Interrater Reliability in Toxicity Identification: Limitations of Current Standards.

PurposeThe National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v5.0 is the standard for oncology toxicity encoding and grading, despite limited validation. We assessed interrater reliability (IRR) in multireviewer toxicity identification.Methods and materialsTwo reviewers independently reviewed 100 randomly selected notes for weekly on-treatment visits during radiation therapy from the electronic health record. Discrepancies were adjudicated by a third reviewer for consensus. Term harmonization was performed to account for overlapping symptoms in CTCAE. IRR was assessed based on unweighted and weighted Cohen's kappa coefficients.ResultsBetween reviewers, the unweighted kappa was 0.68 (95% confidence interval, 0.65-0.71) and the weighted kappa was 0.59 (0.22-1.00). IRR was consistent between symptoms noted as present or absent with a kappa of 0.6 (0.66-0.71) and 0.6 (0.65-0.69), respectively.ConclusionsSignificant discordance suggests toxicity identification, particularly retrospectively, is a complex and error-prone task. Strategies to minimize IRR, including training and simplification of the CTCAE criteria, should be considered in trial design and future terminologies

О "труднопереводимости" фразеологизмов

В данной статье рассматриваются теоретические вопросы перевода всех типов фразеологических словосочетаний.У цій статті розглядаються теоретичні питання перекладу всіх типів фразеологічних словосполучень.The article deals with the theoretical problems of all type idiom combination translations

Innovations in Radiotherapy Technology.

Many low- and middle-income countries, together with remote and low socioeconomic populations within high-income countries, lack the resources and services to deal with cancer. The challenges in upgrading or introducing the necessary services are enormous, from screening and diagnosis to radiotherapy planning/treatment and quality assurance. There are severe shortages not only in equipment, but also in the capacity to train, recruit and retain staff as well as in their ongoing professional development via effective international peer-review and collaboration. Here we describe some examples of emerging technology innovations based on real-time software and cloud-based capabilities that have the potential to redress some of these areas. These include: (i) automatic treatment planning to reduce physics staffing shortages, (ii) real-time image-guided adaptive radiotherapy technologies, (iii) fixed-beam radiotherapy treatment units that use patient (rather than gantry) rotation to reduce infrastructure costs and staff-to-patient ratios, (iv) cloud-based infrastructure programmes to facilitate international collaboration and quality assurance and (v) high dose rate mobile cobalt brachytherapy techniques for intraoperative radiotherapy

A survey on Routing Protocols in Wireless Sensor Networks

In ad-hoc WSN is a collection of mobile nodes that are dynamically and randomly located in such a manner that the interconnections between nodes are changing on a continual basis. The dynamic nature of these networks demands new set of network routing strategy protocols to be implemented in order to provide efficient end-to end communication. Moreover, such issues are very critical due to severe resource constraints like efficient energy utilization, lifetime of network, and drastic environmental conditions in WSNs. Neither hop-by-hop nor neither direct reach ability is possible in case of WSNs. In order to facilitate communication within the network, a routing protocol is used. In this paper we have carried out an extensive survey on WSN protocols based on structure of network, routing protocol of network & clustering techniques of routing protocols

