Mental health and academic outcomes over the first year at university in international compared to domestic Canadian students

OBJECTIVE

To compare risk factors and associated mental health and academic outcomes between international and domestic students.

PARTICIPANTS

Canadian university undergraduate students.

METHODS

Electronic surveys were completed at university entry and the end of first year. Surveys assessed demographics, risk factors, symptoms of mental disorders, and access to support. Academic outcomes were obtained from university databases.

RESULTS

International students had comparable or lower rates of clinically significant anxiety, depression, and insomnia. Domestic female students reported the highest screening rates for common mental disorders. However, international students were more likely to report having attempted suicide. International students felt less connected to the university community and had lower academic performance. Psychosocial risk factor profiles and proportions accessing mental health services were similar.

CONCLUSIONS

The scope of mental health need appears more similar than different between international and domestic students; however, international students may benefit from targeted academic and social support initiatives.

Passivation effect on Cd0.95Mn0.05Te0.98Se0.02 radiation detection performance

CdTe-based detectors have the problem of Te-rich surface layers caused by Br etching, which is one of fabrication steps. Te-rich layer acts as a trapping center and serves as an additional source of charge carriers, thereby degrading transport property of charge carriers and enriching leakage current on surface of detector. To solve this problem, we introduced sodium hypochlorite (NaOCl) as a passivant, and investigated its effect on Cd0.95Mn0.05Te0.98Se0.02 (CMTS), by analyzing chemical state of surface and its performance. After passivation with NaOCl, the results of X-ray photoelectron spectroscopy (XPS) shows the formation of tellurium oxide and elimination of water on CMTS surface, and CMTS presented enhanced performance with Am-241 radioisotope. Consequently, it is demonstrated that the passivation with NaOCl reduces leakage current, compensates defect, and elevates transport of charge carriers, thereby decreasing charge loss of carriers and improving performance of CMTS detector.

Development and evaluation of photon-counting Cd0.875Zn0.125Te0.98Se0.02 detector for measuring bone mineral density

Cadmium zinc telluride (CZT) has been actively researched and developed by researchers in various fields. In medical applications, especially photon-counting, CZT enables improved image quality, multi-material decomposition, and improved dose efficiency. Moreover, band gap engineering and selenium addition on CZT improved electrical, spectroscopic and structural properties, thereby supporting performance of CZT as a photon-counting detector. In this study, it is shown that Cd_0.875Zn_0.125Te_0.98Se_0.02 (CZTS) shows sufficient performance without loss of detection efficiency. We carried out a study involving the application of this CZTS on calculating bone mineral density (BMD) values, because this application has a novelty of new material for BMD sensor which follows the CdTe- or CdZnTe- based BMD detector. Anatomical images from different energy bins contained different information of attenuation although the images were taken in the same region at the same time. Moreover, calculated BMD values had a proper tendency depending on the amount of bone in that region. The final BMD value was 1.1972 g/cm², which is close to the real value of 1.2 g/cm². The introduction with a bone filter and a smaller pixel size will improve the accuracy and precision of photon-counting CZTS detectors for measuring BMD values. However, in this study the CZTS showed the feasibility that a photon-counting CZTS detector can help the measurement of BMD values and the diagnosis of osteoporosis.

The Association of Radiation Dose-Fractionation and Immunotherapy Use With Overall Survival in Metastatic Melanoma Patients

Objective

Metastatic melanoma patients often receive palliative radiotherapy (RT) and immunotherapy (IT). However, the immunological interplay between RT dose-fractionation and IT is uncertain, and the optimal treatment strategy using RT and IT in metastatic melanoma remains unclear. Our main objective was to examine the effect of RT dose-fractionation on overall survival (OS).

Methods

Using the National Cancer Database (NCDB), we classified metastatic melanoma patients who received palliative RT into two dose-fractionation groups - conventionally fractionated RT (CFRT; <5 Gy/fraction) and hypofractionated RT (HFRT: ≥5 Gy/fraction) - with or without IT. Survival analysis was performed using the Cox regression model, Kaplan-Meier method, and propensity-score matching (PSM).

