Whereas titanosaurians represent the most diverse and cosmopolitan clade of Cretaceous sauropod dinosaurs, they remain rare components of Cretaceous African faunas. Currently recognized continental ...African titanosaurians include Aegyptosaurus baharijensis and Paralititan stromeri from early Upper Cretaceous deposits near Bahariya Oasis, Egypt, and Malawisaurus dixeyi and Karongasaurus gittelmani from the Lower Cretaceous (∼Aptian) Dinosaur Beds of Malawi, in addition to several undesignated and fragmentary forms across the continent. Here, we describe a new titanosaurian taxon, Rukwatitan bisepultus, on the basis of a partial, semiarticulated postcranial skeleton recovered from the middle Cretaceous Galula Formation in southwestern Tanzania. Unique to Rukwatitan are carotid processes on posterior cervical vertebrae, a deep coracobrachialis fossa and subquadrangular cross-section of the humerus, and a slender, curved, teardrop-shaped pubic peduncle on the ilium. Parsimony and Bayesian phylogenetic analyses of 35 sauropod taxa congruently place Rukwatitan as a non-lithostrotian titanosaurian, a relationship supported by cervical vertebrae with undivided pleurocoels and strongly procoelous anterior caudal vertebrae. Rukwatitan differs from the potentially penecontemporaneous and geographically proximate Malawisaurus by exhibiting weakly developed chevron articulations and posteriorly inclined neural spines on the middle caudal vertebrae, a proximally robust and distally unexpanded humerus, and an anteroventrally elongated coracoid. Similar to biogeographic patterns identified in certain crocodyliform clades (e.g., small-bodied notosuchians), titanosaurians on continental Africa appear to exhibit a regional (e.g., southern versus northern Africa), rather than a continental- or supercontinental-level signal.
Background: Diffuse large B cell lymphoma (DLBCL) is an aggressive lymphoid malignancy that often affects older adults. Therapy is potentially curative, with up to two-thirds of patients cured with ...chemoimmunotherapy but carries substantial risk of toxicity. Treatment of older adults must balance the potential for cure with the risk of therapy toxicity and intensive healthcare utilization. Therefore, prognostic understanding is a crucial component of informed decision-making for this patient population. Yet, data regarding prognostic understanding in older adults with DLBCL are lacking. Methods: We conducted a prospective study of older adults with aggressive non-Hodgkin lymphomas at two tertiary care hospitals between 9/2020 and 01/2023. Eligible patients were age >= 65 years at time of treatment initiation receiving a combination chemoimmunotherapy. Patients could enroll up until cycle 1 day 8 of therapy. Patients completed questionnaires at baseline that assessed demographics as well as information preferences and prognostic understanding (Prognosis and Treatment Perception Questionnaire) and underwent a comprehensive geriatric assessment. We used descriptive statistics to examine patient beliefs regarding likelihood of cure, the importance of knowing about prognosis, and preferences for information about treatment at baseline. We focused on the subset of patients (N=92) with DLBCL or DLBCL/high grade B-cell lymphoma with MYC and BCL2 translocations (double hit lymphoma) in order to have a relatively homogenous population for prognosis and likelihood of cure. Results: The parent study enrolled 106/163 (65.0%) patients, with 92 patients having DLBCL or double hit lymphoma. 88/92 enrolled patients with DLBCL (95.7%) submitted the prognostic understanding questionnaire. Among DLBCL/double hit lymphoma patients (N=92), the median age was 74 years (range: 66-99), and most were male gender (63%), White race (96.7%), and married/with a life partner (73.9%). 