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To evaluate the quality of rectal hydrogel spacer (HS) insertions from literature in patients undergoing radical radiotherapy for prostate cancer. The secondary aim is to assess the benefit of HSs in patients with risk factors more likely to have rectal complications, such as non-conventional radiotherapy dose fractionations and high-risk disease.
Method and materials:
A literature search of peer-reviewed electronic articles was carried out using Boolean connectors and Medical Subject Headings in the databases. Databases searched included ScienceDirect, Medline and Cinahl. The articles were assessed using relevant critical appraisal skills programme tools.
From the 26 studies used, HS showed a clinically significant relative reduction in rectal planning dose volumes for both high- and low-risk prostate cancer patients in a range of radiotherapy treatment modalities including volumetric modulated arc therapy, intensity-modulated radiotherapy, intensity-modulated proton therapy, stereotactic ablative body radiotherapy and brachytherapy. Spacer placements were successfully inserted in 99% of patients. However, rectal wall infiltration occurrence was 6% and ≥2 cm unsymmetrical placements in 2%.
A spacer scoring system based on the HS symmetry has provided evidence of the quality of the position inserted, which was visually aided by T2-wieghted MRIs. Despite optimal HS placements ranging from 62 to 72%, HS had a clinically significant reduction of ≥25% in planned rectal V70 dose in 97% of patients.
To investigate the association of prenatal alcohol exposure (PAE) and early neurodevelopment in the first 2 years of life, adjusting for maternal socio-demographic and psychosocial factors, in the Drakenstein Child Health Study (DCHS), a South African birth cohort study.
The DCHS comprises a population-based birth cohort of 1143 children, of which a subsample completed the Bayley Scales of Infant Development-III (BSID-III) at 6 (n = 260) and 24 months of age (n = 734). A subset of alcohol-exposed and -unexposed children was included in this analysis at age 6 (n = 52 exposed; n = 104 unexposed) and 24 months (n = 92 exposed; n = 184 unexposed). Multiple hierarchical regression was used to explore the associations of PAE with motor and language development.
PAE was significantly associated with decreased gross motor [odds ratio (OR) = 0.16, 95% confidence interval (CI) = 0.06–0.44, p = 0.001] or fine motor (OR = 0.16, 95% CI = 0.06–0.46, p = 0.001) functioning after adjusting for maternal socio-demographic and psychosocial factors at 6 months of age only. No significant effects were found in either receptive or expressive communication and cognitive outcomes at either time points.
PAE has potentially important consequences for motor development in the first 2 years of life, a period during which the most rapid growth and maturation occur. These findings highlight the importance of identifying high-risk families in order to provide preventive interventions, particularly in antenatal clinics and early intervention services.
This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.
The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.
Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.
In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.
Introduction and regular application of multiplex polymerase chain reaction analysis of bronchoalveolar specimens for community-acquired respiratory viruses in January 2017 led to the identification of adenovirus in multiple patients in a surgical intensive unit in July 2017, which was attributed to a pseudo-outbreak.
While child self-regulation is shaped by the environment (e.g., the parents’ caregiving behaviors), children also play an active role in influencing the care they receive, indicating that children's individual differences should be integrated in models relating early care to children's development. We assessed 409 children's observed temperamental behavioral inhibition (BI), effortful control (EC), and the primary caregiver's parenting at child ages 3 and 5. Parents reported on child behavior problems at child ages 3, 5, and 8. Mediation analyses were conducted to examine relations between child temperament and parenting in predicting child problems. BI at age 3 was positively associated with structured parenting at age 5, which was negatively related to child internalizing and attention-academic problems at age 8. In contrast, parenting at child age 3 did not predict child BI or EC at age 5, nor did age 3 EC predict parenting at age 5. Findings indicate that child behavior may shape the development of caregiving and, in turn, long-term child adjustment, suggesting that studies of caregiving and child outcomes should consider the role of child temperament toward developing more informative models of child–environment interplay.
Jadeite artefacts at Maya sites are normally associated with ritual and ceremonial locations, with high-quality jadeite reserved for elite objects. The discovery of a jadeite gouge with a wooden handle at a Classic Maya salt-working site submerged by sea-level rise—Ek Way Nal, Belize—is therefore unexpected and provides new information about the utilitarian use of this stone. The extremely high quality of this jadeite tool is particularly surprising, offering new insight into the Classic Maya exchange systems and the role of salt makers such as those based at Ek Way Nal.
Caregivers for patients undergoing hematopoietic cell transplantation (HCT) are susceptible to significant psychosocial distress. This cross-sectional study aimed to describe psychosocial support services offered and used by caregivers of pediatric primary immune deficiency (PID) during HCT at 35 hospitals across North America.
