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Wilson RRA, Toups N, Andrews K, Irma C, Myers P, Kirby N, Newman NB. Vertebral Dose Sparing during Lung and Esophageal Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e74-e75. [PMID: 37786148 DOI: 10.1016/j.ijrobp.2023.06.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The vertebral bodies contain approximately 20-25% of all bone marrow in the body. Lymphopenia is a known negative prognostic factor in thoracic malignancies. Studies have previously demonstrated that patients receiving radiation to the lumbar spine and/or pelvis have shown increased fat deposition/bone marrow scarring following therapy, which leads to long term immunosuppressive effects. In anticipation for an open clinical trial, and based on previously published work, we explored whether retrospectively constraining the thoracic bone marrow is practically feasible and leads to minimal increase in dose to the remaining OARs (Organs at Risk). MATERIALS/METHODS Patients with previously treated thoracic cancer were included in this study. The thoracic bone marrow was contoured using PET scan to verify avid areas and a new plan was created. Guideline constraints for the thoracic bone marrow were V10 (<300cc), V20 (<200 cc), and V30 (<150cc). If bone marrow optimization caused a violation of standard OAR guidelines, then the bone marrow constraints were not met. The median changes in thoracic bone marrow and OARs (lung, heart, spinal cord) were compared with the Wilcoxon sign rank test for non-parametric paired samples. RESULTS We included 20 patients, 10 with esophageal cancer and 10 with NSCLC (Non-Small Cell Lung Cancer). Only three cases were able to meet the prespecified bone marrow constraints after optimization (15%). Bone marrow median V10 was reduced by 20cc (-8.16%). Larger changes were seen in V20 and V30 dose-volume reductions, with decreases of 35.3 and 32.3 cc (-16.4% and -21.3%), respectively. There was a significant reduction (p<0.001) for V30, V20, and V10. Though most experienced a decrease in mean heart dose, there was an overall median increase of 21.00 cGy, attributable to a single outlier (P = 1). Median cord dose was decreased by 418.5 cGy. There was a minimal non-significant increase in median Lung V20 of 0.76% as well as minimal median increase in the mean lung dose (7 cGy). CONCLUSION This retrospective dosimetric analysis reveals that bone marrow can be optimized. While not able to meet thresholds predictive of minimizing Grade 4 lymphopenia, dose reduction can safely be done with minimal increase in values known to cause toxicity in the heart, lungs, and cord. Though radiation dosage to the thoracic vertebrae was not eliminated entirely, significant decreases in median dosages were achieved without compromising OAR dose. Bone marrow sparing should be considered when feasible and this planning technique is currently being used in an open prospective trial.
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Affiliation(s)
- R R A Wilson
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | - N Toups
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | - K Andrews
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | - C Irma
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | - P Myers
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | - N Kirby
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | - N B Newman
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
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LeVasseur N, Li H, Cheung W, Myers P, Mckevitt E, Warburton R, Willemsma KA, Tan AD, Chia S, Simmons C. Effects of High Anxiety Scores on Surgical and Overall Treatment Plan in Patients with Breast Cancer Treated with Neoadjuvant Therapy. Oncologist 2019; 25:212-217. [PMID: 32162800 DOI: 10.1634/theoncologist.2019-0512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/20/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with newly diagnosed breast cancer and high levels of anxiety often pursue more aggressive surgical interventions. The neoadjuvant treatment (NAT) setting could provide a window of opportunity to address patients' anxiety. However, the impact of anxiety on surgical decisions in the setting of NAT for breast cancer has not been previously studied. MATERIALS AND METHODS A prospective database of patients with breast cancer treated with NAT at BC Cancer was used to identify patients treated with NAT and subsequent surgical resection. Patients with bilateral breast cancer or BRCA mutations or those referred to the hereditary cancer program were excluded. An anxiety score of 0-3 was assigned based on responses to the Edmonton Symptom Assessment System and Psychosocial Screen for Cancer. Clinicopathological information and treatment data were retrieved and cross-referenced between the low-anxiety (scores 0-1) and high-anxiety (scores 2-3) cohorts. RESULTS From 2012 to 2016, 203 patients met eligibility criteria. Of these, 93 patients (45.8%) had low anxiety and 110 patients (54.2%) had high anxiety. Overall, 161 patients (79.3%) had locally advanced cancers; no differences in stage, grade, or biomarkers were found between the low- and high-anxiety cohorts. Patients with high self-reported anxiety at initial consultation were younger (mean 56 years vs. 60 years; p = .011) and more likely to undergo mastectomy for breast-conserving surgery-eligible disease and bilateral mastectomy for unilateral disease compared with those with low anxiety (37.3% vs. 18.3%; likelihood ratio 9.15; p = .002). No significant differences in treatment timelines were identified between the two cohorts. CONCLUSION Patients with high anxiety at initial consultation were nine times more likely to undergo aggressive surgery compared with patients with low anxiety. These findings underscore the need for early identification of patients who may benefit from tailored supportive and educational services to address sources of anxiety and knowledge gaps. IMPLICATIONS FOR PRACTICE The prevalence of anxiety among women with newly diagnosed breast cancer is being increasingly acknowledged. However, health care providers have not fully appreciated the impact of anxiety on the surgical management of patients with early-stage breast cancer. This study highlights the importance of self-reported anxiety on surgical management. The preoperative period provides a unique window of opportunity to address sources of anxiety and provide targeted educational materials over a period of 4-6 months, which may ultimately lead to less aggressive surgery when it is not needed.
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Affiliation(s)
| | - Huaqi Li
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Winson Cheung
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Canada
| | - Paula Myers
- Department of Patient and Family Counselling, BC Cancer, Vancouver, Canada
| | | | | | | | - Adam Deruchie Tan
- Department of Applied Health Sciences, University of Waterloo, Waterloo, Canada
| | - Stephen Chia
- Department of Medical Oncology, BC Cancer, Vancouver, Canada
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Manca M, Pessoa V, Myers P, Pickles A, Hill J, Sharp H, Murgatroyd C, Bubb VJ, Quinn JP. Distinct chromatin structures at the monoamine oxidase-A promoter correlate with allele-specific expression in SH-SY5Y cells. Genes Brain Behav 2019; 18:e12483. [PMID: 29667298 PMCID: PMC6617726 DOI: 10.1111/gbb.12483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/19/2018] [Accepted: 04/13/2018] [Indexed: 11/30/2022]
Abstract
Monoamine oxidase-A (MAOA) metabolises monoamines and is implicated in the pathophysiology of psychiatric disorders. A polymorphic repetitive DNA domain, termed the uVNTR (upstream variable number tandem repeat), located at the promoter of the MAOA gene is a risk factor for many of these disorders. MAOA is on the X chromosome suggesting gender could play a role in regulation. We analysed MAOA regulation in the human female cell line, SH-SY5Y, which is polymorphic for the uVNTR. This heterozygosity allowed us to correlate allele-specific gene expression with allele-specific transcription factor binding and epigenetic marks for MAOA. Gene regulation was analysed under basal conditions and in response to the mood stabiliser sodium valproate. Both alleles were transcriptionally active under basal growth conditions; however, the alleles showed distinct transcription factor binding and epigenetic marks at their respective promoters. Exposure of the cells to sodium valproate resulted in differential allelic expression which correlated with allele-specific changes in distinct transcription factor binding and epigenetic marks at the region encompassing the uVNTR. Biochemically our model for MAOA promoter function has implications for gender differences in gene × environment responses in which the uVNTR has been implicated as a genetic risk.