Results

A total of 5,281 metastatic melanoma patients were included, with a median follow-up of 5.9 months. The three-year OS was highest in patients who received HFRT+IT [37.3% (95% CI: 31.1-43.5)] compared to those who received HFRT alone [19.0% (95% CI: 16.2-21.9)], CFRT+IT [17.6 (95%CI: 13.9-21.6)], or CFRT alone [8.6% (95%CI: 7.6-9.7); p<0.0001]. The magnitude of OS benefit with the use of IT was greater in those who received HFRT (18.3%) compared with those who received CFRT (9.0%) (p<0.0001). The addition of IT to HFRT, compared to CFRT, was associated with greater OS benefit in patients treated with RT to the brain and soft tissue/visceral (STV) sites. On PSM analysis, HFRT+IT was associated with improved three-year OS compared to other treatments.

Conclusion

Metastatic melanoma patients who received HFRT+IT was associated with the greatest OS benefit. Our findings warrant further prospective evaluation as to whether higher RT dose-per-fraction improves clinical outcomes in metastatic melanoma patients receiving IT.

Patterns of Care and Outcomes of Adjuvant Chemoradiation for Node-Positive Pancreatic Adenocarcinoma

PURPOSE

The literature has been conflicting on the superiority of adjuvant chemoradiation over chemotherapy for node-positive adenocarcinoma of the pancreas following definitive surgery. We aimed to evaluate the patterns of care and outcomes of these two treatment options using the National Cancer Database (NCDB).

METHODS

Patients diagnosed with non-metastatic, node-positive adenocarcinoma of the pancreas from 2006 to 2014 who received oncologic resection with negative margins were identified in the NCDB. Patient- and clinical-related factors were compared between those who received adjuvant chemotherapy alone (aC) versus adjuvant chemoradiation (aCRT). Univariable and multivariable logistic regression was performed to assess for predictors of adjuvant chemoradiation use. The Kaplan-Meier method was used to assess overall survival (OS) and Cox regression analysis was used to assess impact of covariables on OS.

RESULTS

There were 3609 patients who met the study criteria, of which 2988 (82.8%) received chemotherapy alone and 621 (17.2%) who received chemoradiation. Median follow up for living patients was 33.8 months (IQR 22-51). On multivariable logistic regression, those who received treatment in more recent years of diagnoses (OR 0.21-0.37, p < 0.001) were less likely to receive aCRT over aC. Two-year OS for those who received chemo alone was 44.9% and for chemoradiation was 42.6% (p = 0.169). This finding was sustained on multivariable survival analysis (HR 0.99, p = 0.867).

CONCLUSIONS

Adjuvant chemotherapy alone for adenocarcinoma of the pancreas is the predominant treatment of choice among US hospitals. There was no overall survival benefit noted in those who were treated with adjuvant chemoradiation.

1197 Utility of Fitbit Charge 2 for Sleep Monitoring in Patients With Obstructive Sleep Apnea

Introduction

The wearable device may be useful in monitoring sleep. Many studies reported reliable data in detecting sleep-wake states and sleep stage proportion in healthy adults, However, only a few validation studies were performed evaluating sleep using the wearable devices in patients with obstructive sleep apnea(OSA), which showed insufficient accuracy. We aimed to evaluate the reliability of multi-sensory wristband (Fitbit Charge 2) in patients with OSA.

Methods

This was a preliminary analysis of a prospective single-center observational study. Consecutive patients underwent standard Polysomnography (PSG) for evaluation of OSA with Fitbit Charge 2. Sleep data from PSG and Fitbit charge 2 were compared using paired t-tests and Bland-Altman plots.

Results

A total of eighty-six patients were analyzed. Four of them had poor data quality, 18 of them did not show sleep stages. Compared with the PSG, Fitbit Charge 2 showed higher total sleep time (419.1±194.0 vs 269.8±22.6, p&lt;0.001) and sleep efficiency (95.8±2.5 vs 84.6±7.1, p&lt;0.001). Those with sleep stage data showed higher sleep efficacy (87.7±5.5 vs 82.37.5, p=0.024) and a lower proportion of N1 sleep (33.7±19.9 vs 65.3±38.8, p=0.01).

