Improved Arousal and Motor Function Using Zolpidem in a Patient With Space‐Occupying Intracranial Lesions: A Case Report

Patients with disorders of consciousness (DOC) have profound functional limitations with few treatment options for improving arousal and quality of life. Zolpidem is a nonbenzodiazepine hypnotic used to treat insomnia that has also been observed to paradoxically improve arousal in those with DOC, such as the vegetative or minimally conscious states. Little information exists on its use in patients with DOC who have intracranial space‐occupying lesions. We present a case of a 24‐year‐old man in a minimally conscious state due to central nervous system lymphoma who was observed to have increased arousal and improved motor function after the administration of zolpidem.Level of EvidenceVPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147138/1/pmr2831.pd

Cancer Survivorship: A Growing Role for Physiatric Care

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146952/1/pmr2527.pd

An Evolving Role for Cancer Rehabilitation in the Era of Low‐Dose Lung Computed Tomography Screening

Lung cancer is the number one cause of cancer‐related death worldwide, and is often detected in the later stages. Use of low‐dose chest computed tomography in at‐risk patients provides earlier detection and is being adopted as the standard screening tool, replacing less precise methods of radiography and sputum cytology. In the past, late detection of disease meant that rehabilitation interventions attempted to salvage function and to improve aerobic capacity to the point where patients could tolerate the sometimes‐extensive oncologic treatment, including lobectomy or pneumonectomy. Earlier detection may shift this toward more often addressing specific neuromusculoskeletal impairments, such as postthoracotomy pain or peripheral neuropathy, as patients with early‐stage disease may not be as debilitated by chronic disease or metastases as those with late‐stage lung cancer. Patients with advanced disease, however, will still require rehabilitation interventions, and this fragile population creates unique challenges. Rehabilitation professionals should look for ways to expand care to lung cancer patients, as both the number of those treated and the 5‐year survival rate are expected to increase.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147113/1/pmr2s407.pd

Integrating Function‐Directed Treatments into Palliative Care

The growing acceptance of palliative care has created opportunities to increase the use of rehabilitation services among populations with advanced disease, particularly those with cancer. Broader delivery has been impeded by the lack of a shared definition for palliative rehabilitation and a mismatch between patient needs and established rehabilitation service delivery models. We propose the definition that, in the advanced cancer population, palliative rehabilitation is function‐directed care delivered in partnership with other clinical disciplines and aligned with the values of patients who have serious and often incurable illnesses in contexts marked by intense and dynamic symptoms, psychological stress, and medical morbidity to realize potentially time‐limited goals. Although palliative rehabilitation is most often delivered by inpatient physical medicine and rehabilitation consultation/liaison services and by physical therapists in skilled nursing facilities, outcomes in these settings have received little scrutiny. In contrast, outpatient cancer rehabilitation programs have gained robust evidentiary support attesting to their benefits across diverse settings. Advancing palliative rehabilitation will require attention to historical barriers to the uptake of cancer rehabilitation services, which include the following: patient and referring physicians’ expectation that effective cancer treatment will reverse disablement; breakdown of linear models of disablement due to presence of concurrent symptoms and psychological distress; tension between reflexive palliation and impairment‐directed treatment; palliative clinicians’ limited familiarity with manual interventions and rehabilitation services; and challenges in identifying receptive patients with the capacity to benefit from rehabilitation services. The effort to address these admittedly complex issues is warranted, as consideration of function in efforts to control symptoms and mood is vital to optimize patients’ autonomy and quality of life. In addition, manual rehabilitation modalities are effective and drug sparing in the alleviation of adverse symptoms but are markedly underused. Realizing the potential synergism of integrating rehabilitation services in palliative care will require intensification of interdisciplinary dialogue.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146938/1/pmr2s335.pd

Stereotactic Body Radiotherapy re-irradiation for locally recurrent rectal cancer: outcomes and toxicity

