1
|
Amrenova A, Baudin C, Ostroumova E, Stephens J, Anderson R, Laurier D. Intergenerational effects of ionizing radiation: review of recent studies from human data (2018-2021). Int J Radiat Biol 2024; 100:1253-1263. [PMID: 38319708 DOI: 10.1080/09553002.2024.2309917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/22/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE The purpose of this paper was to conduct a review of the studies published between 2018 and 2022 to investigate radiation-related effects in the offspring of human individuals exposed to ionizing radiation. METHODS The search identified 807 publications, from which 9 studies were selected for detailed analysis to examine for effects in children whose parents were exposed to various types and doses of radiation. RESULTS The review does not yield substantial evidence supporting intergenerational effects of radiation exposure in humans. However, caution is required when interpreting the results due to limitations in the majority of the published articles. CONCLUSION This review, covering the period 2018-2022, serves as an extension of the previous systematic review conducted by Stephens et al. (2024), which encompassed the years 1988-2018. Together, these two papers offer a comprehensive overview of the available evidence regarding the intergenerational effects of parental pre-conceptional exposure to ionizing radiation. Overall, the findings do not provide strong evidence supporting a significant association between adverse (or other) outcomes in unexposed children and parental preconception radiation exposure.
Collapse
|
2
|
Gregory A, Wright D, Spencer H, Mankowski JJ, Dickens JC, Stephens J, Neuber AA. An apparatus for probing multipactor in X-band waveguide components. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:2888169. [PMID: 37140338 DOI: 10.1063/5.0139620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023]
Abstract
Rectangular waveguides are susceptible to avalanche-style breakdown via the multipactor phenomenon. The growth in secondary electron density produced via multipactor can damage and destroy RF components. A pulse-adjustable, hard-switched modulator powering an X-band magnetron was utilized to drive a modular experimental setup that enables testing different surface geometries and coatings. Power measurements, taken via diodes, and phase measurements, facilitated via a double-balanced mixer, were integrated into the overall apparatus enabling multipactor detection with high sensitivity and nanosecond temporal resolution. The utilized 150 kW peak microwave source with 2.5 μs pulse width and 100 Hz repetition frequency allows for threshold testing without the need for initial electron seeding. This paper includes the initial results of surface conditioning of the test multipactor gap via electron bombardment.
Collapse
|
3
|
Bondje S, Bateman L, Stephens J. 432 Improving the Use of Acute ENT Clinic in a DGH During the COVID19 Pandemic. Br J Surg 2022. [PMCID: PMC9452109 DOI: 10.1093/bjs/znac269.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aim The SHO led acute ENT clinic is used to assess and treat a variety of ENT pathology. Following the COVID19 pandemic, the department has seen an increase in referrals for conditions that do not meet departmental guidelines. To meet demand, our clinics were always overbooked and over running as juniors sought help from seniors for more complex referrals. Method A quality improvement project was initially set to be performed over a few months; however, due to COVID, data was collected over a year from December 2019 to 2020. We looked specifically at number of patients referred, reason for referral, number of follow-up appointments, senior review required and how COVID affected the running of the clinics. Results Compared with the clinic's standard operating procedure, 77.2% of clinics were overbooked and 69.8% of patients had unsuitable referrals. This prompted changes such as increasing clinic capacity by introducing full day clinics and increasing senior support by moving to the outpatient department, then clinics were only overbooked 1% of the time. Other areas for improvement highlighted such as advice given to patients as well as referral to main ENT clinic. Conclusion It was clear that the capacity of the acute clinic did not meet demand, and this was needed to ensure patient safety and adhere to ENT UK guidance. We implemented a more stringent referral system to increase patient safety by ensuring patients with appropriate pathology are seen in this clinic or referred to other relevant clinics where they can be seen earlier by seniors.
Collapse
|
4
|
Bondje S, Tanna R, Stephens J. 1508 Acute ENT Clinic Audit. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
The acute ENT clinic is run by the ENT SHO’s and is used to assess and treat patients with a variety of everyday ENT pathology. As a department, we are seeing increasing numbers of patients who have been referred via the community for conditions that do not meet the departmental guidelines as well as noting our clinic is consistently overbooked and overrunning.
