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Justice League : the Darkseid War
\"Collected in its entirety, Justice League: The Darkseid War features the epic battle between the Justice League, Darkseid and the Anti-Monitor in this all-new Essential Edition! The Justice League came together to stop the forces of Darkseid from destroying Earth five years ago. Now the ruler of Apokolips returns, but sets his sights on the world-shattering Anti-Monitor. Will the combined might of the Justice League be enough to protect the Earth from the collateral damage as Gods fight? The New York Times best-selling series from Geoff Johns comes to its explosive conclusion here in this massive hardcover!\"-- Provided by publisher.
Book
Use of erectile dysfunction treatments after prostate cancer treatment and their perceived impact on men’s sex life: an analysis of patient reported outcome survey data
Background
Although sexual dysfunction is a common treatment side-effect affecting men’s quality of life, many prostate cancer patients do not receive or seek out treatments for erectile dysfunction (ED). The aims of this study are to investigate the extent and patterns of use of ED treatments and their perceived impact at different times following prostate cancer treatment.
Methods
This retrospective cohort study included all men on the South Australian prostate cancer registry who completed one or more Patient Reported Outcome Measures (PROMs) survey from 2016 to 2023 (
n
= 5561). Outcomes included self-reported use of ED treatment (oral medications, intra-cavernosal injections (ICI) and vacuum pumps) and their impact men’s sex life at various time points after treatment. The type and timing of ED treatments used was analysed descriptively. Sociodemographic and clinical characteristics associated with utilisation and self-reported satisfaction were examined using multivariable mixed-effects binomial logistic regression.
Results
Post-treatment use of ED treatments did not exceed 43% at any timepoint, with utilisation rates decreasing over time. Oral medications were most frequently used, while vacuum pump and ICI use was limited. Oral medications were more likely to be used at three-months (odds ratio [OR] = 2.48; 95% confidence interval [95%CI] = 1.88–3.27) and six-months (OR = 2.10; 95%CI = 1.63–2.27) than at 12-months post-treatment, and among men from higher socioeconomic areas (OR = 2.41; 95%CI = 1.47–3.93, highest vs. lowest quintile), and following prostatectomy (OR = 4.37; 95%CI = 2.92–6.42), and less likely among older men (OR = 0.08; 95%CI = 0.05–0.13, < 60yrs vs. 70-79yrs). Men were more likely to report an improved sex life with oral medication use at two-years (OR = 3.79; 95%CI = 1.69–8.47) and five-years (OR = 3.07; 95%CI = 1.51–6.25) post-treatment compared with 12-months or if they were socioeconomically advantaged (OR = 3.22; 95%CI = 1.30–7.96, highest vs. lowest quintile).
Conclusions
A substantial proportion of Australian men do not access or continue to use ED treatments after prostate cancer treatment, with many users reporting only modest effects on their sex life. There is a need to improve access to and maintenance of ED treatments following prostate cancer treatment.
Journal Article
The unique states of America : can't-miss experiences across the USA
\"Travel off the beaten path and into the heart of each state with our expert itineraries exploring some of the USA's finest art and culture, food and drink, history, sports, and family-friendly places. Get fascinating insights into unmissable sights, attractions, parks and more with Lonely Planet's expert commentary and stunning photography.\"--Provided by publisher.
Book
Patient-reported functional outcome measures and treatment choice for prostate cancer
Background
The aim of this study was to describe changes in patient-reported functional outcome measures (PROMs) comparing pre-treatment and 12 months after radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy and active surveillance (AS).
Methods
Men enrolled from 2010 to 2019 in the South Australian Prostate Cancer Clinical Outcomes Collaborative registry a prospective clinical registry were studied. Urinary, bowel, and sexual functions were measured using Expanded Prostate Cancer Index Composite (EPIC-26) at baseline and 12 months post-treatment. Higher scores on the EPIC-26 indicate better function. Multivariable regression models were applied to compare differences in function and extent of bother by treatment.
