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Σάββατο 16 Φεβρουαρίου 2019
Development of a hearing help-seeking questionnaire based on the theory of planned behavior
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Size-dependent nonlinear pull-in instability of the clamped cylindrical thin micro-/nanoshell based on the non-classical theories
Abstract
In recent decades, non-classical continuum theories have been commonly utilized to model material discontinuities in micro-/nanoscales. In the present study, modified strain gradient theory (MSGT) together with the fully clamped cylindrical thin-shell model has been adopted to investigate the size-dependent nonlinear pull-in instability of thin cylindrical nano-/microshell. The modified strain gradient theory in cylindrical coordinates and virtual work principle has been applied to derive the constitutive size-dependent equations of motion. In this study, the linear strains have been utilized to establish a system of three-coupled partial differential equations. Further, effect of van der Waals force has been included in the nonlinear governing equations of the systems, and extended Kantorovich method has been used to solve the nonlinear differential equations that in turn lead to achieving the pull-in parameters of the microshell. From theoretical point of view, effect of van der Waals attraction, the size dependency, and the importance of coupling between them on the instability performance have been discussed and the pull-in parameters, i.e., critical mid-deflection and instability voltage have been determined. It was found that comparable pull-in parameter of MSGT to those obtained by the classic theory, and modified couple stress theory depends only on the length scale of the microshell.
http://bit.ly/2SEqsU1
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
| Related Articles |
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
Int J Audiol. 2019 Feb 15;:1-9
Authors: Arnold M, Small BJ, Hyer K, Chisolm T, Frederick MT, Silverman SC, Saunders GH
Abstract
OBJECTIVE: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults' behaviours towards seeking a hearing test.
DESIGN: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores.
STUDY SAMPLE: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings.
RESULTS: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not.
CONCLUSIONS: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults.
PMID: 30767581 [PubMed - as supplied by publisher]
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Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
| Related Articles |
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
Int J Audiol. 2019 Feb 15;:1-9
Authors: Arnold M, Small BJ, Hyer K, Chisolm T, Frederick MT, Silverman SC, Saunders GH
Abstract
OBJECTIVE: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults' behaviours towards seeking a hearing test.
DESIGN: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores.
STUDY SAMPLE: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings.
RESULTS: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not.
CONCLUSIONS: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults.
PMID: 30767581 [PubMed - as supplied by publisher]
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Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
| Related Articles |
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
Int J Audiol. 2019 Feb 15;:1-9
Authors: Arnold M, Small BJ, Hyer K, Chisolm T, Frederick MT, Silverman SC, Saunders GH
Abstract
OBJECTIVE: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults' behaviours towards seeking a hearing test.
DESIGN: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores.
STUDY SAMPLE: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings.
RESULTS: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not.
CONCLUSIONS: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults.
PMID: 30767581 [PubMed - as supplied by publisher]
from #Audiology via ola Kala on Inoreader http://bit.ly/2U0m4v2
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
| Related Articles |
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
Int J Audiol. 2019 Feb 15;:1-9
Authors: Arnold M, Small BJ, Hyer K, Chisolm T, Frederick MT, Silverman SC, Saunders GH
Abstract
OBJECTIVE: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults' behaviours towards seeking a hearing test.
DESIGN: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores.
STUDY SAMPLE: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings.
RESULTS: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not.
CONCLUSIONS: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults.
PMID: 30767581 [PubMed - as supplied by publisher]
from #Audiology via ola Kala on Inoreader http://bit.ly/2U0m4v2
via IFTTT
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
| Related Articles |
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
Int J Audiol. 2019 Feb 15;:1-9
Authors: Arnold M, Small BJ, Hyer K, Chisolm T, Frederick MT, Silverman SC, Saunders GH
Abstract
OBJECTIVE: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults' behaviours towards seeking a hearing test.
DESIGN: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores.
STUDY SAMPLE: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings.
RESULTS: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not.
CONCLUSIONS: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults.
PMID: 30767581 [PubMed - as supplied by publisher]
from #Audiology via ola Kala on Inoreader http://bit.ly/2U0m4v2
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
| Related Articles |
Development of a hearing help-seeking questionnaire based on the theory of planned behavior.
Int J Audiol. 2019 Feb 15;:1-9
Authors: Arnold M, Small BJ, Hyer K, Chisolm T, Frederick MT, Silverman SC, Saunders GH
Abstract
OBJECTIVE: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults' behaviours towards seeking a hearing test.
