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Long-term neurotoxicity of chemotherapy in adolescents and young adults treated for bone and soft tissue sarcomas.
Purpose. To study the long-term neurotoxicity of chemotherapy in adolescents and young adults treated for bone and soft tissue sarcomas.Patients and Methods. Thirty-six adolescents and young adults (median age 17 years) were examined following chemotherapy for bone and soft tissue sarcomas. Twenty-nine (29/36) had received cisplatin (median 400 mg/m(2)), 15/36 ifosfamide (median 20 g/m(2)), and 12/36 vincristine (median 16 mg). Neurotoxicity was assessed at a median of 8 months (range, 1-54 months) after completion of chemotherapy by clinical examination, nerve conduction studies, audiograms and autonomic function tests. The same nerve conduction studies were carried out in 20 normal volunteers to define normal ranges in this age group.Results. Sixteen patients (44%) had a significant reduction in deep tendon reflexes, and this clinical parameter correlated well with abnormalities detected in nerve conduction studies. Vibration perception threshold (VPT) was raised in 20/36 patients (55%) and this was the most sensitive single test in the assessment of neuropathy. There was a significant correlation between VPT and cumulative cisplatin dose received in mg/m(-2) (r=0.607, p<0.01). Ten of 29 patients (35%) had abnormal nerve conduction studies with a pattern characteristic of sensory axonal neuropathy. No patient complained of auditory symptoms, but minor high tone hearing loss was detected by audiograms in 5/28 patients who had received cisplatin. No patients had symptoms of autonomic neuropathy, but autonomic function tests showed minor abnormalities in 4/22 patients tested, and all had received cisplatin.Conclusions. This study demonstrates significant, although asymptomatic, long-term neurotoxicity of cisplatin in adolescents and young adults receiving chemotherapy for bone and soft tissue sarcomas. Follow-up studies are planned to assess whether these neurological deficits improve with time.Peer Reviewe
Finding the niche: A review of market assessment methodologies for rural electrification with small scale wind power
The mass roll out of solar PV across the Global South has enabled electricity access for millions of people. In the right context, Small Wind Turbines (SWTs) can be complementary, offering the potential to generate at times of low solar resource (night, monsoon season, winter, etc.) and increasing the proportion of the total energy system that can be manufactured locally. However, many contextual factors critically affect the viability of the technology, such as the extreme variability in the wind resource itself and the local availability of technical support. Therefore, performing a detailed market analysis in each new context is much more important. The Wind Empowerment Market Assessment Methodology (WEMAM) is a multi-scalar, transdisciplinary methodology for identifying the niche contexts where small wind can make a valuable contribution to rural electrification. This paper aims to inform the development of WEMAM with a critical review of existing market assessment methodologies. By breaking down WEMAM into its component parts, reflecting upon its practical applications to date and drawing upon insights from the literature, opportunities where it could continue to evolve are highlighted. Key opportunities include shifting the focus towards development outcomes; creating community archetypes; localised studies in high potential regions; scenario modelling and MCDA ranking of proposed interventions; participatory market mapping; and applying socio-technical transitions theory to understand how the small wind niche can break through into the mainstream