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Global collaboration is the major trend in the architecture, engineering, and construction industry; training in global engineering collaboration thus is highly demanded in existing engineering education. One approach to this training is to expose students to sufficient experiences, such as having them participating in a global project-based course. To do this, the authors participated in and co-designed a global project-based course, called Sky Classroom, from 2014 to 2016. That course, which aimed to teach global engineering collaboration skills, required international students to collaborate in the design of buildings. During the course, we identified three issues in the existing communication platform: low communicability, passive problem finding, and poor spatial cognition. Since the communication platform is the key factor in successful collaboration, we designed and implemented an appropriate platform, the virtual building information modeling (BIM) reviewer (VBR), for addressing these issues. VBR is an avatar-based communication platform that allows users to enter the BIM model and find problems from their individual perspectives. It was developed and continuously improved based on observations of students’ global collaboration behaviors and feedback in Sky Classroom. VBR has undergone two development phases with two virtual reality types, desktop-based and immersive. While the desktop-based VBR solves the issues of low communicability and passive problem finding, the immersive VBR solves the issue of poor spatial cognition, and the application of the VBR in Sky Classroom will solve the issues in the existing communication platform and assist students in collaboration, respectively.

Taiwan has long been categorized as a country suffering from water shortages. The acquisition of knowledge and development of the concept of water conservation, and the development water conservation habits, are considered a civic responsibility of the citizens. The purpose of the present study was to utilize an immersive virtual environment technology (IVET) to create virtual experiences that expose individuals to vivid information with personal relevance and immediacy in hopes of increasing the behavior intention to conserve water. A mediated virtual experience was provided in the form of an experiential learning game, in which participants were situated in a virtual bathroom and asked to repeatedly use a 600-milliliter bottle to fill a specific water tank to flush a toilet and take a one-minute shower. While consuming the water resources, participants received exaggerated feedback (EF) to intensify the negative consequences of water consumption (direct EF) and/or environmental damage (ambient EF) that emphasized personal affective responses. A total of 165 players, separated into four groups according to the ambient or/and direct EF conditions, experienced the game activities. ANOVA was used to examine the effects of the experimental intervention. The results showed that the immersive virtual reality game in this study caused significant changes in cognition and behavior intention. This study contributes a novel persuasive technology specific to water resources.

We hypothesized that participants engaged in a learning activity would show a biological stress response when exposed to a controlling teacher but biological calm when exposed to an autonomy-supportive teacher. Seventy-eight undergraduates (53 females, 25 males) engaged in a 20-minute puzzle-solving activity while exposed to a teacher who enacted either a controlling, neutral, or autonomy-supportive motivating style. Salivary cortisol was assessed before, during, and after the learning activity, and a post-experimental questionnaire assessed participants’ perceptions of the teacher’s motivating style and indices of positive functioning. Manipulated motivating style affected participants’ cortisol, as exposure to a controlling style increased cortisol while exposure to an autonomy-supportive style decreased it, relative to exposure to a neutral style. Correlational analyses with the self-report measures showed that cortisol reactivity occurred in response to interpersonal events rather than to psychological appraisals. We conclude that cortisol reactivity is sensitive to a teacher’s motivating style and that elevated cortisol signals interpersonal obtrusion and pressure while dampened cortisol signals perspective-taking and support.

Guiding students to generate testable scientific questions is essential in the inquiry classroom, but it is not easy. The purpose of the BDC (“Big Idea, Divergent Thinking, and Convergent Thinking”) instructional model is to to scaffold students' inquiry learning. We illustrate the use of this model with an example lesson, designed to help 5th-grade students understand the concept of plant growth. The BDC model functions as an exploration of, and a connection with, related information among students' scientific knowledge, skills, and practice, so that students can further generate research ideas. Students are able to more easily formulate testable questions and are also highly motivated throughout the course of their inquiry practice. This instructional model provides teachers with a practical and meaningful tool, one that increases students’ capabilities to formulate researchable questions and sustains their motivation to engage in activities of scientific and creative inquiry.