DESIGN: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores.
STUDY SAMPLE: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings.
RESULTS: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not.
CONCLUSIONS: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults.
PMID: 30767581 [PubMed - as supplied by publisher]
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Characterizing Perceptions Around the Patient-Oncologist Relationship: a Qualitative Focus Group Analysis
Abstract
The purpose of the current study was to characterize the experiences of cancer patients and their caregiver/family members around their relationship with their oncologist, health care team, and the hospital environment. Participants were recruited from The Ohio State University Comprehensive Cancer Center. Participant sociodemographic factors were assessed. Focus groups were moderated and recorded by two members of the research team using a semi-structured interview format. The audio recordings were transcribed and uploaded to NViVO 11 for analyses. Four focus groups were conducted with 25 participants. The mean age of participants was 58.4 years (SD = 15.1, range 26.0–76.0). Participants who were identified as patients (84%) reported different malignancy types including breast (56%), gynecologic (16%), skin (6%) oral (6%), and non-Hodgkin's lymphoma (6%). Three major themes that emerged around the patient-oncologist relationship, include (1) choosing a physician and health care location, (2) relationship with the physician, health care team, and hospital environment; and (3) patient engagement and decision-making. Subthemes highlighted the importance of the flexible communication behaviors and trustworthiness of the oncologist, and the impact of other health care team members. Patients also reported the desire to be engaged in making treatment-related decisions and to include the caregiver/spouse in all stages of cancer care. Understanding the experience of cancer patients in a relationship with their oncologist in the context of the health care team and health care environment will be an important area of future research to provide optimal, tailored patient-centered cancer care.
http://bit.ly/2GxgWf0
Adopting Robotics Training into a General Surgery Residency Curriculum: Where Are We Now?
Abstract
Purpose of Review
Surgical educators are challenged with introducing new technologies into general surgery training. We aim to review the current state of the art for robotics education in general surgery training and to discuss future considerations.
Recent Findings
Well-established platforms for robotic surgery have allowed curriculum development to help standardize education in this domain. However, new robotic platforms and time constraints for resident education have created challenges to educators in this area of surgical training.
Summary
Incorporating current robotics training into a surgery curriculum is feasible despite time constraints seen by residents and faculty alike. Robotic curricula and mechanisms for testing competency will need to evolve as emerging novel robotic platforms enter the surgical armamentarium.
http://bit.ly/2DWtoRZ
Study of magnetic-responsive nanoparticle on the membrane surface as a membrane antifouling surface coating
Abstract
This study aims to form a dynamic layer of the magnetic protective layer (f- Fe3O4/PDDA) on a surface of cellulose acetate (CA) membrane to prevent direct membrane-foulant interactions during an ultrafiltration process. To this end, Fe3O4 nanoparticles with an approximate size of 151.8 ± 8.2 nm were spin-coated on the surface of CA membrane to provide magneto-induced actuation motions of the magnetic nano-colloid in 3-dimensional space, with the help of an external magnetic field (magnetic rod). ATR-FTIR, QCM-D, and cross-flow filtration of this magnetic-responsive membrane were investigated to determine its influences on surface fouling by humic acid solutions. In fact, ATR-FTIR and QCM-D analyses have demonstrated a minimum membrane fouling for the magnetic-responsive membrane that operated under the influence of an oscillating magnetic field. Cross-flow filtration results showed a practically higher permeation (retaining 54% of the initial flux at its steady-flow) and humic acid rejection (more than 85%) in the presence of an oscillating magnetic field compared to its performance in the absence of an oscillating magnetic field. Findings from this magnetically responsive membranes could represent a new class of fouling-resistant membrane.
