13 research outputs found
The Vehicle, Spring 2001
Vol. 42, No. 2
Table of Contents
To Dream Without CeasingElizabeth Dedmanpage 4-5
Honoring Commandos at Spean BridgeKat Stevenspage 6
The Girl I NamelyKevin Manuspage 7
AbsolutionMike Mauritzenpage 8
Summertime SuperheroesChris Ptasnikpage 9
Flower at GlencoeKat Stevenspage 10
AddictionAdam Funkpage 11
Cornfield in JanuaryRobert Prattepage 12
MelancholyOona Margaret Burkepage 13
In PicturesAmanda McKaypage 14
Words to a Silent FilmBrianne Bolinpage 15
ManagerRobert Prattepage 16
The WellJanet Windegathpage 17
A Meal at the Personal Growth CafeAshley Kieferpage 18
Castlegate Evening at AberdeenKat Stevenspage 19
What We AreKevin Manuspage 20
Ode to My Gin-Soaked OlivesBrianne Bolinpage 21
The Six String PlayerRyan Guimondpage 22
MaxineJay Edwardspage 23
BarefootKrista Bodenpage 24
JulyAdam Funkpage 25
HopeOona Margaret Burkepage 26
UntitledLevy Wooln Dannerpage 27
The One and Only Picture I Have of YouKevin Manuspage 28
Death of a Fat ManBrianne Bolinpage 29-32https://thekeep.eiu.edu/vehicle/1075/thumbnail.jp
Bright spots as climateâsmart marine spatial planning tools for conservation and blue growth
publishedVersio
Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received
Background
The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy.
Objective
To report outcomes according to treatment received in men in randomised and treatment choice cohorts.
Design, setting, and participants
This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy.
Intervention
Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment.
Outcome measurements and statistical analysis
Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores.
Results and limitations
According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa.
Conclusions
Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group.
Patient summary
More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common
Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)
Objective
To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making.
Patients and Methods
Men aged 50â69âyears diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6âyears were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores.
Results
Treatment-received analyses revealed different impacts of treatments over 6âyears. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6âyears and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6âyears. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6âyears, and after EBRT this was reported by 69% and 74%, respectively (Pâ<â0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1âpad/day, persisting for 20% at 6âyears, compared with no change in men receiving EBRT or AM (Pâ<â0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6âyears and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (Pâ<â0.001) with lesser effects after BT. No treatment affected mental or physical QoL.
Conclusion
Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes
Radiotherapy for Prostate Cancer: is it âwhat you doâ or âthe way that you do itâ? A UK Perspective on Technique and Quality Assurance
Design of a Multi-objective Landing Trajectory Using Artificial Neural Networks
During approach and landing, the HL-20 follows a typical reusable launch vehicle (RLV) autoland trajectory: deep descent, followed by a parabolic flare, and final descent. The trajectory shape is determined by six independent parameters. An artificial neural network (ANN) is designed to generate the trajectory parameters for the HL-20 based on desired objectives using MATLABÂźâs Neural Network Toolbox. This research examines three mission objectives: specifying flight time, specifying the final downrange position error, and specifying the average error between the desired angle of attack and actual angle of attack. The ANN successfully produces parameters that meet mission objectives and, in some cases, improve upon nominal errors. It is also demonstrated that the ANN structure and ANN training vectors have a profound impact on the success of the neural network
Phosphorylation of Calcium CalmodulinâDependent Protein Kinase II following Lateral Fluid Percussion Brain Injury in Rats
Long-Term Risk of Skin Cancer and Lymphoma in Users of Topical Tacrolimus and Pimecrolimus : Final Results from the Extension of the Cohort Study Protopic Joint European Longitudinal Lymphoma and Skin Cancer Evaluation (JOELLE)
Purpose: Evidence is insufficient to infer whether topical calcineurin inhibitors (TCIs; tacrolimus and pimecrolimus) cause malignancy. The study objective was to estimate the long-term risk of skin cancer and lymphoma associated with topical TCI use in adults and children, separately. Patients and Methods: A cohort study in Denmark, Sweden, UK, and the Netherlands was conducted. Adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated for nonmelanoma skin cancer (NMSC), melanoma, cutaneous T-cell lymphoma (CTCL), non-Hodgkin lymphoma (NHL) excluding CTCL, and Hodgkin lymphoma (HL) in new users of TCIs versus users of moderate/high-potency topical corticosteroids. Results: The study included 126,908/61,841 adults and 32,605/27,961 children initiating treatment with tacrolimus/pimecrolimus, respectively. Follow-up was â„10 years for 19% of adults and 32% of children. Incidence rate ratios and (95% confidence intervals) for tacrolimus versus corticosteroid users in adults were <1 for melanoma, non-Hodgkin lymphoma, and Hodgkin lymphoma; and 1.80 (1.25-2.58) for cutaneous T-cell lymphoma. For pimecrolimus, IRRs in adults were <1 for non-Hodgkin lymphoma, cutaneous T-cell lymphoma, and Hodgkin's lymphoma; and 1.21 (1.03-1.41) for melanoma; and 1.28 (1.20-1.35) for nonmelanoma skin cancer. In children, results were inconclusive due to few events. In adults, incidence rate ratios â„5 years after first topical calcineurin inhibitor exposure were not higher than in overall analyses. Conclusion: Overall, we found little evidence associating use of topical calcineurin inhibitors with skin cancer and lymphoma; confounding by indication, surveillance bias, and reverse causation may have influenced these results. Even if causal, the public health impact of these excess risks would be low and confined to the first years of exposure
Moving from Flipcharts to the Flipped Classroom: Using Technology Driven Teaching Methods to Promote Active Learning in Foundation and Advanced Masters Social Work Courses
Bright spots as climateâsmart marine spatial planning tools for conservation and blue growth
Marine spatial planning that addresses ocean climate-driven change ('climate-smart MSP') is a global aspiration to support economic growth, food security and ecosystem sustainability. Ocean climate change ('CC') modelling may become a key decision-support tool for MSP, but traditional modelling analysis and communication challenges prevent their broad uptake. We employed MSP-specific ocean climate modelling analyses to inform a real-life MSP process; addressing how nature conservation and fisheries could be adapted to CC. We found that the currently planned distribution of these activities may become unsustainable during the policy's implementation due to CC, leading to a shortfall in its sustainability and blue growth targets. Significant, climate-driven ecosystem-level shifts in ocean components underpinning designated sites and fishing activity were estimated, reflecting different magnitudes of shifts in benthic versus pelagic, and inshore versus offshore habitats. Supporting adaptation, we then identified: CC refugia (areas where the ecosystem remains within the boundaries of its present state); CC hotspots (where climate drives the ecosystem towards a new state, inconsistent with each sectors' present use distribution); and for the first time, identified bright spots (areas where oceanographic processes drive range expansion opportunities that may support sustainable growth in the medium term). We thus create the means to: identify where sector-relevant ecosystem change is attributable to CC; incorporate resilient delivery of conservation and sustainable ecosystem management aims into MSP; and to harness opportunities for blue growth where they exist. Capturing CC bright spots alongside refugia within protected areas may present important opportunities to meet sustainability targets while helping support the fishing sector in a changing climate. By capitalizing on the natural distribution of climate resilience within ocean ecosystems, such climate-adaptive spatial management strategies could be seen as nature-based solutions to limit the impact of CC on ocean ecosystems and dependent blue economy sectors, paving the way for climate-smart MSP