Supine vs. Prone Positioning for Breast Radiation

When treating breast cancer patients with radiation therapy, it is important to find treatment techniques that reduce the dose to organs at risk without compromising the target tumor volume. Due to advances in cancer diagnosis, patients are diagnosed and treated earlier causing them to live longer. However, these patients are at greater risk for developing long-term complications from treatment, specifically cardiac toxicity and cardiac diseases. Research was evaluated regarding the best treatment position for breast cancer patients to reduce the dose to organs at risk, focusing on the dose to the heart. Every breast cancer patient varies in breast anatomy, tumor biology, tumor location, and structures being treated. Due to variation, positioning for breast cancer treatment should be determined on a patient-by-patient basis. Radiation dose to the heart should be of main concern and minimized as much as possible to reduce the chance of long-term treatment complications. Respiratory gating techniques such as deep inspiration breath-hold can be employed to further reduce radiation dose to organs at risk.https://digitalcommons.misericordia.edu/research_posters2020/1046/thumbnail.jp

View From A Hill

My mother and I drive up Parnassus Avenue in the hills of San Francisco. Listening to our iPod, I sing along to “Gold Dust Woman” by Fleetwood Mac. Usually, my mother would join me, especially since this song is one of our favorites, but she seems ashamed of her weakening voice. The pulsating rhythm of the song enhances the nervous tension as we charge up the Victorian-lined incline. ~excerpt from pros

Spin The Bottle

A bottle turns feverishly on its side a compass searching north, east, west, yes pointedly at a predestined angel of crackled lips and sweaty pits A tender moment of locked eyes searching the other’s approval and first move for the fated instant~excerpt from the poe

A Bark But No Bite

Based on New Zealand Election Study (NZES) data from a sample of 2,830 eligible voters, A Bark But No Bite explores a puzzle. While there was a lot of talk about inequality before the 2014 general election in New Zealand, and during the campaign, concern about inequality appeared to have no tangible effect on the election outcome. This book shows that, by its attention to the concerns of middle ground voters, the National Government had reduced the potential of policy differences to drive voter choices. Perceptions of competence and effective leadership were National’s strongest suit, crowding out voter concerns over matters of policy. When voters did consider policy, inequality and related concerns were second to the economy. Traditional priorities about health and education, and perceptions of party differences on these matters, had faded into the background. Meanwhile, voters doubted the opposition Labour Party’s ability to govern effectively in an alternative coalition to that of the National-led government. Labour’s policies were too many. In various ways, they would have chipped away at inequality, but lacked a coherent narrative and presentation. This book confirms that Labour’s proposal to increase the age for receipt of New Zealand superannuation gained Labour no new votes. Hopes that the ‘missing million’ people who failed to turn out to vote in 2011 would vote in 2014 and give an advantage to the left were unfulfilled. A comprehensive study of the 2014 election, this book provides a detailed account of all these findings, and a host of others

INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees

Background: Internationally, pediatric depression and suicide are significant issues. Additionally, in the context of the COVID-19 pandemic, pediatric mental health needs are rising astronomically. In light of Child & Adolescent Psychiatrist (CAP) subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs. Here we report on the development and preliminary evaluation of medical student and resident perceptions on the “INteractive Virtual Expert-led Skills Training” (INVEST) medical education curriculum, a virtual synchronous CAP curriculum employing active learning strategies, including expert-led discussion and video modeling, and discussion designed to meet those priorities., Methods: In a standardized 60-min training format, our curriculum leverages audience response system polling, video modeling of key clinical skills, and interactive discussion with an expert subspecialist, over a virtual video conferencing platform. The primary educational strategy relies on use of video modeling to demonstrate best practice with CAP led group discussion to solidify and explain important concepts. Five waves of medical students and residents (N = 149) participated in the INVEST curriculum and completed pre- and post-training surveys regarding knowledge and comfort in the management of pediatric patients with depression and suicidality., Results: Trainee participants reported significant positive gains in perceived likelihood of encountering pediatric suicidality as well as knowledge/comfort with depression screening and suicidality assessment in a primary care setting. Across some competency areas, there was an effect of medical learner level. Learners at lower levels generally reported the highest benefit. Medical students reported significant increases in their comfort interpreting and discussing positive depression screens and evidenced the greatest relative benefit in comfort with discussing suicidality., Conclusion: To our knowledge, INVEST is the first fully virtual, multimodal curriculum led by expert CAP subspecialists. Our findings suggest that INVEST shows promise for equipping medical learners with baseline knowledge for caring for patients with pediatric depression and suicidality. This synchronous, virtually delivered curriculum allows for critical training delivered to diverse medical learners regardless of geographic location, a particular benefit during the current COVID-19 pandemic

