Michelle Davis

THIS chapter invites educators and parents to take on the transformation of the evaluation process by effectively using a functional analysis of behavior as an ongoing problem-solving approach, where instruction is integrated, and a scientific method is applied. We predict that, with teacher training and understanding of how effective it can be, the functional behavior assessment (FBA) structure will be better utilized for children who are at risk of developing, or are known to have, emotional or behavioral disabilities.

Personalized treatment of genetically stratified subgroups has the potential to improve outcomes in many malignant tumors. This study distills clinically meaningful prognostic/predictive genomic marker for cervical adenocarcinoma using signature genomic aberrations and single-point nonsynonymous mutation-specific droplet digital PCR (ddPCR). Mutations in PIK3CA E542K, E545K, or H1047R were detected in 41.7% of tumors. PIK3CA mutation detected in the patient’s circulating DNA collected before treatment or during follow-up was significantly associated with decreased progression-free survival or overall survival. PIK3CA mutation in the circulating DNA during follow-up after treatment predicted recurrence with 100% sensitivity and 64.29% specificity. It is the first indication of the predictive power of PIK3CA mutations in cervical adenocarcinoma. The work contributes to the development of liquid biopsies for follow up surveillance and a possibility of tailoring management of this particular women’s cancer.

This study aimed to determine the effects of age, race/ethnicity, body mass index, and contraception on human chorionic gonadotropin (hCG) regression following the evacuation of a molar pregnancy. This was a retrospective cohort study of 277 patients with molar pregnancies between January 1, 1994 and December 31, 2015. The rate of hCG regression was estimated using mixed-effects linear regression models on daily log-transformed serum hCG levels after evacuation. There were no differences in hCG half-lives among age (p=0.13) or race/ethnicity (p=0.16) groups. Women with obesity and hormonal contraceptive use demonstrated faster hCG regression than their counterparts (3.2 versus. 3.7 days, p=0.02 and 3.4 versus. 4.0 days, p=0.002, respectively). Age and race/ethnicity were not associated with hCG regression rates. Hormonal contraceptive use and obesity were associated with shorter hCG half-lives, but with unlikely clinical significance. It is important to understand whether the clinical characteristics of patients may influence the hCG regression curve, as it has been proposed as a way to predict the risk of gestational trophoblastic neoplasia.

Importance: Current cancer screening guidelines recommend cessation of cervical cancer screening at the age of 65 years for most women. To examine residual risk among elderly women, we compared cervical cancer incidence rates (IRs) in Massachusetts from 2004 to 2015 among women younger than 65 years versus 65 years and older. Materials and Methods: The Massachusetts Cancer Registry was used to identify all women diagnosed with cervical cancer between January 01, 2004, to December 31, 2015. Cancer incidence was calculated based on age of diagnosis (p < .001). Cervical cancer IRs decreased annually for women younger than 65 years from 2004 to 2015. Among women 65 years and older, cancer IRs decreased by 3.9% annually from 2004 to 2013 (p = .0009), but 2013 to 2015 showed an increasing trend (annual percent change + 14.1%, p = .12). Conclusions and Relevance: Women 65 years and older account for one quarter of cervical cancer diagnoses in Massachusetts and present with higher-stage disease than younger women. Upcoming planned revisions in screening and prevention guidelines should address the continued risk of cervical cancer for older women.

Aim: To report on the unique, innovative management of a super morbidly obese patient presenting for fertility preservation in the setting of Grade 2 endometrioid endometrial adenocarcinoma. Case Report: A back-to-back oocyte retrieval and robot-assisted total laparoscopic hysterectomy (RA-TLH) with bilateral salpingo-oophorectomy (BSO) was performed in a 37-year-old nulligravid woman with super morbid obesity (BMI 63 kg/m²) with endometrial cancer. Main outcome measure: the successful retrieval of oocytes for fertility preservation and oncologic intervention via RA-TLH with BSO in the same operative and anesthetic episode. Results: This combined procedure strategy was successful in our case and is a feasible option for similar high-risk patients in the future. Conclusion: Identifying safe and effective approaches for oocyte retrieval in morbidly obese patients represents a pressing need as obesity rates rise among reproductive-aged women. Back-to-back oocyte retrieval and RA-TLH with BSO are not only feasible, but could also decrease significant anesthetic risks for morbidly obese patients.