http://bit.ly/2SXMT66
Surface-attached dual-functional hydrogel for controlled cell adhesion based on poly(N,N-dimethylacrylamide)
Abstract
In this study poly(N,N-dimethylacrylamide) (PDMAA) chains that contains 5 mol% of benzophenone molecules was synthesized and coated on bare organic substrates. Upon irradiation under UV light, the photo-active benzophenone molecules enabled the formation of polymer network as well as attachment of the polymer network onto the organic substrates. From the film thickness (AFM) and photoreaction kinetics of benzophenone (UV-Vis spectroscopy), the surface density of unreacted (active) benzophenone could be controlled. Five model surfaces carrying different densities of active benzophenone were prepared by pre-irradiating approximately 1000-nm spin-coated polymer films at various irradiation energy doses. Addition of protein (laminin) as the bioactive ligands to the partially cross-linked polymeric layer followed by additional irradiation of the mixture under UV light enabled the C,H-insertion crosslinking (CHiC) process between the polymer and the bioactive ligands. This resulted in the so-called dual-functional surface that contains bioactive spots on a biopassive background. Results from immunostaining and cell adhesion experiments showed that the surface density of active benzophenone (0–2.28 × 109 molecules/nm2) played role to the bioactive properties of laminin-decorated spots, while FTIR results indicated that laminin was stable upon irradiation under UV light (365 nm) up to 18 J/cm2.
http://bit.ly/2NaBHxB
How do patients improve their Timed Up and Go test? Responsiveness to rehabilitation of the TUG test in elderly neurological patients
Publication date: Available online 15 February 2019
Source: Gait & Posture
Author(s): Antonio Caronni, Michela Picardi, Evdoxia Aristidou, Paola Antoniotti, Giuseppe Pintavalle, Valentina Redaelli, Irma Sterpi, Massimo Corbo
Abstract
BACKGROUND
. The timed up and go (TUG) test is widely used for assessing treatments effectiveness on elderly mobility. Although the TUG test consists of different tasks (e.g. walking and turning), the total TUG duration (TTD) is usually the only outcome measure, with TTD shortening indicating the patient’s improvement.
RESEARCH QUESTION
. Does TTD shortening reflect the improvement of each TUG tasks or does it reflect the improvement of only some of them?
METHODS
. This retrospective study recruited 120 elderly patients (mean, SD: 76.9, 6.6 years) admitted to inpatient rehabilitation because of an acute or chronic neurological disease (acute patients, AP; chronic patients, CP). TTD and TUG tasks duration was measured on admission and discharge (five trials/session) by means of the instrumental TUG test (ITUG). Likelihood ratios (LRs) were used for inferring TUG tasks improvement from TTD improvement. TTD and TUG tasks have improved if at least four measurements on discharge were shorter than the shortest measurement on admission.
RESULTS
. TTD improvement per se is not enough to claim that all the TUG tasks have improved (LR+AP = 1.32; LR+CP = 1.85). Conversely, if TTD has not improved, not even a single TUG task has improved (LR-AP = 0.13; LR-CP = 0.19). If TTD has improved, there is at least one TUG task that actually improved (LR+AP = 3.17; LR+CP = 9.54). The improvement of all TUG tasks can be only inferred in the (unusual) event of a large TTD shortening (AP: >39%, LR+AP = 6.26; CP: >30%, LR+CP = 9.0).
SIGNIFICANCE
. In most cases, TTD improvement is not associated with the improvement of all TUG tasks. Moreover, when TTD has improved there is at least a TUG task that has improved, but that remains unknown. To actually understand how treatments ameliorate patients’ mobility, ITUG with TUG task duration measurement should be preferred to TTD.
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How do patients improve their Timed Up and Go test? Responsiveness to rehabilitation of the TUG test in elderly neurological patients
Publication date: Available online 15 February 2019
Source: Gait & Posture
Author(s): Antonio Caronni, Michela Picardi, Evdoxia Aristidou, Paola Antoniotti, Giuseppe Pintavalle, Valentina Redaelli, Irma Sterpi, Massimo Corbo
Abstract
BACKGROUND
. The timed up and go (TUG) test is widely used for assessing treatments effectiveness on elderly mobility. Although the TUG test consists of different tasks (e.g. walking and turning), the total TUG duration (TTD) is usually the only outcome measure, with TTD shortening indicating the patient’s improvement.
RESEARCH QUESTION
. Does TTD shortening reflect the improvement of each TUG tasks or does it reflect the improvement of only some of them?
METHODS
. This retrospective study recruited 120 elderly patients (mean, SD: 76.9, 6.6 years) admitted to inpatient rehabilitation because of an acute or chronic neurological disease (acute patients, AP; chronic patients, CP). TTD and TUG tasks duration was measured on admission and discharge (five trials/session) by means of the instrumental TUG test (ITUG). Likelihood ratios (LRs) were used for inferring TUG tasks improvement from TTD improvement. TTD and TUG tasks have improved if at least four measurements on discharge were shorter than the shortest measurement on admission.
