Analysis of the Workforce and Workplace for Rheumatology, and the Research Activities of Rheumatologists Early in Their Careers

[Excerpt] The scope and scale of clinical research is unknown for any medical or surgical specialty beyond snapshots of the broad aims and expenditures of research programs sponsored by federal agencies or the pharmaceutical industry. As a consequence, the workforce and workplace for clinical investigation is enigmatic and unexamined even after explicit warnings that an essential arm for advancing clinical practice has been disabled. The present study was designed to assess the workforce and workplace for rheumatology, and the extent and type of research prevailing among rheumatologists early in their careers. Our findings provide fresh insights about the workforce and the workplace for rheumatology, and justify interventions to address gaps in both the scope and scale of clinical research in arthritis and rheumatism

The Scope and Scale of Clinical Research Accomplished by Rheumatologists Early in Their Careers

[Excerpt] The scope and scale of clinical research is unknown for any medical or surgical specialty beyond snap shots of the broad aims and expenditures of research programs sponsored by federal agencies or the pharmaceutical industry. As a consequence, the workforce and workplace for clinical investigation is enigmatic and unexamined even after explicit warnings that an essential arm for advancing clinical practice is disabled. The present study was designed to examine the nature and extent of investigative activity prevailing among rheumatologists early in their careers. This assessment provides a lens on: i) the fraction of early career rheumatologists who engage in investigative rheumatology, ii) the scope and scale of research in musculoskeletal diseases, iii) funding available for investigative work, iv) the impact of research-intensive institutions, and NIH-K-series awards on research, and v) the demographic backgrounds of early career rheumatologists. The results provide important new insights about the early career workforce for discovery and innovation in rheumatology. The findings integrate demographic, normative, and predictive data to provide the first estimate of the scope and scale of clinical investigation within rheumatology. The results also justify interventions for promoting investigative work, and ultimately advancing the clinical practice of rheumatology

The elements of economic development

More communities have come to realize that change is inevitable and they are establishing economic development programs to help them manage that change. At a time when the industrial revolution has given way to the information age, a good economic development program will help a community remain "tuned in" to the world. It can help business and industry to be more productive and also contribute to the community's overall viability. Accomplishing this takes a program that is broad-based and long-term.New 6/92/5M

Gamma Knife Radiosurgery to Four Brainstem Lesions After Whole Brain Radiation Therapy

Our patient was a 58-year-old female with a history of extensive stage small cell lung cancer initially diagnosed in November 2018. She received palliative radiation to the right hip and whole brain in December of 2018 and then received chemotherapy. Unfortunately, in October 2019, the repeat brain magnetic resonance imaging (MRI) showed recurrent lesions and she was referred for Gamma Knife Radiosurgery (GKRS). At the time of the treatment, she was found to have four brainstem lesions as well as a left frontal lobe and a right frontal lobe lesion. She completed GKRS to all six lesions without any neurological complications seen in her short-term follow-up. This case report adds to the growing body of literature showing safety of GKRS for multiple brainstem lesions

Decision-making Techniques for Community Groups

Community groups often have a problem coming to a decision about projects to undertake. Quite often, resources, both human and financial, are limited; the number of problems seem overwhelming; or there are forceful advocates of a "pet" project. How can a group overcome these difficulties? The four decision-making techniques shown in this guide will make the task easier. The first two techniques generate ideas about community goals or projects while the last two prioritize the alternatives you have identified.New 6/92/5M

Town Meetings that Work

Town meetings -- The nature of community -- Orgainizing a town meeting -- The town meeting process -- Final thoughts -- AppendiciesNew 4/93/lM.Includes bibliographical reference

Reactivity of permethylscandocene derivatives with acetylene. Structure of acetylenediylbis(permethylscandocene), (η^5-C_5Me_5)_2Sc-C≡C-Sc(η^5-C_5Me_5)_2

Excess acetylene reacts with Cp*_2Sc-R (Cp* = η-C5Me_5; R = H, alkyl, aryl, alkenyl, alkynyl, amide) below -78 °C to yield R-H and Cp*_2Sc-C≡CH; the latter then reacts with excess C_2H_2 to form polyacetylene. Cp*_2Sc-C≡CH cleanly decomposes to Cp*_2Sc-C≡C-ScCp*_2, most likely via u bond metathesis involving the Sc-acetylide and terminal C-H bonds for two molecules of Cp*_2Sc-C≡CH. The structure of this unusual acetylenediyl-bridged dimer has been determined by X-ray diffraction methods. It crystallizes with a half-molecule of toluene per scandium dimer in the tetragonal system, space group P42_1c (No. 114), with a = 15.057 (3) Å, c = 18.617 (6) Å, V = 4220.7 (18) Å^3, and z = 4

SeMi-Supervised Adaptive Resonance Theory (SMART2)

