Explore the vast range of titles available.

Background and objective Radiation pneumonitis (RP) could be a lethal complication of lung cancer treatment. No reliable predictors of RP severity have been recognized. This prospective pilot study was performed to identify early predictors of high grade lung toxicity and to evaluate clinical, biological or dosimetric features associated with different grades of toxicity. Method Sixteen patients with non-small cell lung cancer with indication of concurrent chemoradiotherapy using 60 Gy/2 Gy/fraction starting at cycle one of platinum based chemotherapy were included. Bronchoalveolar lavage (BAL), pulmonary function testing (PFT), and 18 F-2-fluoro-2-deoxy-D-glucose positron-emission tomography was performed before radiotherapy (RT), after three weeks of treatment, and two months post-RT. For analysis, patients were grouped by grade (low [G1-G2] vs. high [G3-G5]). The two groups were compared to identify predictors of RP. Protein expression BAL and lung tissue metabolism was evaluated in two patients (RP-G1 vs. RP-G3). Categorical variables such as comorbidities, stages and locations were summarized as percentages. Radiation doses, pulmonary function values and time to RP were summarized by medians with ranges or as means with standard deviation. Longitudinal analysis PFT was performed by a T-test. Results All 16 patients developed RP, as follows: G1 (5 pts; 31.3%); G2 (5 pts; 31.3%); G3 (5 pts; 31.3%); and G5 (1 pts; 6.1%). Patients with high grade RP presented significant decrease ( p  = 0.02) in diffusing lung capacity for carbon monoxide (DLCO) after three weeks of RT. No correlation between dosimetric values and RP grades was observed. BAL analysis of the selected patients showed that CXCL-1, CD154, IL-1ra, IL-23, MIF, PAI-1 and IFN-γ were overexpressed in the lungs of the RP-G3 patient, even before treatment. The pre-RT SUVmax value in the RP-G3 patient was non-significantly higher than in the patient with RP-G1. Conclusions RT induces some degree of RP. Our data suggest that decrease in DLCO% is the most sensitive parameter for the early detection of RP. Moreover, we detect biological differences between the two grades of pneumonitis, highlighting the potential value of some cytokines as a prognostic marker for developing high grade lung toxicity. Further multicenter studies with larger sample size are essential to validate these findings.

Introduction 4DCT‐ventilation is an exciting new imaging modality that uses 4DCT data to calculate lung‐function maps. Because 4DCTs are acquired as standard of care for lung cancer patients undergoing radiotherapy, 4DCT‐ventiltation provides functional information at no extra dosimetric or monetary cost to the patient. The development of clinical trials is underway to use 4DCT‐ventilation imaging to spare functional lung in patients undergoing radiotherapy. The purpose of this work was to perform a virtual trial using retrospective data to develop the practical aspects of a 4DCT‐ventilation functional avoidance clinical trial. Methods The study included 96 stage III lung cancer patients. A 4DCT‐ventilation map was calculated using the patient's 4DCT‐imaging, deformable registration, and a density‐change‐based algorithm. Clinical trial inclusion assessment used quantitative and qualitative metrics based on the patient's spatial ventilation profile. Clinical and functional plans were generated for 25 patients. The functional plan aimed to reduce dose to functional lung while meeting standard target and critical structure constraints. Standard and dose‐function metrics were compared between the clinical and functional plans. Results Our data showed that 69% and 59% of stage III patients have regional variability in function based on qualitative and quantitative metrics, respectively. Functional planning demonstrated an average reduction of 2.8 Gy (maximum 8.2 Gy) in the mean dose to functional lung. Conclusions Our work demonstrated that 60–70% of stage III patients would be eligible for functional planning and that a typical functional lung mean dose reduction of 2.8 Gy can be expected relative to standard clinical plans. These findings provide salient data for the development of functional clinical trials.

This oral history interview with Mary Sanchez, along with personal diary recollections and letters, give a rare glimpse into a courageous journey. They witness one woman's spiritual awakening, including her struggle with doubt and suffering, to overcoming many obstacles. Her persistent dedication to the poor and aged is central to her quest for meaning in her life. Guided by an enduring faith, she touched many lives, changed many hearts, and thus has left a lasting legacy of love in action and service to others.

