151 research outputs found
Aesthetics & Politics: A Brief History of Japan & The US’S 20th Century
This paper is a look at the combination of aesthetics and politics and how that combination effected the lives of black Americans, Japanese women and the people of Korea under Japanese occupation during the early 1900s
Invasive Species Along the Rock Island Greenway
The abstract for this presentation can be downloaded by clicking on the blue download button
Decision support system in a patient-centered medical home
Lack of sufficient primary care to manage chronic diseases has been quoted as a major drawback of the healthcare system within the United States. Patient-Centered Medical Home is a care delivery model to transform how primary care is delivered. The information technology revolution has brought about several advancements and solutions for medicine and care delivery, and medical homes are no exception to this. However, it is only through a robust decision support system that these medical homes can in fact provide truly coordinated and patient-centered care. The paper describes preliminary work that has been completed at the University of Missouri Health System and next steps in achieving high quality care delivery through a decision support system implementation. Originally presented at the IEEE HealthCon Medial Home conference in June 2011
Evaluation of the Physical Activity and Public Health Course for Practitioners
From 1996–2013, a 6-day Physical Activity and Public Health Course for Practitioners has been offered yearly in the United States. An evaluation was conducted to assess the impact of the course on building public health capacity for physical activity and on shaping the physical activity and public health careers of fellows since taking the courses
Integrated Multimedia Timeline of Medical Images and Data for Thoracic Oncology Patients
A prototype multimedia medical database has been developed to provide image and textual data for thoracic oncology patients undergoing treatment of advanced malignancies. The database integrates image data from the hospital pieture archiving and communication system with textual reports from the radiology information system, alphanumeric data contained in the hospital information system, and other electronic medical data. The database presents information in a timeline format and also contains visualization programs that permit the user to view and annotate radiographic measurements in tabular or graphic form. The database provides an efficient and intuitive display of the changing status of oncology patients. The ability to integrate, manage, and access relevant multimedia information may substantially enhance communication among distributed multidisciplinary health care providers and may ensure greater consistency and completeness of patient-related data
Evaluation of the Physical Activity and Public Health Course for Researchers
Since 1995, an 8-day Physical Activity and Public Health Course for Researchers has been offered yearly in the United States
Circulating tumor DNA in patients with colorectal adenomas: assessment of detectability and genetic heterogeneity.
Improving early detection of colorectal cancer (CRC) is a key public health priority as adenomas and stage I cancer can be treated with minimally invasive procedures. Population screening strategies based on detection of occult blood in the feces have contributed to enhance detection rates of localized disease, but new approaches based on genetic analyses able to increase specificity and sensitivity could provide additional advantages compared to current screening methodologies. Recently, circulating cell-free DNA (cfDNA) has received much attention as a cancer biomarker for its ability to monitor the progression of advanced disease, predict tumor recurrence and reflect the complex genetic heterogeneity of cancers. Here, we tested whether analysis of cfDNA is a viable tool to enhance detection of colon adenomas. To address this, we assessed a cohort of patients with adenomas and healthy controls using droplet digital PCR (ddPCR) and mutation-specific assays targeted to trunk mutations. Additionally, we performed multiregional, targeted next-generation sequencing (NGS) of adenomas and unmasked extensive heterogeneity, affecting known drivers such as APC, KRAS and mismatch repair (MMR) genes. However, tumor-related mutations were undetectable in patients' plasma. Finally, we employed a preclinical mouse model of Apc-driven intestinal adenomas and confirmed the inability to identify tumor-related alterations via cfDNA, despite the enhanced disease burden displayed by this experimental cancer model. Therefore, we conclude that benign colon lesions display extensive genetic heterogeneity, that they are not prone to release DNA into the circulation and are unlikely to be reliably detected with liquid biopsies, at least with the current technologies
Pieces-of-parts for supervoxel segmentation with global context: Application to DCE-MRI tumour delineation
Rectal tumour segmentation in dynamic contrast-enhanced MRI (DCE-MRI) is a challenging task, and an automated and consistent method would be highly desirable to improve the modelling and prediction of
patient outcomes from tissue contrast enhancement characteristics – particularly in routine clinical practice. A framework is developed to automate DCE-MRI tumour segmentation, by introducing: perfusion-supervoxels to over-segment and classify DCE-MRI volumes using the dynamic contrast enhancement characteristics; and the pieces-of-parts graphical model, which adds global (anatomic) constraints that
further refine the supervoxel components that comprise the tumour. The framework was evaluated on 23 DCE-MRI scans of patients with rectal adenocarcinomas, and achieved a voxelwise area-under the receiver operating characteristic curve (AUC) of 0.97 compared to expert delineations. Creating a binary tumour segmentation, 21 of the 23 cases were segmented correctly with a median Dice similarity coefficient (DSC) of 0.63, which is close to the inter-rater variability of this challenging task. A second study is also included to demonstrate the method’s generalisability and achieved a DSC of 0.71. The framework achieves promising results for the underexplored area of rectal tumour segmentation in DCE-MRI, and the methods have potential to be applied to other DCE-MRI and supervoxel
segmentation problems
Clinical Trial of Oral Nelfinavir before and during Radiation Therapy for Advanced Rectal Cancer
Purpose
Nelfinavir, a PI3-kinase pathway inhibitor, is a radiosensitizer which increases tumor
blood flow in preclinical models. We conducted an early-phase study to demonstrate
the safety of nelfinavir combined with hypofractionated radiotherapy (RT) and to
develop biomarkers of tumor perfusion and radiosensitization for this combinatorial
approach.
Patients and Methods
Ten patients with T3-4 N0-2 M1 rectal cancer received 7 days of oral nelfinavir (1250
mg bd) and a further 7 days of nelfinavir during pelvic RT (25 Gy/5 fractions/7 days).
Perfusion CT (p-CT) and DCE-MRI scans were performed pre-treatment, after 7
days of nelfinavir and prior to last fraction of RT. Biopsies taken pre-treatment and 7
days after the last fraction of RT were analysed for tumor cell density (TCD).
Results
There were 3 drug-related grade 3 adverse events: diarrhea, rash, lymphopenia. On
DCE-MRI, there was a mean 42% increase in median Ktrans, and a corresponding
median 30% increase in mean blood flow on p-CT during RT in combination with
nelfinavir. Median TCD decreased from 24.3% at baseline to 9.2% in biopsies taken
7 days after RT (P=0.01). Overall, 5/9 evaluable patients exhibited good tumor
regression on MRI assessed by Tumor Regression Grade (mrTRG).
Conclusions
This is the first study to evaluate nelfinavir in combination with RT without concurrent
chemotherapy. It has shown that nelfinavir-RT is well tolerated and is associated
with increased blood flow to rectal tumors. The efficacy of nelfinavir-RT versus RT
alone merits clinical evaluation, including measurement of tumor blood flow
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