Exploring multilocus associations of inflammation genes and colorectal cancer risk using hapConstructor

<p>Abstract</p> <p>Background</p> <p>In candidate-gene association studies of single nucleotide polymorphisms (SNPs), multilocus analyses are frequently of high dimensionality when considering haplotypes or haplotype pairs (diplotypes) and differing modes of expression. Often, while candidate genes are selected based on their biological involvement in a given pathway, little is known about the functionality of SNPs to guide association studies. Investigators face the challenge of exploring multiple SNP models to elucidate which variants, independently or in combination, might be associated with a disease of interest. A data mining module, hapConstructor (freely-available in Genie software) performs systematic construction and association testing of multilocus genotype data in a Monte Carlo framework. Our objective was to assess its utility to guide statistical analyses of haplotypes within a candidate region (or combined genotypes across candidate genes) beyond that offered by a standard logistic regression approach.</p> <p>Methods</p> <p>We applied the hapConstructor method to a multilocus investigation of candidate genes involved in pro-inflammatory cytokine IL6 production, <it>IKBKB</it>, <it>IL6</it>, and <it>NFKB1 </it>(16 SNPs total) hypothesized to operate together to alter colorectal cancer risk. Data come from two U.S. multicenter studies, one of colon cancer (1,556 cases and 1,956 matched controls) and one of rectal cancer (754 cases and 959 matched controls).</p> <p>Results</p> <p>HapConstrcutor enabled us to identify important associations that were further analyzed in logistic regression models to simultaneously adjust for confounders. The most significant finding (nominal <it>P </it>= 0.0004; false discovery rate <it>q </it>= 0.037) was a combined genotype association across <it>IKBKB </it>SNP rs5029748 (1 or 2 variant alleles), <it>IL6 </it>rs1800797 (1 or 2 variant alleles), and <it>NFKB1 </it>rs4648110 (2 variant alleles) which conferred an ~80% decreased risk of colon cancer.</p> <p>Conclusions</p> <p>Strengths of hapConstructor were: systematic identification of multiple loci within and across genes important in CRC risk; false discovery rate assessment; and efficient guidance of subsequent logistic regression analyses.</p

Expression of Components of the Renin-Angiotensin System in Pyogenic Granuloma

Background: There is a growing body of research demonstrating expression of the renin-angiotensin system (RAS) by a putative embryonic stem cell (ESC)-like population within vascular anomalies. This study investigated the expression of components of the RAS in relation to the putative ESC-like population within pyogenic granuloma (PG) that we have recently reported.Methods: PG samples from 14 patients were analyzed for the expression of components of the RAS: pro-renin receptor (PRR), angiotensin converting enzyme (ACE), angiotensin II receptor 1 (ATIIR1) and angiotensin II receptor 2 (ATIIR2), using 3,3-diaminobenzidine (DAB) immunohistochemical (IHC) staining. Immunofluorescence (IF) IHC staining was performed to localize these proteins on four of the PG samples. RT-qPCR was performed on two snap-frozen PG samples. Western blotting (WB) was performed on one snap-frozen PG sample and two PG-derived primary cell lines.Results: DAB IHC staining demonstrated the expression of ACE, PRR, ATIIR1, and ATIIR2 in all 14 PG tissue samples. RT-qPCR analysis confirmed abundant mRNA transcripts for PRR, ACE, AIITR1 and ATIIR2, relative to the housekeeping gene. WB confirmed the presence of PRR, ATIIR1, and ACE in the PG tissue sample, and PRR and ATIIR1, in the PG-derived primary cell lines. IF IHC staining demonstrated the expression of PRR, ACE, ATIIR1 on the primitive population that expressed NANOG and SOX2 on the ERG+ endothelium of the microvessels within PG.Conclusion: We have demonstrated the expression of PRR, ACE, and ATIIR1 by the putative the ESC-like population within PG