The American Psychiatric Association (APA) has made major changes in the way mental illness is conceptualized, assessed, and diagnosed in its new diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, and has far reaching implications for health care organizations and mental health policy. This paper reviews the four new principles in DSM-5: 1) A spectrum (also called \"dimensional\") approach to the definition of mental illness; 2) recognition of the role played by environmental risk factors related to stress and trauma in predisposing, precipitating, and perpetuating mental illness; 3) cultural relativism in diagnosis and treatment of mental illness; and 4) recognizing the adverse effects of psychiatric medications on patients. Each of these four principles will be addressed in detail. In addition, four major implications for health care organizations and mental health policy are identified as: 1) prevention; 2) client-centered psychiatry; 3) mental health workers retraining; and 4) medical insurance reform. We conclude that DSM-5's new approach to diagnosis and treatment of mental illness will have profound implications for health care organizations and mental health policy, indicating a greater emphasis on prevention and cure rather than long-term management of symptoms.

El presente artículo analiza la evidencia empírica que aportan los estudios sobre la influencia de los factores dinámicos asociados a la reincidencia criminal de menores infractores dentro del contexto español y portugués. La búsqueda de los términos Juvenile delinquency* OR juvenile offenders* AND recidivism* OR Risk factors * se realizó en las bases de datos Scopus, ScienceDirect, Web of science, Dialnet, Scielo y ProQuest. Aplicados los criterios de inclusión y exclusión, de un total de 105 653 artículos, se seleccionaron 20 para análisis cualitativo y 3 para incluir en el metaanálisis. El estudio permite concluir que los factores dinámicos con mayor capacidad de predicción son la educación, la relación con el grupo de pares, el tiempo de ocio, la familia y el consumo de SPA.

The current U.S. health and long term care systems are inadequately prepared to meet the diverse and changing needs of the rapidly growing senior population. This paper describes the importance of naturally occurring retirement communities (NORCs) to promote the health and mental well being of older individuals through the collaborative efforts of formal and informal home and community based services and support. NORCs are considered a crucial model for aging in place since older adults prefer to remain in the comfort of their homes, and services can be provided in a much more efficient and cost effective manner. This paper examines the strengths, opportunities, and challenges of existing NORCs and discusses the need for the development and expansion of additional NORC programs as an innovative and viable solution for older adults aging in place.

Background Central venous catheterization (CVC) is a basic requirement for many medical specialties. Simulated training in CVC may allow the acquisition of this competency but few reports have established a valid methodology for learning and acquiring procedural skills for CVC. This study aims to validate the use of a tracking motion device, the imperial college surgical assessment device (ICSAD), by comparing it with validated global rating scales (GRS) to measure CVC performance in a simulated torso. Methods Senior year medical students, first and last year residents (PGY1, LYR), and expert anesthesiologists performed a jugular CVC assessment in a simulated model (Laerdal IV Torso). A validated GRS for objective assessment of technical skills and motion analysis by ICSAD was used. Statistical analysis was performed through Mann-Whitney and Kruskal-Wallis tests for construct validity and Spearman correlation coefficients between the ICSAD and GRS scores for concurrent validity between both. Results 32 subjects were recruited (10 medical students, 8 PGY1, 8 LYR and 8 experts). Total path length measured with ICSAD and GRS scores were significantly different between all groups, except for LYR compared to experts (p = 0.664 for GRS and p = 0.72 for ICSAD). Regarding jugular CVC procedural time, LYR and experts were faster than PGY1 and MS (p < 0.05). Spearman correlation coefficient was -0.684 (p < 0.001) between ICSAD and GRS scores. Conclusions ICSAD is a valid tool for assessment of jugular CVC since it differentiates between expert and novice subjects, and correlates with a validated GRS for jugular CVC in a simulated torso.

Background Sentinel lymph node biopsy (SLNB) guided by indocyanine green is an innovative technique with a high detection rate in breast cancer; however, Latin American reports are scarce. This study describes the first series of patients in Peru who underwent this technique and evaluates the relationships between clinicopathological factors and lymph node positivity. Methods A retrospective study was conducted on breast cancer patients who underwent SLNB guided by indocyanine green between 2021 and 2024. Clinical and pathological variables were analyzed, and their associations with lymph node positivity were evaluated via bivariate and multivariate statistical tests. Results Sixty-nine patients were analyzed, and a detection rate of 100% was achieved with the indocyanine green technique. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.9% (CI: 90.8%—99.9%), 97.3% (CI: 92.1%—99.9%), 96.9% (CI: 90.8%—99.9%), and 97.3% (CI: 92.0 – 99.9%), respectively, with 95% confidence intervals (CIs). SLN positivity was significantly associated with a larger preoperative ultrasound tumor size (25.4 ± 9.0 vs. 20.7 ± 9.2 mm; p  = 0.018), pT stage (65.6% vs. 37.8%; p  = 0.023), and the presence of lymphovascular invasion ( p  < 0.001). No significant differences were found in terms of age, body mass index, menopausal status, comorbidities, laterality, or histological grade. Conclusions Tumor size, pT stage, and lymphovascular invasion were the main predictors of lymph node positivity in this Peruvian cohort. This study constitutes the first Peruvian series evaluating indocyanine green-guided SLNB, providing relevant evidence for its implementation in Latin America and supporting its use as a safe and effective technique for the treatment of breast cancer.

