Local treatment failure after globe-conserving therapy for choroidal melanoma.

Local treatment failure after globe-conserving therapy for choroidal melanoma is a surgical complication with significant morbidity to the vision and eye. Few reports in the literature have addressed this complication exclusively. A review of the published literature with reference to local treatment failure in the management of choroidal melanoma was performed to make known the potential differences in failure rates between treatment modalities and methods. A search of the literature regarding local treatment failure was performed to identify relevant studies using combinations of the following keywords on PubMed: uveal melanoma, choroidal melanoma, local recurrence, local failure, endoresection, gamma knife, radiotherapy, helium, iodine, proton, palladium, ruthenium, trans-scleral resection, transpupillary thermotherapy. Further studies were found by searching the text and references of previously identified studies for articles reporting local treatment failure rates in choroidal melanoma. Among the 49 studies identified, the local treatment failure rate ranged from 0% to 55.6%, with follow-up ranging from 10 to 150 months. The two most widely used forms of radiation therapy, iodine-125 and ruthenium-106 brachytherapy, were both associated with a local recurrence rate of 9.6%. The weighted-average of treatment failure in all radiation therapies was 6.15% compared with 18.6% in surgical and 20.8% in laser therapies. Rates of local treatment failure for globe-conserving therapy of choroidal melanoma varied widely between modalities and between centres using similar modalities. Radiation therapy overall resulted in lower local treatment failures compared with surgical or transpupillary thermotherapy

The Theory of Three-level Photon Echo Using of Rotating Wave Approximation

The three level photon echo has been described in different works by using rotating wave approximation but none of them did not get results which show the effects of field's frequencies on frequency of ground level of system. In this work, we studied a Lambda type system theoretically and numerically. By considering the Doppler effect in environment, we get different equation for polarization of echo signal and its intensity

Making space for proactive adaptation of rapidly changing coasts: a windows of opportunity approach

Coastlines are very often places where the impacts of global change are felt most keenly, and they are also often sites of high values and intense use for industry, human habitation, nature conservation and recreation. In many countries, coastlines are a key contested territory for planning for climate change, and also locations where development and conservation conflicts play out. As a “test bed” for climate change adaptation, coastal regions provide valuable, but highly diverse experiences and lessons. This paper sets out to explore the lessons of coastal planning and development for the implementation of proactive adaptation, and the possibility to move from adaptation visions to actual adaptation governance and planning. Using qualitative analysis of interviews and workshops, we first examine what the barriers are to proactive adaptation at the coast, and how current policy and practice frames are leading to avoidable lock-ins and other maladaptive decisions that are narrowing our adaptation options. Using examples from UK, we then identify adaptation windows that can be opened, reframed or transformed to set the course for proactive adaptation which links high level top-down legislative requirements with local bottom-up actions. We explore how these windows can be harnessed so that space for proactive adaptation increases and maladaptive decisions are reduced

Assessing a decade of interstate bank branching

U.S. banking regulation has historically prohibited the ability of a bank to open or own a branch located outside of its home state, commonly referred to as interstate branching. Only since the passage of the Riegle-Neal Interstate Banking and Branching Efficiency Act (IBBEA) in 1994 have banks have been able to engage in interstate branching, though subject to state restrictions. Despite IBBEA’s removal of branching barriers, it still allowed the states to impose restrictions on the entry of out-of-state branch offices. This article describes the changes in Federal and state interstate branching law since passage of IBBEA and reviews how initial (1994-1997) and evolving (1998-2004) interstate branching laws affect out-of-state branch growth. It concludes that anticompetitive state provisions restricted out-of- state growth when those provisions were more restrictive than the provisions set by IBBEA or by neighboring states.Interstate banking

Telehealth in Palliative Care: A Systematic Review of Patient Reported Outcomes

A systematic review was conducted to explore published quantitative and qualitative research describing patient-reported outcomes of palliative telehealth intervention studies. Multiple databases were searched for articles published between January 2006 and May 2016, which met study criteria. Methodological quality was assessed using Cochrane Collaboration’s tool for assessing risk of bias for quantitative articles. For studies reporting qualitative outcomes, a checklist was used to evaluate trustworthiness of the methodology. Of the 6 studies reporting quantitative outcomes, 3 studies were rated as having moderate study quality, and 3 studies were rated as having low study quality. Of the 6 studies reporting qualitative outcomes, 3 reported 5 different methods for ensuring trustworthiness, whereas 1 article reported 4 methods, 1 reported 3, and 1 article reported 2 methods. Studies were notably diverse in terms of patient population, technology used, outcomes measures, and methodology. Results across studies were also variable. Methodological factors were major limitations. Recruitment problems, participant attrition, and lack of standardized outcomes measures impacted outcome assessment. Overall, research support for positive patient outcomes in palliative telehealth interventions was weak. However, all studies but one found positive results to support the intervention

