02–6/05 in the salvage setting. Pts were evaluable if full medical records (including radiographic imaging for disease assessment) were available, had received ≥2 cycles of VNR, and had advanced, recurrent or metastatic NSCLC. Primary endpoint was response rate (RR); secondary endpoints included safety, median overall survival (OS), and median time to progression (TTP). Results: 52 pts were included, 28 pts were ultimately evaluable (13 pts received <2 cycles of VNR, 7 pts did not have NSCLC, and 4 pts received VNR with RT or other agents). Median age was 64 yrs, 64% were female; ECOG-PS 0–18%, 1–50%, 2–28.5%, 3–3.5%. 82% exhausted 2 lines of systemic therapy before VNR; 32% exhausted 3; 21.4% received prior EGFR-TKI; 18% received other prior protocol therapies. 96.3% of pts had stage IV, stage IIIB, or recurrent disease. 21.4% had bone mets; 25% had brain mets; and 42.8% had visceral metastases. 85.8% had significant comorbidities. Median number of VNR cycles was 4. RR:PR 10.7%, SD/MR 35.7%, and PD 50%. 25% required dose reductions, predominantly for gr 4 hematologic toxicities. Non-hematologic toxicities were generally mild, and included neuropathy, fatigue and GI distress; there were no Tx-related deaths. 32% were able to receive other systemic therapy after VNR. Median OS was 5 months, and median TTP was 3 months. Conclusions: Vinorelbine is active and relatively well-tolerated in the salvage treatment of NSCLC, including heavily pretreated pts. Response rates exceed that observed in the literature. [Table: see text]
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Zhao, Rui-Feng, Bo Ren, Guo-Peng Zhang, Zhong-Xia Liu, and Jian-Jian Zhang. "Phase Transition of As-Milled and Annealed CrCuFeMnNi High-Entropy Alloy Powder." Nano 13, no. 09 (September 2018): 1850100. http://dx.doi.org/10.1142/s179329201850100x.
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The CrCuFeMnNi high entropy alloy (HEA) powder was synthesized by mechanical alloying. The effects of milling time and subsequent annealing on the structure evolution, thermostability and magnetic property were investigated. After 50[Formula: see text]h of milling, the CrCuFeMnNi HEA powder consisted of a major FCC phase and a small amount of BCC phase. The crystallite size and strain lattice of 50[Formula: see text]h-ball-milled CrCuFeMnNi HEA powder were 12[Formula: see text]nm and 1.02%, respectively. The powder exhibited refined morphology and excellent chemical homogeneity. The supersaturated solid solution structure of the as-milled HEA powder transformed into FCC1, FCC2, a small amount of BCC and [Formula: see text] phase in annealed state. Most of the BCC phase decomposed into FCC (mainly FCC2 phase) and [Formula: see text] phases, and the dynamic phase transition was almost in equilibrium at 900[Formula: see text]C. The saturated magnetization and coercivity force of the 50[Formula: see text]h-ball-milled CrCuFeMnNi HEA powder were respectively 16.1[Formula: see text]emu/g and 56.2[Formula: see text]Oe.
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Zangerolame Taroco, Lara Santos, and Ana Cecília Sabbá Colares. "The UN Framework Convention on Climate Change and the Paris Agreement: Challenges of the Conference of the Parties." Prolegómenos 22, no. 43 (February 24, 2020): 125–36. http://dx.doi.org/10.18359/prole.3449.
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The purpose of this article is to analyze, within the scope of the United Nations Framework Convention on Climate Change, how the Conference of the Parties provides a new locus for discussion within the International Environmental Law. Increasing scientific evidence about the possibility of global climate change in the 1980s led to growing awareness that human activities have been contributing to substantial increases in the atmospheric concentrations of greenhouse gases. Concerned with it, on December 11, 1990, the 45th session of the un General Assembly adopted a resolution that established the Intergovernmental Negotiating Committee for a Framework Convention on Climate Change (INC/FCCC). It was the beginning of the United Nations Framework Convention on Climate Change and also the beginning of the establishment of the Conferences of the Parties, which is currently in its 25th edition. The Paris Agreement was negotiated at the 21st edition of the Conference of the Parties and is the central theme of this study because of its rel- evance in the context of emission reduction. The Paris Agreement was created in December 2015, and the work on climate change had just begun. The final text of the Paris Agreement addresses important topics. Nonetheless, the document lacks clarity on many subjects, which were intentionally left aside in order to reach consensus to finish the Paris Committee’s work. Considering this scenario and the challenges arising from this international treaty, the article analyzes the Conferences already held until the Paris Agreement. It also reviews the COP21 negotiations from 2015, taking into account a historical comprehension of the in- ternational concern over climate change, and the documents created by the Conference. Finally, this article discusses the developments and setbacks on the subject since 1997, and the objections made by interna- tional actors at the COP21 negotiations.