BackgroundThe performance of left ventricular (LV) functional assessment using gated myocardial perfusion SPECT (MPS) relies on the accuracy of segmentation. Current methods require manual adjustments that are tedious and subjective. We propose a novel machine-learning-based method to automatically segment LV myocardium and measure its volume in gated MPS imaging without human intervention.MethodsWe used an end-to-end fully convolutional neural network to segment LV myocardium by delineating its endocardial and epicardial surface. A novel compound loss function, which encourages similarity and penalizes discrepancy between prediction and training dataset, is utilized in training stage to achieve excellent performance. We retrospectively investigated 32 normal patients and 24 abnormal patients, whose LV myocardial contours automatically segmented by our method were compared with those delineated by physicians as the ground truth.ResultsThe results of our method demonstrated very good agreement with the ground truth. The average DSC metrics and Hausdorff distance of the contours delineated by our method are larger than 0.900 and less than 1 cm, respectively, among all 32 + 24 patients of all phases. The correlation coefficient of the LV myocardium volume between ground truth and our results is 0.910 ± 0.061 (P < 0.001), and the mean relative error of LV myocardium volume is − 1.09 ± 3.66%.ConclusionThese results strongly indicate the feasibility of our method in accurately quantifying LV myocardium volume change over the cardiac cycle. The learning-based segmentation method in gated MPS imaging has great promise for clinical use.

Purpose Methods have been developed that apply image processing to 4DCTs to generate 4DCT‐ventilation/perfusion lung imaging. Traditional methods for 4DCT‐ventilation rely on Hounsfield‐Unit (HU) density‐change methods and suffer from poor numerical robustness while not providing 4DCT‐perfusion data. The purpose of this work was to evaluate the clinical differences between classic HU‐based 4DCT‐ventilation approaches and novel 4DCT‐ventilation/perfusion approaches. Methods Data from 63 lung cancer patients enrolled in a functional avoidance clinical trial were analyzed. 4DCT‐data were used to generate four lung‐function images: (1) classical HU‐based 4DCT‐ventilation (“4DCT‐vent‐HU”), and three novel, statistically robust methods: (2) 4DCT‐ventilation based on the Mass Conserving Volume Change (“4DCT‐vent‐MCVC”), (3) 4DCT‐ventilation using the Integrated Jacobian Formulation, and (4) 4DCT‐perfusion. A radiologist reviewed all images for ventilation/perfusion defects (scored as yes/no) and the scores for the novel approaches were compared to those of 4DCT‐vent‐HU using receiver operating characteristic (ROC) analysis. Functional contours were generated using thresholding methods, and the contours from the three novel 4DCT‐ventilation methods were compared against that from 4DCT‐vent‐HU (Dice similarity coefficients [DSC]). Functional mean lung dose (fMLD) and dose‐function metrics were compared against dose‐function metrics using 4DCT‐vent‐HU. Results ROC analysis revealed accuracy in the range of 0.55 to 0.73 comparing radiologist interpretations of 4DCT‐vent‐HU against the three novel approaches. Average DSC values were 0.41 ± 0.19, 0.44 ± 0.16, and 0.42 ± 0.17 comparing 4DCT‐vent‐HU to 4DCT‐vent‐IJF, 4DCT‐vent‐MCVC, and 4DCT‐perf, respectively. All novel imaging methods showed significant differences (p < 0.01) in dose‐function metrics compared to those of 4DCT‐vent‐HU. 4DCT‐vent‐MCVC and 4DCT‐Perf depicted the smallest and largest differences from 4DCT‐vent‐HU in fMLD (3.51 ± 3.20 Gy and 5.90 ± 5.29 Gy, respectively). Conclusion This is the first work to comprehensively compare novel 4DCT‐ventilation/perfusion methods against classical formulations. Our data show that significant differences between the 4DCT‐based functional imaging methods exist, suggesting that studies are needed to evaluate which methods provide the most robust clinical results.