RESULTS
. TTD improvement per se is not enough to claim that all the TUG tasks have improved (LR+AP = 1.32; LR+CP = 1.85). Conversely, if TTD has not improved, not even a single TUG task has improved (LR-AP = 0.13; LR-CP = 0.19). If TTD has improved, there is at least one TUG task that actually improved (LR+AP = 3.17; LR+CP = 9.54). The improvement of all TUG tasks can be only inferred in the (unusual) event of a large TTD shortening (AP: >39%, LR+AP = 6.26; CP: >30%, LR+CP = 9.0).
SIGNIFICANCE
. In most cases, TTD improvement is not associated with the improvement of all TUG tasks. Moreover, when TTD has improved there is at least a TUG task that has improved, but that remains unknown. To actually understand how treatments ameliorate patients’ mobility, ITUG with TUG task duration measurement should be preferred to TTD.
from #Audiology via ola Kala on Inoreader http://bit.ly/2SCUEPA
via IFTTT
How do patients improve their Timed Up and Go test? Responsiveness to rehabilitation of the TUG test in elderly neurological patients
Publication date: Available online 15 February 2019
Source: Gait & Posture
Author(s): Antonio Caronni, Michela Picardi, Evdoxia Aristidou, Paola Antoniotti, Giuseppe Pintavalle, Valentina Redaelli, Irma Sterpi, Massimo Corbo
Abstract
BACKGROUND
. The timed up and go (TUG) test is widely used for assessing treatments effectiveness on elderly mobility. Although the TUG test consists of different tasks (e.g. walking and turning), the total TUG duration (TTD) is usually the only outcome measure, with TTD shortening indicating the patient's improvement.
RESEARCH QUESTION
. Does TTD shortening reflect the improvement of each TUG tasks or does it reflect the improvement of only some of them?
METHODS
. This retrospective study recruited 120 elderly patients (mean, SD: 76.9, 6.6 years) admitted to inpatient rehabilitation because of an acute or chronic neurological disease (acute patients, AP; chronic patients, CP). TTD and TUG tasks duration was measured on admission and discharge (five trials/session) by means of the instrumental TUG test (ITUG). Likelihood ratios (LRs) were used for inferring TUG tasks improvement from TTD improvement. TTD and TUG tasks have improved if at least four measurements on discharge were shorter than the shortest measurement on admission.
RESULTS
. TTD improvement per se is not enough to claim that all the TUG tasks have improved (LR+AP = 1.32; LR+CP = 1.85). Conversely, if TTD has not improved, not even a single TUG task has improved (LR-AP = 0.13; LR-CP = 0.19). If TTD has improved, there is at least one TUG task that actually improved (LR+AP = 3.17; LR+CP = 9.54). The improvement of all TUG tasks can be only inferred in the (unusual) event of a large TTD shortening (AP: >39%, LR+AP = 6.26; CP: >30%, LR+CP = 9.0).
SIGNIFICANCE
. In most cases, TTD improvement is not associated with the improvement of all TUG tasks. Moreover, when TTD has improved there is at least a TUG task that has improved, but that remains unknown. To actually understand how treatments ameliorate patients' mobility, ITUG with TUG task duration measurement should be preferred to TTD.
from #Audiology via ola Kala on Inoreader http://bit.ly/2SCUEPA
Neuro-Oncology Diet and risk of glioma
| Estimating survival for renal cell carcinoma patients with brain metastases: an update of the Renal Graded Prognostic Assessment tool Abstract Background Brain metastases are a common complication of renal cell carcinoma (RCC). Our group previously published the Renal Graded Prognostic Assessment (GPA) tool. In our prior RCC study (n = 286, 1985–2005), we found marked heterogeneity and variation in outcomes. In our recent update in a larger, more contemporary cohort, we identified additional significant prognostic factors. The purpose of this study is to update the original Renal-GPA based on the newly identified prognostic factors.Methods A multi-institutional retrospective institutional review board–approved database of 711 RCC patients with new brain metastases diagnosed from January 1, 2006 to December 31, 2015 was created. Clinical parameters and treatment were correlated with survival. A revised Renal GPA index was designed by weighting the most significant factors in proportion to their hazard ratios and assigning scores such that the patients with the best and worst prognoses would have a GPA of 4.0 and 0.0, respectively.Results The 4 most significant factors were Karnofsky performance status, number of brain metastases, extracranial metastases, and hemoglobin. The overall median survival was 12 months. Median survival for GPA groups 0–1.0, 1.5–2.0, 2.5–3, and 3.5–4.0 (% n = 25, 27, 30 and 17) was 4, 12, 17, and 35 months, respectively.Conclusion The updated Renal GPA is a user-friendly tool that will help clinicians and patients better understand prognosis, individualize clinical decision making and treatment selection, provide a means to compare retrospective literature, and provide more robust stratification of future clinical trials in this heterogeneous population. To simplify use of this tool in daily practice, a free online application is available at brainmetgpa.com.
