Cohesive Neighborhoods Where Social Expectations Are Shared May Have Positive Impact On Adolescent Mental Health

Adolescent mental health problems are associated with poor health and well-being in adulthood. This study uses data from a birth cohort of children born in large U.S. cities (N=2,264) to examine whether neighborhood collective efficacy (social cohesion and control) is associated with improvements in adolescent mental health. We find that children who grow up in high collective efficacy neighborhoods experience fewer depressive and anxiety symptoms during adolescence than similar children from low collective efficacy neighborhoods. The magnitude of this neighborhood effect is comparable to the effects of depression prevention programs. Findings do not vary by family or neighborhood income, indicating that neighborhood collective efficacy supports adolescent mental health across diverse populations and urban settings. We recommend greater emphasis on neighborhood environments in individual mental health risk assessments and greater investment in community-based initiatives that strengthen neighborhood social cohesion and control

Intensity modulated proton arc therapy via geometry-based energy selection for ependymoma

We developed a novel method of creating intensity modulated proton arc therapy (IMPAT) plans that uses computing resources efficiently and may offer a dosimetric benefit for patients with ependymoma or similar tumor geometries. Our IMPAT planning method consists of a geometry-based energy selection step with major scanning spot contributions as inputs computed using ray-tracing and single-Gaussian approximation of lateral spot profiles. Based on the geometric relation of scanning spots and dose voxels, our energy selection module selects a minimum set of energy layers at each gantry angle such that each target voxel is covered by sufficient scanning spots as specified by the planner, with dose contributions above the specified threshold. Finally, IMPAT plans are generated by robustly optimizing scanning spots of the selected energy layers using a commercial proton treatment planning system. The IMPAT plan quality was assessed for four ependymoma patients. Reference three-field IMPT plans were created with similar planning objective functions and compared with the IMPAT plans. In all plans, the prescribed dose covered 95% of the clinical target volume (CTV) while maintaining similar maximum doses for the brainstem. While IMPAT and IMPT achieved comparable plan robustness, the IMPAT plans achieved better homogeneity and conformity than the IMPT plans. The IMPAT plans also exhibited higher relative biological effectiveness (RBE) enhancement than did the corresponding reference IMPT plans for the CTV in all four patients and brainstem in three of them. The proposed method demonstrated potential as an efficient technique for IMPAT planning and may offer a dosimetric benefit for patients with ependymoma or tumors in close proximity to critical organs. IMPAT plans created using this method had elevated RBE enhancement associated with increased linear energy transfer.Comment: 24 pages with 8 figures and 2 table

Improved human observer performance in digital reconstructed radiograph verification in head and neck cancer radiotherapy.

Purpose: Digitally reconstructed radiographs (DRRs) are routinely used as an a priori reference for setup correction in radiotherapy. The spatial resolution of DRRs may be improved to reduce setup error in fractionated radiotherapy treatment protocols. The influence of finer CT slice thickness reconstruction (STR) and resultant increased resolution DRRs on physician setup accuracy was prospectively evaluated. Methods: Four head and neck patient CT-simulation images were acquired and used to create DRR cohorts by varying STRs at 0.5, 1, 2, 2.5, and 3 mm. DRRs were displaced relative to a fixed isocenter using 0–5 mm random shifts in the three cardinal axes. Physician observers reviewed DRRs of varying STRs and displacements and then aligned reference and test DRRs replicating daily KV imaging workflow. A total of 1,064 images were reviewed by four blinded physicians. Observer errors were analyzed using nonparametric statistics (Friedman’s test) to determine whether STR cohorts had detectably different displacement profiles. Post hoc bootstrap resampling was applied to evaluate potential generalizability. Results: The observer-based trial revealed a statistically significant difference between cohort means for observer displacement vector error (p = 0.02) and for Z-axis (p < 0.01). Bootstrap analysis suggests a 15% gain in isocenter translational setup error with reduction of STR from 3 mm to ≤2 mm, though interobserver variance was a larger feature than STR-associated measurement variance. Conclusions: Higher resolution DRRs generated using finer CT scan STR resulted in improved observer performance at shift detection and could decrease operator-dependent geometric error. Ideally, CT STRs ≤2 mm should be utilized for DRR generation in the head and break neck

Head and neck cancer predictive risk estimator to determine control and therapeutic outcomes of radiotherapy (HNC-PREDICTOR):development, international multi-institutional validation, and web implementation of clinic-ready model-based risk stratification for head and neck cancer

