When deciding about surgical treatment options, an important aspect of the decision-making process is the potential risk of complications. A risk assessment performed by a spinal surgeon is based on ...their knowledge of the best available evidence and on their own clinical experience. The objective of this work is to demonstrate the differences in the way spine surgeons perceive the importance of attributes used to calculate risk of post-operative and quantify the differences by building individual formal models of risk perceptions. We employ a preference-learning method - ROR-UTADIS - to build surgeon-specific additive value functions for risk of complications. Comparing these functions enables the identification and discussion of differences among personal perceptions of risk factors. Our results show there exist differences in surgeons' perceived factors including primary diagnosis, type of surgery, patient's age, body mass index, or presence of comorbidities.
Abstract
Gravitational lensing is an important prediction of general relativity, providing both its test and a tool to detect faint but amplified sources and to measure masses of lenses. For some ...applications, (e.g., testing the theory), a point source lensed by a point-like lens would be more advantageous. However, until now only one gravitationally lensed star has been resolved. Future telescopes will resolve very small lensing signatures for stars orbiting the supermassive black hole (SMBH) in the center of the Milky Way. The lensing signatures, however, should be easier to detect for background stars. We predict that the Extremely Large Telescope (ELT), Thirty Meter Telescope (TMT), and Giant Magellan Telescope (GMT) will resolve the lensed images of around 100 (60) stars in the disk and 30 (20) stars in the bulge in the background of the SMBH, down to 28 (27) mag (Vega) limits at
K
-band, requiring 5 (1) hr of integration. In order to detect several such stars one needs the limit of at least 24 mag. With decade-long monitoring, one can also detect the rotation of the lensed images. The detection of elongated images will not be possible, because this would require a nearly perfect source-lens alignment. The James Webb Space Telescope (JWST) will likely be limited by the confusion caused by stars near the Galactic center. The detection of such lensed images will provide a very clean test of general relativity, when combined with the SMBH mass measurement from orbital motions of stars, and accurate measurements of the SMBH properties, because both the source and the lens can be considered point-like.
Background
In oncology, pharmacists contribute to safety and effectiveness of drug treatment, identifying, preventing and forwarding solutions to drug-related problems (DRPs). However, it is still ...necessary to elucidate the profile of drug-related problems in pediatric cancer treatment to contribute to guide clinical pharmacy activities.
Methods
A retrospective cross-sectional study was conducted. Records on Excel® spreadsheets of 2 years of pharmaceutical assistance were analyzed regarding the prescriptions of chemotherapy for hospitalized patients aged 0–19 years. Data on age, sex, cancer diagnosis, protocol and drugs prescribed were collected. Causes and types of DRPs and pharmacists’ interventions as their rate of acceptance were measured according to PCNE V 9.0.
Results
Drug-related problems were identified for 84 patients, in 5.3% of analyzed prescriptions. Leukemias, patients aged 0–4 years and male sex were associated with higher rates of drug-related problems. The BFM 2009 protocol for acute lymphocytic leukemia treatment had the highest frequency of prescriptions with drug-related problems. Main drug-related problems were related to effectiveness (49.2%) and safety (33.2%), with most of them due to drug selection and dose. Rate of acceptance of interventions was 92.2% and 90.6% of drug-related problems were fully resolved. Mercaptopurine and filgrastim were the drugs most associated with drug-related problems. Oral antineoplastic agents represented 36% of the prescriptions with drug-related problems.
Conclusion
The high rate of acceptance of pharmacist interventions demonstrates the relevance of the pharmacist participation in the care of hospitalized pediatric patients undergoing chemotherapy. Pharmacists need to take attention to cases of necessity of drug prescription, intervening with other health professionals. Special attention to oral chemotherapy is required.
We present a fully automated AI-based system for intensive monitoring of cognitive symptoms of neurotoxicity that frequently appear as a result of immunotherapy of hematologic malignancies. Early ...manifestations of these symptoms are evident in the patient's speech in the form of mild aphasia and confusion and can be detected and effectively treated prior to onset of more serious and potentially life-threatening impairment. We have developed the Automated Neural Nursing Assistant (ANNA) system designed to conduct a brief cognitive assessment several times per day over the telephone for 5-14 days following infusion of the immunotherapy medication. ANNA uses a conversational agent based on a large language model to elicit spontaneous speech in a semi-structured dialogue, followed by a series of brief language-based neurocognitive tests. In this paper we share ANNA's design and implementation, results of a pilot functional evaluation study, and discuss technical and logistic challenges facing the introduction of this type of technology in clinical practice. A large-scale clinical evaluation of ANNA will be conducted in an observational study of patients undergoing immunotherapy at the University of Minnesota Masonic Cancer Center starting in the Fall 2023.
