IMPORTANCE: There is concern that African American men with low-risk prostate cancer may harbor more aggressive disease than non-Hispanic White men. Therefore, it is unclear whether active ...surveillance is a safe option for African American men. OBJECTIVE: To compare clinical outcomes of African American and non-Hispanic White men with low-risk prostate cancer managed with active surveillance. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study in the US Veterans Health Administration Health Care System of African American and non-Hispanic White men diagnosed with low-risk prostate cancer between January 1, 2001, and December 31, 2015, and managed with active surveillance. The date of final follow-up was March 31, 2020. EXPOSURES: Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy. MAIN OUTCOMES AND MEASURES: Progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer–specific mortality, and all-cause mortality. RESULTS: The cohort included 8726 men, including 2280 African American men (26.1%) (median age, 63.2 years) and 6446 non-Hispanic White men (73.9%) (median age, 65.5 years), and the median follow-up was 7.6 years (interquartile range, 5.7-9.9; range, 0.2-19.2). Among African American men and non-Hispanic White men, respectively, the 10-year cumulative incidence of disease progression was 59.9% vs 48.3% (difference, 11.6% 95% CI, 9.2% to 13.9%); P < .001); of receipt of definitive treatment, 54.8% vs 41.4% (difference, 13.4% 95% CI, 11.0% to 15.7%; P < .001); of metastasis, 1.5% vs 1.4% (difference, 0.1% 95% CI, –0.4% to 0.6%; P = .49); of prostate cancer–specific mortality, 1.1% vs 1.0% (difference, 0.1% 95% CI, –0.4% to 0.6%; P = .82); and of all-cause mortality, 22.4% vs 23.5% (difference, 1.1% 95% CI, –0.9% to 3.1%; P = 0.09). CONCLUSIONS AND RELEVANCE: In this retrospective cohort study of men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer–specific mortality. Longer-term follow-up is needed to better assess the mortality risk.
Interprofessional collaboration is essential to maintain high-quality care in long-term care and geriatric rehabilitation. However, little is known regarding perceived factors influencing ...interprofessional collaboration by people involved in care. This concerns both long-term care and geriatric rehabilitation. Moreover, knowledge of using patient outcome measures to enhance interprofessional collaboration during multidisciplinary team meetings is insufficient. This study examined the perceived facilitators of and barriers to interprofessional collaboration in general and during multidisciplinary team meetings, specifically according to healthcare professionals, patients, and informal caregivers. Differences between long-term care and geriatric rehabilitation were also investigated. Finally, it was examined which patient outcome measures were used in multidisciplinary team meetings.
A constructivist qualitative study using 10 focus groups and 18 semi-structured interviews with 14 patients, 13 informal caregivers,10 managers, and 22 healthcare professionals from eight Dutch long-term care and geriatric rehabilitation facilities. A combined inductive and deductive approach to a thematic analysis was performed.
The perceived influencing factors of interprofessional collaboration were classified into two general themes: (1) 'Involvement of patient, informal caregiver, and healthcare professional', categorised into: 'participation of patients and informal caregivers', 'behaviour and attitude of team members', 'expectations of team members towards each other', and 'exchange of information, knowledge, and reciprocity in communication'; and (2) 'A systematic approach to providing care for older people', consisting of: 'coordination of team procedures', and 'coordination of organisational procedures'. Also, one theme for multidisciplinary team meetings was identified: 'Organised participation of patient, informal caregiver, and healthcare professional in multidisciplinary team meeting, categorised into: 'team procedures', 'working systematically', and 'participation in multidisciplinary team meetings. Standardised patient outcome measures were scarcely used in multidisciplinary team meetings.
People involved in long-term care and geriatric rehabilitation indicated that, apart from working systematically, being involved in care and multidisciplinary team meetings are essential factors for interprofessional collaboration. These factors must be taken into consideration to provide valuable, high-quality care to older people residing in long-term care and geriatric.
Not applicable.
This paper measures the extent to which effects of foreclosures vary across neighborhoods. It offers a simple empirical framework for decomposing the spillover effects on neighboring property prices. ...Data from Orange County, Florida, reveal that the effects systematically vary across neighborhoods by morphology. The results indicate that older, homogeneous age structure, and non-gated neighborhoods with high vacancy rates are most in jeopardy when foreclosures are present, as these neighborhoods show the greatest neighborhood house price effects.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective
To test the cross‐cultural validity of the U.S. Patient Perception of Integrated Care (PPIC) Survey in a Dutch sample using a standardized procedure.
Data Sources
Primary data collected ...from patients of five primary care centers in the south of the Netherlands, through survey research from 2014 to 2015.
Study Design
Cross‐sectional data collected from patients who saw multiple health care providers during 6 months preceding data collection.
Data collection
The PPIC survey includes 59 questions that measure patient perceived care integration across providers, settings, and time. Data analysis followed a standardized procedure guiding data preparation, psychometric analysis, and included invariance testing with the U.S. dataset.
Principal Findings
Latent scale structures of the Dutch and U.S. survey were highly comparable. Factor “Integration with specialist” had lower reliability scores and noninvariance. For the remaining factors, internal consistency and invariance estimates were strong.
Conclusions
The standardized cross‐cultural validation procedure produced strong support for comparable psychometric characteristics of the Dutch and U.S. surveys. Future research should examine the usability of the proposed procedure for contexts with greater cultural differences.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
A report of clinical outcomes of a computed tomography (CT)-based image guided brachytherapy (IGBT) technique for treatment of cervical cancer.
Seventy-six women with International Federation of ...Gynecology and Obstetrics stage IB to IVA cervical carcinoma diagnosed between 2007 and 2014 were treated with definitive external beam radiation therapy (EBRT) with or without concurrent chemotherapy followed by high-dose-rate (HDR) IGBT. All patients underwent planning CT simulation at each implantation. A high-risk clinical target volume (HRCTV) encompassing any visible tumor and the entire cervix was contoured on the simulation CT. When available, magnetic resonance imaging (MRI) was performed at implantation to assist with tumor delineation. The prescription dose was prescribed to the HRCTV.
The median follow-up time was 17 months. Thirteen patients (17%) had an MRI done before brachytherapy, and 16 patients (21%) were treated without MRI guidance. The mean EBRT/IGBT sum 2-Gy equivalent dose (EQD2) delivered to the 90% volume of the HRCTV was 86.3 Gy. The mean maximum EQD2s delivered to 2 cm(3) of the rectum, sigmoid, and bladder were 67.5 Gy, 66.2 Gy, and 75.3 Gy, respectively. The 2-year cumulative incidences of local, locoregional, and distant failure were 5.8% (95% confidence interval CI: 1.4%-14.8%), 15.1% (95% CI: 5.4%-29.4%), and 24.3% (95% CI: 12.1%-38.9%), respectively. The 2-year overall and disease-free survival rates were 75% (95% CI, 61%-91%) and 73% (95% CI, 60%-90%), respectively. Twenty-nine patients (38%) experienced grade ≥ 2 acute toxicity, with 5 cases of acute grade 3 toxicity and no grade ≥ 4 toxicities. One patient experienced grade 3 gastrointestinal toxicity. No other late grade ≥ 3 events were observed.
This is the largest report to date of CT/MRI-based IGBT for the treatment of cervical cancer. The results are promising, with excellent local control and acceptable toxicity. Further investigation is needed to assess the long-term safety and efficacy of this treatment.
Full text
Available for:
GEOZS, IJS, NUK, OILJ, UL, UM, UPUK
To examine facilitators of and barriers to interprofessional collaboration (IPC) in institutional long-term care (LTC) and geriatric rehabilitation (GR), and to provide an overview of instruments ...used to assess IPC in LTC and GR.
Systematic integrative review.
Institutional long-term care and geriatric rehabilitation.
We systematically searched relevant databases for articles using the terms interprofessional collaboration, interdisciplinary, long-term care, geriatric rehabilitation, elderly, facilitators, and barriers. We conducted a systematic integrative review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis method. Papers containing empirical data about barriers to and facilitators of IPC in LTC and GR were included. The Mixed Method Appraisal Tool was used for quality assessment. Data were analyzed using qualitative thematical analysis.
Three interdependent themes regarding facilitators of and barriers to IPC emerged: Team performance, Organizational conditions, and Sharing information. Eight instruments were used to assess IPC in LTC and none for GR. Limited descriptions and insufficient psychometric qualities of the instruments were reported.
To enhance IPC, it is necessary to stimulate facilitators and limit barriers on all 3 themes. Furthermore, a reliable, validated instrument to assess IPC in LTC and GR, based on a clear definition of IPC is needed. Successful IPC when caring for patients with multimorbidity in LTC and GR requires integration, understanding, and recognition of the interdependency from all persons involved, including patients and family caregivers.
In this work, we developed a novel strategy to synthesize porous (alumino)silicate materials using a single structure-directing agent composed of an imidazole unit with a hydrophobic tail, namely, ...1,2-dimethyl-3-hexadecyl-1H-imidazol-3-ium bromide (C16dMImz). A wide range of products such as ordered mesoporous silicas, layered silica–alumina, and hierarchically porous mordenite zeolite were obtained by varying synthesis parameters such as temperature and aluminum concentration. By changing crystallization temperature, we could control the degree of silica condensation and tune the textural and morphological properties of the final materials. By varying the aluminum concentration in the gel, we can obtain mesoporous amorphous silica–alumina or crystalline mordenite zeolite with, respectively, weak and strong Brønsted acid sites. Obtained acidic silica–alumina materials displayed promising performance in catalytic reactions of linear paraffin hydroisomerization and Friedel–Crafts alkylation of benzene with benzyl alcohol.
Full text
Available for:
IJS, KILJ, NUK, PNG, UL, UM
Purpose
Reporting neurodevelopmental outcome of 8-year-old children treated with neonatal extracorporeal membrane oxygenation (ECMO).
Methods
In a follow-up study in 135 8-year-old children who ...received neonatal ECMO between 1996 and 2001 we assessed intelligence (Revised Amsterdam Intelligence Test), concentration (Bourdon-Vos test), eye-hand coordination (Developmental Test of Visual-Motor Integration) and behavior (Child Behavior Checklist and Teacher Report Form).
Results
Intelligence fell within normal range (mean IQ 99.9, SD 17.7,
n
= 125) with 91 % of the children following regular education. Significantly more children attended special education (9 %) or received extra support in regular education (39 %) compared with normative data. Slower working speed (χ
2
= 132.36,
p
< 0.001) and less accuracy (χ
2
= 12.90,
p
< 0.001) were found on the Bourdon-Vos test (
n
= 123) compared with normative data. Eye-hand coordination fell within the normal range (mean 97.6, SD 14.3,
n
= 126); children with congenital diaphragmatic hernia scored lowest but still normally (mean 91.0, SD 16.4,
n
= 28). Mothers (
n
= 117) indicated more somatic and attention behavior problems; teachers (
n
= 115) indicated more somatic, social, thought, aggression and total problems compared with normative data. Mothers indicated more somatic problems than teachers (
p
= 0.003); teachers reported more attention problems than mothers (
p
= 0.036;
n
= 111).
Conclusions
Eight-year-old children treated with neonatal ECMO fall in the normal range of intelligence with problems with concentration and behavior. Long-term follow-up for children treated with neonatal ECMO should focus on early detection of (subtle) learning deficits.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Fibroblast growth factor (FGF)-dependent epithelial-mesenchymal transitions and cell migration contribute to the establishment of germ layers in vertebrates and other animals, but a comprehensive ...demonstration of the cellular activities that FGF controls to mediate these events has not been provided for any system. The establishment of the Drosophila mesoderm layer from an epithelial primordium involves a transition to a mesenchymal state and the dispersal of cells away from the site of internalisation in a FGF-dependent fashion. We show here that FGF plays multiple roles at successive stages of mesoderm morphogenesis in Drosophila. It is first required for the mesoderm primordium to lose its epithelial polarity. An intimate, FGF-dependent contact is established and maintained between the germ layers through mesoderm cell protrusions. These protrusions extend deep into the underlying ectoderm epithelium and are associated with high levels of E-cadherin at the germ layer interface. Finally, FGF directs distinct hitherto unrecognised and partially redundant protrusive behaviours during later mesoderm spreading. Cells first move radially towards the ectoderm, and then switch to a dorsally directed movement across its surface. We show that both movements are important for layer formation and present evidence suggesting that they are controlled by genetically distinct mechanisms.
PDF
