Abstract Background Minimally invasive approaches to partial nephrectomy have been rapidly gaining popularity but require advanced laparoscopic surgical skills. Renal hilar tumors, due to their ...anatomic location, pose additional technical challenges to the operating surgeon. Objective We compared the outcomes of robot-assisted partial nephrectomy (RPN) for hilar and nonhilar tumors in our large multicenter contemporary series of patients. Design, setting, and participants We retrospectively reviewed prospectively collected data on 446 consecutive patients who underwent RPN by renal surgeons experienced in minimally invasive techniques at four academic institutions from June 2006 to March 2010. Patients were stratified into two groups: those with hilar lesions and those with nonhilar lesions. Measurements Patient demographics, operative outcomes, and postoperative outcomes, including oncologic outcomes, were recorded. Results and limitations Forty-one patients (9%) had hilar renal masses; 405 patients (91%) had nonhilar masses. There was no statistical differences in patient demographics except for larger median tumor size in the hilar cohort (3.2 cm vs 2.6 cm; p = 0.001). The only significant difference in operative outcomes was an increase in warm ischemia times for the hilar group versus the nonhilar group (26.3 ± 7.4 min vs 19.6 ± 10.0 min; p = <0.0001). There were no differences in postoperative outcomes; however, there was a trend for increased risk of malignancy and higher stage tumors in the hilar lesion group. Final pathologic margin status was similar in both groups. Only one patient in the nonhilar group had evidence of recurrence at 21 mo. The study was limited by the lack of standard anatomic classification of renal tumors and the potential influence of the surgeons’ prior robotic experience. Conclusions The data represent the largest series of its kind and strongly suggest that RPN is a safe, effective, and feasible option for the minimally invasive approach to renal hilar tumors with no increased risk of adverse outcomes compared with nonhilar tumors in the hands of experienced robotic surgeons.
Chronic malnutrition during infancy, marked by stunting, has been associated with poor cognitive function. We assessed the effect of stunting, diarrhoeal disease, and parasitic infections during ...infancy on cognitive function in late childhood.
We followed up from birth to 2 years, a cohort of 239 Peruvian children for anthropometrics, stool samples, and diarrhoeal status. At 9 years of age, we assessed cognitive function in 143 (69%) with the full-scale intelligence quotient of the Wechsler intelligence scale for children-revised (WISC-R).
All findings were adjusted for socioeconomic status and schooling; in addition, findings related to diarrhoea prevalence, Giardia lamblia, and Cryptosporidium parvum were adjusted for severe stunting. During the first 2 years of life, 46 (32%) of 143 children were stunted. Children with severe stunting in the second year of life scored 10 points lower on the WISC-R test (95% Cl 2·4–17·5) than children without severe stunting. Children with more than one episode of G lamblia per year scored 4·1 points (0·2–8·0) lower than children with one episode or fewer per year. Neither diarrhoea prevalence nor C parvum infection was associated with WISC-R scores.
Malnutrition in early childhood, indexed by stunting, and potentially G lamblia, are associated with poor cognitive function at age 9 years. If the observed associations are causal, then intervention programmes designed to prevent malnutrition and G lamblia early in life could lead to significant improvement in cognitive function of children in similar lower-income communities throughout the less-developed world.
One of the most computationally challenging problems expected for the High-Luminosity Large Hadron Collider (HL-LHC) is determining the trajectory of charged particles during event reconstruction. ...Algorithms used at the LHC today rely on Kalman filtering, which builds physical trajectories incrementally while incorporating material effects and error estimation. Recognizing the need for faster computational throughput, we have adapted Kalman-filter-based methods for highly parallel, many-core SIMD architectures that are now prevalent in high-performance hardware. In this paper, we discuss the design and performance of the improved tracking algorithm, referred to as MKFIT. A key piece of the algorithm is the MATRIPLEX library, containing dedicated code to optimally vectorize operations on small matrices. The physics performance of the MKFIT algorithm is comparable to the nominal CMS tracking algorithm when reconstructing tracks from simulated proton-proton collisions within the CMS detector. We study the scaling of the algorithm as a function of the parallel resources utilized and find large speedups both from vectorization and multi-threading. MKFIT achieves a speedup of a factor of 6 compared to the nominal algorithm when run in a single-threaded application within the CMS software framework.