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Yoon, Stephanie, Mohammad Zahid, Pooja Phull, Jordan Senchak, Richard I. Fisher, Essel Dulaimi, Eric A. Ross, Jian Qin Yu, Mohan Doss, and Nadia Khan. "Checkpoint inhibitor therapy, with and without radiation, in diffuse large B cell lymphoma: A single-center analysis." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e19059-e19059. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e19059.
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e19059 Background: Single agent checkpoint inhibitors (CPI) in NHLs have resulted in modest successes. Exceptions include RT, PCNS and testicular lymphomas, where higher activity is seen. As a single agent, CPI response rates range from 10-40% in relapsed refractory (RR) DLBCL, with few CRs and short response durations. In a cohort of RR DLBCL patients at our institution, we sought to identify clinical features that defined responders and non-responders. Methods: Between 9/2016 and 7/2018, 13 pts with DLBCL/RT, treated with a CPI, either on trial or as off-label therapy, with at minimum 1 infusion/cycle were included. Pathology specimens confirming DLBCL/RT were reviewed at FCCC. All pts had measurable disease by CT or PET/CT prior to CPI and had an evaluable response. Cell of origin was determined by Hans IHC. Results: Almost half (6/13) of pts achieved a response to CPI. Notably all responders had either concurrent or pre-treatment XRT. All 3 RT patients responded to CPI and continued to allo transplant. P3 and P6 both developed GVHD post allo, resulting in a demise in P3. No GC subtype pts responded nor had prior/ concurrent XRT with CPI. In 2 pts responses are ongoing, > 1 yr, and 1 RT pt remains in CR. Conclusions: XRT, prior or concurrent with CPI , was associated with durable responses in RR DLBCL. Patients with bulky ( > 7cm), rapidly progressive disease (8/13 cases) may require a 'debulking' strategy for CPI efficacy. An abscopal effect achieved with XRT/CPI combinations, may be impactful RR NHL. Analysis of PDL1/2 and MHC I/II, with other biomarkers, are underway. These clinical results warrant validation in a larger cohort, therefore a prospectively designed study is planned for 2019 in RR DLBCL/RT. [Table: see text]
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Siripurapu, V., J. C. Watson, Y. S. Chun, A. Gumbs, and J. P. Hoffman. "Preoperative or postoperative therapy for resectable gallbladder cancer? A retrospective analysis of patients treated at a single institution." Journal of Clinical Oncology 29, no. 4_suppl (February 1, 2011): 309. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.309.
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309 Background: Gallbladder cancer (GBC) is the most common malignancy of the biliary tract. Less than 30% present at an early stage where surgical resection is curative. We examine a cohort of patients with GBC toward determining if preoperative and postoperative treatment of locally advanced GBC demonstrate any differing results in complications or survival. Methods: A retrospective review of patients seen at FCCC with GBC from Jan 1991 to Nov 2008 was performed. Demographics, clinical stage, surgical procedure, AJCC 7th stage, details of neoadjuvant and adjuvant treatment and complications of surgery were analyzed. Results: Fifty-one patients with GBC were identified. Of these, 66% had their GBC found incidentally, 77% had stage 2 or greater cancers, and 35 patients needed liver resection with portal lymphadenectomy. 13 patients had an extrahepatic bile duct resection. 10 patients had extended resections including pancreatoduodenectomy (5) or colectomy (5), while 6 had cholecystectomy alone. 25% (n=13) of the population had preoperative chemoradiation only, 30 % (n=15) had postoperative chemoradiation only, while 15% (n=8) received maintenance chemotherapy only. 10% (n=5) had preoperative and postoperative therapy, while twenty percent of the group (n=10) had surgery only. 49% had recurrences (n=25), with 48% percent of these being local-regional. Median survival was 30 months for the whole group, with 54.6 month median survival for the 41 patients without extended resection. No significant difference in survival was seen comparing preoperative therapy versus postoperative treatment (p=0.13). Five-year survival is 47% for those with minor hepatic resection compared to 25% for those with combined hepatic and colon or pancreatic resection. Conclusions: We present a retrospective view of patients treated in our center, the majority of whom received either preoperative or postoperative adjuvant therapy, both of which had good median survival and acceptable morbidity and mortality. Given the poor survival and high recurrence rate for stage II and greater cancers, we suggest that preoperative or postoperative adjuvant therapy for these cases may be equally effective. No significant financial relationships to disclose.
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Plimack, Elizabeth R., Jean H. Hoffman-Censits, Rosalia Viterbo, Richard Evan Greenberg, David Chen, Costas D. Lallas, Edouard John Trabulsi, et al. "Neoadjuvant accelerated MVAC (AMVAC) in patients with muscle invasive bladder cancer: Results of a multicenter phase II study." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 4526. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.4526.
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4526 Background: Standard methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) demonstrates a survival benefit in the neoadjuvant setting for patients (pts) with muscle invasive bladder cancer (MIBC). Compared with standard MVAC, AMVAC yielded higher response rates with less toxicity in the metastatic setting. Methods: Pts with MIBC, cT2-T4a, and N0-N1 with CrCl >=50 and adequate hepatic and marrow function were eligible. Pts received 3 cycles of AMVAC (methotrexate 30 mg/m2, vinblastine 3 mg/m2, doxorubicin 30 mg/m2, cisplatin 70mg/m2) on day 1, with pegfilgrastim 6 mg day 2 or 3, every 2 weeks. Pts with CrCl < 60 could receive cisplatin split over 2 days. Radical cystectomy (RC) with lymph node dissection was performed 4-8 weeks after the last dose of chemotherapy. Primary endpoint was pathologic complete response (pCR) rate. Results: Accrual is complete with 44 MIBC pts enrolled at 2 institutions (FCCC, TJU) over a 25 month period. Median age 64 (range 45-83). Three withdrew from study early and are not evaluable for response (2 physician discretion, 1 withdrawal of consent). An additional 8 are currently receiving treatment on study with toxicity and response data pending. Of the 33 evaluable pts for whom final data is available, 30 received all 3 cycles of AMVAC at full dose. Three pts received < 3 cycles due to grade 3 fatigue (1), low platelets (1), and disease progression precluding RC (1). 32/33 pts underwent RC, all within 8 weeks of last chemotherapy. Median time from start of chemotherapy to RC was 9.7 wks (range 4.6-13 wks). 13/33 pts (39.4%, 95% CI, 22.7-56.1%) had a pCR. An additional 3 (9.1%) were downstaged to non muscle invasive disease. For the intent to treat cohort (n=36) 8 pts had grade 3-4 AMVAC related adverse events, the most common being anemia (3), fatigue (3) and neutropenia (2) and overall pCR rate was 36.1%. (95% CI, 20.4-51.8%). All pts will have completed study treatment by April 2012. Final results will be presented. Conclusions: Neoadjuvant AMVAC is well tolerated and preliminary results show a pCR rate similar to that reported for standard 12-week MVAC, suggesting that AMVAC for three cycles (6 weeks) is a safe and efficient alternative.
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Nweze, Nkem, Ashlie Nadler, Sanjay S. Reddy, Biao Luo, Elin R. Sigurdson, Wafik S. El-Deiry, Crystal Shereen Denlinger, Michael J. Hall, and Jeffrey M. Farma. "Practice patterns of molecular profiling in colorectal cancer." Journal of Clinical Oncology 35, no. 4_suppl (February 1, 2017): 641. http://dx.doi.org/10.1200/jco.2017.35.4_suppl.641.
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641 Background: Colorectal cancer (CRC) is a genetically heterogeneous disease. Molecular profiling (MP) using next-generation sequencing is increasingly used to personalize therapy. No guidelines currently exist regarding patient selection and optimal timing. Our goal was to describe our experience at a tertiary cancer center using MP in CRC patients. Methods: This is an IRB-approved, retrospective study in patients with CRC who underwent MP between March 2007 and August 2016. Tissue samples were sent for analysis in the following MP platforms: Foundation One, Caris, and FCCC Targeted Cancer Panel (FTCP), which tests for the 50 most common mutations. Data regarding patient demographics, mutations, and clinical outcomes were analyzed. Kaplan Meier methods were used for survival analysis using SPSS. Results: We evaluated 248 patients with CRC. 60.1% were male and 80.1% were white. The median age was 59.5 years. 66.5% had colon and 33.5% had rectal CA. Initial stages: stage 1 (2.8%), stage 2 (14.1%), stage 3 (22.9%), stage 4 (59.2%). 82.2% were tested via FTCP, 8.9% via Foundation One, and 9.3% via Caris. 60.9% had the primary tumor tested. 5.2% had no mutations, 19% had 1 mutation, 28.6% had 2 mutations, 27% had 3 mutations and 20.2% had >4 mutations. The most common mutation guiding targeted therapy was KRAS (43.5%). 50% of patients had R0 resection and 19.3% went on to targeted therapy. 76.2% of resectable patients had a metastatic recurrence. 51.9% had targeted therapy for recurrence and/or stage 4 disease. The median time from diagnosis to MP was 9.9 months overall and 2.7 months for stage 4 patients. The median time from date of recurrence to MP was 7.7 months. Median length of follow up was 1.7 years. 14.9% had no evidence of disease at last follow up, 73% were alive with disease and 10.9% had died of the disease. Median overall survival was 55.8 months (CI 41.9 - 69.7). Conclusions: MP is utilized commonly in patients with stage 4 and recurrent CRC and occurs within 2.7 months and 7.7 months respectively. Further research is underway to evaluate if the information provided by MP improves outcomes in CRC, provides novel targets and will lead to increased clinical trial accrual.
