Microwave ablation therapy for colorectal liver metastases

BACKGROUND: The gold standard treatment for colorectal cancer liver metastases (CRCLM) is surgical resection. Unfortunately, the majority of patients with colorectal hepatic metastases are not candidates for resection. In recent years, several alternatives have emerged for patients whom are not resection candidates including modern systemic chemotherapy, targeted biologic treatments, regional therapies and local tumor ablation options. Microwave ablation (MWA) therapy is one such treatment alternative, based on thermal tissue ablation. This modality in concert with the most recent published literature on its use for patients with CRCLM will be reviewed in this paper. LITERATURE REVIEW FINDINGS: A structured review of the literature on ablative technologies was performed. In recent years, there has been an evolution from radiofrequency ablation (RFA) to microwave ablation therapy for the treatment of CRCLM. RFA has several limitations to its use and MWA theoretically avoids such limitations making it the currently preferable treatment option. There are limited publications comparing the use of RFA to MWA and limited publications on the use of microwave ablation for CRCLM. This paper will focus on the most recent data on MWA for CRCLM. This data can then be compared to the already published data on RFA. PROPOSED METHODS: Given the relative novel status for MWA as a treatment option for CRCLM, a potential disadvantage for its use is the perceived lack of knowledge across the medical professional spectrum. In an effort to expand the knowledge of MWA, the proposed outcomes for this study include creating a curriculum to be offered as a CME course focused for Primary Care Providers (PCPs) to provide a basis of clinical familiarity for its use. This effort will familiarize providers who may have patients diagnosed with CRCLM and also allow them to initiate the conversation about this therapy with their patients who may be candidates for this treatment. CONCLUSIONS: MWA therapy is a safe and effective treatment modality for CRCLM. Due to this new development in treating liver lesions originating from colorectal cancer, it’s imperative for providers to become familiar with these new technologies especially considering the high incidence of CRCLM. Therefore, a curriculum for PCPs will allow for a better understanding of this new technology and foster better provider-patient relationships

Dominance of grain size impacts on seasonal snow albedo at deforested sites in New Hampshire

Snow cover serves as a major control on the surface energy budget in temperate regions due to its high reflectivity compared to underlying surfaces. Winter in the northeastern United States has changed over the last several decades, resulting in shallower snowpacks, fewer days of snow cover, and increasing precipitation falling as rain in the winter. As these climatic changes occur, it is imperative that we understand current controls on the evolution of seasonal snow albedo in the region. Over three winter seasons between 2013 and 2015, snow characterization measurements were made at three open sites across New Hampshire. These near-daily measurements include spectral albedo, snow optical grain size determined through contact spectroscopy, snow depth, snow density, black carbon content, local meteorological parameters, and analysis of storm trajectories using the Hybrid Single-Particle Lagrangian Integrated Trajectory model. Using analysis of variance, we determine that land-based winter storms result in marginally higher albedo than coastal storms or storms from the Atlantic Ocean. Through multiple regression analysis, we determine that snow grain size is significantly more important in albedo reduction than black carbon content or snow density. And finally, we present a parameterization of albedo based on days since snowfall and temperature that accounts for 52% of variance in albedo over all three sites and years. Our improved understanding of current controls on snow albedo in the region will allow for better assessment of potential response of seasonal snow albedo and snow cover to changing climate

Perceptions of fecal microbiota transplantation for Clostridium difficile infection: factors that predict acceptance.

BackgroundDespite the effectiveness of fecal microbiota transplantation (FMT) for treating recurrent Clostridium difficile (C. difficile) infection, some patients are reluctant to accept this therapy. Our study examined attitudes towards FMT and factors that contribute to patients' acceptance of this treatment.MethodsWe distributed patient surveys at a Veterans Affairs hospital, a public hospital, and an academic faculty practice. Multivariable logistic regression was performed, adjusting for factors associated with FMT acceptance on univariate analysis and prior experience with C. difficile infection.ResultsOf 267 patients, only 12% knew of FMT prior to the survey, but 77% would undergo the procedure if medically indicated. On multivariable analysis, those with children and with college degrees or higher were more likely to agree to FMT (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.02-4.35; OR 2.27, 95% CI 1.11-4.60 respectively). Sixty-five respondents (71%) chose colonoscopy as the preferred vehicle for FMT, while nasogastric tube was least preferred. Disease transmission was the most common concern (30%, n=242), and FMT success rate was the least selected concern (9.1%).ConclusionsMost patients in a diverse sample of gastroenterology clinics had no prior knowledge of FMT, but were receptive to the procedure. Having children and higher education levels were predictors for FMT acceptance. Our findings suggest that barriers to FMT utilization may be overcome with counseling about safety concerns. More data on the risk of transmitting diseases or clinical characteristics, such as obesity, through FMT are needed and will be important for the acceptance of this procedure

Back-calculating emission rates for ammonia and particulate matter from area sources using dispersion modeling