Caregivers of pediatric patients with PID were recruited by e-mail to participate in an anonymous 140-question survey instrument between April and May 2016 (N = 171).
Of those meeting inclusion criteria (53%), family counseling services were only offered to fewer than half of caregivers (42%). Of the survey participants not offered counseling services, the majority desired family counseling (70%) and sibling counseling (73%). That said, when offered counseling, utilization rates were low, with 22% of caregivers using family counseling and none using sibling counseling.
Significance of results
These results indicate the need to offer and tailor counseling services for families throughout the HCT process. Further research should focus on reducing barriers to utilization of counseling services such as offering bedside counseling services, online modalities, and/or financial assistance.
Objectives: Obstructive sleep apnea (OSA) is associated with cognitive impairment but the relationships between specific biomarkers and neurocognitive domains remain unclear. The present study examined the influence of common health comorbidities on these relationships. Adults with suspected OSA (N=60; 53% male; M age=52 years; SD=14) underwent neuropsychological evaluation before baseline polysomnography (PSG). Apneic syndrome severity, hypoxic strain, and sleep architecture disturbance were assessed through PSG. Methods: Depression (Center for Epidemiological Studies Depression Scale, CESD), pain, and medical comorbidity (Charlson Comorbidity Index) were measured via questionnaires. Processing speed, attention, vigilance, memory, executive functioning, and motor dexterity were evaluated with cognitive testing. A winnowing approach identified 9 potential moderation models comprised of a correlated PSG variable, comorbid health factor, and cognitive performance. Results: Regression analyses identified one significant moderation model: average blood oxygen saturation (AVO2) and depression predicting recall memory, accounting for 31% of the performance variance, p<.001. Depression was a significant predictor of recall memory, p<.001, but AVO2 was not a significant predictor. The interaction between depression and AVO2 was significant, accounting for an additional 10% of the variance, p<.001. The relationship between low AVO2 and low recall memory performance emerged when depression severity ratings approached a previously established clinical cutoff score (CESD=16). Conclusions: This study examined sleep biomarkers with specific neurocognitive functions among individuals with suspected OSA. Findings revealed that depression burden uniquely influence this pathophysiological relationship, which may aid clinical management. (JINS, 2018, 28, 864–875)
Multiple sclerosis (MS) is a chronic, progressive, autoimmune, neurodegenerative disorder that can interfere with physical and psychological functioning, negatively affecting health-related quality of life (HRQoL). Fostering mindfulness may mitigate the negative consequences of MS on HRQoL. The relationship between mindfulness, mood and MS-related quality of life was investigated. In total, 52 individuals with MS completed questionnaires to examine the relationship between trait mindfulness and wellness. Higher levels of trait mindfulness were associated with better HRQoL, lower depression and anxiety, lower fatigue impact and fewer perceived cognitive deficits. Mindfulness interventions have the potential to enhance wellness in those living with MS.
To determine which concomitant boost technique is dosimetrically superior in the treatment of breast cancer; volumetric-modulated arc therapy (VMAT) or fixed field intensity-modulated radiotherapy (ff-IMRT).
Materials and methods
In total, 30 breast patients were re-planned with both VMAT and fixed field concomitant boost intensity-modulated radiotherapy techniques. A hybrid technique was used delivering 80% of the dose through tangential beams and 20% through an integrated boost. A two-tailed t-test sample for means was used to compare the dosimetric differences between the techniques.
Maximum dose was statistically lower for VMAT; 103·2 versus 103·7% for ff-IMRT along with statistically lower V2 Gy doses to the contralateral lung (0·7 versus 1·6%) and heart for both left- (19·0%/22·6%), and right- (5·5%/8·8%) sided patients, respectively. ff-IMRT boasted significantly lower ipsilateral lung V20, V18 and V10 Gy (7·9/8·6/13·1 versus 8·1/8·8/13·4%) than VMAT, respectively. No differences were found with minimum coverage, mean dose and V5 Gy to all organs at risk (OARs).
VMAT and ff-IMRT techniques demonstrate excellent target coverage and OAR sparing facilitated by the hybrid planning technique and deep inspiration breath hold. There is no obvious dosimetrically superior option between the two techniques. Reduced treatment times with VMAT make it more desirable to implement clinically.
