Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors.

All gynecologists are faced with ovarian tumors on a regular basis, and the accurate preoperative diagnosis of these masses is important because appropriate management depends on the type of tumor. Recently, the International Ovarian Tumor Analysis (IOTA) consortium published the Assessment of Different NEoplasias in the adneXa (ADNEX) model, the first risk model that differentiates between benign and four types of malignant ovarian tumors: borderline, stage I cancer, stage II-IV cancer, and secondary metastatic cancer. This approach is novel compared to existing tools that only differentiate between benign and malignant tumors, and therefore questions may arise on how ADNEX can be used in clinical practice. In the present paper, we first provide an in-depth discussion about the predictors used in ADNEX and the ability for risk prediction with different tumor histologies. Furthermore, we formulate suggestions about the selection and interpretation of risk cut-offs for patient stratification and choice of appropriate clinical management. This is illustrated with a few example patients. We cannot propose a generally applicable algorithm with fixed cut-offs, because (as with any risk model) this depends on the specific clinical setting in which the model will be used. Nevertheless, this paper provides a guidance on how the ADNEX model may be adopted into clinical practice

Dutch Adolescents’ Everyday Expressions of Sexual Behavior Trajectories Over a 2-Year Period:A Mixed-Methods Study

Using an extended definition of sexuality, this mixed-methods study builds on existing research into adolescents' emergent sexual development by longitudinally examining adolescents' sexual behavior trajectories (i.e., from less to more intimate sexual behavior). Over a 2-year period, 45 adolescents (M age = 15.9 years) reported on their sexual behavior using questionnaires and on their everyday expressions of sexuality in the form of semi-structured diaries. Cluster analysis using the questionnaire data identified three sexual behavior trajectories: a non-sexually active trajectory (meaning no or minor sexual behavior) (n = 29), a gradually sexually active trajectory (meaning step-by-step sexual behavior development) (n = 12), and a fast sexually active trajectory (meaning rapid sexual behavior development) (n = 4). Qualitative analysis using diaries revealed the following themes: romantic versus sex-related topics, desires, uncertainties, and references to the social context. In general, all adolescents reported more about romantic aspects of sexuality (than about sexual acts) in the diaries, regardless of their sexual behavior trajectory. Sexually active adolescents (i.e., gradual and fast) were more concerned with sexuality in their diaries, especially more with the physical aspects of sexuality, than non-active adolescents. Gradual adolescents experienced more desires about physical sexual contact and reported fewer references to their social network than non-active and fast adolescents. The findings suggest that sexual education that discusses the internal experiences of sexuality, such as feelings and thoughts, particularly the romantic aspects, may help adolescents process their preferences for different sexual and romantic acts and may contribute to healthy sexual development

Young people's everyday romance and sexual experiences in relation to sex-related conversations with parents:a diary study in the Netherlands

This study builds on existing research into how young people's emergent sexual development is connected to parent-child sex-related communication through avoidance vs. disclosure. Over the course of one year, a total of 21 young people (age range 12-17.5) reported in longitudinal qualitative diaries their (1) everyday sexual experiences and (2) sex-related conversations with their parents. Using a mixed-methods approach, findings show that less sexually experienced participants reported greater avoidance of parent-child sex-related conversations than more experienced participants. The sex-related conversations of more experienced participants mainly concerned overt experiences in the form of everyday issues with their romantic partner, while the conversations of less experienced participants were characterised by more covert experiences such as opinions about romantic relationships in general. These results suggest that the degree to which young people feel comfortable talking about sexuality with their parents partly depends on when the conversation takes place during a young person's romantic and sexual development

Pilot-Scale Testing of In Situ Vitrification of Arnold Engineering Development Center Site 10 Contaminated Soils

Process verification testing using in situ vitrification (ISV) was successfully performed in a pilot-scale test using soils containing fuel oils and heavy metals from Site 10 Installation Restoration Program (IRP) at the Arnold Engineering Development Center (AEDC) located in the southern portion of middle Tennessee. This effort was directed through the U.S. Department of Energy ' s Hazardous Waste Remedial Action Program (HAZWRAP) Office managed by Martin Marietta Energy Systems. In situ vitrification is a thermal treatment process that converts contaminated soils and wastes into a durable product containing glass and crystalline phases. During processing, heavy metals or other inorganic constituents are retained and immobilized in the glass structure; organic constituents are typically destroyed or removed and captured by the off-gas treatment system. The objective of this test is to verify the applicability of the ISV process for stabilization of the contaminated soil at Site 10 . The pilotscale ISV testing results, reported herein, indicate that the AEDC Site 10 Fire Training Area may be successfully processed by ISV. Site 10 is a fire training pit that is contaminated with fuel oils and heavy metals from fire training exercises. Actual site material was processed by ISV to verify its feasible application to those soils . Initial feasibility bench-scale testing and analyses of the soils determined that a lower-melting, electrically conductive fluxing additive (such as sodium carbonate) is required as an additive to the soil for ISV processing to work effecti vely. The actual Site 10 soils showed a larger degree of compositional variation than the soil used for the bench-scale test . This variation dictates that each vitrification setting should be analyzed to determine the composition as. a function of depth and location . This data will dictate the amount (if any) of fluxing add itives of sodium and calci um to bring the melt composition to the recommended quantity of 5 wt% sodium and 5 wt% calcium oxide. Each variable additive adjustment would result in a vitrification melt composition of 5 wt% calcium and sodium oxide content . The pilot -scale operation created a vitrified block weighing 15 metric t onnes (t) and measuring 1.5 m (5 ft) deep and 2.4 m (8 ft) on each side. The quantity of fluxing additives and the method of placing the fluxing additives in the surface cover soil limited the operating electrical system providing power to the ISV melt. The power limitation created enhanced lateral growth of the block and resulted in a shallower depth . This method of adding fluxes demonstrated that ISV operating efficiency would be greatly improved if the fluxes were injected or mixed with the entire designated vitrification volume. However, the volume vitrified contained a sufficient quantity of hazardous contaminants to allow for an effective verification evaluation of ISV processing of the AEDC Site 10. Analytical efforts for this project were directed towards evaluating the organic destruction and thermal transport effects of ISV processing on the Site 10 contaminated soil. No thermal transport of hydrocarbon contaminants to the surrounding soil were detected. These results continue to confirm the organic destruction and nontransport mechanisms presented in this report . Off-gas releases of the hydrocarbons indicated an 89 wt% destruction efficiency by the ISV process exclusive of off-gas treatment. The destruction and removal efficiency of the overall ISV system was 99.85 wt%. Leach testing using extraction procedure (EP) toxicity and toxic characteristics leach procedure (TCLP) showed that all metals of concern were below leach testing release limits, indicating that the ISV process produces a nonhazardous product . These favorable results indicate that ISV can be used to effectively treat and remediate the contaminated soils at the AEDC Site 10

