A dose‐gradient analysis tool for IMRT QA

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135372/1/acm20062.pd

Acceptable risks of treatments to prevent rheumatoid arthritis among first-degree relatives:demographic and psychological predictors of risk tolerance.

Objectives:To quantify tolerance to risks of preventive treatments among first-degree relatives (FDRs) of patients with rheumatoid arthritis (RA).Methods:Preventive treatments for RA are under investigation. In a preference survey, adult FDRs assumed a 60% chance of developing RA within 2 years and made choices between no treatment and hypothetical preventive treatment options with a fixed level of benefit (reduction in chance of developing RA from 60% to 20%) and varying levels of risks. Using a probabilistic threshold technique, each risk was increased or decreased until participants switched their choice. Perceived risk of RA, health literacy, numeracy, Brief Illness Perception Questionnaire and Beliefs about Medicines Questionnaire-General were also assessed. Maximum acceptable risk (MAR) was summarised using descriptive statistics. Associations between MARs and participants’ characteristics were assessed using interval regression with effects coding.Results:289 FDRs (80 male) responded. The mean MAR for a 40% reduction in chance of developing RA was 29.08% risk of mild side effects, 9.09% risk of serious infection and 0.85% risk of a serious side effect. Participants aged over 60 years were less tolerant of serious infection risk (mean MAR ±2.06%) than younger participants. Risk of mild side effects was less acceptable to participants who perceived higher likelihood of developing RA (mean MAR ±3.34%) and more acceptable to those believing that if they developed RA it would last for a long time (mean MAR ±4.44%).Conclusions:Age, perceived chance of developing RA and perceived duration of RA were associated with tolerance to some risks of preventive RA therapy

Exploring preferences of at-risk individuals for preventive treatments for rheumatoid arthritis

Objective: Some immunomodulatory drugs have been shown to delay the onset of, or lower the risk of developing, rheumatoid arthritis (RA), if given to individuals at risk. Several trials are ongoing in this area; however, little evidence is currently available about the views of those at risk of RA regarding preventive treatment. Method: Three focus groups and three interviews explored factors that are relevant to first degree relatives (FDRs) of RA patients and members of the general public when considering taking preventive treatment for RA. The semi-structured qualitative interview prompts explored participant responses to hypothetical attributes of preventive RA medicines. Transcripts of focus group/interview proceedings were inductively coded and analysed using a framework approach. Results: Twenty-one individuals (five FDRs, 16 members of the general public) took part in the study. Ten broad themes were identified describing factors that participants felt would influence their decisions about whether to take preventive treatment if they were at increased risk of RA. These related either directly to features of the specific treatment or to other factors, including personal characteristics, attitude towards taking medication, and an individual’s actual risk of developing RA. Conclusion: This research highlights the importance of non-treatment factors in the decision-making process around preventive treatments, and will inform recruitment to clinical trials as well as information to support shared decision making by those considering preventive treatment. Studies of treatment preferences in individuals with a confirmed high risk of RA would further inform clinical trial design

Can the General Public Be a Proxy for an “At-Risk” Group in a Patient Preference Study? A Disease Prevention Example in Rheumatoid Arthritis

Background: When selecting samples for patient preference studies, it may be difficult or impractical to recruit participants who are eligible for a particular treatment decision. However, a general public sample may not be an appropriate proxy. Objective: This study compares preferences for rheumatoid arthritis (RA) preventive treatments between members of the general public and first-degree relatives (FDRs) of confirmed RA patients to assess whether a sample of the general public can be used as a proxy for FDRs. Methods: Participants were asked to imagine they were experiencing arthralgia and had screening tests indicating a 60% chance of developing RA within 2 yrs. Using a discrete choice experiment, participants were offered a series of choices between no treatment and 2 unlabeled hypothetical treatments to reduce the risk of RA. To assess data quality, time to complete survey sections and comprehension questions were assessed. A random parameter logit model was used to obtain attribute-level estimates, which were used to calculate relative importance, maximum acceptable risk (MAR), and market shares of hypothetical preventive treatments. Results: The FDR sample (n = 298) spent more time completing the survey and performed better on comprehension questions compared with the general public sample (n = 982). The relative importance ranking was similar between the general public and FDR participant samples; however, other relative preference measures involving weights including MARs and market share differed between groups, with FDRs having numerically higher MARs. Conclusion: In the context of RA prevention, the general public (average risk) may be a reasonable proxy for a more at-risk sample (FDRs) for overall relative importance ranking but not weights. The rationale for a proxy sample should be clearly justified. Participants from the general public were compared to first-degree relatives on their preferences for rheumatoid arthritis (RA) preventive treatments using a discrete choice experiment. Preferences were similar between groups in terms of the most important and least important attributes of preventive treatments, with effectiveness being the most important attribute. However, relative weights differed. Attention to the survey and predicted market shares of hypothetical RA preventive treatments differed between the general public and first-degree relatives. The general public may be a reasonable proxy for an at-risk group for patient preferences ranks but not weights in the disease prevention context; however, care should be taken in sample selection for patient preference studies when choosing nonpatients