48/91 (52.7%) had an age-adjusted International Prognostic Index of 2 or 3, 30/92 (32.6%) had a Charlson comorbidity index of 2+ (not counting the patients' lymphoma), 14/92 (15.2%) had an Eastern Cooperative Group performance status of 2-4, and 50% (46/92) were frail based on comprehensive geriatric assessment. When asked about their likelihood of cure, 37.5% (33/88) selected >90% chance, 37.5% (33/88) selected 75-90% chance, 20.5% (18/88) selected 50-74% chance, 3.4% (3/88) selected 25-49% chance, and 1.1% (1/88) selected 10-24% chance of cure. Most (88.6%;78/88) patients believed that the primary goal of their current treatment was to cure their cancer, and most (93%; 80/86) believed that was their oncologist's primary goal. When asked if they would prefer a course of treatment focused on extending life as much as possible even if it meant more pain and discomfort versus a plan of care focused on relieving pain and discomfort as much as possible, even if it meant not living as long, 30.0% (26/88) chose extending life as much as possible, 40.9% (36/88) chose relieving pain as much as possible, and 30.0% (26/88) did not know. 94.0% (78/83) reported that they had a conversation about prognosis with their oncologist. The majority (91%; 78/86) felt it was extremely important or very important to know about their prognosis over time, and felt (81.4%; 70/86) they had just the right amount of information about their prognosis. Patients stated that knowing about their prognosis was extremely helpful in making decisions about treatment (75.3%; 61/81), preparing for the future (68.3%; 56/82), maintaining hope (79.3%; 65/82), and coping with the disease (72.5%; 58/80). 74.4% (61/82) said that overall knowing about prognosis was extremely helpful. Conclusion: In this cohort of older adults receiving treatment for DLBCL or double hit lymphoma, the vast majority felt it was important to know prognostic information over time and found that this information was helpful for decision making. Our finding that the majority estimated their likelihood of cure to exceed 75% despite most having aa-IPI scores indicating average cure rates < 60 suggests that older adults with newly diagnosed DLBCL hold overly optimistic views of their prognosis.
Background: Older adults with aggressive non-Hodgkin lymphoma (NHL) can experience durable remissions with therapy but also substantial toxicities and healthcare utilization. The Vulnerable Elders ...Survey (VES-13) is a 13-item tool assessing age, self-rated health, and ability to perform physical and functional activities (score of 3+ indicates vulnerability). The Fondazione Italiana Linfomi comprehensive geriatric assessment (CGA) assesses age, comorbidities, and ability to perform physical and functional activities and classifies patients as fit, unfit, or frail. Both the VES-13 and CGA hold promise to risk stratify older adults for poor outcomes. Few data are available comparing these tools in assessing risk for poor survival and healthcare utilization, and prior studies have not examined the impact of therapy on longitudinal patient-reported outcomes (PROs). Methods: We conducted a longitudinal prospective study of 105 older adults with aggressive NHL at Massachusetts General Hospital or the Dana-Farber Cancer Institute between 9/2020 and 1/2023. Eligible patients were age >= 65 years at time of treatment initiation receiving combination chemoimmunotherapy. Patients could enroll up until cycle 1 day 8 of therapy. Patients completed questionnaires at baseline and 6 weeks, 12 weeks, 18 weeks, and 6 months post therapy initiation assessing demographics, quality of life (QOL-Functional Assessment of Cancer Therapy-Lymphoma FACT-Lym), depression and anxiety (Hospital Depression and Anxiety Scale HADS), and physical symptoms (Edmonton Symptom Assessment Scale-revised ESAS-r). At baseline patients also completed the VES-13 and underwent CGA evaluated by an oncologist. We utilized linear mixed models to examine longitudinal QOL, depression, anxiety, and physical symptoms. We assessed univariate factors associated with longitudinal QOL. Using Cox regression models controlling for gender, age-adjusted International Prognostic Index (IPI), hypoalbuminemia, Charlson comorbidity index (CCI), and lymphoma subtype, we assessed the relationship of VES-13 and CGA in separate models with overall survival (OS). We also examined factors associated with unplanned hospitalization within 6 months of therapy start using logistic regression. Results: We enrolled 106/163 (65.0%) patients. 1 patient was excluded due to treatment with an ineligible therapy. Patients had a median age of 73 years (range: 65-99, 38.1% >75, 21.9% >=80); most were male gender (64.8%), White race (96.2%), and married/with a life partner (72.4%). The most common lymphoma subtypes were DLBCL (73.0%), DLBCL/high grade B-cell lymphoma with MYC and BCL2 translocations (12.4%), and mantle cell lymphoma (10.5%). The majority (56/104, 53.8%) had an age-adjusted IPI of 2 or 3, over a third (34.3%) had a CCI score of 2+, and 82.9% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1. 