Method
A retrospective audit was performed analysing all clinic data between December 2019 and January 2020, specifically looking at patient demographics and reason for referral. The total number of patients per clinic was analysed and compared against ENT UK guidelines for safe clinic numbers, which state that an SHO led acute clinic should have 6 patients maximum.
Results
Over a two-month period, we looked at data from 35 clinics. As per our standard operating practice, children should be seen first in the clinic and this occurred in only 8 clinics (22.9%). Secondly, 8 clinics had appropriately booked a maximum of 6 patients, whilst in 27 clinics (77.2%) there were more than 7 patients booked. Finally, 69.8% of patients had unsuitable referrals as per the guideline.
Conclusions
It is clear from our data that the capacity of the acute clinic does not meet its current demand, and this is something that needs to be addressed to ensure patient safety and to adhere to ENT UK guidance. The implementation of a more stringent referral system will increase patient safety by ensuring patients with appropriate pathology are seen in this clinic.
Collapse
|
5
|
Bazan J, Stephens J, Agnese D, Skoracki R, Reiland J, Arneson K, Gupta G, Gallagher K, McElroy S, Park K, Grignol V, Lee C, Sisk G, Schulz S, Chetta M, Jhawar S, Grecula J, Martin D, Carson W, Farrar W, Carlson M, Gupta N, White J. PO-0933: Prospective Evaulation Of Iort Boost In Women Undergoing Lumpectomy With Oncoplastic Reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Campbell D, Chacko S, Abdollah H, Eniquez A, Redfearn D, Wang C, Hazell M, Boose L, Murphy K, Stephens J, Bakker D, Joseph P, McQullian C, Baranchuk A. DEALING WITH TEMPORARY PERMANENT PACEMAKERS: OUR JOURNEY TO IMPROVE QUALITY ASSURANCE. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
7
|
Shah S, O’Connor M, Lewis C, Stephens J, Vaughan D, Chaggar R. Face-to-face videolaryngoscopy-assisted tracheal intubation: does the hand matter? Br J Anaesth 2020. [DOI: 10.1016/j.bja.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
8
|
Soni S, Shah S, Chaggar R, Saini R, James E, Elliot J, Stephens J, McCormack T, Hartle A. Surgical cancellation rates due to peri‐operative hypertension: implementation of multidisciplinary guidelines across primary and secondary care. Anaesthesia 2020; 75:1314-1320. [DOI: 10.1111/anae.15084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
|
9
|
Adusei A, Arko-Mensah J, Dzodzomenyo M, Stephens J, Amoabeng A, Waldschmidt S, Löhndorf K, Agbeko K, Takyi S, Kwarteng L, Acquah A, Botwe P, Tettey P, Kaifie A, Felten M, Kraus T, Küpper T, Fobil J. Spatiality in Health: The Distribution of Health Conditions Associated with Electronic Waste Processing Activities at Agbogbloshie, Accra. Ann Glob Health 2020; 86:31. [PMID: 32211301 PMCID: PMC7082828 DOI: 10.5334/aogh.2630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A walk through the Agbogbloshie e-waste recycling site shows a marked heterogeneity in the spatial distribution of the different e-waste processing activities, which are likely to drive clustering of health conditions associated with the different activity type in each space. Objective of study To conduct a spatial assessment and analysis of health conditions associated with different e-waste activities at different activity spaces at Agbogbloshie. Methods A choropleth showing the various activity spaces at the Agbogbloshie e-waste site was produced by mapping boundaries of these spaces using Etrex GPS device and individuals working in each activity spaces were recruited and studied. Upon obtaining consent and agreeing to participate in the study, each subject was physically examined and assessed various health outcomes of interest via direct physical examination while characterizing and enumerating the scars, lacerations, abrasions, skin condition and cuts after which both systolic and diastolic blood pressure values were recorded alongside the administration of open and close ended questionnaires. All individuals working within each activity space and consented to participate were recruited; giving a total of one hundred and twelve (112) subjects in all. Results A study of the choropleth showed that health conditions associated e-waste processing activities were clustered in a fashion similar to the corresponding distribution of each activity. While a total of 96.2% of all the study subjects had cuts, the dismantlers had higher mix of scars, lacerations and abrasions. Abrasions were observed in 16.3% of the dismantlers. Scars were the most common skin condition and were observed on the skins of 93.6% of the subjects. Prevalence of burns among the study subjects was 23.1%. Developing hypertension was not associated with activity type and while a total of 90.2% of subjects had normal blood pressure and 9.8% of them were hypertensives. Finally, 98.2% of respondents felt the need to have a first aid clinic at the site with 96.4% and 97.3% willing to visit the clinic and pay for services respectively. Conclusion We conclude that while the observed injuries were random and were due purely to accidents without any role of spatial determinants such as the configuration, slope, topography and other subterranean features of the activity spaces, a strong association between the injuries and activity type was observed.