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| Highlights from the Literature |
| Forthcoming Meetings Edited by Albert H. Kim and Jennie W. Taylor |
| Glioblastoma: a prognostic value of AMT-PET? See the article by John et al, pp. 264–273. |
| Old meet new—the path to combination treatments in pediatric low-grade gliomas See the article by Poore et al, pp. 252–263. |
| Disparities along the glioblastoma clinical trials landscape We read with interest the recent work by Vanderbeek et al1 regarding the current clinical trials landscape for glioblastoma (GBM) patients. An unexplored dimension of their analysis centers on disparities and demographic discrepancies between clinical trial participants and the broader GBM population. We therefore examined clinical trials with published results as highlighted by the authors, totaling 51 trials.1 While most of these trials reported details regarding patient age (48/51, 94%) and gender (47/51, 92%), only 14 trials (27%) provided information regarding ethnicity and/or race in either peer-reviewed publications or ClinicalTrials.gov. The rate of reporting ethnicity/race was particularly low among phase I/II studies (9/43, 21%) compared with phase III trials (5/8, 63%, chi-squared test P = 0.02). |
| Multimodal imaging-defined subregions in newly diagnosed glioblastoma: impact on overall survival Abstract Background Although glioblastomas are heterogeneous brain-infiltrating tumors, their treatment is mostly focused on the contrast-enhancing tumor mass. In this study, we combined conventional MRI, diffusion-weighted imaging (DWI), and amino acid PET to explore imaging-defined glioblastoma subregions and evaluate their potential prognostic value.Methods Contrast-enhanced T1, T2/fluid attenuated inversion recovery (FLAIR) MR images, apparent diffusion coefficient (ADC) maps from DWI, and alpha-[11C]-methyl-L-tryptophan (AMT)-PET images were analyzed in 30 patients with newly diagnosed glioblastoma. Five tumor subregions were identified based on a combination of MRI contrast enhancement, T2/FLAIR signal abnormalities, and AMT uptake on PET. ADC and AMT uptake tumor/contralateral normal cortex (T/N) ratios in these tumor subregions were correlated, and their prognostic value was determined.Results A total of 115 MRI/PET-defined subregions were analyzed. Most tumors showed not only a high-AMT uptake (T/N ratio > 1.65, N = 27) but also a low-uptake subregion (N = 21) within the contrast-enhancing tumor mass. High AMT uptake extending beyond contrast enhancement was also common (N = 25) and was associated with low ADC (r = −0.40, P = 0.05). Higher AMT uptake in the contrast-enhancing tumor subregions was strongly prognostic for overall survival (hazard ratio: 7.83; 95% CI: 1.98–31.02, P = 0.003), independent of clinical and molecular genetic prognostic variables. Nonresected high-AMT uptake subregions predicted the sites of tumor progression on posttreatment PET performed in 10 patients.Conclusions Glioblastomas show heterogeneous amino acid uptake with high-uptake regions often extending into non-enhancing brain with high cellularity; nonresection of these predict the site of posttreatment progression. High tryptophan uptake values in MRI contrast-enhancing tumor subregions are a strong, independent imaging marker for longer overall survival. |
| Supratotal resection in glioma: a systematic review Abstract Background Emerging evidence suggests survival benefit from resection beyond all MRI abnormalities present on T1-enhanced and T2‒fluid attenuated inversion recovery (FLAIR) modalities in glioma (supratotal resection); however, the quality of evidence is unclear. We addressed this question via systematic review of the literature.Methods EMBASE, MEDLINE, Scopus, and Web of Science databases were queried. Case studies, reviews or editorials, non-English, abstract-only, brain metastases, and descriptive works were excluded. All others were included.Results Three hundred and nine unique references yielded 41 studies for full-text review, with 7 included in the final analysis. Studies were mostly of Oxford Center for Evidence-Based Medicine Level 4 quality. A total of 88 patients underwent supratotal resection in a combined cohort of 492 patients (214 males and 278 females, age 18 to 82 years). Fifty-one supratotal resections were conducted on high-grade gliomas, and 37 on low-grade gliomas. Karnofsky performance status, overall survival, progression-free survival, neurological deficits postoperatively, and anaplastic transformation were the main measured outcomes. No randomized controlled trials were identified. Preliminary low-quality support was found for supratotal resection in increasing overall survival and progression-free survival for both low-grade and high-grade glioma.Conclusion The literature suggests insufficient evidence for carte blanche application of supratotal resection, particularly in lower-grade gliomas where neurological deficits can result in long-term disability. While the preliminary studies discussed here, containing data from only a few centers, have reported increased progression-free and overall survival, these claims require validation in prospective research studies involving larger patient populations with clearly defined appropriate outcome metrics in order to reduce potential bias. |
