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Introduction: Children diagnosed with medulloblastoma (MB) who are refractory to upfront therapy or experience recurrence have very poor prognoses. Although phase I and phase II trials exist, these treatments bear significant treatment-related morbidity and mortality. Methods: A retrospective review of children diagnosed with a recurrence of MB from 2002 to 2015 at McMaster University was undertaken. Results: Recurrent disease in 10 patients involved leptomeningeal dissemination, with 3 experiencing local recurrence. In three recurrent patients the disease significantly progressed, and the children were palliated. The remaining 10 children underwent some form of salvage therapy, including surgical re-resection, radiation, and chemotherapy, either in isolation or in varying combinations. Of the 13 children experiencing treatment-refractory or recurrent disease, 4 are currently alive with a median follow-up of 38.5 months (75.5 months). Of the eight patients with molecular subgrouping data, none of the Wnt MB experienced recurrence. Conclusion: Recurrent MB carried a poor prognosis with a 5-year overall survival (OS) of 18.2% despite the administration of salvage therapy. The upfront therapy received, available treatment, and tolerability of the proposed salvage therapy resulted in significant heterogeneity in the treatment of our recurrent cohort.
As a degenerative disease, the progression of dementia needs continued care provision and poses both psychological and financial burden for family caregivers of persons with dementia (PWD). This study seeks to compare predictors of care costs and caregiver burden, and to identify modifiable factors that could alleviate the burden faced by dementia caregivers.
This study interviewed 231 PWD–caregiver dyads in a dementia clinic at a teaching hospital in southern Taiwan in 2013. A follow-up study was conducted a year later, and 167 dyads completed the second interview. Data collected included PWD characteristics, caregiver characteristics, relationship to PWD, and social support to caregivers. Caregiver burden was measured with the Zarit Burden Interview instrument. The association between each predictor variable and cost of care and caregiver burden scores was examined using linear mixed models.
Predictors of care costs were found to be different from predictors of caregiver burden: functional declines measured by Katz’s activities of daily living (ADL) scale were associated with total cost as compared to behavioral disturbance measured by Neuropsychiatric Inventory (NPI), which showed no impact on care costs. However, NPI was a significant predictor of caregiver burden. Caregivers who were better-off financially also reported significantly lower caregiver burden.
Since predictors of care costs were different from the predictors of caregiver burden, providing training to caregivers in addressing PWD’s behavioral disturbance and proving financial assistance to low income caregivers could be effective in reducing caregiver burden.
Inappropriate antibiotic use is associated with increased antimicrobial resistance and adverse events that can lead to further downstream patient harm. Preventative strategies must be employed to improve antibiotic use while reducing avoidable harm. We use the term “antibiotic never events” to globally recognize and define the most inappropriate antibiotic use.
This case report illustrates an unusual case of a dural arteriovenous fistula and an associated encephalocele presenting as otitis media with effusion.
A 53-year-old man presented with right-sided hearing loss and aural fullness of 2 years’ duration. Examination revealed ipsilateral post-auricular pulsatile tenderness. Computed tomography showed transcalvarial channels suggestive of dural arteriovenous fistula. Further magnetic resonance imaging demonstrated the presence of a temporal encephalocele herniating through the tegmen tympani defect, as well as the abnormal vascularity. Angiography confirmed a Cognard type I dural arteriovenous fistula, which is being managed conservatively. Surgical repair of the encephalocele was recommended but declined by the patient.
Dural arteriovenous fistula is an uncommon intracranial vascular malformation rarely seen by otolaryngologists, with pulsatile tinnitus being the usual presentation. To our knowledge, this is the first reported case of dural arteriovenous fistula presenting with conductive hearing loss and otalgia.
To report a novel management strategy for mixed hearing loss in advanced otosclerosis.
A 50-year-old male was referred to St Thomas’ Hearing Implant Centre with otosclerosis; he was no longer able to wear conventional hearing aids because of recurrent otitis externa. The patient underwent short process incus vibroplasty (using the Med-El Vibrant Soundbridge device), followed at a suitable interval (six weeks) by stapes surgery. The main outcome measures were: pure tone audiometry, functional gain and monosyllabic word recognition scores.
Post-operative pure tone audiometry showed a reduction of the mean air–bone gap from 55 dB HL to 20 dB HL. The residual mixed hearing loss was rehabilitated with the Vibrant Soundbridge, with an average device gain of 32 dB. The monosyllabic word recognition scores in quiet at 65 dB improved from 37 to 100 per cent when using the Vibrant Soundbridge at six months after switch-on of the device.
