Stereotactic body radiotherapy as primary treatment for elderly patients with medically-inoperable head-and-neck cancer

Purpose: With a growing elderly population, elderly patients with head-and-neck cancers represent an increasing challenge with limited prospective data to guide management. The complex interplay between advanced age, associated comorbidities, and conventional local therapies such as surgery and external beam radiotherapy ± chemotherapy, can significantly impact elderly patients' quality-of-life (QOL). SBRT is a well-established curative strategy for medicalinoperable. early-stage lung cancers even in elderly populations; however there is limited data examining SBRT as primary therapy in head-and-neck cancer. Material/Methods: Twelve patients with medically-inoperable head-and-neck cancer treated with SBRT ± cetuximab from 2002 through 2013 were retrospectively reviewed. SBRT consisted of primarily 44Gy in 5 fractions delivered on alternating days over 1-2 weeks. Concurrent cetuximab was administer at a dose of 400mg/m2 on day -7 followed by 250mg/m2 on day 0 and +7 in n=3 (25%). Patient reported quality-of-life (PRQoL) was prospectively recorded using the previously-validated University-of-Washington Quality-of-Life Revised (UW-QoL-R). Results: Median clinical follow-up was 6-months (range: 0.5 - 29 months). The 1-year actuarial local progression-free survival, distant progression-free survival,progression-free survival, and overall survival for definitively treated patients were 69%, 100%, 69% and 64%, respectively. One patient (8%) experienced acute grade 3 dysphagia and one patient (8%) experienced late grade 3 mucositis; there were no grade 4-5 toxicities. Prospective collection of patient report quality-of-life as assessed by UW-QoL-R was preserved across domains. Conclusion: SBRT shows encouraging survival and relatively low toxicity in elderly patients with unresectable head-and-neck cancer; which may provide an aggressive potentially curative local therapy while maintaining quality-of-life. © 2014 Vargo, Ferris, Clump and Heron

Locomotor adaptation to a powered ankle-foot orthosis depends on control method

<p>Abstract</p> <p>Background</p> <p>We studied human locomotor adaptation to powered ankle-foot orthoses with the intent of identifying differences between two different orthosis control methods. The first orthosis control method used a footswitch to provide bang-bang control (a kinematic control) and the second orthosis control method used a proportional myoelectric signal from the soleus (a physiological control). Both controllers activated an artificial pneumatic muscle providing plantar flexion torque.</p> <p>Methods</p> <p>Subjects walked on a treadmill for two thirty-minute sessions spaced three days apart under either footswitch control (n = 6) or myoelectric control (n = 6). We recorded lower limb electromyography (EMG), joint kinematics, and orthosis kinetics. We compared stance phase EMG amplitudes, correlation of joint angle patterns, and mechanical work performed by the powered orthosis between the two controllers over time.</p> <p>Results</p> <p>During steady state at the end of the second session, subjects using proportional myoelectric control had much lower soleus and gastrocnemius activation than the subjects using footswitch control. The substantial decrease in triceps surae recruitment allowed the proportional myoelectric control subjects to walk with ankle kinematics close to normal and reduce negative work performed by the orthosis. The footswitch control subjects walked with substantially perturbed ankle kinematics and performed more negative work with the orthosis.</p> <p>Conclusion</p> <p>These results provide evidence that the choice of orthosis control method can greatly alter how humans adapt to powered orthosis assistance during walking. Specifically, proportional myoelectric control results in larger reductions in muscle activation and gait kinematics more similar to normal compared to footswitch control.</p

Functional Magnetic Resonance Imaging in Conscious Animals: A New Tool in Behavioural Neuroscience Research

Functional magnetic resonance imaging (fMRI) is a unique window to the brain, enabling scientists to follow changes in brain activity in response to hormones, ageing, environment, drugs of abuse and other stimuli. In this review, we present a general background to fMRI and the different imaging modalities that can be used in fMRI studies. Included are examples of the application of fMRI in behavioural neuroscience research, along with discussion of the advantages and disadvantages of this technology

Chronic Lung Function Decline in Cotton Textile Workers: Roles of Historical and Recent Exposures to Endotoxin

BackgroundLong-term occupational exposure to cotton dust that contains endotoxin is associated with chronic respiratory symptoms and excessive decline in forced expiratory volume in 1 sec (FEV1), but the mechanisms of endotoxin-related chronic airflow obstruction remain unclear.ObjectiveIn the current study, we examined temporal aspects of the exposure-response relationship between airborne endotoxin exposure, longitudinal change in FEV1, and respiratory symptoms in a cohort of Chinese cotton textile workers.MethodsThis prospective cohort study followed 447 cotton textile workers from 1981 to 2006. at approximately 5-year intervals. We used a generalized estimating equations approach to model FEV1 level and respiratory symptoms as a function of past exposure (cumulative exposure up to the start of the most recent 5-year survey interval) and cumulative exposure (within the most recent interval) to endotoxins, after adjusting for other covariates. Models were stratified by active versus retired work status and by years employed before the baseline survey (&lt; 5 and &gt; or = 5 years).Results and conclusionsPast exposure to endotoxin was associated with reduced FEV1 level among retired cotton workers. Among all cotton workers, past exposure was more strongly associated with reduced FEV1 for those hired &lt; 5 years before baseline than for those who were hired &gt; or = 5 years after baseline. Recent endotoxin exposure was significantly associated with byssinosis, chronic bronchitis, and chronic cough