Collapse
|
10
|
Feldsine PT, Lienau AH, Roa NH, Green ST, Braut-Taormina J, Braymen C, Chavey C, Cohen A, Deans A, Delancey S, Elems C, Forgey R, Gonzalez E, Hall V, Huang MCJ, Humes L, Johnson F, Kerdaji K, King J, Kipker L, Lau D, Nogle J, Peters C, Pinkston J, Porter M, Potter L, Rogers S, Stephens J, Skorupa G, Taylor R, Tuncan E, Vought K, Vrana D. Enumeration of Total Coliforms and E. coli in Foods by the SimPlate® Coliform and E. coli Color Indicator Method and Conventional Culture Methods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/88.5.1318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The relative effectiveness of the SimPlate® Coliform and E. coli Color Indicator (CEc-CI) method was compared to the AOAC 3-tube Most Probable Number (MPN) methods for enumerating and confirming coliforms and Escherichia coli in foods (966.23 and 966.24). In this study, test portions were prepared and analyzed according to the conditions stated in both the AOAC methods and SimPlate directions for use. Six food types were artificially contaminated with coliform bacteria and E. coli: frozen burritos, frozen broccoli, fluid pasteurized milk, whole almond nut meats, cheese, and powdered cake mix. Method comparisons were conducted. Overall, the SimPlate method demonstrated <0.3 log difference for total coliform and E. coli counts compared to the AOAC reference methods for the majority of food types and levels analyzed. In all cases, the repeatability and reproducibility of the SimPlate CEc-CI method were not different from those of the reference methods and in certain cases, were statistically better than those of the AOAC 3-tube MPN methods. These results indicate that the SimPlate CEc-CI method and the reference culture methods are comparable for enumeration of both total coliforms and E. coli in foods.
Collapse
|
11
|
Haider S, Li J, Aggarwal J, Chambers R, Manocha P, Stephens J. PCV10 EPIDEMIOLOGICAL STUDY DESIGN TO UNDERSTAND CARDIOVASCULAR RISK FACTORS AND TREATMENT IN GENERAL PRACTICE PATIENTS IN LATIN AMERICA. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
12
|
Wesolowski R, Brufsky A, Chambers M, Bhattacharya S, Lustberg M, VanDeusen J, Sardesai S, Williams N, Noonan A, Phelps M, Grever M, Stephens J, Carson W, Ramaswamy B. Phase Ib study of heat shock protein 90 inhibitor, onalespib in combination with paclitaxel in patients with advanced, triple negative breast cancer (NCT02474173). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
13
|
Berryhill M, Arciniega H, Jones K, Stephens J, Gozenman F. Who, what, where and how much: tDCS and training effects on working memory. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
14
|
Bazan JG, Stephens J, Agnese D, Skoracki R, Arneson K, Reiland J, Gupta G, Gallagher K, McElroy S, Gupta N, White JR. Abstract OT2-04-04: Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In women amenable to breast conserving therapy, lumpectomy followed by adjuvant whole breast irradiation (WBI) remains the standard of care. Randomized trials demonstrate that addition of a lumpectomy cavity boost significantly reduces the risk of ipsilateral breast tumor recurrences but also increases the risk of breast fibrosis. Contemporary randomized trials define the lumpectomy cavity boost volume as a 1.7 cm isometric expansion on the lumpectomy cavity as delineated on CT. However, identifying the lumpectomy cavity can be challenging, especially in women that receive adjuvant chemotherapy and in cases in which surgical clips are not present. Recently, the use of oncoplastic techniques in breast conserving surgery has increased. These techniques are used to prevent the poor cosmetic results that can occur when a large volume of breast tissue is resected. Women that undergo oncoplastic reconstruction represent especially difficult cases for lumpectomy cavity delineation. Retrospective series have evaluated the use of intraoperative electron radiotherapy (IOERT) as a boost prior to WBI in women receiving lumpectomy without oncoplastic reconstruction. In the largest series of IOERT boost prior to WBI the local control rate of this approach was >99%. Prospective data regarding IOERT boost in women undergoing oncoplastic reconstruction are limited. The advantages of this approach include direct visualization/irradiation of the tumor bed, sparing the skin of irradiation, and reducing the treatment time by ˜1 week. We hypothesize that IOERT boost followed by WBI will result in acceptably low rates of grade 3 fibrosis in women undergoing lumpectomy with oncoplastic reconstruction.