Critical Thinking has been identified in the Common Core State Standards (CCSS) and Next Generation Science Standards (NGSS) as skills needed to prepare students for advanced education and the future workforce. In science education, argument-based inquiry (ABI) has been proposed as one way to improve critical thinking. The purpose of the current study was to examine the possible effects of the Science Writing Heuristic (SWH) approach, an immersion argument-based inquiry approach to learning science, on students' critical thinking skills. Guided by a question-claims-evidence structure, students who participated in SWH approach were required to negotiate meaning and construct arguments using writing as a tool throughout the scientific investigation process. Students in the control groups learned science in traditional classroom settings. Data from five data sets that included 4417 students were analyzed cross-sectionally and longitudinally. Yearly critical thinking gain scores, as measured by Form X of Cornell Critical Thinking Test, were compared for students who experienced the SWH approach versus students who experienced traditional instruction in both elementary (5th grade) and secondary schools (6th-8th grades). Analyses of yearly gain scores for data sets that represented a single year of implementation yielded statistically significant differences favoring SWH over traditional instruction in all instances and statistically significant interactions between gender and grade level in most instances. The interactions revealed that females had higher gain scores than males at lower grade levels but the reverse was true at higher grade levels. Analyses from data sets that included two years of implementation revealed higher overall gains for SWH instruction than for traditional instruction but most of those gains were achieved during the first year of implementation. Implications of these results for teaching critical thinking skills in science classrooms are discussed in detail.

In the primary analysis of the NeoSphere trial, patients given neoadjuvant pertuzumab, trastuzumab, and docetaxel showed a significantly improved pathological complete response compared with those given trastuzumab and docetaxel after surgery. Here, we report 5-year progression-free survival, disease-free survival, and safety. In this multicentre, open-label, phase 2 randomised trial in hospitals and medical clinics, treatment-naive adults with locally advanced, inflammatory, or early-stage HER2-positive breast cancer were randomly assigned (1:1:1:1) to receive four neoadjuvant cycles of trastuzumab (8 mg/kg loading dose, followed by 6 mg/kg every 3 weeks) plus docetaxel (75 mg/m2 every 3 weeks, increasing to 100 mg/m2 from cycle 2 if tolerated; group A), pertuzumab (840 mg loading dose, followed by 420 mg every 3 weeks) and trastuzumab plus docetaxel (group B), pertuzumab and trastuzumab (group C), or pertuzumab and docetaxel (group D). After surgery, patients received three cycles of FEC (fluorouracil 600 mg/m2, epirubicin 90 mg/m2, and cyclophosphamide 600 mg/m2) every 3 weeks (patients in group C received four cycles of docetaxel prior to FEC), and trastuzumab 6 mg/kg every 3 weeks to complete 1 year's treatment (17 cycles in total). Randomisation was done by a central centre using dynamic allocation, stratified by operable, locally advanced, and inflammatory breast cancer, and by oestrogen and/or progesterone receptor positivity. Safety analyses were done according to treatment received. The primary endpoint (pathological complete response) was previously reported; secondary endpoints reported here are 5-year progression-free survival (analysed in the intention-to-treat population) and disease-free survival (analysed in patients who had surgery). Secondary and exploratory analyses were not powered for formal statistical hypothesis testing, and therefore results are for descriptive purposes only. The study ended on Sept 22, 2014 (last patient, last visit). This study is registered with ClinicalTrials.gov, number NCT00545688. Between Dec 17, 2007, and Dec 22, 2009, 417 eligible patients were randomly assigned to group A (107 patients), group B (107 patients), group C (107 patients), or group D (96 patients). One patient in group A withdrew before treatment. One patient assigned to group D received group A treatment, one patient assigned to group D received group B treatment, and one patient assigned to group B received group C treatment. At clinical cutoff, 87 patients had progressed or died. 5-year progression-free survival rates were 81% (95% CI 71–87) for group A, 86% (77–91) for group B, 73% (64–81) for group C, and 73% (63–81) for group D (hazard ratios 0·69 [95% CI 0·34–1·40] group B vs group A, 1·25 [0·68–2·30] group C vs group A, and 2·05 [1·07–3·93] group D vs group B). Disease-free survival results were consistent with progression-free survival results and were 81% (95% CI 72–88) for group A, 84% (72–91) for group B, 80% (70–86) for group C, and 75% (64–83) for group D. Patients who achieved total pathological complete response (all groups combined) had longer progression-free survival compared with patients who did not (85% [76–91] in patients who achieved total pathological response vs 76% [71–81] in patients who did not achieve total pathological response; hazard ratio 0·54 [95% CI 0·29–1·00]). There were no new or long-term safety concerns and tolerability was similar across groups (neoadjuvant and adjuvant treatment periods combined). The most common grade 3 or worse adverse events were neutropenia (group A: 71 [66%] of 107 patients; group B: 59 [55%] of 107; group C: 40 [37%] of 108; group D: 60 [64%] of 94), febrile neutropenia (group A: 10 [9%]; group B: 12 [11%]; group C: 5 [5%]; group D: 15 [16%]), and leucopenia (group A: 13 [12%]; group B: 6 [6%]; group C: 4 [4%]; group D: 8 [9%]). The number of patients with one or more serious adverse event was similar across groups (19–22 serious adverse events per group in 18–22% of patients). Progression-free survival and disease-free survival at 5-year follow-up show large and overlapping CIs, but support the primary endpoint (pathological complete response) and suggest that neoadjuvant pertuzumab is beneficial when combined with trastuzumab and docetaxel. Additionally, they suggest that total pathological complete response could be an early indicator of long-term outcome in early-stage HER2-positive breast cancer. F Hoffmann-La Roche.