Stapedotomy in conjunction with incus short process vibroplasty (i.e. inner-ear vibroplasty) is a safe and promising procedure for managing advanced otosclerosis with mixed hearing loss in selected patients.
Selenium (Se) is an essential micronutrient for humans, yet its dietary intake is low, mostly due to the low bioavailability in soils and therefore in edible plant tissues. To overcome Se deficiency, the breeding approach (i.e., genetic biofortification), namely in rice, is largely dependent on available Se pools. To ensure the success of genetic biofortification with Se, agronomic biofortification can be accomplished through foliar Se application. Considering this background, the main hypothesis of this work was centered in the foliar application of Se to attain agronomic biofortification of rice crops. This study also aimed to assess the full potential for increasing grain Se concentrations during rice filling, as well as the types of nutrients deposition. An experimental design applying two foliar fertilizers (sodium selenite and sodium selenate) was developed. As test systems, four rice genotypes (Ariete, Albatros, OP1105 and OP1109) were used and the kinetics of micro- and macro-nutrients accumulation and deposition were assessed. Biofortification was performed in field trials for two years with foliar fertilization ranging between 0 and 300 g Se ha−1. At the end of the plant cycle, selenite applications triggered 427- to 884-fold increases in grain Se concentrations among rice genotypes (Albatros > OP1105 > OP1109 > Ariete). The application of selenate also prompted 128- to 347-fold increases in grain Se concentrations in rice crops (Albatros > OP1105 > Ariete > OP1109). Regardless of the foliar fertilizer applied, Se deposition among genotypes occurred throughout the grain without relevant inhibitory effects on yields. In each genotype, micro and macronutrients varied among crop tissues.
We develop an asymmetric aqueous supercapacitor using iron oxide anode and cobalt oxide cathode. The anode was fabricated using electrospinning of carbon precursor/iron oxide precursor blend followed by pyrolysis and in situ electrochemical conversion (to oxide) to form the binder-free and freestanding composite anode which delivered a capacitance of 460 F/g at 1 A/g and retained 82% capacitance after 5000 cycles. The superior performance is attributed to easy electrolyte accessibility as well as the porous fibrous carbon morphology, facilitating volume expansion of iron oxide. The cobalt oxide cathode was prepared using a simple chemical synthesis technique. The electrodes were chosen based on high over potential to water splitting reactions in 6 M KOH electrolyte resulting in a potential window of 1.6 V. The asymmetric device operated in 1.6 V achieved a capacitance of 94.5 F/g at 0.5 A/g while retaining 75% of its capacitance after 12,000 cycles, delivering energy and power densities of 40.53 W h/kg and 2432 W/kg, respectively.
DNA nanotechnology has developed into a state where the design and assembly of complex nanoscale structures is fast, reliable, cost effective, and accessible to nonexperts. Nanometer-precise positioning of organic (e.g., dyes and biomolecules) and inorganic (e.g., metal nanoparticles and colloidal quantum dots) components on DNA nanostructures is straightforward and modular. In this article, we identify the opportunities and challenges that DNA-assembled devices and materials face for optical antennas, metamaterials, and sensing applications. With the ability to arrange hybrid components in defined geometries, plasmonic effects will, for example, amplify molecular recognition transduction such that single-molecule events will be measureable with simple devices. On a larger scale, DNA nanotechnology has the potential to break the symmetry of common self-assembled functional materials, creating predefined optical properties such as refractive-index tuning and topological insulation.
With obesity being a major public health epidemic, dietitians are charged with the difficult task to assist clients in modifying their behaviours. Since there are inconsistent data about dietitians’ beliefs, attitudes and practices concerning obesity and little is known concerning differences in public and private practice, we conducted the present study to address those gaps.
Semi-structured interviews analysed according to thematic analysis procedures.
Public primary-care and private settings.
Seventeen Portuguese registered dietitians working in public primary-care (n 10) and private settings (n 7).
Regardless of work context, ‘persistence of efforts’ emerged as the main characteristic of dietitians’ action. Besides holding negative attitudes towards obese patients, their practices are not negatively influenced. They perceive themselves as active agents in promoting lifestyle changes, offering as many management strategies as possible to empower patients, feeling positive about the accomplishment of a successful weight loss, believing in their own efficacy and competency in helping patients. However, differences in reimbursement, work environment, perceived barriers, patient characteristics and availability of resources seem to contribute to differences in persistence according to the setting in which dietitians are working, evidenced by an increase of efforts and engagement in private practice and a decrease in public primary-care practice.
