Distracted driving(DD) is a public health threat. We initiated a DD program where the objective was to attract parents to a website to download a parent tool box. We report the effectiveness of media ...strategy.
An evidence based interactive DD website was developed which provided a parent tool box. Two different digital media strategies were used. Parent(P)/Teen(T) focus groups were used. Analytics, orders during each media strategy are reported as well the results of the focus group.
There were 73972 visits (>2 min) to the site. The tool box was downloaded/ordered from 10 different countries and 50 states. There were 603 requests via the internet for tools kits, 159 in the first campaign and 444 in the second campaign. Average website time increased from 2.33 min in media campign 1–5.29 min in campaign 2. The focus groups reported the: website was “very useful” in 9/15-P vs 10/15- T.
Contextual placement digital advertising and focused social media was more effective in attracting parents to the website, and increased downloads.
III.
prospective/retrospective study with economic and valued based evaluations.
•Distracted driving is a public health threat to the driver, passenger and others on the road.•Targeted Social Media was more effective than traditional media for website traffic.•Most of participants had not had conversations regarding distracted driving.•The Parent/Teen contract was a useful tool for having a conversation about distracted driving.
The advances in pediatric cancer far exceed those achieved in adults. The success in improving survival and minimizing late effects has been due to several reasons but work of the pediatric cancer ...cooperative groups is a primary. These cooperative groups are multidisciplinary with medical oncologists, pathologists, radiologists, surgeons, radiation oncologists, scientists and most importantly the patients and families. Studies have expanded from regional to national and now international studies which continue to target problems pertinent to improving the outcome for children with cancer. In this article we review the history of the cooperative groups, a selection of seminal studies pertaining to solid tumors, future challenges and collaborations.
Abstract Background Wilms tumor (WT) is the second most common abdominal tumor in children. Methods This chapter discusses surgical considerations for the management of unilateral and bilateral WT. ...Results Currently, survival exceeds 90%, owing to multicenter studies under the auspices of the Children’s Oncology Group and Société Internationale d’Oncologie Pédiatrique. Surgical excision remains the mainstay of oncologic control and is also crucial for proper staging of disease in order to direct adjuvant therapy and limit treatment-related morbidity. Conclusions Careful attention must be paid to proper disease staging, upfront and adjuvant therapy, and surgical technique in order to optimize oncologic outcomes while minimizing short- and long-term morbidity.
Little is known about the impact of sarcopenia (reduced muscle mass and function) in pediatric chronic liver disease. We compared psoas muscle surface area (PMSA), measured at the 4th lumbar ...vertebrae, in children listed for liver transplantation (LT) to that of healthy controls and studied the impact of sarcopenia on transplant‐associated outcomes. The effect of PMSA (raw value and z score) on survival was studied using multivariable proportional hazards, whereas the impact of PMSA on other transplant‐associated outcomes was assessed by multivariable linear or logistic regression. The correlation of PMSA with anthropometric values and markers of disease severity was studied using Spearman’s rank‐order correlation. Mean PMSA was significantly lower in LT candidates (n = 57, 699.4 ± 591.9 mm2 mean ± SD) than controls (n = 53, 1052.9 ± 960.7 mm2; P = 0.02). For LT candidates, there was an increased risk of death (either while on the waiting list or following transplantation) with lower PMSA (hazard ratio HR, 1.6 per 100 mm2 P = 0.03; 95% confidence interval CI, 1.1‐2.8), amounting to a 4.9 times higher risk of death for every 1 unit decrease in PMSA z score (HR, 4.9 P = 0.05, 95% CI, 1.2‐34.5), adjusting for age and sex. PMSA did not correlate with posttransplant length of intubation, hospital length of stay, or perioperative complications. PMSA also did not correlate with calculated (r = 0.10, P = 0.60) or appealed Model for End‐Stage Liver Disease/Pediatric End‐Stage Liver Disease scores (r = 0.10, P = 0.69). Pediatric LT candidates have a significant reduction in muscle compared with controls. LT candidates with lower PMSA experience significant increases in mortality. As such, sarcopenia may provide a novel indicator of disease severity in children with chronic liver disease.
Background The National Wilms Tumor Study (NWTS) approach to treating stage III favorable-histology Wilms tumor (FHWT) is Regimen DD4A (vincristine, dactinomycin, and doxorubicin) and radiation ...therapy. Further risk stratification is required to improve outcomes and reduce late effects. We evaluated clinical and biologic variables for patients with stage III FHWT without combined loss of heterozygosity (LOH) at chromosomes 1p and 16q treated in the Children's Oncology Group protocol AREN0532. Methods From October 2006 to August 2013, 588 prospectively treated, centrally reviewed patients with stage III FHWT were treated with Regimen DD4A and radiation therapy. Tumor LOH at 1p and 16q was determined by microsatellite analysis. Ineligible patients (n = 5) and those with combined LOH 1p/16q (n = 40) were excluded. Results A total of 535 patients with stage III disease were studied. Median follow-up was 5.2 years (range, 0.2 to 9.5). Four-year event-free survival (EFS) and overall survival estimates were 88% (95% CI, 85% to 91%) and 97% (95% CI, 95% to 99%), respectively. A total of 58 of 66 relapses occurred in the first 2 years, predominantly pulmonary (n = 36). Eighteen patients died, 14 secondary to disease. A better EFS was associated with negative lymph node status ( P < .01) and absence of LOH 1p or 16q ( P < .01), but not with gross residual disease or peritoneal implants. In contrast, the 4-year EFS was only 74% in patients with combined positive lymph node status and LOH 1p or 16q. A total of 123 patients (23%) had delayed nephrectomy. Submitted delayed nephrectomy histology showed anaplasia (n = 8; excluded from survival analysis); low risk/completely necrotic (n = 7; zero relapses), intermediate risk (n = 63; six relapses), and high-risk/blastemal type (n=7; five relapses). Conclusion Most patients with stage III FHWT had good EFS/overall survival with DD4A and radiation therapy. Combined lymph node and LOH status was highly predictive of EFS and should be considered as a potential prognostic marker for future trials.
Abstract Despite an impressive increase in survival rate over the past decades, there is still a need to improve the survival of specific subgroups of Wilms tumor (anaplastic, metastatic, and ...bilateral) and to decrease the late effects of treatment in terms of renal function and heart toxicity. We aim to explore new areas of improvement, from diagnosis to treatment: in the field of radiology the increased use of MRI and exploration of its diffusion-weighted imaging capabilities to predict WT histology at diagnosis and for preoperative assessment; in biology the emergence of new biomarkers that could be integrated into the decision-making process; and surgical techniques with more accurate indication of nephron-sparing surgery that is no longer reserved for bilateral WT and the minimally invasive approach. The long-term outcome of patients with WT should thus be a strong indicator of the improvement in adapting and personalizing the treatment to each individual.
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