Treatment Of Type Research Articles

Megaureter in adults: a review of the current literature.

Megaureter (MU) is an uncommon condition in adults. The aim is to present a review of the current literature. A literature search was conducted to explore the current literature including case reports on MU in adults in the period 2003-2023. Each case was characterised in terms of the eight categories: sex, age, etiology, location, symptoms, diagnostic tool used, type of treatment and follow-up. There was no meta-analysis but two reviews. Total, 39 case reports were included based on 35 articles. The most common observations for the first four categories were male (sex), age below 40 (age), obstructed MU (etiology) and left-sided MU (location). Almost every patient appeared with symptoms, most frequently flank pain, abdominal pain and recurrent urinary tract infections. CT scan and transabdominal ultrasonography are the most commonly used diagnostic tools. Most cases underwent either laparoscopic or open surgical treatment with ureteral reimplantation as the most performed surgical procedure. A majority of the patients had an uneventful follow-up. MU in adults is a rare condition presenting with heterogeneous symptoms. CT scan and transabdominal ultrasonography should be used as diagnostic tools. Nearly all patients underwent surgical treatment with an uneventful follow-up. Complications such as stone formation and altered function of the affected kidney are common. Surgical treatment is recommended and is determined by consideration of age, symptoms, ureteral extension and progressive loss of renal function.

An application of machine learning to classify food waste interventions from a food supply chain perspective

PurposeThe purpose of this paper is to demonstrate the efficacy of machine learning (ML) in managing natural language processing tasks, specifically by developing two ML models to systematically classify a substantial number of food waste interventions.Design/methodology/approachA literature review was undertaken to gather global food waste interventions. Subsequently, two ML models were designed and trained to classify these interventions into predefined supply chain-related groups and intervention types. To demonstrate the use of the models, a meta-analysis was performed to uncover patterns amongst the interventions.FindingsThe performance of the two classification models underscores the capabilities of ML in natural language processing, significantly enhancing the efficiency of text classification. This facilitated the rapid and effective classification of a large dataset consisting of 2,469 food waste interventions into six distinct types and assigning them to seven involved supply chain stakeholder groups. The meta-analysis reveals the most dominant intervention types and the strategies most widely adopted: 672 interventions are related to “Process and Operations Optimisation”, 457 to “Awareness and Behaviour Interventions” and 403 to “Technological and Engineering Solutions”. Prominent stakeholder groups, including “Processing and Manufacturing”, “Retail” “Government and Local Authorities” and “NGOs, Charitable Organisations and Research and Advocacy Groups”, are actively involved in over a thousand interventions each.Originality/valueThis study bridges a notable gap in food waste intervention research, a domain previously characterised by fragmentation and incomprehensive classification of the full range of interventions along the whole food supply chain. To the best of the authors’ knowledge, this is the first study to systematically classify a broad spectrum of food waste interventions while demonstrating ML capabilities. The study provides a clear, systematic framework for interventions to reduce food waste, offering valuable insight for practitioners in the food system, policymakers and consumers. Additionally, it lays the foundation for future in-depth research in the food waste reduction domain.

Bone Radiation-Induced Sarcomas: Outcomes Based on Histology and Surgical Treatment: A Systematic Review of the Literature.

Bone radiation-induced sarcomas (B-RIS) are secondary neoplasms with reportedly worse overall survival than de novo bone sarcoma. Treatment strategy for these neoplasms remains uncertain. Our systematic review sought to assess overall survival based on histology and surgical intervention. A systemic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO (438415). Studies describing oncologic outcomes of patients with B-RIS in the appendicular and axial skeleton were included. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Survival analysis by histologic subtype and surgery type was performed in a subset of 234 patients from 11 articles with individualized data. A total of 20 articles with a total of 566 patients were included. The most frequent location was the pelvis (27.7%), and the main histological types were osteosarcoma (69.4%), undifferentiated pleomorphic sarcoma (14.1%), and fibrosarcoma (9.2%). Limb-salvage and amputation were performed in 68.5% and 31.5% of cases, respectively. Local recurrence was 13%, without difference between limb-salvage surgery and amputation (p = 0.51). The metastasis rate was 42.3%. Five-year OS was 43.7% (95% confidence interval [CI], 33.3%-53.5%) for osteosarcoma, 31.5% (95% CI, 11.3%-54.2%) for UPS, and 28.1% (95% CI, 10.6%-48.8%) for fibrosarcoma. Five-year OS was 49.2% (95% CI, 35.3%-61.6%) for limb-salvage and 46.9% (95% CI, 29.1%-62.9%) for amputation. There was no difference in 5-year OS between histologic subtypes (p = 0.18) or treatment type (p = 0.86). B-RIS demonstrated poor OS at 5 years after initial management regardless of histology. Limb-salvage surgery was not associated with lower 5-year OS compared with amputation. Future studies should compare both groups while controlling for confounders. Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical stage IIA/B seminoma - to do or not to do: the role of retroperitoneal lymphadenectomy