Over the last 20 years of our careers, we have witnessed a significant decline in the respect for the liberal arts and social sciences. This decline forces us to regularly respond to questions about the relevance, value and future of our discipline. We know that political science provides fundamental skills for our students to succeed in the 21st century. Yet we also believe that as teachers and scholars we can do a better job of connecting to the realities of our students, articulating the skills and attitudes that our students will develop, and adapting our teaching methods to include high impact practices (Kuh, 2008) that focus on student learning. Here we argue that there are four important conversations that we need to have that can strengthen the appeal and interest in our discipline: the articulation of learning outcomes, the inclusion of high impact practices, attention to information literacy that recognizes the significant change in the delivery and access of research materials and a deep integration of indigenous ways of knowing in our teaching.
Persistently elevated behavioral inhibition (BI) in children is a marker of vulnerability to psychopathology. However, little research has considered the joint influences of caregiver and child factors that may moderate the continuity of BI in early childhood, particularly genetic variants that may serve as markers of biological plasticity, such as the serotonin transporter linked polymorphic region (5-HTTLPR). We explored this issue in 371 preschoolers and their caregivers, examining whether parent characteristics (i.e., overinvolvement or anxiety disorder) and child 5-HTTLPR influenced the continuity of BI between ages 3 and 5. Measures were observational ratings of child BI, observational and questionnaire measures of parenting, and parent interviews for anxiety disorder history, and children were genotyped for the 5-HTTLPR. Parent factors did not moderate the association between age 3 and age 5 BI; however, child BI at age 3 interacted with children's 5-HTTLPR variants to predict age 5 BI, such that children with at least one copy of the short allele exhibited less continuity of BI over time relative to children without this putative plasticity variant. Findings are consistent with previous work indicating the 5-HTTLPR short variant increases plasticity to contextual influences, thereby serving to decrease the continuity of BI in early childhood.
A great deal has been written about the British Royal Navy frigate hmsIndefatigable and her first captain, Sir Edward Pellew, including three biographies, many accounts of actions in which the ship engaged and a number of works of historical fiction. In this last category the best-known example is the series of Hornblower novels by the twentieth-century author C. S. Forester, who chose Pellew's Indefatigable as the ship on which his eponymous antihero, Horatio Hornblower, served the majority of his time as a midshipman. This book presents an examination of the lives and careers of seventeen of the young gentlemen who would have been Hornblower's historical shipmates aboard hms Indefatigable; the volunteers, midshipmen and mates alongside whom he would have lived, berthed and fought.
Captain Sir Edward Pellew, later Admiral Lord Exmouth, is still highly regarded as a gifted and audacious sea officer. In a long and successful career he served as Commander in Chief of both the East Indies station and the Mediterranean Fleet, was feted as the victor of the Bombardment of Algiers and rose to the rank of Admiral of the Red and Vice Admiral of the United Kingdom. Notwithstanding these notable achievements, Pellew is most widely remembered as the quintessential frigate commander and captain of the 44-gun rasée hms Indefatigable.
Pellew captained the Indefatigable for just over three years, from December 1795 to March 1799. It was a successful command by any measure and during this time the ship took numerous prizes and fought several notable engagements. The Indefatigable's most famous action was unquestionably the dramatic Droits de L'Homme engagement when, on 13 January 1797, the Indefatigable, together with her consort the 36-gun frigate Amazon, took on a French 74-gun ship of the line and ran her on shore following a brutal twelve-hour engagement fought at night in the teeth of a ferocious storm on the lee shore of Audierne Bay on the Breton coast.
The Droits de L'Homme engagement is regarded as one of the most emblematic frigate engagements of the French Revolutionary Wars, but, despite being cited in almost every contemporary and modern naval history of this period, little has been written about the Indefatigable's officers and crew.
The young gentlemen who served under Pellew's command aboard hmsIndefatigable in 1797 are in many ways indicative of the countless men and boys who benefited from his patronage throughout his long career. Three individuals, George Cadogan, the son of an earl, Jeremiah Coghlan, a brave and capable merchant seaman, and William Kempthorne, the son of a Falmouth packet captain, are particularly illustrative of the breadth of Pellew's patronage and the wide range of young officers whose careers he nurtured and promoted. Irrespective of their widely varying family backgrounds and social standing, all benefited from Pellew's support, particularly during their formative years in the service. These young gentlemen highlight the nature of Pellew's patronage, his enduring friendship and the ongoing, sometimes dogged, support he provided to those who ran foul of the vicissitudes of naval service.
The Honourable George Cadogan is unique among the young gentlemen of hms Indefatigable in that he was the only one of the seventeen who came to the ship bearing his own aristocratic title. On the evidence of contemporary naval biographies, Cadogan's naval career bears all the hallmarks of privilege and patronage. The eighth son of Earl Cadogan joined the navy at the age of twelve, following a recommendation from the First Lord of the Admiralty, he made lieutenant at nineteen, commander at twenty-one, post captain at twenty-four, achieved the rank of Admiral of the Red in retirement and served as naval aide-de-camp to two monarchs.