Adaptive resonance theory (ART) algorithms represent a class of neural network architectures which self-organize stable recognition categories in response to arbitrary sequences of input patterns. The authors discuss incorporation of supervision into one of these architectures, ART2. Results of numerical experiments indicate that this new semi-supervised version of ART2 (SMART2) outperformed ART for classification problems. The results and analysis of runs on several data sets by SMART2, ART2, and backpropagation are analyzed. The test accuracy of SMART2 was similar to that of backpropagation. However, SMART2 network structures are easier to interpret than the corresponding structures produced by backpropagation

Serum, urinary, and salivary nitric oxide in rheumatoid arthritis: complexities of interpreting nitric oxide measures

Nitric oxide (NO) may play important roles in rheumatoid arthritis (RA). RA is an inflammatory disease involving joints and other systems including salivary glands. To assess NO production in RA patients, we compared levels of serum, urine, and salivary nitrite and nitrate (NOx) in patients with RA and normal subjects, and we examined the relationships of these measures to disease activity. Serum, urine, and NOx levels as well as renal creatinine, NOx clearance and fractional excretion rates were compared in 25 RA patients and 20 age- and gender-matched healthy controls. Subjects were hospitalized for 3 days and placed on a NOxrestricted diet. NOx was assayed using nitrate reductase and the Griess reagent. RA activity was assessed using standard clinical and laboratory measures. While consuming a restricted diet for 3 days to eliminate the effects of oral intake of NOx, 24 hour urinary NOx excretion decreased in both RA patients and healthy controls. Urine NOx levels at all time points were not significantly different between RA patients and normal subjects. Serum NOx levels also decreased during the 3 days of NOx restriction, but RA patients had higher serum NOx levels at all time points compared with the control group. Likewise, serum NOx/creatinine ratios were higher in RA patients than in controls. Although basal salivary flow rate and tear flow were lower in RA patients, salivary NOx levels did not differ between normal and RA subjects. While renal creatinine clearance was not different between the two groups, we found that RA patients had lower renal NOx clearance and lower renal NOx fractional excretion. After correction of p values for multiple comparisons, there were no significant relationships for the RA group between measures of disease activity and the urinary NOx, serum NOx, or urinary NOx clearance. Despite interest in the use of NO as a marker of disease activity, alterations in renal NOx clearance and fractional excretion in RA make it difficult to assess in vivo NO production even with strict dietary restriction of NOx intake

Predicting the Effect of Indirect Cell Kill in the Treatment of Multiple Brain Metastases via Single-Isocenter/Multitarget Volumetric Modulated Arc Therapy Stereotactic Radiosurgery

PURPOSE: Due to spatial uncertainty, patient setup errors are of major concern for radiosurgery of multiple brain metastases (m-bm) when using single-isocenter/multitarget (SIMT) volumetric modulated arc therapy (VMAT) techniques. However, recent clinical outcome studies show high rates of tumor local control for SIMT-VMAT. In addition to direct cell kill (DCK), another possible explanation includes the effects of indirect cell kill (ICK) via devascularization for a single dose of 15 Gy or more and by inducing a radiation immune intratumor response. This study quantifies the role of indirect cell death in dosimetric errors as a function of spatial patient setup uncertainty for stereotactic treatments of multiple lesions. MATERIAL AND METHODS: Nine complex patients with 61 total tumors (2-16 tumors/patient) were planned using SIMT-VMAT with geometry similar to HyperArc with a 10MV-FFF beam (2400 MU/min). Isocenter was placed at the geometric center of all tumors. Average gross tumor volume (GTV) and planning target volume (PTV) were 1.1 cc (0.02–11.5) and 1.9 cc (0.11–18.8) with an average distance to isocenter of 5.4 cm (2.2–8.9). The prescription was 20 Gy to each PTV. Plans were recalculated with induced clinically observable patient setup errors [±2 mm, ±2o] in all six directions. Boolean structures were generated to calculate the effect of DCK via 20 Gy isodose volume (IDV) and ICK via 15 Gy IDV minus the 20 Gy IDV. Contributions of each IDV to the PTV coverage were analyzed along with normal brain toxicity due to the patient setup uncertainty. Induced uncertainty and minimum dose covering the entire PTV were analyzed to determine the maximum tolerable patient setup errors to utilize the ICK effect for radiosurgery of m-bm via SIMT-VMAT. RESULTS: Patient setup errors of 1.3 mm /1.3° in all six directions must be maintained to achieve PTV coverage of the 15 Gy IDV for ICK. Setup errors of ±2 mm/2° showed clinically unacceptable loss of PTV coverage of 29.4 ± 14.6% even accounting the ICK effect. However, no clinically significant effect on normal brain dosimetry was observed. CONCLUSIONS: Radiosurgery of m-bm using SIMT-VMAT treatments have shown positive clinical outcomes even with small residual patient setup errors. These clinical outcomes, while largely due to DCK, may also potentially be due to the ICK. Potential mechanisms, such as devascularization and/or radiation-induced intratumor immune enhancement, should be explored to provide a better understanding of the radiobiological response of stereotactic radiosurgery of m-bm using a SIMT-VMAT plan