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Affiliation(s)
- M. Manca
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
- Institute of Psychology, Health and SocietyUniversity of LiverpoolLiverpoolUK
| | - V. Pessoa
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
- Institute of Psychology, Health and SocietyUniversity of LiverpoolLiverpoolUK
| | - P. Myers
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| | - A. Pickles
- King's College London, MRC Social Genetic and Developmental Psychiatry Research CentreInstitute of PsychiatryLondonUK
| | - J. Hill
- School for Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - H. Sharp
- Institute of Psychology, Health and SocietyUniversity of LiverpoolLiverpoolUK
| | - C. Murgatroyd
- School of Healthcare ScienceManchester Metropolitan UniversityManchesterUK
| | - V. J. Bubb
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| | - J. P. Quinn
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
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Affiliation(s)
- P Myers
- University of Rochester, Rochester, NY
| | - R Park
- University of Rochester, Rochester, NY
| | - A Patel
- University of Rochester, Rochester, NY
| | - D E Bell
- University of Rochester, Rochester, NY
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Li H, Cheung W, Myers P, McKevitt E, Willemsma K, Deruchie Tan A, Chia S, Simmons C. Abstract P4-11-01: Effects of high anxiety scores on surgical and overall treatment plan in breast cancer patients treated with neoadjuvant therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-11-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Anxiety is a common symptom in patients with newly diagnosed cancer. Patients with high levels of anxiety have been shown to choose more invasive surgeries in various cancer settings. Rates of contralateral prophylactic mastectomy in the adjuvant setting remain high, despite offering no survival advantage. In the neoadjuvant setting, patients have more time for decisions regarding final surgery. If anxiety is playing a role in their decisions, this could be addressed while on neoadjuvant therapy (NAT). However, the impact of anxiety at initial diagnosis on surgical decision making in this setting has not yet been studied.
Methods:
Data collected from a prospective institutional database of breast cancer patients treated with NAT at the British Columbia Cancer Agency (BCCA) were utilized to identify all patients. Information was extracted from this database with regards to patient and tumour characteristics, initial surgical plan, and final surgery performed. This was cross referenced with patient self-reported anxiety, which was extracted from the Edmonton Symptom Assessment System (ESAS) and the Psychosocial Screen for Cancer (PSSCAN) forms administered at initial consultation. Patients were assigned a score of 0 to 3 based on their answers to the ESAS anxiety scale and the PSSCAN anxiety questions, and whether or not they had any concerns related to their care. Patients were excluded if they had bilateral breast cancer, BRCA mutation or referral to the Hereditary Cancer Program, did not receive NAT or undergo breast surgery, or did not complete the forms. Fisher's exact tests were applied for statistical analysis.
Results:
From 2012-2016, 361 potential patients were identified for this study. A total of 203 patients met eligibility criteria. 93 patients (46%) had low anxiety (score 0 or 1) and 110 patients (54%) had high anxiety (score 2 or 3). Patients with high self-reported anxiety at initial consultation were significantly more likely to undergo bilateral mastectomy for unilateral disease and mastectomy for breast conserving surgery (BCS) eligible disease than those with low self-reported anxiety at initial consultation (37.3% VS 18.3%; p=0.003). No significant differences in treatment times (time interval between biopsy to chemotherapy, chemotherapy to surgery, and surgery to radiation) or investigations were identified when comparing high and low anxiety patients.
Anxiety level and type of surgery performedType of SurgeryAnxiety Level Low (n=93)High (n=110) Bilateral Mastectomy and Mastectomy for BCS eligible disease17 (18.3%)41 (37.3%) BCS and Mastectomy for non-BCS eligible disease76 (81.7%)69 (62.7%) p = 0.0031
Conclusion:
High anxiety scores lead to a 19% increase in bilateral mastectomies in patients without bilateral disease and mastectomies in patients eligible for BCS compared to patients with low anxiety (p = 0.003). These findings suggest that self-reported anxiety levels can inform and assist physicians to identify patients who are more likely to undergo aggressive surgery and may need further counselling and support services. Future work should examine the effects of counselling intervention in patients with high anxiety on surgical decisions.
Citation Format: Li H, Cheung W, Myers P, McKevitt E, Willemsma K, Deruchie Tan A, Chia S, Simmons C. Effects of high anxiety scores on surgical and overall treatment plan in breast cancer patients treated with neoadjuvant therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-11-01.
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Affiliation(s)
- H Li
- University of Waterloo, Waterloo, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Patient and Family Counseling, BC Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
| | - W Cheung
- University of Waterloo, Waterloo, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Patient and Family Counseling, BC Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
| | - P Myers
- University of Waterloo, Waterloo, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Patient and Family Counseling, BC Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
| | - E McKevitt
- University of Waterloo, Waterloo, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Patient and Family Counseling, BC Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
| | - K Willemsma
- University of Waterloo, Waterloo, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Patient and Family Counseling, BC Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
| | - A Deruchie Tan
- University of Waterloo, Waterloo, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Patient and Family Counseling, BC Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
| | - S Chia
- University of Waterloo, Waterloo, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Patient and Family Counseling, BC Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
| | - C Simmons
- University of Waterloo, Waterloo, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Patient and Family Counseling, BC Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada; Wilfrid Laurier University, Waterloo, ON, Canada
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Li H, Cheung WY, Myers P, McKevitt E, Willemsma K, Deruchie Tan A, Chia SKL, Simmons CE. Anxiety in breast cancer patients treated with neoadjuvant therapy: Effects on surgical plan and role of supportive care. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
35 Background: The impact of high anxiety on surgical decision making has been demonstrated in various cancer settings. For patients undergoing neoadjuvant therapy (NAT) for breast cancer, supportive services can be offered prior to surgery and may help them choose between the options of bilateral mastectomy, unilateral mastectomy, or breast conserving surgery (BCS) where clinically appropriate. However, the effect of anxiety at initial diagnosis and psychological support on these decisions has not yet been studied. Methods: A prospective database of breast cancer patients treated with NAT at the British Columbia Cancer Agency was utilized to extract demographic information, surgical plan with regards to BCS and unilateral or bilateral mastectomy, and information about supportive services utilized. This was correlated with anxiety scores at initial consultation recorded by the Edmonton Symptom Assessment System and the Psychosocial Screen for Cancer. Patients were excluded if they had bilateral breast cancer, BRCA mutation, or missing data. Fisher’s exact tests were applied for statistical analysis. Results: From 2012-2016, 361 potential patients were identified. In total, 203 patients met eligibility criteria: 93 patients (46%) had low anxiety and 110 patients (54%) had high anxiety. Patients with high self-reported anxiety at initial consultation were 19% more likely to undergo aggressive surgery (bilateral mastectomy for unilateral disease or mastectomy for BCS eligible disease) than those with low self-reported anxiety at initial consultation (37% VS 18%; p = 0.003). Of the 110 patients with high anxiety, only 46 patients (42%) utilized counselling before surgery. No significant difference in rate of aggressive surgery was observed in patients with high anxiety who had counselling compared to those who did not (33% VS 41%; p = 0.43). Conclusions: High anxiety at initial consultation is associated with a 19% increase in aggressive surgery compared to patients with low anxiety. Counselling resources are currently underutilized by eligible patients, but this did not have an impact on surgical decision making in this study. This may be an area of opportunity for further research.
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Affiliation(s)
- Huaqi Li
- University of Waterloo, Waterloo, ON, Canada
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Henry JA, Thielman EJ, Zaugg TL, Kaelin C, Schmidt CJ, Griest S, McMillan GP, Myers P, Rivera I, Baldwin R, Carlson K. Randomized Controlled Trial in Clinical Settings to Evaluate Effectiveness of Coping Skills Education Used With Progressive Tinnitus Management. J Speech Lang Hear Res 2017; 60:1378-1397. [PMID: 28418492 DOI: 10.1044/2016_jslhr-h-16-0126] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/07/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE This randomized controlled trial evaluated, within clinical settings, the effectiveness of coping skills education that is provided with progressive tinnitus management (PTM). METHOD At 2 Veterans Affairs medical centers, N = 300 veterans were randomized to either PTM intervention or 6-month wait-list control. The PTM intervention involved 5 group workshops: 2 led by an audiologist (teaching how to use sound as therapy) and 3 by a psychologist (teaching coping skills derived from cognitive behavioral therapy). It was hypothesized that PTM would be more effective than wait-list control in reducing functional effects of tinnitus and that there would be no differences in effectiveness between sites. RESULTS At both sites, a statistically significant improvement in mean Tinnitus Functional Index scores was seen at 6 months for the PTM group. Combined data across sites revealed a statistically significant improvement in Tinnitus Functional Index relative to wait-list control. The effect size for PTM using the Tinnitus Functional Index was 0.36 (small). CONCLUSIONS Results suggest that PTM is effective at reducing tinnitus-related functional distress in clinical settings. Although effect sizes were small, they provide evidence of clinical effectiveness of PTM in the absence of stringent research-related inclusion criteria and with a relatively small number of sessions of cognitive behavioral therapy.
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Affiliation(s)
- James A Henry
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, ORDepartment of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Emily J Thielman
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
| | - Tara L Zaugg
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
| | - Christine Kaelin
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
| | - Caroline J Schmidt
- Psychology Service and Audiology Service, Veterans Affairs Connecticut Healthcare System, West HavenDepartment of Psychiatry, Yale University, New Haven, CT
| | - Susan Griest
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, ORDepartment of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Garnett P McMillan
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
| | - Paula Myers
- Department of Audiology, James A. Haley Veterans Hospital, Tampa, FL
| | - Izel Rivera
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO
| | | | - Kathleen Carlson
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, ORVeterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Portland Health Care System, ORSchool of Public Health, Oregon Health & Science University, Portland
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Saunders GH, Frederick MT, Arnold M, Silverman S, Chisolm TH, Myers P. Auditory difficulties in blast-exposed Veterans with clinically normal hearing. ACTA ACUST UNITED AC 2016; 52:343-60. [PMID: 26237266 DOI: 10.1682/jrrd.2014.11.0275] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/12/2015] [Indexed: 11/05/2022]
Abstract
UNLABELLED Vast numbers of blast-injured Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn personnel report postconcussive symptoms that include headache, dizziness, poor memory, and difficulty concentrating. In addition, many report hearing problems, such as difficulty understanding speech in noise, yet have no measureable peripheral auditory deficits. In this article, self-report and performance-based measures were used to assess 99 blast-exposed Veterans. All participants reported auditory problems in difficult listening situations but had clinically normal hearing. Participants' scores on self-report questionnaires of auditory difficulties were more similar to scores of older individuals with hearing impairment than to those of younger individuals with normal hearing. Participants showed deficits relative to published normative data on a number of performance-based tests that have demonstrated sensitivity to auditory processing deficits. There were several measures on which more than the expected number of participants (15.9%) performed one or more standard deviations below the mean. These were assessments of speech understanding in noise, binaural processing, temporal resolution, and speech segregation. Performance was not universally poor, with approximately 53% of participants performing abnormally on between 3 and 6 of the 10 measures. We concluded that participants exhibited task-specific deficits that add to the evidence suggesting that blast injury results in damage to the central auditory system. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov; Approaches to Auditory Rehabilitation for Mild Traumatic Brain Injury (mTBI); NCT00930774; https://clinicaltrials.gov/ct2/show/NCT00930774?term=NCT00930774&rank=1.
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Affiliation(s)
- Gabrielle H Saunders
- National Center for Rehabilitative Auditory Research, Department of Veterans Affairs Portland Health Care System, Portland, OR
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Abstract
BACKGROUND Referrals to ophthalmology are predominantly made from general practitioners (GPs) and optometrists. These two groups of referrers receive differing types and levels of training and are equipped with different instrumentation. The purpose of this study was to determine whether the quality of referrals to the hospital eye service (HES) differs between GPs and optometrists in Walsall. METHODS Referrals into the HES were identified from Q1 2014 retrospectively until 1000 notes had been reached. Each record was scrutinized using a standard template. Data were analysed and summary statistics produced including positive predictive values and interobserver agreement. RESULTS We achieved our target of auditing 1000 records. The false-positive rate (patients being discharged from HES with a 'normal vision' diagnosis) was 7.7% of referrals from GPs and 6.2% of referrals from optometrists. Concordance between referred condition and diagnosed condition at HES between optometrists and ophthalmologists was 76.1%, and between GPs and ophthalmologists was 67.2%. CONCLUSIONS In view of findings from this study, it is important for commissioners in the new reconfigured National Health Service to ensure that enhanced ophthalmic services are commissioned only on the basis of hard evidence sourced from local data rather than opinion or on data from another geographical area.
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Affiliation(s)
- M Fung
- Public Health Department, Walsall Council, Walsall WS1 1TP, UK
| | - P Myers
- Public Health Department, Walsall Council, Walsall WS1 1TP, UK
| | - P Wasala
- Public Health Department, Walsall Council, Walsall WS1 1TP, UK
| | - N Hirji
- Academic Unit of Public Health, University of Leeds, Leeds LS2 9JT, UK
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Taylor Z, Myers P, Hoffman S. Colonization of the Beaver Island Archipelago by deer mice (Peromyscus maniculatus gracilis): mtDNA evidence for multiple origins. CAN J ZOOL 2015. [DOI: 10.1139/cjz-2014-0234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Beaver Island group in Lake Michigan comprises nine islands ranging from 0.3 to 144 km2, lying approximately 30 km west of Michigan’s Lower Peninsula (LP) and 15 km south of the Upper Peninsula (UP). The islands have been isolated from mainland Michigan for most of their postglacial history, but were connected to the mainland LP during the low-water Chippewa stage (ending about 7400 years before present (YBP)). Although plants and animals could have colonized the islands during the Chippewa period, flooding during the subsequent Nipissing high-water stand means that the smaller islands have been colonized more recently. We analyzed 481 bp of mitochondrial D-loop sequences from woodland deer mice (Peromyscus maniculatus (Wagner, 1845)) on six of these islands in northern Lake Michigan to elucidate the mainland origin and minimum number of colonization events for this species. Surprisingly, the distribution of haplotypes on the islands suggests that the populations on most islands likely had separate recent origins on the mainland UP. Approximate Bayesian computation supports a scenario in which individual islands were colonized separately by distinct groups of mice. Together, the data suggest multiple colonization events from the UP, rather than expansion from a bottlenecked population or a single colonization event.
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Affiliation(s)
- Z.S. Taylor
- Department of Biology, Miami University, Oxford, OH 45056-1400, USA
| | - P. Myers
- Museum of Zoology and Department of Ecology and Evolutionary Biology, University of Michigan, 1109 Geddes, Ann Arbor, MI 48109-1079, USA
| | - S.M.G. Hoffman
- Department of Biology, Miami University, Oxford, OH 45056-1400, USA
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Frederick M, Chisolm T, Silverman S, Arnold M, Myers P, Saunders G. Use of a Frequency-Modulated System for Veterans with Blast Exposure, Perceived Hearing Problems, and Normal Hearing Sensitivity. Semin Hear 2014. [DOI: 10.1055/s-0034-1383507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Melissa Frederick
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center
| | - Theresa Chisolm
- Department of Communication Sciences and Disorders, University of South Florida
| | - ShienPei Silverman
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center
| | - Michelle Arnold
- Department of Communication Sciences and Disorders, University of South Florida
| | - Paula Myers
- James A. Haley Veterans' Hospital, Tampa, Florida
| | - Gabrielle Saunders
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center
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Rocha LA, Aleixo A, Allen G, Almeda F, Baldwin CC, Barclay MVL, Bates JM, Bauer AM, Benzoni F, Berns CM, Berumen ML, Blackburn DC, Blum S, Bolaños F, Bowie RCK, Britz R, Brown RM, Cadena CD, Carpenter K, Ceríaco LM, Chakrabarty P, Chaves G, Choat JH, Clements KD, Collette BB, Collins A, Coyne J, Cracraft J, Daniel T, de Carvalho MR, de Queiroz K, Di Dario F, Drewes R, Dumbacher JP, Engilis A, Erdmann MV, Eschmeyer W, Feldman CR, Fisher BL, Fjeldså J, Fritsch PW, Fuchs J, Getahun A, Gill A, Gomon M, Gosliner T, Graves GR, Griswold CE, Guralnick R, Hartel K, Helgen KM, Ho H, Iskandar DT, Iwamoto T, Jaafar Z, James HF, Johnson D, Kavanaugh D, Knowlton N, Lacey E, Larson HK, Last P, Leis JM, Lessios H, Liebherr J, Lowman M, Mahler DL, Mamonekene V, Matsuura K, Mayer GC, Mays H, McCosker J, McDiarmid RW, McGuire J, Miller MJ, Mooi R, Mooi RD, Moritz C, Myers P, Nachman MW, Nussbaum RA, Foighil DÓ, Parenti LR, Parham JF, Paul E, Paulay G, Pérez-Emán J, Pérez-Matus A, Poe S, Pogonoski J, Rabosky DL, Randall JE, Reimer JD, Robertson DR, Rödel MO, Rodrigues MT, Roopnarine P, Rüber L, Ryan MJ, Sheldon F, Shinohara G, Short A, Simison WB, Smith-Vaniz WF, Springer VG, Stiassny M, Tello JG, Thompson CW, Trnski T, Tucker P, Valqui T, Vecchione M, Verheyen E, Wainwright PC, Wheeler TA, White WT, Will K, Williams JT, Williams G, Wilson EO, Winker K, Winterbottom R, Witt CC. Specimen collection: an essential tool. Science 2014; 344:814-5. [PMID: 24855245 DOI: 10.1126/science.344.6186.814] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- L A Rocha
- California Academy of Sciences, San Francisco, CA 94118, USA.
| | - A Aleixo
- Museu Paraense Emílio Goeldi, Belém, PA, 66040-170, Brazil
| | - G Allen
- Western Australian Museum, Perth, WA, 6986, Australia
| | - F Almeda
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - C C Baldwin
- Smithsonian Institution, Washington, DC 20560, USA
| | | | - J M Bates
- Field Museum of Natural History, Chicago, IL 60605, USA
| | - A M Bauer
- Villanova University, Villanova, PA 19085, USA
| | - F Benzoni
- University of Milano-Bicocca, Milan, 20126, Italy
| | | | - M L Berumen
- King Abdullah University of Science and Technology, Thuwal, 23955, Saudi Arabia
| | - D C Blackburn
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - S Blum
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - F Bolaños
- Universidad de Costa Rica, San José, 11501-2060, Costa Rica
| | - R C K Bowie
- University of California, Berkeley, CA 94720-3161, USA
| | - R Britz
- Natural History Museum, London, SW7 5BD, UK
| | - R M Brown
- University of Kansas, Lawrence, KS 66045, USA
| | - C D Cadena
- Universidad de los Andes, Bogotá, 4976, Colombia
| | - K Carpenter
- Old Dominion University, Norfolk, VA 23529, USA
| | - L M Ceríaco
- Museu Nacional de História Natural e da Ciência, Lisbon, 7005-638, Portugal
| | - P Chakrabarty
- Louisiana State University, Baton Rouge, LA 70803, USA
| | - G Chaves
- Universidad de Costa Rica, San José, 11501-2060, Costa Rica
| | - J H Choat
- James Cook University, Townsville, 4811, Australia
| | - K D Clements
- University of Auckland, Auckland, 1142, New Zealand
| | - B B Collette
- NOAA Systematics Laboratory, Washington, DC 20013, USA
| | - A Collins
- NOAA Systematics Laboratory, Washington, DC 20013, USA
| | - J Coyne
- University of Chicago, Chicago, IL 60637, USA
| | - J Cracraft
- American Museum of Natural History, New York, NY 10024, USA
| | - T Daniel
- California Academy of Sciences, San Francisco, CA 94118, USA
| | | | - K de Queiroz
- Smithsonian Institution, Washington, DC 20560, USA
| | - F Di Dario
- Universidade Federal do Rio de Janeiro, Macaé, RJ, 27965-045, Brazil
| | - R Drewes
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - J P Dumbacher
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - A Engilis
- University of California, Davis, CA 95616, USA
| | - M V Erdmann
- Conservation International, Denpasar, Bali, 80235, Indonesia
| | - W Eschmeyer
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - C R Feldman
- University of Nevada, Reno, NV 89557-0314, USA
| | - B L Fisher
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - J Fjeldså
- Natural History Museum of Denmark, Copenhagen, DK-2100, Denmark
| | - P W Fritsch
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - J Fuchs
- Muséum National d'Histoire Naturelle, Paris, 75005, France
| | - A Getahun
- Addis Ababa University, Addis Ababa, 1176, Ethiopia
| | - A Gill
- University of Sydney, Sydney, NSW, 2006, Australia
| | - M Gomon
- Museum Victoria, Melbourne, 3001, VIC, Australia
| | - T Gosliner
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - G R Graves
- Smithsonian Institution, Washington, DC 20560, USA
| | - C E Griswold
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - R Guralnick
- University of Colorado, Boulder, CO 80309-0334, USA
| | - K Hartel
- Harvard University, Cambridge, MA 02138, USA
| | - K M Helgen
- Smithsonian Institution, Washington, DC 20560, USA
| | - H Ho
- University of California, Davis, CA 95616, USA
| | - D T Iskandar
- Conservation International, Denpasar, Bali, 80235, Indonesia
| | - T Iwamoto
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - Z Jaafar
- Smithsonian Institution, Washington, DC 20560, USA. National University of Singapore, 117543, Singapore
| | - H F James
- Smithsonian Institution, Washington, DC 20560, USA
| | - D Johnson
- Smithsonian Institution, Washington, DC 20560, USA
| | - D Kavanaugh
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - N Knowlton
- Smithsonian Institution, Washington, DC 20560, USA
| | - E Lacey
- University of California, Berkeley, CA 94720-3161, USA
| | - H K Larson
- Museum and Art Gallery of the Northern Territory, Darwin, 0820, NT, Australia
| | - P Last
- CSIRO Marine & Atmospheric Research, Hobart, TAS, 7000, Australia
| | - J M Leis
- Australian Museum, Sydney, NSW, 2010, Australia
| | - H Lessios
- Smithsonian Tropical Research Institute, Balboa, 0843-03092, Panamá
| | - J Liebherr
- Cornell University, Ithaca, NY 14853, USA
| | - M Lowman
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - D L Mahler
- University of California, Davis, CA 95616, USA
| | - V Mamonekene
- Université Marien Ngouabi, Brazzaville, B.P. 69, Republic of Congo
| | - K Matsuura
- National Museum of Nature and Science, Tsukuba, 305-0005, Japan
| | - G C Mayer
- University of Wisconsin-Parkside, Kenosha, WI 53141-2000, USA
| | - H Mays
- Cincinnati Museum Center, Cincinnati, OH 45203, USA
| | - J McCosker
- California Academy of Sciences, San Francisco, CA 94118, USA
| | | | - J McGuire
- University of California, Berkeley, CA 94720-3161, USA
| | - M J Miller
- Smithsonian Tropical Research Institute, Balboa, 0843-03092, Panamá
| | - R Mooi
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - R D Mooi
- The Manitoba Museum, Winnipeg, MB, R3B 0N2, Canada
| | - C Moritz
- Australian National University, Canberra, ACT, 0200, Australia
| | - P Myers
- University of Michigan, Ann Arbor, MI 48109-1079, USA
| | - M W Nachman
- University of California, Berkeley, CA 94720-3161, USA
| | - R A Nussbaum
- University of Michigan, Ann Arbor, MI 48109-1079, USA
| | - D Ó Foighil
- University of Michigan, Ann Arbor, MI 48109-1079, USA
| | - L R Parenti
- Smithsonian Institution, Washington, DC 20560, USA
| | - J F Parham
- California State University, Fullerton, CA 92831, USA
| | - E Paul
- The Ornithological Council, Chevy Chase, MD 20815, USA
| | - G Paulay
- University of Florida, Gainesville, fl32611, USA
| | - J Pérez-Emán
- Universidad Central de Venezuela, Caracas, 1041, Venezuela
| | - A Pérez-Matus
- Pontif cia Universidad Católica de Chile, Santiago 6513677, Chile
| | - S Poe
- University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - J Pogonoski
- CSIRO Marine & Atmospheric Research, Hobart, TAS, 7000, Australia
| | - D L Rabosky
- University of Michigan, Ann Arbor, MI 48109-1079, USA
| | - J E Randall
- Bernice P. Bishop Museum, Honolulu, HI 96817, USA
| | - J D Reimer
- University of the Ryukyus, Nishihara, 903-0213, Japan
| | - D R Robertson
- Smithsonian Tropical Research Institute, Balboa, 0843-03092, Panamá
| | - M-O Rödel
- Museum für Naturkunde, Berlin, 10115, Germany
| | - M T Rodrigues
- Universidade de São Paulo, São Paulo, SP, 05508-090, Brazil
| | - P Roopnarine
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - L Rüber
- Naturhistorisches Museum der Burgergemeinde Bern, Bern, CH-3005, Switzerland
| | - M J Ryan
- University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - F Sheldon
- Louisiana State University, Baton Rouge, LA 70803, USA
| | - G Shinohara
- National Museum of Nature and Science, Tsukuba, 305-0005, Japan
| | - A Short
- University of Kansas, Lawrence, KS 66045, USA
| | - W B Simison
- California Academy of Sciences, San Francisco, CA 94118, USA
| | | | - V G Springer
- Smithsonian Institution, Washington, DC 20560, USA
| | - M Stiassny
- American Museum of Natural History, New York, NY 10024, USA
| | - J G Tello
- American Museum of Natural History, New York, NY 10024, USA. Long Island University, Brooklyn, NY 11201-8423, USA
| | - C W Thompson
- University of Michigan, Ann Arbor, MI 48109-1079, USA
| | - T Trnski
- Auckland Museum, Auckland, 1142, New Zealand
| | - P Tucker
- University of Michigan, Ann Arbor, MI 48109-1079, USA
| | - T Valqui
- Centro de Ornitologia y Biodiversidad, Lima, 33, Peru
| | - M Vecchione
- NOAA Systematics Laboratory, Washington, DC 20013, USA
| | - E Verheyen
- Royal Belgian Institute of Natural Sciences, Brussels, 1000, Belgium
| | | | - T A Wheeler
- McGill University, Montreal, QC, H9X 3V9, Canada
| | - W T White
- CSIRO Marine & Atmospheric Research, Hobart, TAS, 7000, Australia
| | - K Will
- University of California, Berkeley, CA 94720-3161, USA
| | - J T Williams
- Smithsonian Institution, Washington, DC 20560, USA
| | - G Williams
- California Academy of Sciences, San Francisco, CA 94118, USA
| | - E O Wilson
- Harvard University, Cambridge, MA 02138, USA
| | - K Winker
- University of Alaska Museum, Fairbanks, AK 99775, USA
| | | | - C C Witt
- University of New Mexico, Albuquerque, NM 87131-0001, USA
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Myers P, Tran D, Liu T, Rodriguez-Rivera E. SU-E-J-22: Alternative Method for Evaluating the Need for Replanning in Patient's with Significant Anatomical Changes. Med Phys 2014. [DOI: 10.1118/1.4888073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Stathakis S, Mavroidis P, Esquivel C, Gutierrez A, Jones W, Eng T, Ha C, Papanikolaou N. SU-E-T-281: Pediatric Cranio-Spinal Axis Irradiation: Comparison of Radiation-Induced Secondary Malignancy Estimations Based On Three Methods of Analysis for Three Different Treatment Techniques. Med Phys 2013. [DOI: 10.1118/1.4814715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stathakis S, Mavroidis P, Markovic M, Esquivel C, Myers P, Crownover R, Li Y, Papanikolaou N. SU-E-T-226: SRT/SBRT Patient Specific QA with a New High Resolution 2D Detector Array. Med Phys 2013. [DOI: 10.1118/1.4814661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Stathakis S, Mavroidis P, Gutierrez A, Esquivel C, Jones W, Eng T, Ha C, Papanikolaou N. SU-E-T-308: Radiobiological Evaluation of the Three Dimensional Conformal Radiation Therapy, SmartArc, and Helical Tomotherapy Treatment Techniques for Pediatric Cranio-Spinal Axis Irradiation. Med Phys 2013. [DOI: 10.1118/1.4814742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stathakis S, Mavroidis P, Esquivel C, Myers P, Li Y, Crownover R, Papanikolaou N. SU-D-105-02: Small Field SRS/SBRT Patient Specific QA at Extended SSD. Med Phys 2013. [DOI: 10.1118/1.4813998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Watson C, Pirotta M, Myers P. Corrigendum to “Use of complementary and alternative medicine in recurrent vulvovaginal candidiasis––Results of a practitioner survey” [Compliment. Ther. Med. 20 (4) (2012) 218–221]. Complement Ther Med 2012. [DOI: 10.1016/j.ctim.2012.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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McKinsey R, Stathakis S, Esquivel C, Gutierrez A, Myers P, Nayebi N, Regan M, Papanikolaou N. SU-E-T-387: Validation of a New System for Patient Specific IMRT QA and Comparison with Other Commerical Systems. Med Phys 2012; 39:3793. [PMID: 28517189 DOI: 10.1118/1.4735476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The focus of this project is to compare the Octavius 4D with current commercial available dose validation systems: MatriXX MultiCube and Delta4. METHODS AND MATERIALS Many challenges are faced with properly measuring Intensity Modulated Radiotherapy (IMRT). It has become common practice for clinics to use film, arrays, or multiple detectors to validate dose measurements pretreatment for static and dynamic treatments. IMRT QAs for various treatment sites were measured for patients using three different dose validation systems. All measurements were taken on a Varian CLinac 2100 C/D, SN-757, 80 MLC with 6MV. The treatment plans evaluated were Step-N-Shoot. Data analysis was performed using the software provided with each dose validation system. Detailed information was gathered from each system with their perspective advantages. The latest system, Octavius 4D, allows one to calculate the Gamma Index for Coronal, Sagittal, and Transversal views for every slice included in the measurement along with the traditional data analysis provided; histograms, horizontal and vertical profiles, DTA. RESULTS AND DISCUSSION The Gamma Index values were observed using the MatriXX Multicube, Delta4, and Octavius 4D. The treatment plan included five fields at various gantry angles. Also the gamma index and profiles were calculated for various treatment sites. Delta 4 and the Octavius 4D appears to be quite comparable. Each device has the ability to allow one to verify segmented and composite fields, measure dose profiles and analysis using the Gamma Method. ConclusionsSimilar IMRT QA measurements will be made for more Step-N-Shoot cases with the addition of SmartArcs. The limitations of each system will be determined for each system using the Gamma Index as a reference while varying the Region of Interest, Threshold, and Gamma Method (local, normalization, and maximum dose), as well as the 2D- profiles for these cases.
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Affiliation(s)
- R McKinsey
- University of Texas HSC SA, San Antonio, TX
| | | | - C Esquivel
- University of Texas HSC SA, San Antonio, TX
| | | | - P Myers
- University of Texas HSC SA, San Antonio, TX
| | - N Nayebi
- University of Texas HSC SA, San Antonio, TX
| | - M Regan
- University of Texas HSC SA, San Antonio, TX
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Stathakis S, Myers P, Esquivel C, Gutierrez A, Mavroidis P, Papanikolaou N. SU-E-T-361: Evaluation of a New Commercially Device for Patient Specific IMRT QA. Med Phys 2012. [DOI: 10.1118/1.4735448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Stathakis S, Gutierrez A, Esquivel C, Mavroidis P, Papanikolaou N. SU-E-T-562: Reducing the Arc Span for CSA VMAT Delivery. Med Phys 2012; 39:3835. [PMID: 28517078 DOI: 10.1118/1.4735651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To dosimetrically evaluate advantages and disadvantages of using multiple, shorter, sub-arcs versus full arc deliveries for treatment of cranio-spinal axis (CSA) irradiation. METHODS Five (n=5) cranio-spinal axis irradiation patients were planned using 2 complete arcs, one superior and one inferior; with gantry rotations from 1 to 359 degrees. Due to supine patient setup, each original full arc was then replanned split into two sub arcs with gantry rotations from 1 to 100 and 260 to 359 degrees creating 4 smaller arcs. The PTV was normalized such that 95% received at least 23.4 Gy in 13 fractions. The PTV was evaluated based on conformity number and homogeneity index. The normal structures were evaluated based on maximum and mean doses. Beam on times and monitor units were compared. RESULTS Averaged over all patients, conformity number was calculated to be approximately 0.86 and 0.82 for full arc and sub arc plans respectively. The homogeneity index was approximately 1.07 and 1.06 for full arc and sub arc plans. This indicates better target conformity but less homogeneous dose distribution for full arc plans as compared with sub arc plans. With the exception of the eyes, each normal structure evaluated had lower maximum doses with subarc plans. All normal structures, with the exception of the left kidney, had lower mean doses using sub arc deliveries. Beam on times were shorter on average for full arcs, but the monitor units were lower on average for sub arcs. CONCLUSIONS Overall, CSA patients would benefit from the use of sub arc treatment deliveries versus full arc deliveries. Nearly all normal structure doses were lower for sub arcs, while the PTV was still adequately covered and beam on times and monitor units were similar.
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Affiliation(s)
- P Myers
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - S Stathakis
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - A Gutierrez
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - C Esquivel
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - P Mavroidis
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - N Papanikolaou
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
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Stathakis S, Myers P, Esquivel C, Gutierrez A, Mavroidis P, Papanikolaou N. SU-E-T-341: Characterization of a New Commercially Available System for Patient Specific IMRT/VMAT QA. Med Phys 2012. [DOI: 10.1118/1.4735428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Regan M, Stathakis S, Nayebi N, McKinsey R, Myers P, Knaup C, Quino LV, Gutierrez A, Esquivel C, Mavroidis P, Papanikolaou N. SU-E-T-350: Three Year Analysis Using Ionization Chamber Array for Patient Specific IMRT QA. Med Phys 2012. [DOI: 10.1118/1.4735437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Stathakis S, Esquivel C, Gutierrez A, Mavroidis P, Papanikolaou N. WE-G-BRCD-05: Evaluation of Localization Errors for CSA Delivery Using VMAT. Med Phys 2012; 39:3965. [PMID: 28519609 DOI: 10.1118/1.4736182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To dosimetrically evaluate the effects of improper patient positioning in the junction area of a VMAT cranio-spinal axis irradiation technique consisting of one superior and one inferior arc. METHODS Five (n=5) cranio-spinal axis irradiation patients were planned with 2 arcs: one superior and one inferior. The plans were then recalculated with inferior isocenter shifted, in order to mimic patient setup errors, eight times: lmm, 2mm, 5mm, and 10mm superiorly, and 1mm, 2mm, 5mm, and 10mm inferiorly. Plans were then compared to the original, non-shifted arc plan based on target metrics of conformity number and homogeneity index, as well as several normal structure mean doses. RESULTS Percent differences were calculated in order to compare each of the eight shifted plans to the original arc plan without shifts, which would be the ideal setup of patient without error. The conformity number was on average 0.87%, 2.74%, 5.75%, and 9.10% lower for the 1mm, 2mm, 5mm, and 10mm inferiorly- shifted plans and 0.41%, 0.82%, 2.75%, and 5.99% lower for the respective superiorly-shifted plans. The homogeneity indices were, averaged among the five patients, 0.03%, 0.26%, 0.97%, and 2.84% for the inferior shifts and 0.23%, 1.17%, 6.31%, and 15.29% worse, or less homogenous for the superior shifts. Overall the mean doses to the organs at risk were less than 2% different for the 1mm, 2mm, and 5mm shifted plans. The 10mm shifted plans, however, showed percent differences from original plan of up to 5.6% on average. CONCLUSIONS Setup errors when shifting isocenters should be minimized in order to provide the patient with the best treatment possible. Errors of 1 to 2mm can negatively affect patient treatment, most notably in the arc junction area, but are not as problematic as larger errors of 5 to 10mm.
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Affiliation(s)
- P Myers
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - S Stathakis
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - C Esquivel
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - A Gutierrez
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - P Mavroidis
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - N Papanikolaou
- Cancer Therapy and Research Center at UT Health Science Center, San Antonio, TX.,Karolinska Institutet & Stockholm University, Stockholm, Sweden
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Watson CJ, Pirotta M, Myers SP, Myers P. Use of complementary and alternative medicine in recurrent vulvovaginal candidiasis--results of a practitioner survey. Complement Ther Med 2012; 20:218-21. [PMID: 22579433 DOI: 10.1016/j.ctim.2012.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 01/18/2012] [Accepted: 01/25/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The mainstream long term management of recurrent vulvovaginal candidiasis (RVVC) often results in poor outcomes. It is expensive and unacceptable for many women who therefore have incorporated complementary and alternative medicine (CAM) into their personal care plan. OBJECTIVE To ascertain clinicians' knowledge of CAM and their recommendations for the use of CAM and non-pharmacological management in women with RVVC. DESIGN AND SETTING Anonymous, single page, self completed survey using convenience sampling at a vulval disorders meeting in New South Wales, Australia in 2009. PARTICIPANTS Sixty six health professionals (medical practitioners, dermatologists, nurses and allied health professionals). RESULTS Most clinicians reported asking about their patients' use of CAM and non-pharmacological management of RVVC, although only around half reported recommending it. CAM management included lactobacillus, oral and vaginal yoghurt, vinegar, garlic, Chinese medicine and tea-tree oil. Non-pharmacological management included dietary changes and use of cotton undergarments. Lactobacillus was the most commonly recommended CAM. CONCLUSION CAM is popular with patients and many clinicians actively recommend its use in RVVC despite limited supporting evidence. Further research in the area of CAM and RVVC is long overdue.
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Affiliation(s)
- C J Watson
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Australia.
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Engstrom C, Green A, Hay P, Friis P, Myers P, Fraser J, Schafer J. eCAPS—An innovative web-based online system for clinical assessment of practical skills in joint examination. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Myers P, Konstantinidis S, Karatzas N, Milas F, Panos A. Pericardial synovial sarcoma of the heart; is it always worth operating? J Cardiovasc Surg (Torino) 2011; 52:749-751. [PMID: 21894142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Synovial sarcoma is a rare malignant soft-tissue tumor that most commonly occurs in the extremities of young adults. Primary pericardial synovial sarcoma is extremely rare. We report the case of a 37 year old male patient who presented with intermittent fever, nocturnal sweating and asthenia. Chest X-ray revealed an enlarged cardiac silhouette. Echocardiography identified pericardial effusion and a mass compressing the right ventricle. After percutaneous drainage of the effusion, the mass was not visible and deemed to have been septations of the effusion. Chest computed tomography (CT) did not show the mass visible on the X-ray. At one month follow-up, the pericardial mass was again visible on echocardiography and confirmed by magnetic resonance imaging (MRI). CT-guided biopsy showed malignant mesenchymal cells. Complete resection was attempted, but not possible due to diffuse infiltration of the epicardium. Histological examination of the resected tissue revealed an undifferentiated primary pericardial synovial sarcoma. The patient refused adjuvant treatment and died 15 days later. Surgical resection is considered the cornerstone of treatment of this rare type of malignant tumor of the young; our patient presented with a diffusely infiltrating tumor which could not be resected and required reoperation for tamponade and left pericardectomy. We question whether the choice to attempt resection was beneficial.
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Affiliation(s)
- P Myers
- Division of Cardiac Surgery, Harvard Medical School, Boston, MA, USA.
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Buckey C, Myers P, Mavroidis P, Esquivel C, Mihailidis D, Gutiérrez A, Papanikolaou N, Stathakis S. SU-E-T-151: Application of a 2D Ionization Chamber Array for Monthly and Annual Linear Accelerator QA. Med Phys 2011. [DOI: 10.1118/1.3612102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Buckey C, Myers P, Esquivel C, Mihailidis D, Mavroidis P, Gutiérrez A, Papanikolaou N, Stathakis S. SU-E-T-155: Evaluation of An in Vivo Device for Daily Patient Treatment Delivery Measurements Using a Varian Linear Accelerator. Med Phys 2011. [DOI: 10.1118/1.3612105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Buckey C, Mihailidis D, Mavroidis P, Esquivel C, Gutiérrez A, Papanikolaou N, Stathakis S. SU-E-T-125: VMAT Monthly Quality Assurance Using a 2D Ionization Chamber Array. Med Phys 2011. [DOI: 10.1118/1.3612076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Buckey C, Mihailidis D, Mavroidis P, Esquivel C, Gutiérrez A, Papanikolaou N, Stathakis S. SU-E-T-91: VMAT Monthly Quality Assurance Using an in Vivo Dosimetric Device Attached to the Linac Gantry. Med Phys 2011. [DOI: 10.1118/1.3612042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stathakis S, Gutierrez A, Esquivel C, Kim S, Buckey C, Myers P, Mihailidis D, Mavroidis P, Papanikolaou N. SU-E-T-549: Hypofractionated Spine Radiotherapy: How Do You QA? Med Phys 2011. [DOI: 10.1118/1.3612511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stathakis S, Esquivel C, Gutierrez A, Mihailidis D, Buckey C, Myers P, Mavroidis P, Papanikolaou N. SU-E-T-702: Accuracy of a Commercially Available Dose Calculation Algorithm for Small Field Dosimetry. Med Phys 2011. [DOI: 10.1118/1.3612664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Beghetti M, Cikirikcioglu M, Sierra J, Aggoun Y, Touati R, Kalangos A. Novel approach to mitral valve repair in childhood dilated cardiomyopathy. MINERVA CHIR 2011; 66:119-121. [PMID: 21593713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Evidence is mounting that mitral valve repair can improve symptoms in adults with dilated cardiomyopathy. Data is currently lacking for children with dilated cardiomyopathy and options for annuloplasty are limited in children. We report on the successful management of a 21 month-old child in heart failure from dilated cardiomyopathy and severe mitral regurgitation. The echocardiogram showed severely dilated left heart cavities, severe mitral regurgitation from a dilated annulus (23 mm, Z-score 1.74) with discrete anterior leaflet tethering, and moderate systolic dysfunction. The mitral valve was repaired using a 16 mm Bioring Kalangos biodegradable annuloplasty ring. The patient was extubated on the third postoperative hour and discharged on the fifth postoperative day with trivial mitral regurgitation and a 5 mmHg mean transvalvular gradient. At 12 months, the patient is in NYHA class I and presents trivial central mitral regurgitation without any transmitral gradient. This represents the first report in successfully managing a child with dilated cardiomyopathy with mitral regurgitation using a novel biodegradable annuloplasty ring, which has the potential to durably remodel the mitral annulus and grow with the patient.
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Affiliation(s)
- P Myers
- Division of Cardiovascular Surgery, Geneva University Hospital, Geneva, Switzerland.
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Myers P, Tissot C, Cikirikcioglu M, Kalangos A. Complex Aortic Coarctation, Regurgitant Bicuspid Aortic Valve with VSD and Ventricular Non-Compaction: A Challenging Combination. Thorac Cardiovasc Surg 2011; 59:313-6. [DOI: 10.1055/s-0030-1250392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barrow DA, Castell OK, Sykes N, Myers P, Ritchie H. A microfabricated graphitic carbon column for high performance liquid chromatography. J Chromatogr A 2010; 1218:1983-7. [PMID: 21241990 DOI: 10.1016/j.chroma.2010.11.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/23/2010] [Accepted: 11/29/2010] [Indexed: 11/18/2022]
Abstract
We report the first development of a novel, planar, microfluidic, graphitic carbon separations column utilizing an array of graphitic micropillars of diamond cross-section as the chromatographic stationary phase. 795 nm femtosecond laser ablation was employed to subtractively machine fluidic architectures and a micropillared array in a planar, graphitic substrate as a monolithic structure. A sample injector was integrated on-chip, together with fluid-flow distribution architectures to minimize band-broadening and ensure sample equi-distribution across the micro-pillared column width. The separations chip was interfaced directly to the ESI probe of a Thermofisher Surveyor mass spectrometer, enabling the detection of test-mixture analytes following their differential retention on the micro-pillared graphitic column, thus demonstrating the exciting potential of this novel separations format. Importantly, unlike porous, graphitic microspheres, the temperature and pressure resilience of the microfluidic device potentially enables use in subcritical H(2)O chromatography.