About 10% of patients with seminomatous testicuar germ cell tumors are diagnosed with clinical stage II/B. The current guideline recommended treatment options include systemic chemotherapy with 3 cycles PEB or radiation therapy with 30 Gy for CS IIA and 36 Gy for CS IIB. Despite a high cure rate of 90-94% and 82-90% for CS IIA and CS IIB, respectively, both options are associated with a high rate of treatment-associated long-term toxicities. A significantly increased risk for the development of secondary malignancies, cardiovascular and metabolic disease as well as an increased for treatment-associated mortality has been proven in various studies. Primary nerve sparing retroperitoneal lymph node dissection (nsRPLND) has been evaluated in 5 prospective and retrospective clinical studies and it has emerged as a valid treatment alternative. The relapse-rate after a median follow-up of 25-33 months is in the range of 11-30%, so that 70-90% of patients are cured without being subjected to chemotherapy and potential long-term toxicities. All relapsing patients have been cured with secondary salvage chemotherapy. The frequency of significant surgery-associated complications is low with 3-13%. Therapeutic success depends on the surgical experience of the various surgeons and the chosen template, so that this type of surgical interventions should only be performed in centres of excellence with dedicated surgeons. Preoperative evaluation of the new biomarker miR371 has been shown to predict the presence of metastatic disease with an accuracy of around 100% so that this marker might be used in daily routine prior to active treatment in CS IIA/B seminomas.

Adoption of Reverse Total Shoulder Arthroplasty for Surgical Treatment of Proximal Humerus Fractures Differs by Patient Race

BackgroundReverse total shoulder arthroplasty (rTSA) has gained popularity for the operative treatment of proximal humerus fractures (PHF). The purpose of this study was to compare racial differences in surgical management of PHF between open reduction and internal fixation (ORIF), hemiarthroplasty, and rTSA. Our hypothesis was that there would be no difference in fixation by race. MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried for ORIF, rTSA, and hemiarthroplasty between 2006 and 2020 for patients with a PHF. Race, ethnicity, age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) class were recorded. Chi squared tests were performed to assess relationships between patient factors and operative intervention. Factors significant at the 0.10 level in univariable analyses were included in a multivariable multinomial model to predict operative intervention. Results7,499 patients underwent surgical treatment for a PHF, including 526 (7%) undergoing hemiarthroplasty, 5,011 (67%) undergoing ORIF, and 1,962 (26%) undergoing rTSA. 27% of white patients with PHF underwent rTSA compared to 21% of Black patients, 16% of Asian patients, and 14% of Native American and Alaskan Native patients (p<0.001). In the multivariable analysis, utilization of rTSA increased over time (OR 1.2 per year since 2006, p < 0.001) and hemiarthroplasty decreased over time (OR 0.86 per year since 2006, p < 0.001). Non-white patients had significantly lower odds of undergoing rTSA versus ORIF (OR 0.75, 95% CI 0.58-0.97), as did male patients (OR 0.77, 95% CI 0.66-0.88). Patients over 65 (OR 3.86, 95% CI 3.39-4.38), patients with higher ASA classifications (ASA2: OR 3.24, 95% CI 1.86-5.66, ASA3: OR 4.77, 95% CI 2.74-8.32, ASA4: OR 5.25, 95% CI 2.89-9.54), and patients who were overweight (OR 1.33, 95% CI 1.14-1.55) or obese (OR 1.52, 95% CI 1.32-1.75) had higher odds of undergoing rTSA versus ORIF. DiscussionAs utilization of rTSA increases, understanding disparities in surgical treatment of PHF is crucial to improving outcomes and equitable access to emerging orthopedic technologies. While patient factors such as age, BMI, and comorbidities are known to directly impact outcomes and thus may be predictive of the type of surgical intervention, patient race should not dictate treatment.