Conclusion

Fitbit Charge 2 showed limited utility in monitoring sleep in patients with obstructive sleep apnea.

Support

none

Nickel and dimed: Parking fees at NCI-designated cancer centers

2029

Background: Nonmedical costs from cancer treatment can be a significant out-of-pocket expense. As treatment may span over months, parking costs can become a significant burden on patients and caregivers. This cross-sectional study aims to report parking fees at National Cancer Institute (NCI)-designated cancer centers and to project parking costs for the treatment duration of certain cancers. Methods: Parking fees from NCI treatment centers were obtained via online search or phone call in Fall of 2019. City cost of living, median city household income, and discount availability were documented. Pearson correlation was used between parking costs and city variables. Parking costs were estimated for treatment of node positive breast cancer (12 daily rates plus 20 1-hr rates), definitive head and neck cancer (35 1-hr rates) and acute myeloid leukemia (AML) (42 daily rates). RStudio Version 1.2.5033 was used for analyses. Results: Parking costs were obtained for 100% of the 63 NCI centers included. Median city cost of living relative to New York City was 75.0 (out of 100); median city household income was $55,295 (range $28,974-$120,573). Twenty-five (40%) of NCI centers did not have detailed parking cost information online. Average parking costs were $3.55/hr (median $2, range 0-$15) and $7.79/day (median $5, range 0-$40). Twenty centers (32%) offered completely free parking for patients. Free parking was available at 43 (68%) centers for radiation appointments and 34 (54%) centers for chemotherapy appointments. Averaged estimated parking costs including discounts for a course of treatment for breast cancer was $122.03 (range 0-$800); head and neck cancer, $85.56 (range 0-$665); and AML hospitalization, $327.33 (range 0-$1470). City cost of living was positively correlated with daily parking costs (R = 0.7, p < 0.01) and negatively correlated with both free daily parking (R = -0.33, p = 0.02) and free parking during radiation (R = -0.34, p = 0.02) or chemotherapy (R = -0.37, p < 0.01). The median city household income was correlated with the daily parking costs (R = 0.30 p = 0.02) but not with free daily parking (R = -0.19, p = 0.16), free parking for patients on radiation (R = -0.23, p = 0.09) or on chemotherapy (R = -0.21, p = 0.14). Conclusions: Patients may face significant nonmedical costs through parking fees, even at centers that reflect the highest standard of care. There was high variability in costs with the potential for patients to pay hundreds of dollars in parking in order to receive their care. Efforts to minimize financial toxicity should focus on this potentially under-reported patient concern.

Evaluation of patient education materials for stereotactic radiosurgery from high-performing neurosurgery hospitals and professional societies

Background

Little is known about the readability and utility of patient education materials for stereotactic radiosurgery (SRS). Therefore, the goal of this investigation was to evaluate such materials from high-performing neurosurgery hospitals and professional societies through an analysis of readability and educational content.

Methods

In this cross-cross sectional study, 61 websites associated with the top 50 neurosurgery and neurology hospitals according to U.S. News & World Report (USNWR) and 11 predetermined professional medical societies were queried. Identified SRS education materials were analyzed by 6 readability indices. Educational content was assessed by 10 criteria based on surveys of patients' perspectives about SRS.

Results

Fifty-four materials were identified from the target population (45 from USNWR hospital websites and 9 from professional society websites). Mean readability of materials ranged from 11.7 to 15.3 grade level, far more difficult than national recommendations of sixth and eighth grade. Materials were found to have deficiencies in educational content. Compared with high-performing hospitals, materials from websites of professional societies were longer (P = .002), and more likely to discuss risks and benefits specific to SRS (P = .008), alternative treatment options (P = .05) and expected outcomes or postprocedure descriptions (P = .004). Hospital materials were also more likely to favor brand-specific terminology (eg, GammaKnife) over generic terminology (eg, radiosurgery; P = .019).

Conclusion

Publicly available online patient educational materials for SRS are written at reading levels above national recommendations. Furthermore, many lack information identified as important by patients. Reevaluation and improvement of online SRS educational materials on a national scale are warranted.