Trial Design: This is a single-arm, prospective study to evaluate the safety, toxicity and efficacy of IOERT boost at the time of breast conserving surgery in women with early-stage breast cancer undergoing oncoplastic reconstruction. Eligible women will receive 1 dose of 8 Gy to the surgical bed after lumpectomy but prior to oncoplastic reconstruction. Women will then receive adjuvant WBI of 40 Gy in 15 fractions or 50 Gy in 25 fractions.
Eligibility: Key criteria include age≥18 yo, clinically node-negative stage I/II, any breast cancer subtype.
Specific Aims: To determine the rate of grade 3 breast fibrosis at 1 year. Additional aims include surgical complication rates, cosmesis, and local regional cancer control.
Statistical Methods: Safety will be evaluated by the rate of surgical complications necessitating hospital readmission or return to the operating room within 30 days of surgery+IOERT. If ≥4 events in the first 10 patients, ≥7 events in the first 20 patients, or ≥9 events in the first 30 patients are seen, the study will be halted. We hypothesize that the grade 3 fibrosis rate in our study will be ≤5%. Assuming an actual rate of 4%, an unacceptable rate of 9%, and a drop-out rate of 10%, the expected sample size is 176.
Sites: Ohio State University, Avera Medical Group, University of North Carolina-Chapel Hill
Patient Accrual: Current accrual is 5/176.
Contact Information: Jose Bazan (jose.bazan2@osumc.edu)
Funding Source: Intraop Medical
Citation Format: Bazan JG, Stephens J, Agnese D, Skoracki R, Arneson K, Reiland J, Gupta G, Gallagher K, McElroy S, Gupta N, White JR. Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-04-04.
Collapse
|
15
|
Sardesai S, Liu J, Palettas M, Stephens J, Stover D, Williams N, Reinbolt R, VanDeusen J, Wesolowski R, Lustberg M, Ramaswamy B. Abstract P4-16-03: Cardiovascular outcomes and long term survival with discontinuation of adjuvant trastuzumab. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-16-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Trastuzumab (T) induced cardiomyopathy remains a significant limitation to adjuvant HER2 directed therapy. Recent studies have aimed to reduce cardiotoxicity through combination with non-anthracycline (non-A) chemotherapy or shorter treatment duration. However there is limited data regarding cardiac outcomes and long-term survival with early discontinuation of adjuvant T.
Methods: An IRB-approved single-institution retrospective analysis was performed for 401 consecutive patients with non-metastatic HER2+ breast cancer treated at the Ohio State University Comprehensive Cancer Center from 2005-2015. Medical records were reviewed for clinicopathologic features, systemic treatment and survival information. Disease Free Survival (DFS) was defined as time from diagnosis to first recurrence (loco-regional or distant recurrence) including second primary breast cancer or death. Overall survival (OS) was defined as time from diagnosis to death or last known follow up. OS and DFS estimates were generated using Kaplan Meier methods and compared using Log-rank tests. Cox proportional hazard models were used to calculate univariate and multivariate hazard ratios for OS and DFS.