| Uncommon low-grade brain tumors Abstract The 2016 World Health Organization (WHO) classification of primary central nervous system (CNS) tumors includes numerous uncommon (representing ≤1% of tumors) low-grade (grades I–II) brain neoplasms with varying clinical behaviors and outcomes. Generally, gross tumor or maximal safe resection is the primary treatment. Adjuvant treatments, though their exact role is unknown, may be considered individually based on pathological subtypes and a proper assessment of risks and benefits. Targetable mutations such as BRAF (proto-oncogene B-Raf), TRAIL (tumor necrosis factor apoptosis inducing ligand), and PDGFR (platelet derived growth factor receptor) have promising roles in future management. |
| Outcomes following stereotactic radiosurgery for small to medium-sized brain metastases are exceptionally dependent upon tumor size and prescribed dose Abstract Background At our institution, we have historically treated brain metastasis (BM) ≤2 cm in eloquent brain with a radiosurgery (SRS) lower prescription dose (PD) to reduce the risk of radionecrosis (RN). We sought to evaluate the impact of this practice on outcomes.Methods We analyzed a prospective registry of BM patients treated with SRS between 2008 and 2017. Incidences of local failure (LF) and RN were determined and Cox regression was performed for univariate and multivariate analyses (MVAs).Results We evaluated 1533 BM ≤2 cm. Median radiographic follow-up post SRS was 12.7 months (1.4–100). Overall, the 2-year incidence of LF was lower for BM treated with PD ≥21 Gy (9.3%) compared with PD ≤15 Gy (19.5%) (sub–hazard ratio, 2.3; 95% CI: 1.4–3.7; P = 0.0006). The 2-year incidence of RN was not significantly higher for the group treated with PD ≥21 Gy (9.5%) compared with the PD ≤15 Gy group (7.5%) (P = 0.16). MVA demonstrated that PD (≤15 Gy) and tumor size (>1 cm) were significantly correlated (P < 0.05) with higher rates of LF and RN, respectively. For tumors ≤1 cm, when comparing PD ≤15 Gy with ≥21 Gy, the risks of LF and RN are equivalent. However, for lesions >1 cm, PD ≥21 Gy is associated with a lower incidence of LF without significantly increasing the risk of RN.Conclusion Our results indicate that rates of LF or RN following SRS for BM are strongly correlated with size and PD. Based on our results, we now, depending upon the clinical context, consider increasing PD to 21 Gy for BM in eloquent brain, excluding the brainstem. |
| Sex difference of mutation clonality in diffuse glioma evolution Abstract Background Sex differences in glioma incidence and outcome have been previously reported but remain poorly understood. Many sex differences that affect the cancer risk were thought to be associated with cancer evolution.Methods In this study, we used an integrated framework to infer the timing and clonal status of mutations in ~600 diffuse gliomas from The Cancer Genome Atlas (TCGA) including glioblastomas (GBMs) and low-grade gliomas (LGGs), and investigated the sex difference of mutation clonality.Results We observed higher overall and subclonal mutation burden in female patients with different grades of gliomas, which could be largely explained by the mutations of the X chromosome. Some well-established drivers were identified showing sex-biased clonality, such as CDH18 and ATRX. Focusing on glioma subtypes, we further found a higher subclonal mutation burden in females than males in the majority of glioma subtypes, and observed opposite clonal tendency of several drivers between male and female patients in a specific subtype. Moreover, analysis of clinically actionable genes revealed that mutations in genes of the mitogen-activated protein kinase (MAPK) signaling pathway were more likely to be clonal in female patients with GBM, whereas mutations in genes involved in the receptor tyrosine kinase signaling pathway were more likely to be clonal in male patients with LGG.Conclusions The patients with diffuse glioma showed sex-biased mutation clonality (eg, different subclonal mutation number and different clonal tendency of cancer genes), highlighting the need to consider sex as an important variable for improving glioma therapy and clinical care. |
New WHO-ITU Guidelines Aim to Reduce NIHL among the Young
The World Health Organization (WHO) and the International Telecommunication Union (ITU) have issued a new international standard for the manufacture and use of devices like smartphones and audio players to make them safer for young people to listen. The Safe listening devices and systems: a WHO-ITU standard recommends that personal audio devices include a sound allowance function, which tracks the level and duration of the user's exposure to sound as a percentage used of a reference exposure; a personal sound profile that informs the user of how safely he or she has been listening and gives cues for action based on his or her listening practices; and volume limiting options such as automatic volume reduction and parental volume control. The two organizations also suggest that information and guidance to users on safe listening practices, both through personal audio devices and for other leisure activities, be included.