The Impact of Formal Mentorship Programs on Mentorship Experience Among Radiation Oncology Residents From the Northeast

Purpose: Strong mentorship has been shown to improve mentee productivity, clinical skills, medical knowledge, and career preparation. We conducted a survey to evaluate resident satisfaction with mentorship within their radiation oncology residency programs. Methods and Materials: In January 2019, 126 radiation oncology residents training at programs in the northeastern United States were asked to anonymously complete the validated Munich Evaluation of Mentoring Questionnaire (MEMeQ). Results of residents with a formal mentoring program were compared to those without a formal program. Results: Overall response rate was 42%(n = 53). Participants were 25% post-graduate year two (PGY-2), 21% PGY-3, 26% PGY-4, and 28% PGY-5. Only 38% of residents reported participation in a formal mentoring program, while 62% had no formal program, and 13% reported having no mentor at all. Residents participating in a formal mentoring program reported strikingly higher rates of overall satisfaction with mentoring compared to those who were not (90% vs. 9%, p < 0.001). Overall, 38% of residents were either satisfied/very satisfied with their mentoring experience, while 49% of residents were unsatisfied/very unsatisfied. Conclusion: Residents participating in a formal mentorship program are significantly more likely to be satisfied with their mentoring experience than those who are not. Our results suggest that radiation oncology residency programs should strongly consider implementing formal mentorship programs.

Readability of Patient Education Materials in Radiation Oncology-Are We Improving?

PURPOSE

Prior research suggests that patient education materials on radiation therapy from various professional groups are written at reading levels above national recommendations of sixth to eighth grade. Since publication of these initial findings, many materials from these sources have been updated or newly created. However, the extent to which readability was considered in the design of these new documents remains unknown. Therefore, the goal of this investigation was to evaluate readability of online education materials for radiation therapy, comparing readability of updated materials with those included in the previous study.

METHODS AND MATERIALS

Patient education materials related to radiation oncology were identified from websites of the 3 professional societies used in the original investigation (the American College of Radiology, the American Cancer Society, and the American Society for Radiation Oncology). The documents included in the first analysis were used as a comparator. To allow for accurate evaluation across groups, materials were matched by content; when necessary, documents were combined from the original cohort to create topically equivalent materials to reflect those currently available on society websites. Identified materials were analyzed using 7 validated readability indices, and results are reported in grade-level equivalents. Original materials were also reanalyzed with the same method.

RESULTS

American Cancer Society materials had the lowest average baseline levels (9.4-11.3 grade level) and showed improved readability in the more recent materials (8.0-10.5 grade level). By contrast, the American Society for Radiation Oncology materials had high average baseline readability levels (11.1-13.9 grade level) that actually worsened in the more recent materials (11.7-16.2 grade level). The number of documents meeting national recommendations did not improve in the updated cohort.

CONCLUSION

Despite evidence that readability levels of patient education materials in radiation oncology are unacceptably high, the readability of newly created materials is not consistently improving across professional societies. Although certain groups may incorporate readability in the design of educational documents, more consistent consideration across all organizations is needed.

Outcomes after empiric radiation therapy for leukemic infiltrates of the lung: A single institution experience

225

Background: Acute leukemias (AL) may present with variable clinical findings, from incidental discovery to respiratory distress or obtundation. However, patients may progress rapidly, requiring emergent treatments including leukophoresis, chemotherapy or radiation. There is little to no data supporting the use of radiation therapy in the setting of presumed lung infiltration. We present the first known case series on the treatment of presumed leukemic lung infiltration with empiric radiation therapy (eRT). Methods: Eleven patients with AL from 2008 – 2018 were identified who were treated with eRT at our center. All patients were on empiric antibiotics, and all were noted to have at least one chest plain film with suspicious infiltrates. The median age was 66 years old (29-77), and five of eleven patients were febrile at the start of radiation. One patient had been intubated prior to radiation delivery. Three of seven patients underwent leukophoresis and six of ten patients received any chemotherapy prior to eRT. Results: The median treatment regimen was 450cGy (range 50 – 1050) in 3 fractions (1 – 7). The median white blood cell (WBC) count prior to radiation therapy was 119.0 x 103 /μL (highest recorded, 1.9 – 317.6), with median blast percentage on manual differential, 88% (3 – 98). All eleven patients had a large reduction in WBC count within the first day of eRT, with median response 48.2% decrease in WBC count (31.7 –99.8; average 57.3%). Ten of ten patients reported subjective improvement in breathing. Conclusions: Empiric radiation therapy is a safe and effective means for rapidly decreasing leukocyte counts and for symptomatic palliation in patients with AL and radiographic chest infiltrates.