45.7% (48/105) had a VES-13 score of 3+. 40.0%, 9.5%, and 50.5% were fit, unfit, and frail, respectively, on CGA. QOL, depression, anxiety, and physical symptoms all improved over time (Figure 1). QOL improved regardless of age group, VES-13 category (<3 vs 3+), or CGA result (Figure 1). Compared to other patients, those 80+ years with either VES-13 score 3+ (β= -2.90, p=0.045) or frail on CGA (β= -3.68, p=0.007) had a worse QOL trajectory. Income > $50,000 annually (β=2.41; p=0.041) was associated with better QOL trajectory. VES-13 score of 3+ (HR=6.08; p=0.014) and frail on CGA (HR=5.20; p=0.028) were both associated with worse survival. Of those with follow up (N=66), 8 died within 1 year (1-year OS=87.9%), all of whom were both frail on CGA and had VES-13 score 3+. 25.8% (8/31) of the CGA frail patients and 28.6% (8/28) of those with VES-13 3+ died within 1 year. VES-13 score (OR=1.16, p=0.028) was associated with greater likelihood of unplanned hospitalization. Conclusion: Older adults with aggressive NHL often experience improvement in QOL and other PROs with treatment, even across age and frailty categories. VES-13 score and CGA identify patient groups at high risk for early death and poor QOL trajectory, for whom novel therapies and supportive care interventions are warranted. Higher VES-13 score is also associated with higher risk of unplanned hospitalization. Routine assessment of VES-13 and CGA has high potential for early identification of high risk patients and implementation of appropriate interventions.
This brief review summarizes key epidemiological and experimental evidence concerning relationships between chronic physical activity and feelings of energy (vigor, vitality) and fatigue. The ...epidemiological studies show a positive association between the amount of typical weekly physical activity reported and the frequency with which people report feeling energetic. The randomized controlled experiments show that 10-20 wk of exercise training is associated with an increase in the frequency and intensity of feelings of energy among fatigued people with medical conditions. The results of longitudinal studies with non-fatigued, healthy adults are mixed. Overtraining by athletes is associated with increased intensity of feelings of fatigue. Additional well-controlled investigations into relationships between physical activity and feelings of energy and fatigue, especially among sedentary and fatigued individuals, are warranted given the available evidence and the importance of these moods to health, work productivity, and quality of life.
PURPOSELittle is known about whether acute exercise affects signs or symptoms of attention deficit/hyperactivity disorder (ADHD) in adults. This experiment sought to determine the effects of a single ...bout of moderate-intensity leg cycling exercise on measures of attention, hyperactivity, mood, and motivation to complete mental work in adult men reporting elevated ADHD symptoms.
METHODSA repeated-measures crossover experiment was conducted with 32 adult men (18–33 yr) with symptoms consistent with adult ADHD assessed by the Adult Self-Report Scale V1.1. Measures of attention (continuous performance task and Bakan vigilance task), motivation to perform the mental work (visual analog scale), lower leg physical activity (accelerometry), and mood (Profile of Mood States and Addiction Research Center Inventory amphetamine scale) were measured before and twice after a 20-min seated rest control or exercise condition involving cycling at 65% V˙O2peak. Condition (exercise vs rest) × time (baseline, post 1, and post 2) ANOVA was used to test the hypothesized exercise-induced improvements in all outcomes.
RESULTSStatistically significant condition–time interactions were observed for vigor (P < 0.001), amphetamine (P < 0.001), motivation (P = 0.027), and Profile of Mood States depression (P = 0.027), fatigue (P = 0.030), and confusion (P = 0.046) scales. No significant interaction effects were observed for leg hyperactivity, simple reaction time, or vigilance task performance (accuracy, errors, or reaction time).