Results: A total of 371/401 (92.5%) patients received adjuvant T (n= 401, mean age: 59.4 years; stage 1: 120, 30%; stage II: 194, 48%; stage III: 87, 22%; ER+: 235, 58%); among whom 106/371 (28.6%) patients held adjuvant T for any reason. Median duration of therapy in patients with any interruption with T was 11.3 (0.5-16.9) months and 23/371 (6.9%) received less than 6 months of adjuvant T. Cardiomyopathy (measured as LVEF decline on 2D echocardiogram or MUGA >= 15 points) was the most common reason for withholding T (66/106, 62.3%). The majority of these patients received a cardiology referral (77/ 106, 72.6%) with a 13 day mean time to evaluation in outpatient clinic. Patients receiving non-A chemotherapy and beta blockers or ACE inhibitors during treatment were significantly less likely to experience cardiomyopathy (A vs non-A: 49/190, 25.8% vs. 16/136, 11.8% p=0.002); (Med vs no Med: 7/148, 4.73% vs 59/184, 32.1%; p<0.001). Log-rank tests indicate a significant worsening in OS and DFS for patients who discontinued T (p=0.021, 0.001 respectively). Multivariate analyses confirmed significant worsening in DFS after adjusting for age, stage, ER , node status, and cardiomyopathy (Adjusted HR: 4.0[2.02 – 7.92], p< 0.001)
Table 1- Discontinuation of adjuvant trastuzumab Number of patients (%)Initial treatment371Completed therapy with no interruption265 (71.4)Interruption of therapy for minimum of 2 weeks64 (17.2)Permanently discontinued42 (11.3)
Conclusion: Discontinuation of adjuvant trastuzumab, most often from cardiomyopathy, is an independent prognostic marker for worse DFS in non-metastatic HER2 positive breast cancer. Non-anthracycline chemotherapy and use of cardio-protective medication is associated with significantly reduced incidence of cardiotoxicity in this population. Future prospective studies should consider optimizing cardiovascular function to avoid interruption in adjuvant HER 2 directed therapy.
Citation Format: Sardesai S, Liu J, Palettas M, Stephens J, Stover D, Williams N, Reinbolt R, VanDeusen J, Wesolowski R, Lustberg M, Ramaswamy B. Cardiovascular outcomes and long term survival with discontinuation of adjuvant trastuzumab [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-03.
Collapse
|
16
|
Buck K, Southerland L, Schwaderer A, Exline M, Hebert C, Lampert B, Stephens J, Caterino J. 140EMF Older Adult Emergency Department Patients With Dyspnea: Epidemiology and Improved Diagnostic Strategies. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
17
|
Amaducci A, Anderson R, Frey A, Sheen A, Colon M, Roth P, Stephens J, Weaver K, Burmeister D, Greenberg M, Cannon R. 361 Sex-Specific Outcomes in a Substance Use Intervention Program. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
18
|
Bazan JG, Stephens J, Terando A, Skoracki R, McElroy S, Sexton J, Gupta N, White J. Abstract OT2-03-01: Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-Stage breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-03-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In women amenable to breast conserving therapy, lumpectomy followed by adjuvant whole breast irradiation (WBI) remains the standard of care. Randomized trials have demonstrated that the addition of a lumpectomy cavity boost significantly reduces the risk of ipsilateral breast tumor recurrences but also increases the risk of breast fibrosis. Contemporary randomized trials define the lumpectomy cavity boost volume as a 1.7 cm isometric expansion on the lumpectomy cavity as delineated on CT. However, identifying the lumpectomy cavity can be challenging, especially in women that receive adjuvant chemotherapy and in cases in which surgical clips are not present. Recently, the use of oncoplastic techniques in breast conserving surgery has increased. These techniques are used to prevent the poor cosmetic results that can occur when a large volume of breast tissue is resected. Women that undergo oncoplastic reconstruction represent especially difficult cases for lumpectomy cavity delineation. Retrospective series have evaluated the use of intraoperative electron radiotherapy (IOERT) as a boost prior to WBI in women receiving lumpectomy without oncoplastic reconstruction. In the largest series of IOERT boost prior to WBI the local control rate of this approach was >99%. Prospective data regarding IOERT boost in women undergoing oncoplastic reconstruction are limited. Advantages of this approach include direct visualization/irradiation of the tumor bed, sparing the skin of irradiation, and reducing the treatment time by ˜1 week. We hypothesize that IOERT boost followed by WBI will result in acceptably low rates of grade 3 fibrosis in women undergoing lumpectomy with oncoplastic reconstruction.
Trial Design: This is a single-arm, prospective study to evaluate the safety, toxicity and efficacy of IOERT boost at the time of breast conserving surgery in women with early-stage breast cancer undergoing oncoplastic reconstruction. Eligible women will receive 1 dose of 8 Gy to the surgical bed after lumpectomy but prior to oncoplastic reconstruction. Women will then receive adjuvant WBI of 40 Gy in 15 fractions or 50 Gy in 25 fractions.
Eligibility: Key inclusion criteria include age≥18 yo, clinically node-negative stage I/II, any breast cancer subtype.
Specific Aims: Our primary aim is to determine the rate of grade 3 breast fibrosis at 1 year. Additional aims include surgical complication rates, cosmesis, and local regional cancer control.
Statistical Methods: Safety will be evaluated by the rate of surgical complications necessitating hospital readmission or return to the operating room within 30 days of surgery+IOERT. If ≥4 events in the first 10 patients, ≥7 events in the first 20 patients, or ≥9 events in the first 30 patients are seen, the study will be halted. We hypothesize that the grade 3 fibrosis rate in our study will be ≤5%. Assuming an actual rate of 4%, an unacceptable rate of 9%, and a drop-out rate of 10%, the expected sample size is 176.
Patient Accrual: Current accrual is 0 of 176.
Contact Information: Soyhum McElroy (soyhun.mcelroy@osumc.edu) or Jose Bazan (jose.bazan2@osumc.edu)
Funding Source: Intraop Medical
Citation Format: Bazan JG, Stephens J, Terando A, Skoracki R, McElroy S, Sexton J, Gupta N, White J. Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-Stage breast cancer [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 OT2-03-01.
Collapse
|
19
|
Stephens J, Alonso PL, Byass P, Snow RW. Tropical Epidemiology: A System for Continuous Demographic Monitoring of a Study Population. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1635562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract:Epidemiologists in many developing countries, where official demographic services are unavailable, have to include some demographic functions in their work. The usual method of documenting a study population for epidemiological research in a developing country consists of three stages: mapping, enumeration and vital registration. This paper considers the last element of this process, detailing the development of a suitable data system and explaining how its implementation using microcomputers and a database management system can help in the creation of an on-line continuous vital registration system for a study population as an epidemiological tool. The issues covered are data collection, entry and analysis, and the advantages of such a system for use in epidemiological research in developing countries are also discussed.
Collapse
|
20
|
Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A. Focused Acute Medicine Ultrasound (FAMUS). Acute Med 2018; 17:164-167. [PMID: 30129952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Point of care ultrasound (POCUS) has seen steady growth in its use and applications in aiding clinicians in the management of acutely unwell patients. Focused Acute Medicine Ultrasound (FAMUS) is the standard created specifically for Acute Medicine physicians and is endorsed by the Society for Acute Medicine and recognised by the Acute Internal Medicine (AIM) training committee as a specialist skill. In this document we present a curriculum mapping exercise which utilises a 'knowledge, skills and behaviours' framework and incorporates the GMC's 'Good Medical Practice' (GMP) domains. We believe this will provide a standard for consideration of integrating focused ultrasound in AIM training programmes, with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.
Collapse
|
21
|
Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A. Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS). Acute Med 2018; 17:168. [PMID: 30129953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell.
Collapse
|
22
|
Takhar A, Stephens J, Randhawa PS, Poirrier AL, Andrews P. Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery. Rhinology 2017; 52:301-304. [PMID: 25479209 DOI: 10.4193/rhino14.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). METHODOLOGY We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. RESULTS SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. CONCLUSION SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery.
Collapse
|
23
|
Wakelam OC, Dimitriadis PA, Stephens J. The use of FloSeal haemostatic sealant in the management of epistaxis: a prospective clinical study and literature review. Ann R Coll Surg Engl 2017; 99:28-30. [PMID: 27490981 PMCID: PMC5392783 DOI: 10.1308/rcsbull.2017.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2016] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION It is standard practice in the UK that if conservative measures or chemical cautery fail to control epistaxis, patients receive nasal packing which is often uncomfortable, requires admission and has well documented associated morbidity. Our study aims to evaluate the use of FloSeal haemostatic sealant in managing patients with epistaxis. MATERIALS AND METHODS Patients were identified from those referred with active epistaxis. A successful outcome was defined as complete haemostasis with FloSeal alone, with no further significant bleeding requiring admission or further interventions in the subsequent 7 days. Patients reported satisfaction using a ten-point visual analogue scale. Ear, nose and throat doctors recorded patient demographics, time to prepare FloSeal, length of stay, need for further treatment and adverse events on an electronic database. RESULTS 30 patients were enrolled in the study. The mean time to prepare FloSeal was 5 minutes. The success rate of FloSeal was 90%. The mean length of stay was 2.75 hours. The mean patient satisfaction with FloSeal was 8.4/10. No adverse events occurred. DISCUSSION FloSeal was found to be effective in controlling anterior epistaxis. There was a single case of posterior epistaxis which required operative management. The literature largely supports FloSeal in anterior epistaxis, but indicates sphenopalatine artery ligation as the definitive management of posterior epistaxis. CONCLUSIONS Our data support the use of FloSeal in patients with anterior epistaxis not controlled with conservative measures or chemical cautery. It was found to be easy to use, is well tolerated by patients and is efficient in financial terms.
Collapse
|
24
|
Srigboh RK, Basu N, Stephens J, Asampong E, Perkins M, Neitzel RL, Fobil J. Multiple elemental exposures amongst workers at the Agbogbloshie electronic waste (e-waste) site in Ghana. CHEMOSPHERE 2016; 164:68-74. [PMID: 27580259 PMCID: PMC5048578 DOI: 10.1016/j.chemosphere.2016.08.089] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/01/2016] [Accepted: 08/19/2016] [Indexed: 05/04/2023]
Abstract
Electronic waste (e-waste) recycling is growing worldwide and raising a number of environmental health concerns. One of the largest e-waste sites is Agbogbloshie (Ghana). While several toxic elements have been reported in Agbogbloshie's environment, there is limited knowledge of human exposures there. The objectives of this study were to characterize exposures to several essential (copper, iron, manganese, selenium, zinc) and toxic (arsenic, cadmium, cobalt, chromium, mercury, nickel, lead) elements in the urine and blood of male workers (n = 58) at Agbogbloshie, as well as females (n = 11) working in activities that serve the site, and to relate these exposures to sociodemographic and occupational characteristics. The median number of years worked at the site was 5, and the average worker indicated being active in 6.8 tasks (of 9 key e-waste job categories). Additionally, we categorized four main e-waste activities (in brackets % of population self-reported main activity): dealing (22.4%), sorting (24.1%), dismantling (50%), and burning (3.4%) e-waste materials. Many blood and urinary elements (including essential ones) were within biomonitoring reference ranges. However, blood cadmium (1.2 μg/L median) and lead (6.4 μg/dl; 67% above U.S. CDC/NIOSH reference level), and urinary arsenic (38.3 μg/L; 39% above U.S. ATSDR value) levels were elevated compared to background populations elsewhere. Workers who burned e-waste tended to have the highest biomarker levels. The findings of this study contribute to a growing body of work at Agbogbloshie (and elsewhere) to document that individuals working within e-waste sites are exposed to a number of toxic elements, some at potentially concerning levels.
Collapse
|
25
|
Wilcock AA, van der Arend H, Darling K, Scholz J, Siddall R, Snigg C, Stephens J. An Exploratory Study of People's Perceptions and Experiences of Wellbeing. Br J Occup Ther 2016. [DOI: 10.1177/030802269806100206] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper describes an exploratory study aimed at understanding peoples perceptions and experiences of wellbeing. As health and wellbeing are considered by world and national health authorities to be closely related, occupational therapists along with other health workers need to know more about wellbeing, particularly from the perspective of ‘the people’. Using a questionnaire, seven cluster samples of 20 people, giving a total of 140 participants, were asked to define their concept of wellbeing, how it felt to them and how often they experienced the feeling. Data were also collected about nationality, marital status, employment, income, religion and levels of education because these have been identified as affecting wellbeing. In this study, wellbeing was described as happiness, peace, mind and body health and self-esteem, and was strongly associated with occupations as varied as work, relaxation and dressing up; relationships; and environments. No particular associations were found with any of the demographic data.
Collapse
|