Occupational exposure and idiopathic pulmonary fibrosis: a multicentre case-control study in Korea

SETTING

Multicentred hospital-based cases and control subjects in Korea.

OBJECTIVE

To evaluate the association between idiopathic pulmonary fibrosis (IPF) and hazardous materials to which people are occupationally exposed.

DESIGN

A multicentre, hospital-based, matched case-control study was performed. The ratio of IPF cases to controls was 1:1 (n = 78 in each group). IPF cases and controls were matched in terms of age group, sex and place of residence. Conditional logistic regression analysis was performed.

RESULTS

In simple logistic regression analysis, exposure to metal dust and any exposure for >1 year in an occupational setting were significantly associated with IPF (metal dust OR 4.00, 95%CI 1.34-11.97; any exposure OR 3.67, 95%CI 1.02-13.14). After adjustment for environmental and military exposures and smoking history, the OR for metal dust exposure was 4.97 (95%CI 1.36-18.17) in multiple logistic regression analysis.

CONCLUSIONS

Metal dust was associated with incident IPF in Seoul and Gyeonggi Provinces in Korea. This information will be used to support a tailored preventive strategy in specific industries or occupations.

Liver-directed therapy (LDT) for metastatic renal cell carcinoma (mRCC): Single center experience

681

Background: Liver metastases arising from RCC are common and signify a poor prognosis. Given the negative impact of liver metastases on overall survival (OS) and quality of life, it is reasonable to to consider therapies directly targeting these lesions in select patients. Little is known about how minimally invasive LDT affects outcomes in patients with mRCC. Methods: Nine patients with mRCC underwent LDT for liver-dominant or liver-only metastatic disease between 2005 and 2015. Retrospective chart review was performed under an IRB protocol to identify patient and disease characteristics, imaging response, and time to next systemic treatment, OS and toxicities. Patients were seen in clinic at one month post-LDT to monitor for toxicities. Imaging was obtained within 2 months prior to treatment and at 3 and 6 months following LDT. Results: Each patient underwent a median of 2.3 procedures. A total of 18 transarterial chemoembolizations (TACE) and 5 yttrium-90 radioembolizations were performed. 2 patients had metastatic disease confined to the liver, and 7 had liver-dominant disease. 7 had multifocal disease involving < 25% of the liver, and 2 had multifocal disease involving > 25% of the liver. 8/9 patients received prior systemic therapies, receiving a median of 3 (0-4) distinct treatments. 4/9 patients were undergoing systemic therapy at the time of LDT, 1 patient declined further treatment, and the median time to initiation of the next systemic therapy in the remaining patients was 3 months (range 2-4 months). Median OS from first line systemic therapy was 39 months, 95% CI [25.9-53.3], and the median OS from the first LDT was 22 months (from 5-45 months). Follow-up imaging post-LDT showed PR or SD in 88% of cases at 3 months and 44% of cases at 6 months. At one month post-procedure, 8/9 patients maintained performance status, and only one patient experienced CTCAE grade 3-4 toxicity. Conclusions: The median OS in RCC patients with liver disease and systemic therapy alone is 14.3 months. The improved median OS of 39 months with LDT in our unmatched and heavily pretreated cohort suggests a role for LDT. LDT is generally well tolerated and should be considered for patients with liver-dominant mRCC with good performance status.

Local Therapy Improves Overall Survival in Patients With Newly Diagnosed Metastatic Prostate Cancer

BACKGROUND

The role of local therapy, in the form of radiation therapy (RT) or radical prostatectomy(RP), and its association on outcomes is not well established in patients with metastatic prostate cancer.

