Lifestyle considerations in multiple myeloma Shapiro, Yael N; Peppercorn, Jeffrey M; Yee, Andrew J ...
Blood cancer journal (New York),
10/2021, Letnik:
11, Številka:
10
Journal Article
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As the prognosis for multiple myeloma (MM) has significantly improved and patients remain on therapy longer, there is a need for supportive care interventions to optimize patient quality of life ...(QOL) and functional status over the course of cancer treatment. MM is characterized by a significant symptom burden and a relatively lower QOL compared to other cancers. This review evaluates the role of healthy lifestyle behaviors in improving both the physical functioning and psychological well-being of the MM population. We (1) describe the current literature on physical activity, weight management, diet, sleep, and substance use in the context of MM, (2) present important considerations for incorporating lifestyle factors into clinical practice, and (3) identify directions for future research. Developing MM-specific guidelines for modifiable lifestyle changes that take into account both the length of treatment and the unique disease features (i.e. osteolytic lesions and anemia) may provide a promising path for improved patient QOL and functioning.
Richard Morin: The American College of Radiology Dose Index Registry
The American College of Radiology Dose Index Registry, part of the ACR National Radiology Data Registry, provides the ...infrastructure platform for institutions, hospitals, and clinics to report dose indices from Computed Tomography (CT) clinical exams by body part / exam type, and allows those facilities to compare their CT dose indices to regional and national values through periodic feedback reports. This presentation describes the current state of the registry, how the data can be used to establish national benchmarks, to improve patient safety through identification of outlier protocols, and to demonstrate how participation in the registry can be part of a professional Maintenance of Certification effort.
Learning Objectives:
1. Understand how registries perform.
2. Understand the way in which registries have altered physician behavior and improve patient care.
3. Identify the parameters involved in optimizing radiation dose in clinical practice.
4. Apply this knowledge by participating in a dose index registry and utilizing these techniques in Maintenance of Certification.
Madan Rehani: The International Perspective on Recording and Reporting Dose
There are no common regulations valid for all of Europe, but there are a number of initiatives and concepts in place which originated here. Among these are primarily the generation of conversion coefficients k for estimating values of the effective dose E from the dose length product (DLP) by E = k*DLP and the concept of dose reference levels (DRL). DRLs for radiological examinations in the European Union were demanded by law in 2000. DRL values are considered advisory and aim at identifying practices with dose levels exceeding the 75 percentile level of reference distributions. Member states have installed the concepts and specific values to different degrees. A drawback is that both the values of k and DRL relate to CTDI and DLP. There is no major debate regarding the validity of the computed tomography dose index (CTDI) because it is mostly considered as a tool for scanner acceptance and constancy testing. Its use for that purpose is undisputed. More accurate measures for patient dose are still to be established in an international consensus. The lecture will review the above concepts and will point to both strengths and weaknesses.
Learning Objectives:
1. Understand that CTDI is merely a technical concept for scanner acceptance and constancy testing, but not a measure for patient dose.
2. Learn about concepts for patient‐and scanner‐specific patient dose estimates.
3. Learn about the concept of diagnostic reference levels and its strengths and weaknesses.
Kevin O'Donnell: Informatics Tools for Recording/Tracking Dose
Informatics tools are available to assist in the recording and tracking of patient radiation doses, and notification to system operators about potentially high dose settings prior to scanning a patient. This presentation describes the DICOM Radiation Dose Structured Report (RDSR), its characteristics, and modality‐specific information contained in the RDSR object. Coordinating the capture and management of such objects can be accomplished with the Integrating the Healthcare Enterprise Radiation Exposure Monitoring (REM) profile. These topics, in addition to how to incorporate of legacy system dose reporting into the RDSR, as well as how to set up the new “Dose Check” standard on CT scanners are presented.
Learning Objectives:
1. Understand how DICOM Radiation Dose SR (RDSR) captures procedure dose information, the modalities and details covered.
2. Understand how the IHE Radiation Exposure Monitoring Profile (REM) coordinates the capture and management of RDSR objects and how it can be applied in a radiology practice.
3. Understand how “CT dose screens” from legacy scanners can be ported into RDSR.
4. Understand how to apply the pre‐scan dose pop‐ups on the CT console specified in the MITA CT Dose Check (XR‐25) standard.
5. Understand how to specify the above standards & features when purchasing and integrating radiology systems.
Kevin O'Donnell, Toshiba America Medical Systems
AAV-DJ, a leading candidate vector for liver gene therapy, was created through random homologous recombination followed by directed evolution, selecting for in vivo liver tropism and resistance to ...in vitro immune neutralization. Here, the 4.5 Å resolution cryo-EM structure is determined for the engineered AAV vector, revealing structural features that illuminate its phenotype. The heparan sulfate receptor-binding site is little changed from AAV-2, and heparin-binding affinity is similar. A loop that is antigenic in other serotypes has a unique conformation in AAV-DJ that would conflict with the binding of an AAV-2 neutralizing monoclonal antibody. This is consistent with increased resistance to neutralization by human polyclonal sera, raising the possibility that changed tropism may be a secondary effect of altered immune interactions. The reconstruction exemplifies analysis of fine structural changes and the potential of cryo-EM, in favorable cases, to characterize mutant or ligand-bound complexes.