While Cadogan's achievements appear respectable by any measure, archival evidence reveals a troubling picture of a man who had a turbulent naval career and an unsettled family life. By the time he retired from active service, George Cadogan had survived two mutinies, lost one ship, served time as a prisoner of war, been investigated by two courts of inquiry following accusations of cruelty and brutality, and been court martialled on charges relating to the death of a young midshipman. Though honourably acquitted of all charges, accusations of tyranny and brutality dogged George Cadogan throughout his career . Cadogan's personal life was also marred by a series of scandals. His parents and his sister were involved in acrimonious and very public divorce cases, which resulted in Cadogan fighting a duel in an attempt to restore the family's honour.
Since his death in 1833, Admiral Edward Pellew, 1st Viscount Exmouth, has been the subject of three biographies and numerous character studies, both contemporary and modern, which have shaped the perception of the man, his reputation and his legacy. While Pellew's reputation as a gifted sea officer and the foremost frigate commander of his era is beyond dispute, the picture of the man that emerges from his biographies is both complex and contradictory. N. A. M. Rodger's brief but balanced assessment of Pellew as ‘tough, brave, skilful, lucky and unscrupulous’ illustrates the ambiguous nature of his character. From his earliest days as a midshipman, Pellew's courage, activity and zeal were recognised and rewarded, but he was also criticised for being volatile, intemperate and antagonistic. At a time when naval captains were celebrated for their ability to earn enormous fortunes in prize money, Pellew was feted for his success in capturing prizes but gained a reputation for avarice and cupidity. In a system that favoured interest and patronage, Pellew was a generous and steadfast patron who nurtured the careers of many young officers and men, but at the same time he was criticised for taking nepotism to extreme lengths by over-promoting his own sons. Pellew was celebrated by the press and public for rising through the ranks on his own merits, but there were persistent sneers from some of his contemporaries that his eager pursuit of honours was undignified at best. Many of these contradictory attitudes towards Pellew arose from the social and political mores of the period, while others have resulted from the vagaries of Pellew's biographers.
Pellew's first biography, The Life of Admiral Viscount Exmouth, was written in 1835, immediately after his death, by Edward Osler. While Osler's work was sanctioned by Pellew's eldest brother Samuel, the rest of the family vehemently objected to its publication and refused to allow Osler access to Pellew's archive. Osler's primary aim in writing the biography was clearly to glorify Pellew's reputation and that of his family; however, much of what he wrote is ambiguous or just plain wrong, particularly with regard to the details of Pellew's naval service. This is perhaps unsurprising as his primary source was Samuel who, although he had served briefly as a naval surgeon, spent most of his life ashore as a customs official and had little experience of life at sea.
The remarkable exchange of letters between Sir Edward Pellew and Lord Spencer, First Lord of the Admiralty, relating to Pellew's appointment to the Impetueux, has been published in whole and part in many places. It is reproduced in its entirety here as it stands as an eloquent testimony to Pellew's devotion to hms Indefatigable and her crew, the ‘faithful, and attached Companions, grown from boys to manhood under him’.
Spencer to Pellew, 15 February 1799
Admt'y 15 Feb: 1799
Sir Ed Pellew Bart.
The extensive Promotion of Flag Officers which His Majesty has been pleased to authorize me to make brings you so high on the Captains List, that it is no longer consistent with the ordinary Practice of the Service that you should continue to serve in a Frigate: I have therefore given you an Appointment to the Impetueux as being the most active and desirable Line of Battle Ship which the Arrangement on this occasion enabled me to select for you, and I have no doubt but that you will in this new Line of Service continue to gain as much Credit as you have already, by the Acknowledgement of every one who knows you, obtained.
Believe me Dear Sir
your very faithful
Pellew to Spencer, no date
I know not how to express my surprize on the receipt of your lordships’ very unexpected letter; and had I conceived the intended arrangement of Promotion could have affected my situation in the command of the Indefatigable I should have most earnestly entreated your forebearance, and shall now feel myself highly gratified if your lordship will permit me to continue in my present situation, amidst officers, and men who have served under thro’ the war and who look up to me for protection I cannot at the same time that I express my wishes, but feel very sensible of your Lordship's attention to me in the selection you have been pleased to make and if my request should not meet your approbation I indulge myself with the expectation of being permitted to remove with me such officers and young gentlemen as I shall point out and I confide in your lordships goodness for throwing me as much into active service as possible.