The voluntary standard was developed under WHO's Make Listening Safe initiative and by experts from the WHO and ITU over a two-year process drawing on the latest evidence and consultations with a range of stakeholders, including experts from government, industry, consumers, and the general public. Along with the release of the guidelines, the WHO and ITU have also released a toolkit to help those promoting hearing care advocate for the standard and raise public awareness of the importance of safe listening. It can be accessed at http://bit.ly/2tnuIYZ.
Published: 2/15/2019 2:14:00 PM
from #Audiology via ola Kala on Inoreader http://bit.ly/2GsUNi2
via IFTTT
New WHO-ITU Guidelines Aim to Reduce NIHL among the Young
The World Health Organization (WHO) and the International Telecommunication Union (ITU) have issued a new international standard for the manufacture and use of devices like smartphones and audio players to make them safer for young people to listen. The Safe listening devices and systems: a WHO-ITU standard recommends that personal audio devices include a sound allowance function, which tracks the level and duration of the user's exposure to sound as a percentage used of a reference exposure; a personal sound profile that informs the user of how safely he or she has been listening and gives cues for action based on his or her listening practices; and volume limiting options such as automatic volume reduction and parental volume control. The two organizations also suggest that information and guidance to users on safe listening practices, both through personal audio devices and for other leisure activities, be included.
The voluntary standard was developed under WHO's Make Listening Safe initiative and by experts from the WHO and ITU over a two-year process drawing on the latest evidence and consultations with a range of stakeholders, including experts from government, industry, consumers, and the general public. Along with the release of the guidelines, the WHO and ITU have also released a toolkit to help those promoting hearing care advocate for the standard and raise public awareness of the importance of safe listening. It can be accessed at http://bit.ly/2tnuIYZ.
Published: 2/15/2019 2:14:00 PM
from #Audiology via ola Kala on Inoreader http://bit.ly/2GsUNi2
New WHO-ITU Guidelines Aim to Reduce NIHL among the Young
The World Health Organization (WHO) and the International Telecommunication Union (ITU) have issued a new international standard for the manufacture and use of devices like smartphones and audio players to make them safer for young people to listen. The Safe listening devices and systems: a WHO-ITU standard recommends that personal audio devices include a sound allowance function, which tracks the level and duration of the user's exposure to sound as a percentage used of a reference exposure; a personal sound profile that informs the user of how safely he or she has been listening and gives cues for action based on his or her listening practices; and volume limiting options such as automatic volume reduction and parental volume control. The two organizations also suggest that information and guidance to users on safe listening practices, both through personal audio devices and for other leisure activities, be included.
The voluntary standard was developed under WHO's Make Listening Safe initiative and by experts from the WHO and ITU over a two-year process drawing on the latest evidence and consultations with a range of stakeholders, including experts from government, industry, consumers, and the general public. Along with the release of the guidelines, the WHO and ITU have also released a toolkit to help those promoting hearing care advocate for the standard and raise public awareness of the importance of safe listening. It can be accessed at http://bit.ly/2tnuIYZ.
Published: 2/15/2019 2:14:00 PM
from #Audiology via ola Kala on Inoreader http://bit.ly/2GsUNi2
via IFTTT
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