Engineering directly impacts current and future regulatory policy decisions. The foundation of air pollution control and air pollution dispersion modeling lies in the math, chemistry, and physics of the environment. Therefore, regulatory decision making must rely upon sound science and engineering as the core of appropriate policy making (objective analysis in lieu of subjective opinion). This research evaluated particulate matter and ammonia concentration data as well as two modeling methods, a backward Lagrangian stochastic model and a Gaussian plume dispersion model. This analysis assessed the uncertainty surrounding each sampling procedure in order to gain a better understanding of the uncertainty in the final emission rate calculation (a basis for federal regulation), and it assessed the differences between emission rates generated using two different dispersion models. First, this research evaluated the uncertainty encompassing the gravimetric sampling of particulate matter and the passive ammonia sampling technique at an animal feeding operation. Future research will be to further determine the wind velocity profile as well as determining the vertical temperature gradient during the modeling time period. This information will help quantify the uncertainty of the meteorological model inputs into the dispersion model, which will aid in understanding the propagated uncertainty in the dispersion modeling outputs. Next, an evaluation of the emission rates generated by both the Industrial Source Complex (Gaussian) model and the WindTrax (backward-Lagrangian stochastic) model revealed that the calculated emission concentrations from each model using the average emission rate generated by the model are extremely close in value. However, the average emission rates calculated by the models vary by a factor of 10. This is extremely troubling. In conclusion, current and future sources are regulated based on emission rate data from previous time periods. Emission factors are published for regulation of various sources, and these emission factors are derived based upon back-calculated model emission rates and site management practices. Thus, this factor of 10 ratio in the emission rates could prove troubling in terms of regulation if the model that the emission rate is back-calculated from is not used as the model to predict a future downwind pollutant concentration

Association of functional health literacy and cognitive ability with self-reported diabetes in the English Longitudinal Study of Ageing:A prospective cohort study

OBJECTIVES: We investigated whether functional health literacy and cognitive ability were associated with self-reported diabetes. DESIGN: Prospective cohort study. SETTING: Data were from waves 2 (2004–2005) to 7 (2014–2015) of the English Longitudinal Study of Ageing (ELSA), a cohort study designed to be representative of adults aged 50 years and older living in England. PARTICIPANTS: 8669 ELSA participants (mean age=66.7, SD=9.7) who completed a brief functional health literacy test assessing health-related reading comprehension, and 4 cognitive tests assessing declarative memory, processing speed and executive function at wave 2. PRIMARY OUTCOME MEASURE: Self-reported doctor diagnosis of diabetes. RESULTS: Logistic regression was used to examine cross-sectional (wave 2) associations of functional health literacy and cognitive ability with diabetes status. Adequate (compared with limited) functional health literacy (OR 0.71, 95% CI 0.61 to 0.84) and higher cognitive ability (OR per 1 SD=0.73, 95% CI 0.67 to 0.80) were associated with lower odds of self-reporting diabetes at wave 2. Cox regression was used to test the associations of functional health literacy and cognitive ability measured at wave 2 with self-reporting diabetes over a median of 9.5 years follow-up (n=6961). Adequate functional health literacy (HR 0.64; 95% CI 0.53 to 0.77) and higher cognitive ability (HR 0.77, 95% CI 0.69 to 0.85) at wave 2 were associated with lower risk of self-reporting diabetes during follow-up. When both functional health literacy and cognitive ability were added to the same model, these associations were slightly attenuated. Additionally adjusting for health behaviours and body mass index fully attenuated cross-sectional associations between functional health literacy and cognitive ability with diabetes status, and partly attenuated associations between functional health literacy and cognitive ability with self-reporting diabetes during follow-up. CONCLUSIONS: Adequate functional health literacy and better cognitive ability were independently associated with lower likelihood of reporting diabetes

Architect and contractor attitudes to waste minimisation

Around 420 million t of materials are used each year in the construction industry in the UK; however, only 360 million t are incorporated into products. Additionally, construction and demolition activities in the UK generated more than 150 million t of waste in 1998 comprising 40% from the manufacture of products and 60% from site-based activities, including an estimated 13 million t of unused materials. Research has been undertaken to assess UK architects’ and contractors’ attitudes towards waste minimisation, by investigating the integration of waste minimisation strategies into current design processes, examining contractors’ existing waste management practices and establishing responsibilities for, and barriers to, managing waste minimisation. A questionnaire survey based on specific and interrelated organisational waste minimisation issues was conducted with architects and contractors and revealed that very few attempts are made to reduce waste during the design process. On the other hand, the results show that contractors are pursuing a more proactive approach to manage on-site waste production through the development of environmental and waste management policies. The results reveal that poorly defined responsibilities are leading to confusion regarding who should control and monitor waste management. Both architects and contractors are constrained by internal and external factors, such as ‘waste accepted as inevitable’ and lack of interest from clients