Roberto Yrusta: “Un cuerpo de flores”

Un 7 de febrero de 2013 en la Cárcel de Coronda en Santa Fe, cuando recién habían pasado las seis de la tarde y el calor aún era agobiante, unos presos jugaban a las cartas, otros rodeados de moscas dormían la siesta, y algunos simplemente no hacían nada porque la sensación térmica santafesina los había dejado duros como pájaros con el pico abierto. El sol se estaba recostando sobre el Paraná y los vecinos, como todas las tardes, salían con sus reposeras a la vereda a ver la gente pasar porque es lo único que pasaba. Adentro de la cárcel los minutos se deslizaron sigilosamente hasta llegar a veinte, donde todos los presos saltaron al mismo tiempo como quien se sacude por un hipo repentino. Hasta las bogas del rio Paraná dejaron de nadar, no era horario para semejante espectáculo. La batería de huesos no dejaba de sonar, se podían distinguir los acordes de la carne. Luego de un largo rato, el ruido ya cansado de tanto barullo paró, paró de golpe, como cuando a un violinista se le corta la cuerda del arco. Mientras tanto, en el centro de la ciudad, los autos desfilaban en círculo con la música a todo volumen, el sol ya se abrazaba al rio y adentro de la cárcel, solo se oía un escandaloso silencio

Improving IMRT delivery efficiency using intensity limits during inverse planning

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135056/1/mp5545.pd

Health Professionals' Experience Using an Azure Voice-Bot to Examine Cognitive Impairment (WAY2AGE)

Virtual Assistants (VA) are a new groundbreaking tool for screening cognitive impairment by healthcare professionals. By providing the volume of data needed in healthcare guidance, better treatment monitoring and optimization of costs are expected. One of the first steps in the development of these items is the experience of the healthcare professionals in their use. The general goal of the current project, WAY2AGE, is to examine healthcare professionals' experience in using an Azure voice-bot for screening cognitive impairment. In this way, back-end services, such as the ChatBot, Speech Service and databases, are provided by the cloud platform Azure (Paas) for a pilot study. Most of the underlying scripts are implemented in Python, Net, JavaScript and open software. A sample of 30 healthcare workers volunteered to participate by answering a list of question in a survey set-up, following the example provided in the previous literature. Based on the current results, WAY2AGE was evaluated very positively in several categories. The main challenge of WAY2AGE is the articulation problems of some older people, which can lead to errors in the transcription of audio to text that will be addressed in the second phase. Following an analysis of the perception of a group of thirty health professionals on its usability, potential limitations and opportunities for future research are discussed

Health Professionals’ Experience Using an Azure Voice-Bot to Examine Cognitive Impairment (WAY2AGE)

Virtual Assistants (VA) are a new groundbreaking tool for screening cognitive impairment by healthcare professionals. By providing the volume of data needed in healthcare guidance, better treatment monitoring and optimization of costs are expected. One of the first steps in the development of these items is the experience of the healthcare professionals in their use. The general goal of the current project, WAY2AGE, is to examine healthcare professionals’ experience in using an Azure voice-bot for screening cognitive impairment. In this way, back-end services, such as the ChatBot, Speech Service and databases, are provided by the cloud platform Azure (Paas) for a pilot study. Most of the underlying scripts are implemented in Python, Net, JavaScript and open software. A sample of 30 healthcare workers volunteered to participate by answering a list of question in a survey set-up, following the example provided in the previous literature. Based on the current results, WAY2AGE was evaluated very positively in several categories. The main challenge of WAY2AGE is the articulation problems of some older people, which can lead to errors in the transcription of audio to text that will be addressed in the second phase. Following an analysis of the perception of a group of thirty health professionals on its usability, potential limitations and opportunities for future research are discussed

A dose-gradient analysis tool for IMRT QA

The use of intensity-modulated radiation therapy (IMRT) has led to an increase in the number of complex fields that require measurement and comparison to calculated dose distributions in 2D. Current dose evaluation techniques, including isodose line comparisons, displays of the dose difference between calculated and measured distributions, and distance-to-agreement (DTA) comparisons, are useful for display of differences between two different dose distributions but are often of limited value for the assessment of the discrepancies in terms of significance and/ or cause. In this paper, we present a new gradient compensation method for the evaluation of local dosimetric differences as a function of the dose gradient at each point in the dose distribution. To apply the method, the user specifies a distance parameter (typically 1 mm), which is the geometric tolerance the user is prepared to accept for the dose comparison. The expected geometric uncertainties in the comparison process can include finite calculation and measurement grids, small misalignments of measured and calculated results, and volume-averaging effects in the measurement detector. Since these uncertainties can obscure the interpretation of any of the analysis tools described above, removing dose differences related to the tolerable geometric uncertainty helps the gradient compensation method highlight algorithm and delivery-related differences. The remaining dose differences not explained by the geometric tolerance can then be evaluated graphically (dose difference display) or analytically (dose difference dose-volume histograms) over the entire comparison region. PACS number: 87.53.X