Characteristics and Impact of Randomized Trials on Drugs or Devices in Cardiovascular Medicine.

Clinical trials, essential for medical advancement, vary significantly in methodology and regulatory pathways depending on the type of therapeutic intervention (i.e., drugs or devices). This study aimed to determine whether the drug or device intervention types influence the impact of randomized trials in cardiovascular medicine. We analyzed late-breaking randomized controlled trials presented at major cardiology conferences from 2015 to 2021. The primary endpoint was the total number of citations obtained. Secondary endpoints included the number of citations at 1 and 2 years, number of total and 1-year mentions, and several metrics of study conduct and publication. Statistical analysis included tests for comparisons of continuous or categorical variables, based on their distribution, as appropriate. To adjust the results for potential confounders, univariable and multivariable regression models were utilized. Additionally, sensitivity analyses were conducted to explore both the effect of neutral or positive study outcomes on the comparative impact of drug versus device trials and the impact of the coronavirus disease 2019 (COVID-19) pandemic on the primary endpoint. Of 382 eligible randomized trials, 227 (59.4%) were trials of drugs and 155 (40.6%) were trials of devices. Drug trials had a higher median number of total citations compared to device studies (93 [interquartile range {IQR} 48-137] vs. 82 [IQR 39-192]; p = 0.025). This difference was consistent at 1 and 2 years and was also observed in the number of total mentions and mentions at 1 year. All the metrics of study conduct and publication were similar, except for drug studies being more often stopped prematurely (8.8 vs. 1.9%; p = 0.006). After adjusting for multiple potential confounders, the difference in citations and mentions was no longer statistically significant. However, drug trials remained more likely to be stopped prematurely (adjusted odds ratio = 1.15; 95% confidence interval 1.03-1.28; p = 0.009). Positive study outcomes significantly influenced the number of citations and the likelihood of a trial being stopped prematurely. Drug trials are often stopped early and receive more citations and mentions than device trials. However, these differences are mainly due to factors other than the treatment itself. Studies published simultaneously tend to get more attention, and drug trials with positive results are cited more often than those with neutral results.

Smartphone-Based Smoking Cessation Intervention (OKquit) for Oklahoma Tobacco Helpline Users: Protocol for a Randomized Controlled Trial.

Tobacco quitlines provide effective resources (eg, nicotine replacement therapy, smoking cessation counseling, and text and web-based support) for those who want to quit smoking in the United States. However, quitlines reach approximately only 1%-3% of people who smoke each year. Novel, smartphone-based, and low-burden interventions that offer 24/7 access to smoking cessation resources that are tailored to current readiness to quit may increase appeal, reach, and effectiveness of smoking cessation interventions. This study will examine the efficacy of OKquit, a low-burden smartphone-based app for smoking cessation. Approximately 500 people who smoke cigarettes and access the Oklahoma Tobacco Helpline (OTH) will be randomized to receive standard OTH care (SC) or SC plus the novel OKquit smartphone app for smoking cessation (OKquit). All participants will use a smartphone app to complete study surveys (ie, baseline, 27 weekly surveys, brief daily check-ins, and 27-week follow-up). Upon completion of daily check-ins and weekly surveys, participants will receive either trivia type messages (SC) or messages that are tailored to current readiness to quit smoking and currently experienced lapse triggers (OKquit). In addition, those assigned to receive the OKquit app will have access to on-demand smoking cessation content (eg, quit tips, smoking cessation medication tips). It is hypothesized that participants assigned to OKquit will be more likely to achieve biochemically verified 7-day point prevalence abstinence than those assigned to SC at 27 weeks post enrollment. In addition, participants who use more OTH resources (eg, more cessation coaching sessions completed) or more OKquit resources (eg, access more quit tips) will have greater biochemically verified smoking cessation rates. Data collection began in September 2022 and final follow-ups are expected to be completed by May 2025. Data from this randomized controlled trial will determine whether the OKquit smartphone app combined with OTH care will increase smoking cessation rates over standard OTH care alone. If successful, OKquit could provide tailored intervention content at a fraction of the cost of traditional interventions. Furthermore, this type of low-burden intervention may offer a way to reach underserved populations of adults who smoke and want to quit. ClinicalTrials.gov NCT05539209; https://clinicaltrials.gov/study/NCT05539209. DERR1-10.2196/56827.