The influence of soil communities on the temperature sensitivity of soil respiration

Soil respiration represents a major carbon flux between terrestrial ecosystems and the atmosphere, and is expected to accelerate under climate warming. Despite its importance in climate change forecasts, however, our understanding of the effects of temperature on soil respiration (RS) is incomplete. Using a metabolic ecology approach we link soil biota metabolism, community composition and heterotrophic activity, to predict RS rates across five biomes. We find that accounting for the ecological mechanisms underpinning decomposition processes predicts climatological RS variations observed in an independent dataset (n = 312). The importance of community composition is evident because without it RS is substantially underestimated. With increasing temperature, we predict a latitudinal increase in RS temperature sensitivity, with Q10 values ranging between 2.33 ±0.01 in tropical forests to 2.72 ±0.03 in tundra. This global trend has been widely observed, but has not previously been linked to soil communities

Symptomatic snapping knee from biceps femoris tendon subluxation: an unusual case of lateral pain in a marathon runner

Snapping biceps femoris syndrome is an uncommon cause of lateral knee pain and may be difficult to diagnose, resulting in unsuccessful surgical intervention. In this report, we present an unusual case of a 37-year-old male marathon runner with unilateral snapping knee secondary to dislocation of the long head of the biceps femoris over the fibular head during knee flexion. The pain was great enough to interfere with his ability to practice sport. Possible causes of symptomatic snapping knee include multiple intra-articular or extra-articular pathology. Biceps femoris snapping over the fibular head is a rare condition. Reported causes include an anomalous insertion of the tendon into the tibia, trauma, and fibular-head abnormality. However, none of those conditions accounted for his symptoms. Failing conservative treatment, the patient underwent surgery for partial resection of the fibular head, with subsequent sudden resolution of symptoms and return to sport. Accurate knowledge and management of this rare condition is mandatory to avoid inappropriate therapy and unnecessary surgical procedures

Proactive and politically skilled professionals: What is the relationship with affective occupational commitment?

The aim of this study is to extend research on employee affective commitment in three ways: (1) instead of organizational commitment the focus is on occupational commitment; (2) the role of proactive personality on affective occupational commitment is examined; and (3) occupational satisfaction is examined as a mediator and political skills as moderator in the relationship between proactive personality and affective occupational commitment. Two connected studies, one in a hospital located in the private sector and one in a university located in the public sector, are carried out in Pakistan, drawing on a total sample of over 400 employees. The results show that proactive personality is positively related to affective occupational commitment, and that occupational satisfaction partly mediates the relationship between proactive personality and affective occupational commitment. No effect is found for a moderator effect of political skills in the relationship between proactive personality and affective occupational commitment. Political skills however moderate the relationship between proactive personality and affective organizational commitment

A Preliminary Study on Robot-Assisted Ankle Rehabilitation for the Treatment of Drop Foot

This paper involves the use of a compliant ankle rehabilitation robot (CARR) for the treatment of drop foot. The robot has a bio-inspired design by employing four Festo Fluidic muscles (FFMs) that mimic skeletal muscles actuating three rotational degrees of freedom (DOFs). A trajectory tracking controller was developed in joint task space to track the predefined trajectory of the end effector. This controller was achieved by controlling individual FFM length based on inverse kinematics. Three patients with drop foot participated in a preliminary study to evaluate the potential of the CARR for clinical applications. Ankle stretching exercises along ankle dorsiflexion and plantarflexion (DP) were delivered for treating drop foot. All patients gave positive feedback in using this ankle robot for the treatment of drop foot, although some limitations exist. The proposed controller showed satisfactory accuracy in trajectory tracking, with all root mean square deviation (RMSD) values no greater than 0.0335 rad and normalized root mean square deviation (NRMSD) values less than 6.7%. These preliminary findings support the potentials of the CARR for clinical applications. Future work will investigate the effectiveness of the robot for treating drop foot on a large sample of subjects

Survey of patient satisfaction with the Breastfeeding Education and Support Services of The Royal Women's Hospital, Melbourne

<p>Abstract</p> <p>Background</p> <p>The Breastfeeding Education and Support Services (BESS) is a unit of The Royal Women's Hospital in Melbourne, Australia, staffed by International Board Certified Lactation Consultants (IBCLCs), providing day/short-stay and an outpatient clinic for mothers and infants with breastfeeding problems. It is important to measure women's experience of visiting the service as part of quality assurance. The aim of this project was to conduct an anonymous postal survey of clients' satisfaction with BESS.</p> <p>Methods</p> <p>An anonymous survey was posted on 16 November 2005 and again on 31 January 2006, to all women who had attended BESS in September 2005.</p> <p>Results</p> <p>The response rate was 60.5% (78/129). Eighty percent (62/78) of respondents attended day-stay, 33% (26/78) attended short-stay and 15% (12/78) attended the outpatient clinic. The percentage of women who responded "strongly agree" to the statement "Overall, I am satisfied with the services" was 49% (35/72) and 50% (6/12) for those who went to day/short-stay and the outpatient clinic respectively. Overall, 56% of all respondents responded that the quality of BESS was "better than expected". The most common breastfeeding problem reported was difficulty attaching the baby to the breast, followed by nipple damage, low milk supply and painful feeding.</p> <p>Conclusion</p> <p>BESS seems to have provided a satisfactory service to most clients. Most respondents were clearly satisfied with the support given by the IBCLCs and have also responded that the staff were professional and knowledgeable in their field of work.</p