Results
Of the 4926 eligible men, 57.0% underwent RP, 20.5% EBRT, 7.0% brachytherapy and 15.5% AS. While baseline urinary and bowel function varied little across treatment groups, sexual function differed greatly (adjusted mean scores: RP = 56.3, EBRT = 45.8, brachytherapy = 61.4, AS = 52.8; p < 0.001). Post-treatment urinary continence and sexual function declined in all treatment groups, with the greatest decline for sexual function after RP (adjusted mean score change − 28.9). After adjustment for baseline differences, post-treatment sexual function scores after EBRT (6.4; 95%CI, 0.9–12.0) and brachytherapy (17.4; 95%CI, 9.4–25.5) were higher than after RP. Likewise, urinary continence after EBRT (13.6; 95%CI, 9.0-18.2), brachytherapy (10.6; 95%CI, 3.9–17.3) and AS (10.6; 95%CI, 5.9–15.3) were higher than after RP. Conversely, EBRT was associated with lower bowel function (− 7.9; 95%CI, − 12.4 to − 3.5) than RP. EBRT and AS were associated with lower odds of sexual bother (OR 0.51; 95%CI, 0.29–0.89 and OR 0.60; 95%CI, 0.38–0.96, respectively), and EBRT with higher odds of bowel bother (OR 2.01; 95%CI, 1.23–3.29) compared with RP.
Conclusion
The four common treatment approaches for prostate cancer were associated with different patterns of patient-reported functional outcomes, both pre- and 12 months post-treatment. However, after adjustment, RP was associated with a greater decline in urinary continence and sexual function than other treatments. This study underscores the importance of collecting baseline PROMs to interpret post-treatment functional outcomes.
Journal Article
Justice League vs. Suicide Squad
\"The first major crossover of the Rebirth era starring the biggest heroes and villains in comics, this action-packed epic JUSTICE LEAGUE VS. SUICIDE SQUAD features an all-star creative team, including writers Joshua Williamson, Tim Seeley, Rob Williams and Si Spurrier, with superstar artists Jason Fabok, Tony S. Daniel, Jesus Merino, Fernando Pasarin, Robson Rocha, Howard Porter, Scot Eaton, Riley Rossmo, Christian Duce, Giuseppe Cafaro and more! The members of the Justice League are Earth's most powerful and famous superheroes ... but they aren't the only team in town. The Suicide Squad strikes from the shadows and does the jobs too dirty for superheroes to handle. Under the iron fist of Director Amanda Waller, these monsters and maniacs have operated in total secrecy ... until now. Batman is on their trail and the Squad's existence isn't something he or the Justice League can tolerate. It must be shut down. But while the heroes and antiheroes are distracted fighting each other, twisted mastermind Maxwell Lord assembles a nightmarish army of DC's deadliest villains to take out both teams!\"-- Provided by publisher.
Book
Clinical and functional outcomes for risk‐appropriate treatments for prostate cancer
Objectives To describe real‐world clinical and functional outcomes in an Australian cohort of men with localised prostate cancer according to treatment type and risk category. Subjects and methods Men diagnosed from 2008 to 2018 who were enrolled in South Australian Prostate Cancer Clinical Outcomes Collaborative registry—a multi‐institutional prospective clinical registry—were studied. The main outcome measures were overall survival, cancer‐specific survival, decline in functional outcomes, biochemical recurrence and transition to active treatment following active surveillance. Multivariable adjusted models were applied to estimate outcomes. Results Of the 8513 eligible men, majority of men (46%) underwent radical prostatectomy (RP) followed by external beam radiation therapy with or without androgen deprivation therapy (EBRT +/− ADT) in 22% of the cohort. Five‐year overall survival was above 91%, and 5‐year prostate cancer‐specific survival was above 97% in the low‐ and intermediate‐risk categories across all treatments. Five‐year prostate cancer‐specific survival in the active surveillance group was 100%. About 37% of men with high‐risk disease treated with RP and 17% of men treated with EBRT +/− ADT experienced biochemical recurrence within 5 years of treatment. Of men on active surveillance, 15% of those with low risk and 20% with intermediate risk converted to active treatment within 2 years. The decline in urinary continence and sexual function 12 months after treatment was greatest among men who underwent RP while the decline in bowel function was greatest for men who received EBRT +/− ADT. Conclusion This contemporary real‐world evidence on risk‐appropriate treatment outcomes helps inform treatment decision‐making for clinicians and patients.
Journal Article
Batman rebirth deluxe edition
\"The first two volumes of BATMAN as a part of DC Universe Rebirth are collected here in hardcover for the first time ever! The Caped Crusader has never been stopped. Not by the Joker. Not by Two-Face. Not even by the entire Justice League. But now, in the wake of DC UNIVERSE: REBIRTH, Batman must face his most challenging foe ever--a hero who wants to save Gotham...from the Batman! This collection features the first two paperback volumes of the series, combined to make a deluxe edition graphic novel in hardcover for the first time ever.\"-- Provided by publisher.