A Changing Representation: “Personal Writing” in Artistic Intervention in Chinese Rural Communities

Abstract As socially engaged art has played a vibrant role in responding to the crisis of the postmodernist art regime, the current post-Occupy condition has manifested itself in artistic interventions in rural China. In contrast to social writing, which encompasses street art, designers going to the countryside, and industrial empowerment to construct “good cultural governance” or “good cultural taste,” the term personal writing as used here describes a type of avant-garde intervention that has sparked interest in vernacular communities. It provides a socially minded critique of art production as bifurcated from the remaking of everyday social relations and subjectivities, political and cultural possibilities, and the rural Chinese future. Grounded in a contextual analysis of the social turn in Chinese contemporary art and the lingering “rural problem” under post-socialism, this article takes artist Mao Chenyu's Paddy Film project as an example of personal writing and proposes this artist's activisms at Dongting Lake as a specific intervening field, visual ethnography as a method, paddy rice as a distinctive “thing,” and archival practices as a deconstructive pathway that together have promoted the emergence of a resistance narrative in artistic intervention in Chinese rural communities.

An Empirical Study of How Tribunals Interpret Stand-Alone FET Clauses regarding Their Relationship with the MST and How It Impacts Findings on Liability

This article provides the first empirical survey since the 2012 UNCTAD Report of how tribunals have addressed a specific type of Fair and Equitable Treatment (FET) clause: stand-alone clauses containing no reference to international law or any other standard. The vast majority of awards did not take a position on the issue of whether that standard offers the same or different level of protection compared to the Minimum Standard of Treatment (MST) under custom. Yet, those that did have overwhelmingly concluded that the clause must be interpreted to have an autonomous character, not related to the MST. These tribunals have also given broad interpretation of the scope and content of the clause which, in turn, had an impact on how they have addressed matters of liability and compensation. The success rate of FET claims is higher for tribunals which have expressly stated that a stand-alone FET clause has an ‘autonomous’ character compared to others which did not take a position on this question (two-thirds versus 50%). Notably, the overall success rate of FET claims under a stand-alone clause (50%) is much higher compared to that of awards examining FET clauses where the standard is expressly linked to the MST.

Periodontal host-modulation therapy with avocado/soybean unsaponifiables in rats with arthritis.

The aim of this study was to evaluate the effect of the avocado/soybean unsaponifiables (ASU) in the treatment of induced periodontitis in rats with experimental arthritis. Sixty rats were randomly assigned to 4 groups according to the type of treatment and the systemic condition of the animals: CTR-S: healthy animals in which saline solution (SS) was administered; ASU-S: healthy animals in which ASU (0.6 mg/kg) was administered; AR/ASU-S: animals with induced arthritis in which ASU was administered; AR-S: animals with induced arthritis in which SS was administered. Periodontitis was induced by ligatures, maintained for 15 days. Subsequently, the treatment was performed by scaling with hand instruments. The SS and ASU were administered daily by gavage until euthanasia of the animals that occurred at 7, 15 or 30 days after the scaling procedure (N.=5 animals/group). Bone resorption, inflammatory infiltrate composition, and osteoclastogenesis were assessed. The AR-S group had greater bone loss, smaller amounts of fibroblasts and larger amounts of inflammatory cells than all other groups. In addition, the AR-S group had greater osteoclastogenesis in relation to the healthy animal groups. The use of ASU improved the healing pattern after treatment for experimental periodontitis in animals with arthritis reducing the periodontal bone loss.

Clinical Outcomes of Enfortumab Vedotin in Advanced Urothelial Carcinoma With Prior Avelumab Versus Pembrolizumab Therapy.