METHODS

Using the National Cancer Database (NCDB), we evaluated patterns of care and outcomes among patients diagnosed with metastatic prostate cancer from 2004 to 2013 treated with local therapy (RP, intensity-modulated radiation therapy [IMRT], or 2D/3D-conformal radiation therapy [CRT]). The association between local therapy, co-variates, and outcomes was assessed in a multivariable Cox proportional hazards model and Propensity score (PS) matching was performed to balance confounding factors. Survival was estimated using the Kaplan-Meier method.

RESULTS

Among the 1,208,180 patients in the NCDB with prostate cancer, 6,051 patients met the inclusion criteria. No local therapy was used in 5,224 patients, while 622 (10.3%), 52 (0.9%), 153 (2.5%) patients received RP, IMRT, and 2D/3D-CRT, respectively. Use of local therapy was associated with younger age (≤70), lower co-morbidity score, lower T-stage, Gleason score <8, node-negative status, private, and Medicare insurance, higher income quartile, and treatment at comprehensive or academic/research programs (P < 0.05). Five-year overall survival for patients receiving local therapy was 45.7% versus 17.1% for those not receiving local therapy (P < 0.01). In multivariate analysis, RP (HR = 0.51; 95%CI, 0.45-0.59, P < 0.01) and IMRT (HR = 0.47; 95%CI, 0.31-0.72, P < 0.01) were independently associated with superior overall survival. After PS-matching, the use of local therapy (RP or IMRT) remained significantly associated with overall survival (HR = 0.35; 95%CI, 0.30-0.41, P < 0.01).

CONCLUSIONS

The use of RP and IMRT, to treat the primary disease, was associated with improvements in overall survival for patients with metastatic prostate cancer. We have identified patient-specific variations in the use of local therapy that may be tested in subsequent prospective clinical trials to improve patient outcomes in this setting. Prostate 77: 559-572, 2017. © 2017 Wiley Periodicals, Inc.

Rapid extraction of uranium ions from seawater using novel porous polymeric adsorbents

Nanoporous polymeric networks, are firstly exploited for uranium capture from seawater. Amidoxime PIM-1 is capable of uptake 95% of uranium in 24 h, and the U extraction efficiency is to be intact throughout three cycles of sorbent regeneration.

Observation of the wrapping mechanism in amine carbon dioxide molecular interactions on heterogeneous sorbents

CO₂ binds multiple amines if nearby, leading to higher heats of adsorption, a previously unknown observation.

CR6-interacting factor 1 is a key regulator in Aβ-induced mitochondrial disruption and pathogenesis of Alzheimer's disease

Mitochondrial dysfunction, often characterized by massive fission and other morphological abnormalities, is a well-known risk factor for Alzheimer's disease (AD). One causative mechanism underlying AD-associated mitochondrial dysfunction is thought to be amyloid-β (Aβ), yet the pathways between Aβ and mitochondrial dysfunction remain elusive. In this study, we report that CR6-interacting factor 1 (Crif1), a mitochondrial inner membrane protein, is a key player in Aβ-induced mitochondrial dysfunction. Specifically, we found that Crif1 levels were downregulated in the pathological regions of Tg6799 mice brains, wherein overexpressed Aβ undergoes self-aggregation. Downregulation of Crif1 was similarly observed in human AD brains as well as in SH-SY5Y cells treated with Aβ. In addition, knockdown of Crif1, using RNA interference, induced mitochondrial dysfunction with phenotypes similar to those observed in Aβ-treated cells. Conversely, Crif1 overexpression prevented Aβ-induced mitochondrial dysfunction and cell death. Finally, we show that Aβ-induced downregulation of Crif1 is mediated by enhanced reactive oxygen species (ROS) and ROS-dependent sumoylation of the transcription factor specificity protein 1 (Sp1). These results identify the ROS-Sp1-Crif1 pathway to be a new mechanism underlying Aβ-induced mitochondrial dysfunction and suggest that ROS-mediated downregulation of Crif1 is a crucial event in AD pathology. We propose that Crif1 may serve as a novel therapeutic target in the treatment of AD.