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► The 4.5 Åcryo-EM structure of AAV-DJ fully resolves the polypeptide backbone ► Liver tropism selected for in AAV-DJ has not changed the heparin binding site ► Changed conformation in an antigenic loop blocks binding of a neutralizing mAb ► Changed in vivo tropism may result from changed immune interactions
AAV-DJ is an engineered adeno-associated virus (AAV) vector and a leading candidate for liver gene therapy. Here, Lerch et al. report a 4.5Å resolution cryo-EM structure of AAV-DJ, revealing structural features that underscore its unique phenotype. The reconstruction exemplifies potential of cryo-EM to analyze fine structural changes.
A notorious case in Southwest Africa of assault and murder of indigenous workers by a panic-stricken master exposed German colonists' fascination with African women's bodies as a source of danger. ...O'Donnell's study of the imagery and language of poisoning rumors in the territory examines how settlers adapted Western notions of gender and race to portray local conflicts and legitimate illicit sexual and nonsexual acts of violence against female domestic servants.
Problems of subjectivity and uncertainty can arise during the execution of risk management and quality risk management exercises, but many existing risk management tools do not provide formal ...strategies for addressing such problems. The influences of what are known as human heuristics during quality risk management-related activities (such as brainstorming and probability of occurrence estimation) can add to those problems. Heuristics are cognitive behaviours that can influence how individuals make judgments in the face of uncertainty, and they can be a source of significant bias and errors in judgment. The potential adverse effects of such heuristics when identifying potential negative events and their probabilities of occurrence should be counteracted so that the best judgments may be made in relation to these. This paper discusses some of the most important human heuristics and how the good manufacturing practice (GMP) environment might benefit from the peer-reviewed research that has been performed in various fields on those heuristics. In this way, design elements can be incorporated into quality risk management tools that may help counteract the adverse effects of human heuristics. This has the potential to reduce the extent of guesswork in some current quality risk management activities. Several simple, practical strategies are presented that are designed to improve the outcomes of quality risk management exercises with respect to problems of subjectivity and uncertainty. Other cognitive approaches to maximize good judgments are also described. These should be useful to session facilitators to help yield more accurate analyses of risk situations. PUBLICATION ABSTRACT
Background Enhanced recovery programmes (ERPs) have demonstrated reduced morbidity and length of hospital stay in patients undergoing open elective colorectal resections. The application of ...laparoscopic techniques to colorectal surgery is associated with shorter length of stay and morbidity compared to open resections. In the setting of laparoscopic surgery, it is unclear whether there is an additive effect on length of stay and morbidity by combining these. The current study addresses the benefit of an ERP (RAPID protocol) in a cohort of matched patients undergoing laparoscopic sigmoid colon resection Materials and methods Consecutive patients over a 40-month period who underwent laparoscopic sigmoid colon resection were assigned either to the RAPID protocol (group 1) or traditional post operative care (group 2) in a non-randomised manner. Analysis was on an “intention to treat” basis. Primary and secondary endpoints were identified; primary endpoints included length of hospital stay and readmission rate. Secondary endpoints included morbidity and mortality rate. Results Seventy-three consecutive patients were included. Group 1 included 37 patients. Group 2 included 36 patients. Median length of hospital stay in groups 1 and 2 was 5 and 8 days, respectively (p = 0.01). Readmission rate in groups 1 and 2 was 8.1% and 8.3%, respectively (p = 0.98). Morbidity rate in groups 1 and 2 was 30% and 22%, respectively (p = 0.61); there was one mortality in each group. Conclusion The application of the ERP (RAPID) to patients undergoing laparoscopic sigmoid colon resection results in a significant improvement in length of hospital stay, with comparable morbidity and readmission rates.
High quality Al1xInxN/GaN bilayers, grown by metal organic chemical vapor deposition (MOCVD), were characterized using structural and optical techniques. Compositional analysis was performed using ...Rutherford backscattering spectrometry(RBS) and elastic recoil detection analysis (ERDA). The InN molar fraction x decreased approximately linearly with increasing growth temperature and ranged from x¼0.13 to0.24. Up tox¼0.20 the layers grow pseudomorphically to GaN with good crystalline quality. These layers show a smoothsurface with V-shaped pits. Two layers with InN contents around 24% showed partial strain relaxation. However, themechanisms leading to relaxation of compressive strain arevery different in the two samples grown both at similartemperature but with different growth rates. One sample shows a decreased c/a ratio, as expected for relaxation of the compressive strain, while In was shown to be homogeneouslydistributed with depth. The other sample started to grow withx¼0.24 but relaxed mainly by reduction of the incorporated InN content towards the lattice-match composition of x0.17. Both samples have an increased surface roughness. All samples show strong Al1xInxN band edge luminescence with large bowing parameter and Stokes’ shifts.
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