BOOK
Protocol for the Flinders Kidney Health Registry: patient outcomes of kidney cancers and nephrectomies
Background
Kidney cancer accounts for 2% of new cancers diagnosed in Australia annually. Partial and radical nephrectomy are the treatment of choice for kidney cancer. Nephrectomy is also performed for living donor kidney transplantation. Nephrectomy is a risk factor for new-onset chronic kidney disease (CKD) or deterioration of pre-existing CKD. Understanding the risk factors for new-onset or deterioration of existing CKD after nephrectomy is important in developing preventive measures to provide better care for these patients. There is also a need to understand the incidence, natural history, management trends, and sequelae of radiofrequency ablation as well as surveillance of small renal cancers or small renal masses (SRMs). Clinical registries are critical in providing excellent patient-centre care and clinical research as well as basic science research. Registries evaluate current practice and guide future practice. The Flinders Kidney Health Registry will provide the key information needed to assess various treatment outcomes of patients with kidney cancer and patients who underwent nephrectomy for other reasons. The registry aims to provide clinical decision makers with longitudinal data on patient outcomes, health systems performance, and the effect of evolving clinical practice. The registry will also provide a platform for large-scale prospective clinical studies and research.
Methods
Patients above the age of 18 undergoing nephrectomy or radiofrequency ablation for any indication and patients with SRMs will be included in the registry. Demographic, clinical and quality of life data will be collected from hospital information systems and directly from the patient and/or caregiver.
Discussion
The Registry will report a summary of patient characteristics including indication for treatment, clinical risk profiles, surgical and oncological outcomes, the proportion of patients who progress to CKD and end stage kidney disease, quality of life post treatment as well as other relevant outcomes for all patients who have undergone nephrectomy for any indication, ablation or surveillance for SRMs. The registry will record the follow-up practice after nephrectomy and patient on active surveillance, which will help to develop and enhance a best practice protocol. The collected prospective data will provide a platform for ongoing patient-orientated research and improve patient-centred healthcare delivery.
Journal Article
Does biomass growth increase in the largest trees? Flaws, fallacies and alternative analyses
Summary The long‐standing view that biomass growth in trees typically follows a rise‐and‐fall unimodal pattern has been challenged by studies concluding that biomass growth increases with size even among the largest stems in both closed forests and in open competition‐free environments. We highlight challenges and pitfalls that influence such interpretations. The ability to observe and calibrate biomass change in large stems requires adequate data regarding these specific stems. Data checking and control procedures can bias estimates of biomass growth and generate false increases with stem size. It is important to distinguish aggregate and individual‐level trends: a failure to do so results in flawed interpretations. Our assessment of biomass growth in 706 tropical forest stems indicates that individual biomass growth patterns often plateau for extended periods, with no significant difference in the number of stems indicating positive and negative trends in all but one of the 14 species. Nonetheless, when comparing aggregate growth during the most recent five years, 13 out of our 14 species indicate that biomass growth increases with size even among the largest sizes. Thus, individual and aggregate patterns of biomass growth with size are distinct. Claims concerning general biomass growth patterns for large trees remain unconvincing. We suggest how future studies can improve our knowledge of growth patterns in and among large trees. A lay summary is available for this article. Lay Summary
Journal Article
Reporting Real-World Data on Prostate Cancer Treatment Outcomes to Consumers: The Prostate Cancer Report Card
Aim. To describe the process of developing a resource, the “Prostate Cancer Outcomes Report Card,” that provides information for men with prostate cancer and their family members about the outcomes of different treatment approaches. Methods. The project consisted of two phases. The first phase involved analysis of real-world data and translating outcomes into a format that consumers found easy to understand and interpret. The Report Card was developed in consultation with a consumer advisory group (n = 8). The second phase involved refinements of the resource through exploratory qualitative interviews with consumers (n = 14), an online survey among the general public (n = 134), and clinician feedback (n = 8). Results. Consumer engagement to explore preferences about the content and visual presentation from the end-users’ perspective was crucial in designing this report. Consumers required trustworthy, comprehensive, simple, and up-to-date information collated in one place to help them understand the risks and benefits of their treatments. Presenting survival, cancer recurrence, and functional outcomes by treatment type and risk category was highly commended while data on high survival rates were considered reassuring. We identified high levels of unmet psychosocial and supportive care need, with differences in individual preferences around extent of information required. Conclusions. Communicating registry data about real-world outcomes in a consumer-friendly way may help fill a gap in information needs among prostate cancer survivors. Providing relatively simple and easily understandable evidence in a single consumer-oriented report may help prostate cancer survivors become better informed and facilitate patient-provider communication and shared decision making.
Journal Article