Cancer development requires a favorable tissue microenvironment. By deleting
in keratinocytes or specific bone marrow subpopulations in oncogenic RAS-mediated skin carcinogenesis, we show that IL17 ...from infiltrating T cells and IκBζ signaling in keratinocytes are essential to produce a permissive microenvironment and tumor formation. Both normal and RAS-transformed keratinocytes respond to tumor promoters by activating canonical NF-κB and IκBζ signaling, releasing specific cytokines and chemokines that attract Th17 cells through MyD88-dependent signaling in T cells. The release of IL17 into the microenvironment elevates IκBζ in normal and RAS-transformed keratinocytes. Activation of IκBζ signaling is required for the expression of specific promoting factors induced by IL17 in normal keratinocytes and constitutively expressed in RAS-initiated keratinocytes. Deletion of
in keratinocytes impairs RAS-mediated benign tumor formation. Transcriptional profiling and gene set enrichment analysis of IκBζ-deficient RAS-initiated keratinocytes indicate that IκBζ signaling is common for RAS transformation of multiple epithelial cancers. Probing The Cancer Genome Atlas datasets using this transcriptional profile indicates that reduction of IκBζ signaling during cancer progression associates with poor prognosis in RAS-driven human cancers. IMPLICATIONS: The paradox that elevation of IκBζ and stimulation of IκBζ signaling through tumor extrinsic factors is required for RAS-mediated benign tumor formation while relative IκBζ expression is reduced in advanced cancers with poor prognosis implies that tumor cells switch from microenvironmental dependency early in carcinogenesis to cell-autonomous pathways during cancer progression.
War, Aggression and State Crime Kramer, Ronald C.; Michalowski, Raymond J.
British journal of criminology,
07/2005, Letnik:
45, Številka:
4
Journal Article
Recenzirano
In this article, we argue that the 2003 US/UK invasion and occupation of Iraq was a form of state crime and offer a criminological analysis of the event. First, we describe how the war on Iraq ...violated the UN Charter and international humanitarian law. Then, we provide a narrative analysis of the historical and contemporary origins of this crime through the lens of an integrated model for the study of organizational deviance that has proved useful in the analysis of a number of other upper-world crimes. A key part of our explanation of this war resides in the dynamics of America’s long-standing will to empire coupled with the imperial designs of neoconservative policy makers within the Bush administration.
Purpose
The nonalcoholic fatty liver disease is the most common liver abnormality. Up to date, liver biopsy is the reference standard for direct liver steatosis quantification in hepatic tissue ...samples. In this paper we propose a neural network-based approach for nonalcoholic fatty liver disease assessment in ultrasound.
Methods
We used the Inception-ResNet-v2 deep convolutional neural network pre-trained on the ImageNet dataset to extract high-level features in liver B-mode ultrasound image sequences. The steatosis level of each liver was graded by wedge biopsy. The proposed approach was compared with the hepatorenal index technique and the gray-level co-occurrence matrix algorithm. After the feature extraction, we applied the support vector machine algorithm to classify images containing fatty liver. Based on liver biopsy, the fatty liver was defined to have more than 5% of hepatocytes with steatosis. Next, we used the features and the Lasso regression method to assess the steatosis level.
Results
The area under the receiver operating characteristics curve obtained using the proposed approach was equal to 0.977, being higher than the one obtained with the hepatorenal index method, 0.959, and much higher than in the case of the gray-level co-occurrence matrix algorithm, 0.893. For regression the Spearman correlation coefficients between the steatosis level and the proposed approach, the hepatorenal index and the gray-level co-occurrence matrix algorithm were equal to 0.78, 0.80 and 0.39, respectively.
Conclusions
The proposed approach may help the sonographers automatically diagnose the amount of fat in the liver. The presented approach is efficient and in comparison with other methods does not require the sonographers to select the region of interest.
Chloride intracellular channel 4 (CLIC4) is a tumor suppressor implicated in processes including growth arrest, differentiation, and apoptosis. CLIC4 protein expression is diminished in the tumor ...parenchyma during progression in squamous cell carcinoma (SCC) and other neoplasms, but the underlying mechanisms have not been identified. Data from The Cancer Genome Atlas suggest this is not driven by genomic alterations. However, screening and functional assays identified miR-142-3p as a regulator of
.
and miR-142-3p expression are inversely correlated in head and neck (HN) SCC and cervical SCC, particularly in advanced stage cancers.
localization revealed that stromal immune cells, not tumor cells, are the predominant source of miR-142-3p in HNSCC. Furthermore, HNSCC single-cell expression data demonstrated that
is lower in tumor epithelial cells than in stromal fibroblasts and endothelial cells. Tumor-specific downregulation of
was confirmed in an SCC xenograft model concurrent with immune cell infiltration and miR-142-3p upregulation. These findings provide the first evidence of
regulation by miRNA. Furthermore, the distinct localization of CLIC4 and miR-142-3p within the HNSCC tumor milieu highlight the limitations of bulk tumor analysis and provide critical considerations for both future mechanistic studies and use of miR-142-3p as a HNSCC biomarker.
Secondary ion mass spectrometry (SIMS) measurements show that boron nitride (BN) films grown under an argon flow are contaminated with carbon in the form of clusters. SIMS imagining of carbon ...clusters with atomic depth resolution allows us to show that there are two different growth modes for BN films: 3D growth and self-terminated growth. The choice of the growth mode predominantly depends on reactor pressure. In the 3D growth mode (low pressure) carbon clusters appear in an organized way: the cluster in one BN layer nucleates the one in the successive layer. Eventually, they create three-dimensional carbon grains. In the self-terminated growth mode (high pressure) the distribution of carbon within the volume of the film is chaotic. The differences observed between the growth modes seem to depend on the diffusion length of the carbon and boron species.
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