Background: Personalised radiotherapy can improve treatment outcomes of patients with head and neck cancer (HNC), where currently a ‘one-dose-fits-all’ approach is the standard. The aim was to establish individualised outcome prediction based on multi-institutional international ‘big-data’ to facilitate risk-based stratification of patients with HNC. Methods: The data of 4611 HNC radiotherapy patients from three academic cancer centres were split into four cohorts: a training (n = 2241), independent test (n = 786), and external validation cohorts 1 (n = 1087) and 2 (n = 497). Tumour- and patient-related clinical variables were considered in a machine learning pipeline to predict overall survival (primary end-point) and local and regional tumour control (secondary end-points); serially, imaging features were considered for optional model improvement. Finally, patients were stratified into high-, intermediate-, and low-risk groups. Results: Performance score, AJCC8th stage, pack-years, and Age were identified as predictors for overall survival, demonstrating good performance in both the training cohort (c-index = 0.72 [95% CI, 0.66–0.77]) and in all three validation cohorts (c-indices: 0.76 [0.69–0.83], 0.73 [0.68–0.77], and 0.75 [0.68–0.80]). Excellent stratification of patients with HNC into high, intermediate, and low mortality risk was achieved; with 5-year overall survival rates of 17–46% for the high-risk group compared to 92–98% for the low-risk group. The addition of morphological image feature further improved the performance (c-index = 0.73 [0.64–0.81]). These models are integrated in a clinic-ready interactive web interface: https://uic-evl.github.io/hnc-predictor/ Conclusions: Robust model-based prediction was able to stratify patients with HNC in distinct high, intermediate, and low mortality risk groups. This can effectively be capitalised for personalised radiotherapy, e.g., for tumour radiation dose escalation/de-escalation

Patterns of Failure after IMRT in Head and Neck Squamous Cell Carcinoma of Unknown Primary: Implication of Elective Nodal and Mucosal Dose Coverage

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Geography of intergenerational mobility and child development

Recent research by Chetty and colleagues finds that children’s chances of upward mobility are affected by the communities in which they grow up [Chetty R, Hendren N (2016) Working paper 23002]. However, the developmental pathways through which communities of origin translate into future economic gain are not well understood. In this paper we examine the association between Chetty and Hendren's county-level measure of intergenerational mobility and children’s cognitive and behavioral development. Focusing on children from low-income families, we find that growing up in a county with high upward mobility is associated with fewer externalizing behavioral problems by age 3 years and with substantial gains in cognitive test scores between ages 3 and 9 years. Growing up in a county with 1 SD better intergenerational mobility accounts for ∼20% of the gap in developmental outcomes between children from low- and high-income families. Collectively, our findings suggest that the developmental processes through which residential contexts promote upward mobility begin early in childhood and involve the enrichment of both cognitive and social-emotional development

Linguistic Validation of the Turkish Version of the M.D. Anderson Symptom Inventory - Head and Neck Cancer Module

Background: The use of patient symptom reports with frequent symptom assessment may be preferred over the more commonly used health-related quality of life questionnaires. Aims: We sought to linguistically validate the Turkish version of the M.D. Anderson Symptom Inventory-Head and Neck module (MDASI-HN) patient reported outcome questionnaire. Study Design: Validation study. Methods: Following standard forward and backward translation of the original and previously validated English MDASI-HN into a Turkish version (T-MDASI-HN), it was administered to patients with head and neck cancer able to read and understand Turkish. Patients were then cognitively debriefed to evaluate their understanding and comprehension of the T-MDASI-HN. Individual and group responses are presented using descriptive statistics. Results: Twenty-six participants with head and neck cancer completed the T-MDASIHN and accompanying cognitive debriefing. Overall, 97 percent of the individual TMDASI-HN items were completed. Average recorded time to complete the 28 item TMDASI-HN questionnaire was 5.4 minutes (range 2-10). Average overall ease of completion, understandability, and acceptability were favorably rated at 1.0, 1.1, and 0.2, respectively, on scales from 0 to 10. Only 5 of the 26 of participants reported trouble completing any single questionnaire items, namely the “difficulty remembering” item for 3 individuals. Conclusion: The T-MDASI-HN is linguistically valid with ease of completion, relevance, comprehensibility, and applicability and it can be a useful clinical and research tool

Cohesive Neighborhoods Where Social Expectations Are Shared May Have Positive Impact On Adolescent Mental Health

Adolescent mental health problems are associated with poor health and well-being in adulthood. This study uses data from a birth cohort of children born in large U.S. cities (N=2,264) to examine whether neighborhood collective efficacy (social cohesion and control) is associated with improvements in adolescent mental health. We find that children who grow up in high collective efficacy neighborhoods experience fewer depressive and anxiety symptoms during adolescence than similar children from low collective efficacy neighborhoods. The magnitude of this neighborhood effect is comparable to the effects of depression prevention programs. Findings do not vary by family or neighborhood income, indicating that neighborhood collective efficacy supports adolescent mental health across diverse populations and urban settings. We recommend greater emphasis on neighborhood environments in individual mental health risk assessments and greater investment in community-based initiatives that strengthen neighborhood social cohesion and control