This study investigated whether diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values provide specific information that allows the diagnosis of solid or predominantly solid ...gynaecological adnexial lesions, especially whether they can discriminate benign and malignant lesions.
DWI was performed in 37 patients with histologically proven solid or predominantly solid adnexial lesions (22 malignant and 15 benign neoplasms). The lesions in our data set were divided into two groups, all adnexial lesions or lesions of ovarian origin, for evaluation. The areas of the highest signal intensity on DWI (b = 800 s mm(-2)) and the lowest ADC values within the lesions were evaluated.
On DWI, high signal intensity was observed more often in malignant than in benign lesions (p<0.0001). There was no significant difference between the ADC values of the malignant and benign lesions in either the adnexial (0.88±0.16 vs 0.84±0.42; p = 0.96) or the ovarian (0.85±0.14 vs 1.05±0.2; p = 0.133) lesions. When signal intensities on DWI were compared, however, malignant lesions had higher values than the benign lesions in both the adnexial (0.69±0.21 vs 0.29±0.13; p<0.0001) and the ovarian lesions (0.75±0.14 vs 0.37±0.24; p = 0.003).
On DWI, high signal intensity was observed more frequently with the malignant lesions.
Three focus groups (n = 23) with Korean American older adults explored the role of culture in end-of-life decision making. No participants had completed an advance directive and few had discussed ...end-of-life treatment preferences. Focus group themes addressed: (a) whether children are resistant or receptive to discussing their parents' end-of-life treatment preferences; (b) whether the older adults or their children should make decisions about end-of-life treatment; (c) whether decision making should be the responsibility of the eldest son or of all the children; and (d) whether children would implement the parent's preferences for end-of-life treatment. Understanding the role of children in end-of-life decision making among Korean American older adults is important for culturally competent care.
The purpose of this study was to review the effect of age and body mass index (BMI) on the prognosis, demographic characteristics, and pathological features of patients diagnosed with endometrial ...cancer, specifically before menopause.
Patients that were diagnosed with endometrial cancer before menopause, were screened retrospectively. Between 1999 and 2011, 163 patients were identified while 40 were excluded. Patients were classified into three groups according to age (under 40 years, between 40-45 years, more than 45 years) and BMI (normal weight group, overweight group, and obese weight group). Demographical characteristics, histopathological features (Stage, grade and histology of the tumor, the presence of myometrial and/or lymphovascular invasion, history of diabetes mellitus, history of hypertension, hormonal contraception method, smoking, parity, infertility, family history, and recurrences) and survival rates were compared among the groups.
In total, 123 patients with a mean of 65.0 months follow up were enrolled into the study. The majority of the patients had endometrioid type in all age-related subgroups. Advanced stage endometrium cancer (Stage 2 and greater) was seen more commonly in the group of patient over 45 years of age against the other age-related subgroups (27.9% vs. 8% vs. 3.3%). Ratio of myometrial invasion more than 50% and occurrence of well-differentiated tumor were seen with a similar ratio among the age-related subgroups. Ratio of nulliparity and infertility were found statistically significant in the group of patients under 45 years of age against the group of patients over 45 years of age (p = 0.001, p = 0.03). The five-year estimated disease-free survival rates of women under 40 years of, women with an age between 40-45 years, and women over the age of 45 years were calculated as 73%, 95%, and 87%, respectively (p = 0.152). Concerning the histopathological features, there were no statistical differences between weight related subgroups. Comorbid conditions (hypertension and diabetes mellitus) were found as statistically high in the obese patients' group (43.5%-25.8%). In contrast to comorbid conditions, nulliparity and infertility histories were observed more often within the normal weight group (55.6%-38.5%). Mean disease-free survival time was calculated as 155.81 months in the normal weight group; 114.691 months in the overweight group, and 144.677 months in the obese group. Five-year disease-free survival rate was calculated as 91%, 81%, and 87%, respectively (p = 0.452).
Women with premenopausal cancers generally exhibit early and favorable histopathological symptoms. Although advanced stage endometrium cancer incidence was detected to be higher in the premenopausal endometrium cancer patients aged above 45 years compared to other age subgroups. A significant difference in terms of survival rates between these groups was not reached. In the same manner, the authors did not find a significant difference in survival rates among different weight subgroups of premenopausal endometrium cancer patients. As a secondary result, the authors discovered that diabetes mellitus and hypertension play a key role in patients with a BMI above 30 kg/m2 and nulliparity and infertility play a key role in patients with a BMI below 25 kg/m2 in the development of premenopausal endometrial cancer.