Portuguese dietitians present a positive mindset and actions about obesity treatment outcomes; however, education in behaviour change strategies should be improved. The public health system requires reorganization to enhance effective obesity management delivery. Motivation driving dietitians’ work in private settings should be addressed.
Systematic paleontology of three new species of Petalocrinidae (Crinoidea) are documented from the carbonate-dominated units of the Shihniulan and equivalent Leijiatun formations (Llandovery, Silurian) of the Baisha, Fengxiang, and Shuibatang sections in Guizhou (China). New taxa are from the Upper Yangtze Epicontinental Sea of the South China Block. The new taxa include Petalocrinus stenopetalus new species, Spirocrinus circularis new species, and S. dextrosus new species. They have a narrow spatial and temporal (Aeronian) distribution. Evolutionary patterns of the four genera of Petalocrinidae are outlined based on the specialized characters of the fused arm plates. Phylogenetic analysis was used to assess morphological relationships within the Petalocrinidae. Petalocrinus inferior represents the plesiomorphic condition for the group and nests as a sister group of P. stenopetalus n. sp. and the Spirocrinus species used in this analysis and the clade exclusively comprised of Sinopetalocrinus. The phylogenetic analysis suggests that Petalocrinus, as currently defined, might be a paraphyletic genus.
This study aimed to assess the utility of onlay pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage total laryngectomy.
A retrospective analysis was performed of 172 patients who underwent salvage laryngectomy for recurrent carcinoma of the larynx or hypopharynx between 1999 and 2014. One hundred and ten patients underwent primary closure and 62 patients had pectoralis major myofascial flap onlay.
The overall pharyngocutaneous fistula rate was 43 per cent, and was similar in both groups (primary closure group, 43.6 per cent; onlay flap group, 41.9 per cent; p = 0.8). Fistulae in the onlay flap group healed faster: the median and mean fistula duration were 37 and 55 days, respectively, in the primary closure group and 20 and 25 days, respectively, in the onlay flap group (p = 0.008).
Use of an onlay pectoralis major myofascial flap did not decrease the pharyngocutaneous fistula rate, although fistula duration was shortened. A well-designed randomised-controlled trial is needed to establish parameters for its routine use in clinical practice.
Caregiver burden (CB) of Alzheimer's disease (AD) in Taiwan is becoming an urgent social issue as well as that in Japan. The comparison of CB may explain how caregiver feels burden in each country.
The participants were 343 outpatients with AD and their caregivers of Japan (n = 230) and Taiwan (n = 113). We assessed the CB using the Japanese and Chinese version of Zarit Caregiver Burden Interview (ZBI). The initial analysis was an exploratory factor analysis for each group to confirm the factor structure of ZBI. Then, the multiple-group structural equation modeling (MG-SEM) was used to assess the measurement invariance of ZBI such as configural, metric, and scalar invariances. Lastly, we compared the latent factor means of the ZBI between Japan and Taiwan.
In both groups, the confirmatory factor analysis extracted 3 factors which were labeled “Impact on caregiver's life”, “Embarrassed/anger”, and “Dependency”. The MG-SEM indicated an acceptable model fit, and established the partial scalar measurement invariance (comparative fit index (CFI) = 0.901, root mean square error of approximation (RMSEA) = 0.066). When we compared the latent factor means, the score of “Impact on caregiver's life” in Taiwanese caregivers was significantly higher than that in Japanese (p = 0.001). However, “Dependency” in Taiwanese caregivers was lower than that in Japanese (p < 0.001).
Partial measurement invariance allowed comparing the latent factor mean across two countries. The results of comparisons suggested that there may be differences in the way of feeling CB between Japan and Taiwan.
Metatronics, or metamaterial-inspired optical nanocircuitry, has provided a powerful toolset to tailor and implement modular quasi-static circuit functionalities in the optical regime. So far, these concepts have been mostly limited to linear operations, while many of the relevant operations in integrated circuits require nonlinear responses. In this work, we introduce nonlinear infrared nanocircuit elements exploiting large quantum conductance driven by photon-assisted tunneling and enhanced by hybrid plasmonic nanojunctions. Based on these concepts, we present infrared lumped nanocircuit mixers and switches for second-harmonic generation, and wide-spectrum self-amplitude modulators based on nanorods.