Strategies to diagnose ovarian cancer: new evidence from phase 3 of the multicentre international IOTA study

Background: To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer diagnosis using a meta-analysis approach of centre-specific data from IOTA3. Methods: This prospective multicentre diagnostic accuracy study included 2403 patients with 1423 benign and 980 malignant adnexal masses from 2009 until 2012. All patients underwent standardised transvaginal ultrasonography. Test performance of RMI, subjective assessment (SA) of ultrasound findings, two IOTA risk models (LR1 and LR2), and strategies involving combinations of IOTA simple rules (SRs), simple descriptors (SDs) and LR2 with and without SA was estimated using a meta-analysis approach. Reference standard was histology after surgery. Results: The areas under the receiver operator characteristic curves of LR1, LR2, SA and RMI were 0.930 (0.917–0.942), 0.918 (0.905–0.930), 0.914 (0.886–0.936) and 0.875 (0.853–0.894). Diagnostic one-step and two-step strategies using LR1, LR2, SR and SD achieved summary estimates for sensitivity 90–96%, specificity 74–79% and diagnostic odds ratio (DOR) 32.8–50.5. Adding SA when IOTA methods yielded equivocal results improved performance (DOR 57.6–75.7). Risk of Malignancy Index had sensitivity 67%, specificity 91% and DOR 17.5. Conclusions: This study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference

The ELPAT Living Organ Donor Psychosocial Assessment Tool (EPAT): from 'What' to 'How' of Psychosocial Screening - a Pilot Study

Thorough psychosocial screening of donor candidates is required in order to minimize potential negative consequences and to strive for optimal safety within living donation programmes. We aimed to develop an evidence-based tool to standardize the psychosocial screening process. Key concepts of psychosocial screening were used to structure our tool: motivation and decision-making, personal resources, psychopathology, social resources, ethical and legal factors and information and risk processing. We (i) discussed how each item per concept could be measured, (ii) reviewed and rated available validated tools, (iii) where necessary developed new items, (iv) assessed content validity and (v) pilot-tested the new items. The resulting ELPAT living organ donor Psychosocial Assessment Tool (EPAT) consists of a selection of validated questionnaires (28 items in total), a semi-structured interview (43 questions) and a Red Flag Checklist. We outline optimal procedures and conditions for implementing this tool. The EPAT and user manual are available from the authors. Use of this tool will standardize the psychosocial screening procedure ensuring that no psychosocial issues are overlooked and ensure that comparable selection criteria are used and facilitate generation of comparable psychosocial data on living donor candidates.info:eu-repo/semantics/publishedVersio

Changes in quantitative sensory testing and patient perspectives following spinal cord stimulation for persistent spinal pain syndrome:an observational study with long-term follow-up

BACKGROUND: Spinal cord stimulation (SCS) can impact sensory, pain and tolerance thresholds in various ways, which can be accessed via quantitative sensory testing (QST). The objectives of this study were to (1) assess the subjective sensory responses using QST in patients following SCS therapy for PSPS and (2) to get a clinical impression of the results of SCS during an interview of these patients with PSPS and SCS during long term follow-up. METHODS: Forty patients with PSPS who received SCS treatment underwent QST via electrical and mechanical pressure stimuli. QST was performed at four different moments (1. pre-implantation SCS, 2. two weeks postoperatively, 3. three months after permanent SCS implantation and 4. six months after permanent SCS implantation. Patients' perspectives on pain, use of drugs and quality of life were assessed via semi-structured interviews during a follow-up between five and eleven years. RESULTS: We found statistical differences in the changes of sensory, pain and tolerance thresholds. A decrease in pain complaints and analgesics use were reported by the patients during follow-up. The quality of life in patients increased from three to eight (NRS 0 (worst QoL imaginable) -10 (best QoL imaginable) after receiving SCS. CONCLUSIONS: The increased thresholds on areas without pain or being covered by the SCS induced paresthesias may indicate that there are central changes contributing to these deviations in thresholds. The overall QoL in patients improved greatly after receiving SCS