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Suksamran, Amnart, Nawarat Worauaychai, Nattaya Tosangthum, Thanyaporn Yodkaew, Rungtip Krataitong, Pongsak Wila, and Ruangdaj Tongsri. "Effect of Aluminum Addition on AlxCoFeMnNiZn Multi-Component Production." Key Engineering Materials 751 (August 2017): 53–59. http://dx.doi.org/10.4028/www.scientific.net/kem.751.53.
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Five multi-component alloy (MCA) formulations of CoFeMnNiZn (MCA01), Al0.5CoFeMnNiZn (MCA02), Al1.0CoFeMnNiZn (MCA03), Co5Fe5Mn30Ni20Zn40 (MCA04) and Al8.4Co4.6Fe4.6Mn27Ni18.4Zn37 (MCA05) were prepared by mechanical alloying and melting process (MAM). Five-component alloys of MCA01-MCA05 were designed using empirical formulae for high entropy alloys. Phase formation and microstructure were evaluated by X-ray diffraction (XRD) and scanning electron microscopy (SEM). The results showed that MCA01 was partially melted by MAM process. However, MCA02-MCA05 could be melted and cast by MAM process. The microstructures of as-cast MCA02 and MCA03 showed dendritic solidification. Nevertheless, the as-cast MCA04 showed microstructure similar to that of Ni-based superalloy, i.e., the as-cast MCA04 consisted of γ matrix and γ′ phase. Moreover, egg type core shell structure was found in the interdendritic regions of the MCA05 alloy. In addition, the Al-added MCA02 and MCA03 alloys showed crystal structures of FCC1, FCC2 and BCC. MCA04 alloy demonstrated crystal structure of FCC whereas MCA05 alloy had crystal structures of FCC and Primitive Cubic.
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Hoffman-Censits, Jean H., Edouard John Trabulsi, David Y. T. Chen, Alexander Kutikov, Jianqing Lin, Rosalia Viterbo, Gary R. Hudes, et al. "Neoadjuvant accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (AMVAC) in patients with high-grade upper-tract urothelial carcinoma." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 326. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.326.
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326 Background: Improved safety and response rates of AMVAC over standard MVAC in patients (pts) with metastatic bladder cancer support study of neoadjuvant AMVAC for pts with muscle invasive bladder cancer (MIBC) and prenephroureterectomy (NU) for pts with high-grade upper-tract urothelial cancer (UTUC). We performed a phase II study of neoadjuvant AMVAC in MIBC and UTUC, and herein report the results of the UTUC exploratory subgroup. Methods: Pts with UTUC (ureter or renal pelvis) with high-grade UC on biopsy, or positive urine cytology and mass on cross sectional imaging, N0-N1, CrCl >=50, adequate hepatic and marrow function were eligible. Pts received 3 cycles of AMVAC (methotrexate 30 mg/m2, vinblastine 3 mg/m2, doxorubicin 30 mg/m2, cisplatin 70mg/m2) day 1, pegfilgrastim 6 mg day 2 or 3, every 2 weeks. NU, with lymph node dissection at surgeon discretion, was performed 4-8 weeks after last cycle. Exploratory endpoint was pathologic complete response (pCR) rate. Results: Accrual is complete with 10 evaluable UTUC pts enrolled at 2 institutions (FCCC, TJU) over 46.5 months. Median age 67 (range 49-83). Of 10 pts, 6 completed all 3 cycles of AMVAC. Four pts received < 3 cycles due to grade 3 acute kidney injury (1), pyelonephritis and grade 3 diverticulitis (1), flare of underlying hepatitis (1), grade 3 fatigue (1). Additional related grade 3 adverse events (AE) were anemia (1) and nausea/vomiting (1), no grade 4 or 5 AE. All pts underwent NU within 8 weeks of last chemotherapy, median 5.5 weeks. Median time from day 1 AMVAC to NU was 9 wks. 1/10 pts had a pCR, 4/10 patients were staged <pT1, 2/10 pT2, and 3/10 >pT3 or N+. An additional 21.5 months of enrollment were needed in this expansion cohort to accrue 10 pts with UTUC, compared to 44 MIBC pts in 25 mos. All pts completed study treatment as of July 2013. Conclusions: In this small sample, neoadjuvant AMVAC prior to NU was clinically active with manageable toxicity. With short duration from start of chemotherapy to NU, 3 neoadjuvant AMVAC cycles should be considered for further study for high-grade UTUC prior to NU in the cooperative group setting. Clinical trial information: NCT01031420.