This study retrospectively evaluated whether enfortumab vedotin (EV) monotherapy is effective as a late-line treatment according to prior treatment type in patients with advanced urothelial carcinoma (UC). We assessed consecutive patients from the Uro-Oncology Group in the Kyushu study population with lower and upper urinary tract cancer treated with EV monotherapy after platinum-based chemotherapy and immune checkpoint inhibitor therapy failure between December 2021 and March 2024. In particular, patients receiving avelumab maintenance or pembrolizumab therapy before EV for advanced UC were analyzed and compared according to the response rate, progression-free survival (PFS), and overall survival (OS). Of the 80 enrolled patients, 31 and 49 received avelumab and pembrolizumab before EV therapy, respectively. The avelumab and pembrolizumab groups had comparable objective response rates (48.4% vs. 44.9%, p=0.820) and disease control rates (77.4% vs. 67.3%, p=0.448). These two groups showed no significant difference in PFS from the initiation of EV (median: 6.4 months vs. 4.2 months, p=0.184); meanwhile, the avelumab group had better OS from the initiation of EV than the pembrolizumab group (median: 16.0 months vs. 10.2 months, p=0.019). Moreover, the median OS after first-line chemotherapy initiation was longer in the avelumab group than in the pembrolizumab group (40.3 months vs. 24.7 months, p=0.054). On multivariate analysis, avelumab maintenance therapy before EV reduced the mortality risk by 47% (95% confidence interval=0.27-1.03; p=0.059). EV monotherapy after avelumab maintenance therapy provides favorable survival outcomes in patients with advanced UC.

Transcranial ultrasound with electrical stimulation of the cerebello-parietal nucleus on cerebral blood flow and limb function in patients with stroke.

To investigate the efficacy of transcranial ultrasound stimulation (TUS) combined with Fastigial nucleus stimulation (FNS) on cerebral blood flow and limb function in patients in the acute phase of ischemic stroke. A total of 90 patients in the acute phase of ischemic stroke were randomly divided into an FNS, TUS, and TUS + FNS group (30 patients each), and all patients also received conventional treatment. The FNS group was treated with FNS alone. The TUS group was treated with TUS alone. The TUS + FNS group was treated with both TUS and FNS. The three groups were treated once a day for 6 days a week. The simplified Fugl-Meyer Assessment (FMA) and Barthel index scores (BI), and the peak systolic blood flow velocity (Vs) and the mean blood flow velocity (Vm) of the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery, were significantly higher in all three groups compared with before treatment (P < 0.05). The scores for the TUS group were higher than for the FNS group (P < 0.05), and the scores of the TUS + FNS group were higher than the TUS and FNS groups, respectively (P < 0.05). The total effective rate was 63.3%, 70.0%, and 90.0% in the FNS, TUS, and TUS + FNS groups, respectively, and the difference between the three groups was statistically significant (P < 0.05). The FNS and TUS treatments improved the function of and accelerated cerebral blood flow in patients with acute ischemic stroke to different degrees, and the combined use of both treatment types was overall more effective.

Fish Collagen Cross‐Linking Strategies to Improve Mechanical and Bioactive Capabilities for Tissue Engineering and Regenerative Medicine

AbstractCollagen is the most abundant protein found in humans and is fundamental to tissue structure and function. Collagen products used in biomedical research are primarily derived from mammals, and despite being mainly responsible for providing strength to native connective tissue, collagen hydrogels have comparatively low mechanical properties without the use of additional cross‐linking strategies. Alternative sources of collagen, like fish collagen, are emerging as key biomaterials in tissue engineering and regenerative medicine (TERM). By addressing cultural/religious concerns, ease of extraction, absence of mammalian‐derived allergens, and retention of functional motifs, fish collagen has many promising characteristics that make it a suitable alternative to mammalian collagen. Several physical and chemical cross‐linking strategies of fish collagen are explored to create more stable and resilient scaffolds for a variety of TERM applications. This comprehensive review explores how these modifications are optimized in fish collagen hydrogel systems. Herein, the use of fish collagen and their reported sources for TERM research, as well as the types of treatments (including sterilization) used to alter collagen structures and functions, are presented to date.

Laser Therapy in Heavily Treated Oncological Patients Improves Vaginal Health Parameters

This study aimed to investigate the efficacy and duration of multiple non-ablative intravaginal CO2 laser (V-lase®) cycles in breast cancer patients, gynecological and other pelvic cancers previously subjected to multiple oncological treatments. This prospective study enrolled women under the age of 65 years who reported vaginal symptoms. Data on the Vaginal Health Index (VHI), vaginal length (VL), vaginal pain measured using a Visual Analog Scale (VAS), and the Female Sexual Function Index (FSFI) were collected at baseline and before each laser application, and at subsequent follow-up visits. A total of 170 laser applications were performed on 113 women with various types of cancer. Most patients (57.5%) had received radiotherapy-based treatments before receiving laser treatment. Vaginal health parameters and sexual function improved significantly with each laser application. However, a temporary decline in these improvements occurred during the intervals between cycles. Such worsening was reversed with the subsequent cycle in all groups of patients, irrespective of the type of oncological treatments they had undergone. Multiple course vaginal laser therapy showed promising results as a potential treatment for vaginal atrophy in heavily treated gynecological and breast cancer patients, necessitating further research to determine the optimal time interval between cycles to ensure sustained positive effects.