Primary Meningeal Rhabdomyosarcoma

Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy

THE EFFECTIVENESS OF FISHBOWL METHOD ON STUDENTS’ SPEAKING SKILL AT THE SECOND GRADE STUDENTS OF SMA N 8 CIREBON

AYU WULANDARI. THE EFFECTIVENESS OF FISHBOWL METHOD ON STUDENTS’ SPEAKING SKILL AT THE SECOND GRADE STUDENTS OF SMA N 8 CIREBON In Indonesia English has drawn up by government as foreign language that the students should master English language. In fact, the students still have weakness in skill of English, especially in speaking skill. In this thesis, the writer focuses on the students’ speaking skill as Y variable that they have any weakness to master speaking skill. And the writer focuses on the fishbowl method as the X variable that will help student to practice speaking English. The aims of this research are to find out the students’ responses towards the application of fishbowl method, to find out the students’ achievement of speaking skill before and after using the application of fishbowl method and to find out the effectiveness of fishbowl method to improve the students’ speaking skill Looking forward the problem in speaking skill that students have the weakness in this skill thus the writer offered fishbowl method which can be effective teaching tools for modeling group processes that can improve the students’ speaking skill and more active in classroom to practice speaking English. The research design is quantitative research and experiment research. To know the response the application of fishbowl method, the writer uses questionnaire. To know the students’ achievement speaking skill, the writer uses two tests, pretest and posttest. The data was analyzed statistically by using Microsoft Excel, ANA test4 and SPSS program V 2.2.0. The result of the students’ response towards the application of fishbowl method is 1237 with the percentage 82,5 %, it can be categorized strong response. And the result of the students’ achievement in speaking skill between experimental class and control class where Gain of experiment class get the mean score 0.26, but the N-Gain of control class get the mean score 0.12 so that the deviation is 0.14. It means that the experiment class is better than control class in improving the students’ speaking skill. Then conclusion of this thesis is that the alternative hypothesis (Ha) is received and the Null Hypothesis (Ho) is refused where t-test < t-table or <0.05. It means that there is any significant effectiveness of using fishbowl method to improve students’ speaking skill the second grade students of SMA N 8 Cirebon

Investigation of common, low-frequency and rare genome-wide variation in anorexia nervosa

Correction: Volume: 23 Issue: 9 DOI: 10.1038/mp.2017.202 Published: SEP 2018Anorexia nervosa (AN) is a complex neuropsychiatric disorder presenting with dangerously low body weight, and a deep and persistent fear of gaining weight. To date, only one genome-wide significant locus associated with AN has been identified. We performed an exome-chip based genome-wide association studies (GWAS) in 2158 cases from nine populations of European origin and 15 485 ancestrally matched controls. Unlike previous studies, this GWAS also probed association in low-frequency and rare variants. Sixteen independent variants were taken forward for in silico and de novo replication (11 common and 5 rare). No findings reached genome-wide significance. Two notable common variants were identified: rs10791286, an intronic variant in OPCML (P = 9.89 x 10(-6)), and rs7700147, an intergenic variant (P = 2.93 x 10(-5)). No low-frequency variant associations were identified at genome-wide significance, although the study was well-powered to detect low-frequency variants with large effect sizes, suggesting that there may be no AN loci in this genomic search space with large effect sizes.Peer reviewe

Midlife systemic inflammation is associated with frailty in later life: The ARIC study

Background: Evidence suggests that systemic inflammation may have a mechanistic role in age-related frailty, yet prospective data is limited. We examined whether systemic inflammation during midlife was associated with late-life frailty within the community-based Atherosclerosis Risk in Communities Study. Methods: Plasma levels of four inflammatory markers (fibrinogen, von Willebrand factor, and Factor VIII, and white blood cell count) were measured during Visit 1 (1987-1989; mean age: 52 [5]), standardized into z-scores, and combined to create an inflammation composite score. High-sensitivity C-reactive protein (CRP) was measured 3 (Visit 2, 1990-1992) and 9 (Visit 4, 1996-1999) years later. Frailty was evaluated in 5,760 participants during late life (Visit 5, 2011-2013; mean age: 75 [5]). Analyses were adjusted for demographic and physiological variables, and midlife medical comorbidity using logistic regression. Results: A 1 SD increase in midlife inflammation composite score was associated with higher odds of frailty 24 years later (odds ratio [OR] = 1.39, 95% confidence interval [CI]: 1.18-1.65). Similarly, each standard deviation increase in Visit 2 CRP (OR = 1.24, 95% CI: 1.09-1.40) and Visit 4 CRP (OR = 1.35, 95% CI: 1.19-1.53) was associated with a higher odds of frailty 21 and 15 years later. Participants who maintained elevated CRP (≥3 mg/L) at Visits 2 and 4 or transitioned to a state of elevated CRP during this period were more likely to subsequently meet frailty criteria compared to those who maintained low CRP. These associations were stronger among white, compared to African American, participants (p-interactions <.038). Conclusions: Systemic inflammation during midlife may independently promote pathophysiological changes underlying frailty in a subset of the population