Background: Stereotactic body radiotherapy (SBRT) has emerged as a potential therapeutic option for locally recurrent rectal cancer (LRRC) but contemporaneous clinical data is limited. We aimed to evaluate the local control, toxicity and survival outcomes in a cohort of patients previously treated with neoadjuvant pelvic radiotherapy for non-metastatic LRRC, now treated with SBRT. Methods: Inoperable rectal cancer patients with ≤ 3 sites of pelvic recurrence and > 6 months since prior pelvic radiotherapy were identified from a prospective registry over 4 years. SBRT dose was 30Gy in 5 fractions, daily or alternate days, using cumulative organ at risk dose constraints. Primary outcome was local control (LC). Secondary outcomes were progression free survival (PFS), overall survival (OS), toxicity and patient reported Quality of Life scores (QoL) using EQ-VAS tool. Results: 30 patients (35 targets) were included. Median GTV size was 14.3cm3. 27/30 (90%) previously received 45-50.4Gy in 25/28 fractions, with 10% receiving an alternative prescription. All patients received the planned re-irradiation SBRT dose. The median FU was 24.5 months (IQR 17.8 – 28.8). The 1-year LC was 84.9% (95% CI 70.6 – 99) and a 2-year LC was 69% (95% CI 51.8 – 91.9). The median PFS was 12.1 months (95% 8.6 – 17.66) and median OS was 28.3 months (95% CI 17.88 – 39.5 months). No patient experienced >G2 acute toxicity and only 1 patient experienced late G3 toxicity. Patient reported QoL outcomes were improved at 3 months following SBRT (Δ EQ-VAS, +10 points, Wilcoxon signed rank, p=0.009). Conclusion: Our study demonstrates that, for small volume pelvic disease relapses from rectal cancer, re-irradiation with 30Gy in 5 fractions is well tolerated and achieves an excellent balance between high local control rates with limited toxicity

ICAM-reg: Interpretable Classification and Regression with Feature Attribution for Mapping Neurological Phenotypes in Individual Scans

An important goal of medical imaging is to be able to precisely detect patterns of disease specific to individual scans; however, this is challenged in brain imaging by the degree of heterogeneity of shape and appearance. Traditional methods, based on image registration to a global template, historically fail to detect variable features of disease, as they utilise population-based analyses, suited primarily to studying group-average effects. In this paper we therefore take advantage of recent developments in generative deep learning to develop a method for simultaneous classification, or regression, and feature attribution (FA). Specifically, we explore the use of a VAE-GAN translation network called ICAM, to explicitly disentangle class relevant features from background confounds for improved interpretability and regression of neurological phenotypes. We validate our method on the tasks of Mini-Mental State Examination (MMSE) cognitive test score prediction for the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort, as well as brain age prediction, for both neurodevelopment and neurodegeneration, using the developing Human Connectome Project (dHCP) and UK Biobank datasets. We show that the generated FA maps can be used to explain outlier predictions and demonstrate that the inclusion of a regression module improves the disentanglement of the latent space. Our code is freely available on Github https://github.com/CherBass/ICAM

ICAM-reg: Interpretable Classification and Regression with Feature Attribution for Mapping Neurological Phenotypes in Individual Scans

Feature attribution (FA), or the assignment of class-relevance to different locations in an image, is important for many classification and regression problems but is particularly crucial within the neuroscience domain, where accurate mechanistic models of behaviours, or disease, require knowledge of all features discriminative of a trait. At the same time, predicting class relevance from brain images is challenging as phenotypes are typically heterogeneous, and changes occur against a background of significant natural variation. Here, we present an extension of the ICAM framework for creating prediction specific FA maps through image-to-image translation

Police Criminal Charging Decisions: An Examination of Post-Arrest Decision-Making

Scholars have encouraged studies of police decision-making to move beyond the arrest decision into research that broadens the understanding of police behavior. The criminal charge placed by officers against offenders is largely an untouched area of study. Examining criminal charging decisions goes beyond simple dichotomous decisions, such as arrest, but instead explores the area of police leniency or punitiveness. Randomly constructed vignettes describing a domestic violence incident were given to officers from four agencies. Officers indicated the criminal charges they would likely list against an offender if they were to make an arrest. Serious criminal charges were often supported by additional, but less serious, charges. Victim injury and an uncooperative offender were related to the decision to charge a misdemeanor offense. There was a significant negative relationship between the number of charges listed and more experienced officers and officers working in smaller agencies. The implications of this study and directions for future research are discussed

Dark sectors 2016 Workshop: community report

This report, based on the Dark Sectors workshop at SLAC in April 2016, summarizes the scientific importance of searches for dark sector dark matter and forces at masses beneath the weak-scale, the status of this broad international field, the important milestones motivating future exploration, and promising experimental opportunities to reach these milestones over the next 5-10 years

LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie