Psychological Impact of Bone Marrow Transplantation: Current Perspectives

Despite advances in bone marrow transplant technology, major psychological stresses remain. Donor selection has become psychologically more complex with the option of seeking an unrelated donor. Family dislocation continues to be necessary for many families despite the proliferation of transplant centers. The range of choices between treatment options, level of room sterility, and the like can leave families open to guilt about their choices. Unpredictability of the transplant course, difficulty for patients in assessing the seriousness of symptoms, and the need to rely on a changing roster of teaching hospital physicians contribute to patient anxiety. Contrary to patient expectations, post-discharge recovery is often longer and more complicated, physically and psychologically, than expected. Follow-up studies on BMT patients show that a majority have a return to a satisfactory level of activity, although some physical symptoms may remain. Behavioral symptoms did increase, with estimates ranging from 15-35 percent of the survivors showing symptoms a year or more post-transplant. Staff impact is briefly addressed. The need for more research on psychosocial follow-up is stressed

Factors Affecting Surgical Decisions in Newly Diagnosed Young Women with Early-Stage Breast Cancer

Given that young women with breast cancer often have concerns and priorities attributable to their life stage, we conducted a series of interviews to better understanding the surgical decision-making experience among women diagnosed at age ≤40. Women spoke of how the potential effect of an extended recovery was affecting their decision and, in some cases, contributing to decisional conflict. Several women described their worry of leaving cancer cells behind; others cited the need for continued surveillance as a consideration. Attention to situational anxiety and concerns about recurrence are warranted to ensure that decisions are made in a supportive and patient-centered setting

Automated hippocampal segmentation in 3D MRI using random undersampling with boosting algorithm

The automated identification of brain structure in Magnetic Resonance Imaging is very important both in neuroscience research and as a possible clinical diagnostic tool. In this study, a novel strategy for fully automated hippocampal segmentation in MRI is presented. It is based on a supervised algorithm, called RUSBoost, which combines data random undersampling with a boosting algorithm. RUSBoost is an algorithm specifically designed for imbalanced classification, suitable for large data sets because it uses random undersampling of the majority class. The RUSBoost performances were compared with those of ADABoost, Random Forest and the publicly available brain segmentation package, FreeSurfer. This study was conducted on a data set of 50 T1-weighted structural brain images. The RUSBoost-based segmentation tool achieved the best results with a Dice’s index of (Formula presented.) (Formula presented.) for the left (right) brain hemisphere. An independent data set of 50 T1-weighted structural brain scans was used for an independent validation of the fully trained strategies. Again the RUSBoost segmentations compared favorably with manual segmentations with the highest performances among the four tools. Moreover, the Pearson correlation coefficient between hippocampal volumes computed by manual and RUSBoost segmentations was 0.83 (0.82) for left (right) side, statistically significant, and higher than those computed by Adaboost, Random Forest and FreeSurfer. The proposed method may be suitable for accurate, robust and statistically significant segmentations of hippocampi

Human subcortical brain asymmetries in 15,847 people worldwide reveal effects of age and sex

The two hemispheres of the human brain differ functionally and structurally. Despite over a century of research, the extent to which brain asymmetry is influenced by sex, handedness, age, and genetic factors is still controversial. Here we present the largest ever analysis of subcortical brain asymmetries, in a harmonized multi-site study using meta-analysis methods. Volumetric asymmetry of seven subcortical structures was assessed in 15,847 MRI scans from 52 datasets worldwide. There were sex differences in the asymmetry of the globus pallidus and putamen. Heritability estimates, derived from 1170 subjects belonging to 71 extended pedigrees, revealed that additive genetic factors influenced the asymmetry of these two structures and that of the hippocampus and thalamus. Handedness had no detectable effect on subcortical asymmetries, even in this unprecedented sample size, but the asymmetry of the putamen varied with age. Genetic drivers of asymmetry in the hippocampus, thalamus and basal ganglia may affect variability in human cognition, including susceptibility to psychiatric disorders

Strengthening conceptual foundations: Analysing frameworks for ecosystem services and poverty alleviation research

AbstractA research agenda is currently developing around the linkages between ecosystem services and poverty alleviation. It is therefore timely to consider which conceptual frameworks can best support research at this nexus. Our review of frameworks synthesises existing research on poverty/environment linkages that should not be overlooked with the adoption of the topical language of ecosystem services. A total of nine conceptual frameworks were selected on the basis of relevance. These were reviewed and compared to assess their ability to illuminate the provision of ecosystem services, the condition, determinants and dynamics of poverty, and political economy factors that mediate the relationship between poverty and ecosystem services. The paper synthesises the key contributions of each of these frameworks, and the gaps they expose in one another, drawing out lessons that can inform emerging research. Research on poverty alleviation must recognize social differentiation, and be able to distinguish between constraints of access and constraints of aggregate availability of ecosystem services. Different frameworks also highlight important differences between categories of services, their pathways of production, and their contribution to poverty alleviation. Furthermore, we highlight that it is important to acknowledge the limits of ecosystem services for poverty alleviation, given evidence that ecosystem services tend to be more associated with poverty prevention than reduction. We conclude by reflecting on the relative merits of dynamic Social–Ecological Systems frameworks versus more static checklists, and suggest that research on ecosystem services and poverty alleviation would be well served by a new framework distilling insights from the frameworks we review