Studies with pertuzumab, a novel anti-HER2 antibody, show improved efficacy when combined with the established HER2-directed antibody trastuzumab in breast cancer therapy. We investigated the combination of pertuzumab or trastuzumab, or both, with docetaxel and the combination of pertuzumab and trastuzumab without chemotherapy in the neoadjuvant setting. In this multicentre, open-label, phase 2 study, treatment-naive women with HER2-positive breast cancer were randomly assigned (1:1:1:1) centrally and stratified by operable, locally advanced, and inflammatory breast cancer, and by hormone receptor expression to receive four neoadjuvant cycles of: trastuzumab (8 mg/kg loading dose, followed by 6 mg/kg every 3 weeks) plus docetaxel (75 mg/m 2, escalating, if tolerated, to 100 mg/m 2 every 3 weeks; group A) or pertuzumab (loading dose 840 mg, followed by 420 mg every 3 weeks) and trastuzumab plus docetaxel (group B) or pertuzumab and trastuzumab (group C) or pertuzumab plus docetaxel (group D). The primary endpoint, examined in the intention-to-treat population, was pathological complete response in the breast. Neither patients nor investigators were masked to treatment. This study is registered with ClinicalTrials.gov, number NCT00545688. Of 417 eligible patients, 107 were randomly assigned to group A, 107 to group B, 107 to group C, and 96 to group D. Patients given pertuzumab and trastuzumab plus docetaxel (group B) had a significantly improved pathological complete response rate (49 of 107 patients; 45·8% [95% CI 36·1–55·7]) compared with those given trastuzumab plus docetaxel (group A; 31 of 107; 29·0% [20·6–38·5]; p=0·0141). 23 of 96 (24·0% [15·8–33·7]) women given pertuzumab plus docetaxel (group D) had a pathological complete response, as did 18 of 107 (16·8% [10·3–25·3]) given pertuzumab and trastuzumab (group C). The most common adverse events of grade 3 or higher were neutropenia (61 of 107 women in group A, 48 of 107 in group B, one of 108 in group C, and 52 of 94 in group D), febrile neutropenia (eight, nine, none, and seven, respectively), and leucopenia (13, five, none, and seven, respectively). The number of serious adverse events was similar in groups A, B, and D (15–20 serious adverse events per group in 10–17% of patients) but lower in group C (four serious adverse events in 4% of patients). Patients given pertuzumab and trastuzumab plus docetaxel (group B) had a significantly improved pathological complete response rate compared with those given trastuzumab plus docetaxel, without substantial differences in tolerability. Pertuzumab and trastuzumab without chemotherapy eradicated tumours in a proportion of women and showed a favourable safety profile. These findings justify further exploration in adjuvant trials and support the neoadjuvant approach for accelerating drug assessment in early breast cancer. F Hoffmann-La Roche.

Background NeoSphere showed significantly higher pathologic complete response (pCR) with neoadjuvant pertuzumab, trastuzumab, and docetaxel compared with trastuzumab plus docetaxel, pertuzumab plus trastuzumab, or pertuzumab plus docetaxel. We assessed associations between human epidermal growth factor receptor 2 (HER2) pathway-related biomarkers and clinical outcome in response to these regimens. Methods Tumor, serum, and whole blood samples were collected at baseline and post neoadjuvant treatment before surgery. Associations between biomarkers and pCR, and between biomarkers and clinical variables were assessed in the overall and estrogen receptor (ER)-positive and ER-negative populations. Changes in serum marker levels between baseline and post-neoadjuvant treatment were examined. Results No markers were associated with pCR across all groups; however, significant associations were observed for two markers in individual groups. High HER2 was significantly associated with higher pCR rates ( P  = 0.001) and a significant treatment interaction ( P  = 0.0236) with pertuzumab, trastuzumab, and docetaxel (odds ratio 2.07, P  = 0.01). Low serum transforming growth factor alpha (TGFα) was associated with higher pCR rates with pertuzumab plus trastuzumab ( P  = 0.04) without a significant treatment interaction. Presence of truncated HER2 did not affect pCR. A non-significant decreased pCR benefit was observed consistently across groups in patients with mutated PIK3CA while the treatment benefit from pertuzumab was maintained when comparing the trastuzumab plus docetaxel and pertuzumab, trastuzumab, and docetaxel groups. Notably, PIK3CA exon 9 mutations were associated with residual disease (pooled groups), which was not found for exon 20 mutations. Serum HER2 extracellular domain levels were significantly increased between baseline and post-neoadjuvant treatment in the non-trastuzumab-treated group, and decreased in the trastuzumab-containing groups (likely due to trastuzumab’s mechanism of action). Differences in biomarker profiles according to ER status were observed. Conclusions The observed associations of HER2 protein levels with sensitivity to pertuzumab, and of PIK3CA exon 9 mutation to lack of sensitivity to HER2-targeted monoclonal antibody treatment, warrant further investigation. Previously reported findings of truncated forms of HER2 as resistance markers to HER2-targeted treatment could not be confirmed in NeoSphere. Conventional HER2 assessment should continue and HER2 remains the only biomarker suitable for patient selection in this population. Trial registration Clinicaltrials.gov, NCT00545688 . Registered on 16 October 2007.