CONCLUSIONIn young men reporting elevated symptoms of ADHD, a 20-min bout of moderate-intensity cycle exercise transiently enhances motivation for cognitive tasks, increases feelings of energy, and reduces feelings of confusion, fatigue, and depression, but this has no effect on the behavioral measures of attention or hyperactivity used.
Background: Aggressive non-Hodgkin lymphoma (NHL) commonly affects older adults and is often treated with intensive therapies. Receipt of intensive therapies and absence of a clear transition between ...the curative and palliative phases of treatment yield prognostic uncertainty and risk for poor end-of-life (EOL) outcomes. However, data regarding the EOL outcomes of this population are lacking.
Methods: We conducted a retrospective analysis of adults >65 years with aggressive NHL treated with systemic therapy at Massachusetts General Hospital from 4/2000-7/2020 who subsequently died. We abstracted patient and clinical characteristics and EOL outcomes from the electronic health record (EHR), including patients' place of death, cause of death, palliative care and hospice utilization, and hospice length of stay using the EHR and the Social Security Death Index. We also determined whether patients were hospitalized (yes versus no), received systemic therapy (yes versus no), or were admitted to the ICU (yes versus no) within 30 days of death. Using multivariable logistic regression, we examined factors associated with hospitalization within 30 days of death and hospice utilization.
Results: Among 91 patients (median age = 75 years; 37.4% female), the most common lymphoma diagnosis was de novo DLBCL/grade 3B follicular lymphoma (64/91, 70.3%), and the majority (64/91, 70.3%) had advanced stage disease. Overall, 70.3% (64/91) were hospitalized, 34.1% (31/91) received systemic therapy, and 23.3% (21/90) had an intensive care unit admission within 30 days of death. The rates of palliative care consultation and hospice utilization were 47.7% (42/88) and 39.8% (35/88), respectively. A minority (21/88, 23.9%,) received palliative care more than 30 days before death. Of those receiving palliative care consultations, the majority (33/42, 78.6%) occurred exclusively in the inpatient setting, and most (32/42, 76.2%) were seen either as a one-time consultation or followed during a single inpatient hospitalization. Symptom management (24/42, 57.1%) was the most common reason for palliative care consultation, followed by both symptom management and goals of care (11/42, 26.2%) and goals of care (4/42, 9.5%). Only 39.8% (35/88) received hospice services, with 80.7% (71/88) having a hospice length of stay ≤ 7 days. Among hospice enrollees, the median length of stay on hospice was 7 days (range: 0-117). Among all patients, 51.6% (47/91) died in hospital, rehab, or nursing home, 23.1% (21/91) died at home, 11.0% (10/91) died in inpatient hospice or a hospice house, and 14.3% (13/91) had an unknown or other place of death. The most common cause of death was cancer progression (44/91, 48.4%,) followed by infection or cancer treatment complication (20/91, 22.0%). In multivariable analysis, elevated LDH was associated with risk of hospitalization within 30 days of death (OR 3.61, p=0.014). Palliative care consultation (OR 4.45, p=0.005) and hypoalbuminemia (OR 0.29, p=0.026) were associated with likelihood of hospice utilization.
Conclusions: Older adults with aggressive NHL often experience high health care utilization and infrequently utilize hospice care at the EOL. Our findings underscore the need for interventions to optimize the quality of EOL care for this population, and provide important data to guide informed decision-making and help inform future interventions aimed at improving the EOL care of this unique geriatric oncology population.
No relevant conflicts of interest to declare.
A gastrocnemius contracture is a common problem that results in decreased ankle dorsiflexion that contributes to an array of foot and ankle ailments. A common surgical treatment for this condition is ...a gastrocnemius recession (GR). Many adaptations of the original procedure have been described. Misinterpretations of proper GR procedures have potentially caused confusion when selecting a treatment. This paper proposes to identify errors between the use of GR and gastrocnemius-soleus recession (GSR) procedure techniques in the current literature.