Atogepant (Qulipta)

CADTH recommends that atogepant (Qulipta) be reimbursed by public drug plans for the prevention of migraine if certain conditions are met. For migraine prevention, Qulipta should only be covered in adult patients who have tried at least 2 other types of treatments for the prevention of migraine. Qulipta should only be reimbursed if it is prescribed by a prescriber with experience managing chronic migraine (CM) headaches and if the cost of Qulipta is not more than the least costly calcitonin gene–related peptide (CGRP) inhibitor currently funded for this population. Qulipta should not be reimbursed for use in combination with other CGRP inhibitors for the prevention of migraine in adult patients with CM.

ANTI-HYPERLIPIDEMIA ACTIVITY IN THE VIVO TEST FROM A COMBINATION OF AVOCADO LEAF EXTRACT (Persea americana Mill) AND GINGER RHIZOME (Curcuma xanthorrhiza Roxb) IN MICE WITH HYPERCHOLESTEROLEMIA

Herbal and traditional medicine are two of the main types of treatment in developing countries, including Indonesia. Hyperlipidemia is a condition in which cholesterol levels in the body exceed normal limits, impacting cardiovascular disease. Avocado leaves and temulawak rhizomes have been shown to have antihyperlipidemic effects in animals. This study aimed to determine the anti-hyperlipidemic activity of avocado leaf (Persea americana Mill) and temulawak rhizome (Curcuma xanthorrhiza Roxb) combination extract in cholesterol levels of white male mice Sprague Dawley strain. The subjects of this study consisted of 20 white male mice Sprague Dawley strain (Rattus novergicus) and were divided into five groups: F1 (standard); F2 (hypercholesterolemic group); F3 (1:1 treatment group); F4 (1:2 treatment group); and F5 (2:1 treatment group). The induction was conducted for 14 days, while the treatment was carried out for seven days. All data were analyzed using the Kruskal-Wallis and Mann-Whitney tests. The combination extract of avocado and temulawak rhizome has an anti-hyperlipidemic activity. Giving a combination extract of avocado leaf and temulawak rhizome to all treatment groups significantly reduced total cholesterol levels in mice (p = 0.028). Avocado leaves and temulawak rhizomes have potential antihyperlipidemic activity derived from flavonoids. In this study, the potency of the extract efficacy can be achieved when given in combination.

Missed Follow-up is associated with worse survival in stage I lung cancer: results from a large multi-site academic hospital system

The purpose of this study is to examine the effect of early incomplete follow-up on overall survival among stage I lung cancer patients. Patients with clinical stage I lung cancer at our institution between 2007 and 2016 were identified (N = 1111). Exclusions included < 18 years of age (N = 2), missing stage or demographics (N = 56), incomplete appointment data or had only one scheduled appointment (N = 351), or did not survive for at least 1 year after diagnosis (N = 120). Missed appointments were defined as unattended follow-up appointments within the first year of diagnosis without an attended appointment in the subsequent 60 days. The primary outcome was the hazard ratio (HR) for death associated per 10% increase in missed oncology follow-up appointments. Univariable and descriptive statistics were performed, and a multivariable landmark Cox regression model was created to examine the effect of missed oncology follow-up on survival. A total of 582 patients were analyzed with median follow-up of 3.2 years and median age of 69 years. On multivariable analysis controlling for age, sex, race, insurance status, and definitive treatment type the HR for death was 1.44 (95% CI 1.05–1.97) for every 10% increase in missed appointments. Incomplete oncologic follow-up may negatively impact overall survival among survivors of early-stage lung cancer.