A Systematic Review of Telehealth in Palliative Care: Caregiver Outcomes

Objective: Telehealth interventions have proven efficacy in healthcare, but little is known about the results of such interventions in palliative care. We conducted a systematic review to evaluate caregiver outcomes related to palliative telehealth interventions. Materials and Methods: We searched multiple databases for articles published between January 2003 and January 2015 related to telehealth in palliative care. Two hundred twenty-one articles were considered; nine of these met study inclusion criteria. Data on study design, population, interventions, methods, outcomes, conclusions, and methodological quality were extracted and evaluated by three investigators. Results: Of the nine studies, five measured caregiver quality of life, three measured caregiver anxiety, and two measured caregiver burden. All the studies measuring caregiver quality of life showed no significant difference after telehealth interventions. The caregiver anxiety score decreased after the intervention in two studies, and one study reported significantly reduced caregiver burden. Although feasibility of or caregiver satisfaction with the telehealth intervention was not the focus of this review, most studies reported such findings. Of the nine studies, the majority were rated as having moderate quality using the Cochrane Collaboration’s tool for assessing risk of bias. Conclusions: This systematic review suggests there is evidence of overall satisfaction in caregivers who undergo a telehealth intervention, but outcomes reported were often not substantial. Methodological flaws and small sample sizes negatively affected study quality. More rigorous research to test and evaluate such palliative interventions is needed

Education Interrupted: The Growing Use of Suspensions in New York City's Public Schools

The New York Civil Liberties Union analyzed 10 years of discipline data from New York City schools, and found that:*The total number of suspensions in New York City grew at an alarming rate over the last decade: One out of every 14 students was suspended in 2008-2009; in 1999-2000 it was one in 25. In 2008-2009, this added up to more than 73,000 suspensions.*Students with disabilities are four times more likely to be suspended than students without disabilities.*Black students, who comprise 33 percent of the student body, served 53 percent of suspensions over the past 10 years. *Black students with disabilities represent more than 50 percent of suspended students with disabilities.*Black students also served longer suspensions on average and were more likely to be suspended for subjective misconduct, like profanity and insubordination.*Suspensions are becoming longer: More than 20 percent of suspensions lasted more than one week in 2008-2009, compared to 14 percent in 1999-2000. The average length of a long-term suspension is five weeks (25 school days).*Between 2001 and 2010, the number of infractions listed in the schools' Discipline Code increased by 49 percent. During that same period, the number of zero tolerance infractions, which mandate a suspension regardless of the individual facts of the incident, increased by 200 percent.*Thirty percent of suspensions occur during March and June of each school year

Medi-Cal Versus Employer-Based Coverage: Comparing Access to Care

This report takes a close look at access to care under Medi-Cal for nonelderly adults and children on the eve of Affordable Care Act (ACA) implementation. Using data from the 2012 and 2013 California Health Interview Surveys (CHIS), the research examines a total of 49 measures (45 on realized and potential access and 4 on health status and health behaviors) for nonelderly adults and 31 measures (28 on realized and potential access and 3 on health status and behaviors) for children.For adults, access under Medi-Cal is compared to access under employer-sponsored insurance (ESI) overall; among Medi-Cal enrollees, access is compared across subgroups defined by region, race/ethnicity, language, and other dimensions. For children, access under Medi-Cal and Healthy Families together (referred hereafter simply as "Medi-Cal") is compared against access under ESI. To account for differences in health status and socioeconomic status between those with Medi-Cal and those with ESI, for each measure, three sets of analyses are presented: unadjusted percentages, predicted percentages adjusted for health care need, and predicted percentages adjusted for both health care need and socioeconomic status. The same approach is used in the analysis of regional and subgroup differences within the Medi-Cal population