Abstract Context Speech-language pathologists (SLP) are often called on to evaluate eating difficulties in patients with dementia. Objectives To assess factors associated with SLPs’ knowledge and ...recommendations about feeding tubes in patients with advanced dementia. Methods A mail survey was administered to a probability sample of 1500 SLPs from the American Speech-Language-Hearing Association mailing list; 731 usable surveys were received (response rate = 53.7%). Self-perceived preparedness, knowledge, and care recommendations were measured. Knowledge items were scored as “evidence based” or not according to the best evidence in the literature. Results Only 42.1% of SLP respondents felt moderately/well prepared to manage dysphagia. Only 22.0% of respondents recognized that tube feeding is unlikely to reduce risk of aspiration pneumonia whereas a slight majority understood that tube feeding would not likely prevent an uncomfortable death (50.2%), improve functional status (54.5%), or enhance quality of life (QOL) (63.2%). A majority (70.0%) was willing to consider recommending oral feeding despite high risk of aspiration. Logistic regression analyses indicated that those willing to consider this recommendation gave the most evidence-based responses to knowledge questions about tube feeding outcomes: aspiration pneumonia (odds ratio OR = 1.75, 95% confidence interval CI = 1.07–2.87), functional status (OR = 1.43, 95% CI = 1.0–2.06), QOL (OR = 2.19, 95% CI = 1.52–3.17), and prevent uncomfortable death (OR = 1.97, 95% CI = 1.37–2.88). Logistic regression analyses also indicated that those with more experience evaluating patients with dementia gave the most evidence-based response to two knowledge questions: aspiration pneumonia (OR = 2.64, 95% CI = 1.48–4.72) and prevent uncomfortable death (OR = 2.03, 95% CI = 1.35–3.05) whereas those with higher self-perceived preparedness in managing dysphagia in dementia had less knowledge in two areas: aspiration pneumonia (OR = 0.57, 95% CI = 0.38–0.84) and QOL (OR = 0.72, 95% CI = 0.51–1.01). Conclusion Misperceptions among SLPs about tube feeding in advanced dementia are common, especially in relation to risk of aspiration. Knowledge about tube feeding outcomes was positively associated with experience and inversely associated with self-perceived higher preparedness in evaluating patients with dementia.
It is important to explore the relationship between teachers' perceptions of their cultural responsiveness as well as students' classroom behavior and risk, as these relationships may impact ...decisions about equitable access to school behavioral health supports. This paper includes two studies conducted with teachers in two large suburban school districts. Study 1 investigated the relationship between teachers' (n = 20) ratings on a measure of cultural responsiveness, the Assessment of Culturally and Contextually Relevant Supports (ACCReS), and students' classroom behavior. Results indicated that higher ACCReS scores significantly predicted lower classwide disruptive behavior. Study 2 investigated the relationship between teachers' (n = 30) ratings on the ACCReS and ratings of their students' risk on the Social, Academic, and Emotional Behavior Risk Screener. For social behavior, higher ACCReS scores predicted teachers perceiving lower social risk; however, identification as a Black student and a student with a disability predicted higher risk. Findings are preliminary, yet implications include recommendations for high‐quality professional development to promote teacher cultural responsiveness. Such support could guide teachers to create educational environments in which fewer discipline referrals for behavior occur, teachers perceive less social risk, and access to school behavior supports is more equitable.
For decades, racially and ethnically minoritized youth have been subject to unequal distributions of access and opportunity in school, leading to inequities in academic outcomes. Educators require ...knowledge and skills to provide relevant instruction and create a more supportive, effective classroom environment. This systematic review includes 24 qualitative and quantitative studies in which researchers investigated a culturally responsive classroom intervention or practice to promote academic outcomes for racially and ethnically minoritized youth. Within these studies, authors described several approaches to promote academic success: (a) developing authentic partnerships with families, (b) using effective pedagogy with students’ culture infused, and (c) accessing rigorous professional development. In addition, studies were assessed for methodological quality, and qualitative works met design standards more often than the quantitative studies reviewed. Implications include the need for additional research to inform comprehensive support for educators to design effective instructional environments for all students, especially those who have historically encountered systemic barriers in school.
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