A systematic literature review was performed in June 2021, using the PubMed database and select orthopedic texts. Only studies that met the established criteria and either correctly or incorrectly described a GR or GSR procedure were included. After applying exclusion criteria, 108 publications were included. These articles and texts were reviewed for surgical technique and terminology errors in accordance with established parameters. The articles were classified as either: “Correct” or “Incorrect.”
Of the 108 publications and texts included, 18 articles incorrectly described either a GR or a GSR (16.67%). Ninety articles correctly described either a GR or a GSR (83.33%).
The literature supports the use of a GR to treat a gastrocnemius contracture. Inaccurate articles create confusion as to what exactly a GR entails. Sources of ambiguity included terminology, inconsistent anatomical zone definition, and technique selection. Due to this confusion, it is suspected that patient outcomes can be impacted. Postoperative outcomes of GSR patients are worse than GR patients. Further investigation is necessary to determine if performing the incorrect procedure negatively affects patient outcomes.
Regular physical activity contributes positively to physical and psychological health. Adverse consequences of inactivity may be an especially important problem among pregnant women. Up to 60% are ...inactive during pregnancy. This review found consistent evidence that physical activity is reduced during pregnancy; however, few investigators have sought to quantify physical activity patterns among pregnant women using well validated measures. Some of the barriers to physical activity during pregnancy, such as depression, anxiety and fatigue, have been shown to be attenuated by regular exercise performed by non-pregnant samples. There is a need to better understand the relationships between these factors and physical activity during pregnancy. Available retrospective and prospective results suggest that both leisure time and work-related physical activities are decreased across pregnancy. Intensity and duration decrease both during pregnancy compared with pre-pregnancy and in the third trimester compared with the first. There is a need for well designed longitudinal investigations that document pregnancy-related changes in physical activity at frequent intervals during pregnancy using validated and more precise measures of physical activity. Reductions in physical activity and a worsening mood are common during pregnancy. If the relationship between physical inactivity and mood disturbances is indeed observed and maintained during pregnancy, then decreases in physical activity in the third trimester would be expected to result in a worsening mood. In recent years, increased attention has been paid to antenatal mood disturbances, and this research has yielded a host of important findings. Prior correlational and experimental research with non-pregnant samples has demonstrated a consistent relationship between physical inactivity and mood disturbances. Whether this relationship occurs among pregnant women and/or is maintained as women progress during pregnancy is uncertain. Prior investigations have revealed that there is higher rate of mood disturbance during pregnancy than following pregnancy but little is known about the mechanisms that cause these mood disturbances. It is important to better understand changes in mood with pregnancy because mood disturbances can have major negative consequences for a pregnant woman. The major adverse consequences of depression among pregnant women are largely the same as those of non-pregnant individuals. Only six investigations have quantified the relationship between changes in physical activity and changes in mood during pregnancy. The available evidence suggests that inactivity is associated with worse mood. Additional research into this topic is warranted due to the limited number of published papers and the design and methodology limitations of these investigations.
This paper evaluates four highly cited measures of energy and fatigue moods. Substantial experimental and correlational evidence supports the conclusion that scores from the vitality scale of the ...SF-36 Health Survey can provide a valid measure of the recalled frequency of month-long feelings of energy and fatigue. Substantial experimental and correlational evidence supports the conclusion that scores from the fatigue and vigor scales of the Profile of Mood States (POMS) can provide reliable and valid measures the intensity of both week-long and “right now” fatigue and energy mood states, respectively. A smaller body of evidence supports the conclusion that scores from the energy scale of the Activation–Deactivation Adjective Checklist (AD-ACL) can provide a valid measure of the “right now” mood of energy; however, the energy scale of the AD-ACL has several limitations compared to the POMS vigor scale. All the measures lacked integration within a compelling theory of the mood of energy–fatigue. It is concluded that progress in understanding of energy and fatigue mood states will be aided by advances in both the psychobiological conceptualization of fatigue and energy mood states and their measurement.
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