Purpose Resistance to HER2 (ErbB2)-targeted therapy may be mediated by other members of the ErbB family. We investigated the efficacy and safety of the irreversible ErbB family blocker, afatinib, alone as first-line therapy in the advanced setting and in combination with vinorelbine or paclitaxel for those who progressed on afatinib monotherapy, in female patients with metastatic breast cancer who had failed or progressed on prior HER2-targeted therapy in the early disease setting. Methods In this phase II, single-arm, two-part study (ClinicalTrials.gov: NCT01271725), patients in part A received afatinib 40 mg/day in 21-day cycles until disease progression or intolerable adverse events (AEs). Patients with progressive disease could then receive afatinib plus weekly vinorelbine 25 mg/m 2 or paclitaxel 80 mg/m 2 until disease progression or intolerable AEs (part B). The primary endpoint was confirmed objective response rate (RECIST v1.1). Results Eighty-seven patients were enrolled and 74 were treated in part A (median age: 51 years [range 27–76]; 31 [42%] estrogen receptor-positive, 26 [35%] progesterone receptor-positive). Of these, 39 (53%) patients went on to receive afatinib plus vinorelbine (13 patients) or paclitaxel (26 patients) in part B. Thirteen (18%) and 12 (31%) patients achieved an objective response in parts A and B, respectively. The most common treatment-related AEs with afatinib monotherapy (any/grade ≥ 3) were diarrhea (68%/8%) and rash (49%/4%). Combination therapy was generally well tolerated, with no additive toxicity observed. Conclusion Afatinib treatment, alone or in combination with vinorelbine or paclitaxel, was associated with objective responses in ≥ 18% of patients with metastatic breast cancer for whom prior HER2-targeted therapy has failed. Treatment-related AEs were generally manageable, with few grade ≥ 3 AEs reported. Trial registration ClinicalTrials.gov, NCT01271725, registered 1 July 2011.

PurposeIn the KATHERINE study (NCT01772472), patients with HER2-positive early breast cancer (EBC) and residual invasive disease after neoadjuvant chemotherapy plus HER2-targeted therapy who were treated with adjuvant trastuzumab emtansine (T-DM1) had a 50% reduction in the risk of an invasive disease-free survival (IDFS) event compared to patients treated with adjuvant trastuzumab. In metastatic disease, T-DM1 has resulted in higher rates of thrombocytopenia in Asian versus non-Asian patients. Here, we report safety and efficacy in Chinese patients from KATHERINE.MethodsPatients with HER2-positive EBC and residual invasive disease after taxane- and trastuzumab-containing neoadjuvant chemotherapy followed by surgery were randomized 1:1 to 14 cycles of adjuvant T-DM1 or trastuzumab. The primary endpoint was time to an IDFS event.ResultsAmong Chinese patients (T-DM1 n = 51, trastuzumab n = 50), T-DM1 treatment resulted in a 43% reduction in risk of an IDFS event compared to trastuzumab (HR = 0.57; 95% CI 0.25–1.31), with similar results for secondary endpoints. As in the global population, Chinese patients receiving T-DM1 versus trastuzumab had more grade ≥ 3 adverse events (AEs; 39.2% versus 4.1%) and AEs leading to treatment discontinuation (27.5% versus 0%). The most common grade ≥ 3 AE with T-DM1 was thrombocytopenia (21.6%), a frequency higher than the frequency in the global population (5.7%). Grade ≥ 3 hemorrhage was reported in 1 patient (T-DM1 arm).ConclusionsIn the KATHERINE study, T-DM1 demonstrated increased efficacy compared to trastuzumab in Chinese patients. Consistent with previous data in Asian patients, T-DM1 was associated with more grade ≥ 3 AEs, and AEs leading to discontinuation, which was driven by an increase in thrombocytopenia.