Relationship Between Type of Treatment And Resilience In Breast Cancer Patients

The high number of cancer patients indicates the need for breast cancer disease control. Various types of treatment include surgery, chemotherapy, radiotherapy, and hormone therapy. Good resilience in cancer patients demonstrates their ability to adapt well to the ongoing treatment effects. Resilience refers to an individual's capacity to manage and overcome problems. The purpose of this study is to investigate the connection between different types of treatment and resilience in breast cancer patients. The research employs a quantitative, cross-sectional approach. Sample calculation used the Lemeshow proportion estimation formula, resulting in 112 respondents at RSUP Persahabatan, selected using purposive sampling based on inclusion and exclusion criteria. Respondent characteristics were assessed using observation sheets, and resilience was measured using the Connor-Davidson Resilience Scale 25 (CD-RISC 25) with a Cronbach Alpha reliability coefficient of 0.892. All variables in this study are categorical; thus, chi-square analysis and, for contingency tables larger than 2x2 with predicted frequencies less than 5, Fisher's exact test were applied. Bivariate analysis results showed a significant relationship between the type of treatment and resilience in breast cancer patients, with a p-value of 0.002 (&lt;0.05). Similarly, one of the respondent characteristics based on cancer stage showed a significant relationship with resilience, with a p-value of 0.016 (&lt;0.05). The resilience of breast cancer patients undergoing treatment is very high, at 25.0%.

Using contact network dynamics to implement efficient interventions against pathogen spread in hospital settings: A modelling study.

Long-term care facilities (LTCFs) are hotspots for pathogen transmission. Infection control interventions are essential, but the high density and heterogeneity of interindividual contacts within LTCF may hinder their efficacy. Here, we explore how the patient-staff contact structure may inform effective intervention implementation. Using an individual-based model (IBM), we reproduced methicillin-resistant Staphylococcus aureus colonisation transmission dynamics over a detailed contact network recorded within a French LTCF of 327 patients and 263 staff over 3 months. Simulated baseline cumulative colonisation incidence was 21 patients (prediction interval: 11, 31) and 35 staff (prediction interval: 19, 54). We examined the potential impact of 3 types of interventions against transmission (reallocation reducing the number of unique contacts per staff, reinforced contact precautions, and hypothetical vaccination protecting against acquisition), targeted towards specific populations. All 3 interventions were effective when applied to all nurses or healthcare assistants (median reduction in MRSA colonisation incidence up to 35%), but the benefit did not exceed 8% when targeting any other single staff category. We identified "supercontactor" individuals with most contacts ("frequency-based," overrepresented among nurses, porters, and rehabilitation staff) or with the longest cumulative time spent in contact ("duration-based," overrepresented among healthcare assistants and patients in elderly care or persistent vegetative state (PVS)). Targeting supercontactors enhanced interventions against pathogen spread in the LTCF. With contact precautions, targeting frequency-based staff supercontactors led to the highest incidence reduction (20%, 95% CI: 19, 21). Vaccinating a mix of frequency- and duration-based staff supercontactors led to a higher reduction (23%, 95% CI: 22, 24) than all other approaches. Although based on data from a single LTCF, when varying epidemiological parameters to extend to other pathogens, our results suggest that targeting supercontactors is always the most effective strategy, indicating this approach could be applied to prevent transmission of other nosocomial pathogens. By characterising the contact structure in hospital settings and identifying the categories of staff and patients more likely to be supercontactors, with either more or longer contacts than others, interventions against nosocomial spread could be more effective. We find that the most efficient implementation strategy depends on the intervention (reallocation, contact precautions, vaccination) and target population (staff, patients, supercontactors). Importantly, both staff and patients may be supercontactors, highlighting the importance of including patients in measures to prevent pathogen transmission in LTCF.

The soft channels of policy diffusion: Insights from local climate change adaptation policy

AbstractDiffusion has become both an important concept for studying policy spread and a popular governance approach, particularly where direct coercion is unavailable or undesirable. However, the prevailing mechanism‐centered concept is difficult to measure and poorly captures the governance potential of policy diffusion. To address these issues, this article presents a new channel‐centered framework that distinguishes between six soft policy diffusion channels: autonomous, collaborative, exemplary, persuasive, organized, and funded diffusion. The framework is probed by studying local climate change adaptation policy using original survey data collected from the administrations of 190 municipalities located in the central German state of Hessen. The regression results indicate that the local institutionalization of adaptation in Hessen is associated with several interventions by higher levels of government, including the provision of a policy model, a municipal climate network, and grant programs. However, the density of concrete adaptation measures is associated with noninstitutionalized exchanges between municipalities. External grants are also found to be more effective in institutionalizing adaptation in larger municipalities. These results demonstrate the usefulness of the framework for distinguishing and comparing different diffusion channels and suggest that different types of interventions may be required to effectively support adaptation policy development at the local level.