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Affiliation(s)
- D A Barrow
- Cardiff School of Engineering, Cardiff University, 1-5 The Parade, Cardiff CF24 3AA, UK.
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Antal A, Cikirikcioglu M, Myers P, Didier D, Kalangos A. Respiratory Distress after Surgery of RVOT Pathologies: A Word of Caution on Pseudoaneurysm Development. Thorac Cardiovasc Surg 2010; 58:356-8. [DOI: 10.1055/s-0029-1185883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Varatharaj C, Stathakis S, Ravikumar M, Esquivel C, Knaup C, Myers P, Papanikolaou N. SU-GG-T-235: Consistency and Reproducibility of the VMAT Plan Delivery Using Three Independent Validation Methods. Med Phys 2010. [DOI: 10.1118/1.3468626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Stathakis S, Gutiérrez A, Mavroidis P, Mihailidis D, Papanikolaou N. SU-GG-T-308: Commissioning of PTW Seven29 for Helical TomoTherapy Quality Assurance. Med Phys 2010. [DOI: 10.1118/1.3468704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Stathakis S, Gutiérrez A, Mavroidis P, Mihailidis D, Papanikolaou N. SU-GG-T-292: Comparison of Helical TomoTherapy Patient Quality Assurance Using PTW Seven29 and ScandiDos Delta4. Med Phys 2010. [DOI: 10.1118/1.3468686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Fernando SL, Myers P. Turning a blind eye: ocular mucous membrane pemphigoid. Case Reports 2009; 2009:bcr02.2009.1584. [DOI: 10.1136/bcr.02.2009.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Myers P, Weber L, Gutiérrez A, Papanikolaou N. SU-FF-T-582: Delivery Angle Dependency On Treatment Plan Quality for Whole Breast Radiotherapy Using Helical Tomotherapy. Med Phys 2009. [DOI: 10.1118/1.3182080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Myers P, Wilmington D, Gallun F, Henry J, Fausti S. Hearing Impairment and Traumatic Brain Injury among Soldiers: Special Considerations for the Audiologist. Semin Hear 2009. [DOI: 10.1055/s-0028-1111103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bonvini RF, Robert-Ebadi H, Fontana P, Fassa A, Myers P, Licker M, Boehlen F, Righini M. Impending paradoxical embolism. When and how to treat? Ann Cardiol Angeiol (Paris) 2008; 57:234-7. [PMID: 18582845 DOI: 10.1016/j.ancard.2008.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 05/05/2008] [Indexed: 11/25/2022]
Abstract
Impending paradoxical embolism (IPDE) is the presence of an entrapped thrombus through the patent foramen ovale (PFO). Usually IPDE are diagnosed by echocardiography or thoracic CT-scan performed during the evaluation of patient presenting with a suspicion of pulmonary embolism (PE). We report the case of a 73-year-old patient presenting with a very large IPDE successfully treated with cardiac surgery and we focus our discussion on the treatment modalities of this rare entity (anticoagulation alone, fibrinolytic regimens, cardiac surgery, percutaneous thrombectomy) and on PFO management after IPDE.
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Affiliation(s)
- R F Bonvini
- Angiology and Hemostasis Division, University Hospital, Geneva, Switzerland.
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Serracino-Inglott F, Myers P. An alternative to aorto-uni-iliac EVAR and femoro-femoral crossover in a patient having an aorto-iliac aneurysm with an occluded external iliac artery. Eur J Vasc Endovasc Surg 2006; 33:575-7. [PMID: 17161632 DOI: 10.1016/j.ejvs.2006.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Accepted: 11/11/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION An endovascular procedure for excluding an aorto-iliac aneurysm whilst simultaneously preserving one internal iliac artery is described in a patient with complex iliac pathology. REPORT The procedure involved the use of Advanta V12 covered stents to bridge the gap between the contralateral limb of the main body of a custom-made Zenith stent graft and the internal iliac artery on the side of an external iliac artery occlusion. DISCUSSION Minimal modifications to the standard design of modular stent grafts make it possible to treat high risk patient with complex pathology with minimal morbidity.
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Affiliation(s)
- F Serracino-Inglott
- Department of Vascular Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
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Fox R, Tomkinson A, Myers P. Morbidity in patients waiting for tonsillectomy in Cardiff: a cross-sectional study. J Laryngol Otol 2006; 120:214-8. [PMID: 16549039 DOI: 10.1017/s002221510600020x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2005] [Indexed: 11/07/2022]
Abstract
Objective: Our aim was to determine the morbidity of patients awaiting tonsillectomy.Design: The study comprised a questionnaire survey of 379 children and 278 adults waiting over 12 months for tonsillectomy.Outcome measures: These comprised frequency of infection, sickness absence and continuing desire for surgery.Results: Response rates were 70 per cent (children) and 60 per cent (adults). Morbidity was similar in adults and children, and in those waiting more or less than two years. In the six months prior to the study, 86 per cent of children and 83 per cent of adults had had tonsillitis. Sixty per cent of children and 50 per cent of adults had had three or more episodes. Sixty-two per cent of children and 59 per cent of adults had had at least one long episode of tonsillitis, and 29 per cent of children and 24 per cent of adults had had more than three long episodes. Eighty-nine per cent of children had missed school at least once, compared with 71 per cent of adults missing work at least once (p = 0.01). The frequency of infection was significantly associated with patients' desire for surgery (p < 0.001).Conclusions: Patients awaiting tonsillectomy experience considerable morbidity. This study does not support the hypothesis that untreated patients will ‘outgrow’ their condition.
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Affiliation(s)
- R Fox
- National Public Health Service for Wales, Cardiff, Wales, UK.
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Logan M, Williams A, Myers P. Intra-operative femoral nerve stimulation as an aid in tibial tuberosity transfer. Ann R Coll Surg Engl 2005; 87:288-9. [PMID: 16082741 PMCID: PMC1963946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- M Logan
- Chelsea & Westminster Hospital, London, UK
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Parr CS, Espinosa R, Dewey T, Hammond G, Myers P. Building a biodiversity content management system for science, education, and outreach. Data Sci J 2005. [DOI: 10.2481/dsj.4.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Separation and focusing of proteins is described in a miniaturised dynamic field gradient focusing device with a 2.5 cm x 0.1 cm channel filled with a porous polymer monolith. The separation channel is in contact with a parallel electric field channel with five individually addressable electrodes through a porous glass membrane so that a variable field can be generated that drives charged proteins electroosmotically against a constant hydrodynamic flow. Separated pre-stained proteins were detected by means of a digital camera and background subtraction.
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Affiliation(s)
- P Myers
- Department of Chemistry, University of Leeds, Leeds LS2 9JT, UK.
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