Developing a Patient-Centered Model of Prostate Cancer Care: Patient Satisfaction With a Survivorship Program Embedded in Urologic-Oncologic Care.

OBJECTIVE: To evaluate patients' and partners' satisfaction with a prostate cancer survivorship program embedded in urologic-oncologic care. As a part of quality improvement activity, we developed a patient and partner-centered, biopsychosocial support program for men and partners coping with the urinary and sexual side-effects of surgical treatment for prostate cancer. The program became a part of usual care for all prostate cancer patients. METHODS: Patients who saw both an advanced practice provider and a sex therapist between August 1, 2018 and July 31, 2019 were eligible. Surveys packets were sent to 146 patients with surveys included for partners (N = 292). We used descriptive statistics to characterize participant responses. RESULTS: Responses were received from 88 patients and 70 partners (56% response rate for the group). Patients and partners reported very high or fairly high satisfaction with the rehabilitation activities of the program (86-97% and 90%-100%, respectively); 91% of patients and 84% of partners thought having pre-operative education and post-operative rehabilitation was a good or fairly good idea; 83% of patients and 79% of partners would very much or somewhat recommend the program to a friend who was considering surgical treatment for prostate cancer. CONCLUSION: Embedding a patient and partner-centered prostate cancer survivorship support program in oncologic care can positively impact patients' and partners' engagement in and satisfaction with post-operative rehabilitation.

Unsupervised continuous sleep analysis.

One aim of the EU-funded project SIESTA was to develop a new way of describing the human sleep-wake continuum with high temporal resolution, and independent of subjective rules, to serve as an alternative to traditional sleep scoring. Here, we report new findings obtained with a fully automatic, probabilistic sleep-analyzer using Hidden Markov Models (HMMs) based on data from a single electroencephalogram (EEG) channel. HMMs allow the analysis of non-stationary time series by modeling both the probability density functions of locally stationary data and the transition probabilities between these stable states. In the context of sleep analysis, the locally stable states can be thought of as sleep stages. The sleep-wake continuum was modeled as a mixture of three different processes by defining a three-state Gaussian Observation HMM (GOHMM). No class information from human scorers was used to train the model. The probabilities of being in any of the three states at each point in time roughly indicate the amount of wakefulness, deep sleep and rapid-eye-movement (REM) sleep with a one-second time resolution. Although it was not the aim to replicate the traditional Rechtschaffen and Kales (R&K) scoring, pseudo R&K hypnograms were constructed from the probability plots in order to compare the analyzer results with classical sleep stages by human experts. We expected that the analyzer would be able to classify data correctly from the "cornerstones" of human sleep (wakefulness, deep sleep, and REM sleep). Contrary to our previous efforts, we trained the HMMs on data from two different sleep laboratories separately, instead of generalizing data from diverse laboratories. While these stages could be detected with an accuracy of around 80% at the sleep laboratory for which we already had achieved the best results, there was no improvement from previous results by the training of a separate model in the other laboratory. This finding indicates clear laboratory effects in the signal characteristics, probably due to differences in hardware and filter settings. The presented approach, going beyond a mere replication of the traditional R&K standard, offers a continuous description of human sleep which is based on probabilistic principles. It provides a second-by-second quantification of the sleep-wake continuum and captures, although being entirely data-driven instead of rule-based, the three main processes in human sleep: wakefulness, deep sleep and REM sleep.

Structure/energy correlation of bowl depth and inversion barrier in corannulene derivatives: combined experimental and quantum mechanical analysis.

Synthesis of a series of corannulene derivatives with varying bowl depths has allowed for a study correlating the structure (bowl depth) and the energy of bowl inversion. Substituents placed in the peri positions are repulsive and flatten the bowl, thus causing a decrease in the bowl inversion barrier. Conversely, annelation across the peri positions causes a deepening of the bowl, thus an increase in the bowl inversion barrier. Barriers between 8.7 and 17.3 kcal/mol have been measured, and their structures have been calculated using a variety of ab initio methods. The energy profile of an individual corannulene derivative is assumed to fit a mixed quartic/quadratic function from which an empirical correlation of bowl depth and inversion barrier that follows a quartic function is derived. Structure/energy correlations of this type speak broadly of the nature of enzymatic and catalytic activation of substrates.

Sonographic characteristics of antenatally diagnosed extralobar pulmonary sequestration and congenital cystic adenomatoid malformation.

Fetal chest masses are uncommonly noted on obstetrical ultrasound examinations. Some masses will undergo in utero regression with no neonatal morbidity whereas others are almost universally fatal. An accurate prenatal diagnosis is essential in enhancing parental decision-making. This paper reviews the published literature of two specific kinds of prenatally diagnosed fetal chest masses (congenital cystic adenomatoid malformations and pulmonary sequestrations) with emphasis on ultrasound characteristics and pregnancy outcome.

Spontaneous, in utero regression of antenatally diagnosed solid fetal chest masses. A report of two cases.

Mediastinal, displacing solid fetal chest masses have been regarded as lethal and thus considered cause for pregnancy termination at diagnosis. This report describes two cases in which solid fetal chest masses regressed spontaneously in utero.

Short-limb skeletal dysplasias: evaluation of the fetal spine with sonography and radiography.

Sonograms and radiographs of the lumbar spine in 51 fetuses and neonates with thanatophoric dwarfism, achondroplasia, and osteogenesis imperfecta type II were retrospectively evaluated. Study data included 27 prenatal and 27 neonatal sonograms and radiographs in 40 fetuses and neonates and 11 cases described in the radiology literature. To precisely compare the sonographic and radiographic appearances of platyspondyly in dysplasia, a simple vertebral ratio was obtained from measurement of vertebral interspace and vertebral body height. Normal ranges were obtained from sonograms in 125 normal fetuses and from radiographs in 55 normal fetuses. The severe platyspondyly of thanatophoric dysplasia and the milder platyspondyly of achondroplasia were detected by about 20 menstrual weeks. The vertebral bodies appeared slightly larger on sonograms than on radiographs in both normal fetuses and fetuses with dysplasia.

Current concepts in sonographic diagnosis of fetal renal disease.

The fetal kidneys and bladder are usually visible by 15 weeks' gestation on sonograms. The authors present their experience with the diagnosis of renal abnormalities in the fetus.

Normal infant brain anatomy: correlated real-time sonograms and brain specimens.

An investigation of the identifiable real-time sonographic features of the normal infant brain in the horizontal, coronal, inclined coronal, and midsagittal planes was undertaken. Correlations were made of sonograms of intact brains in vitro, corresponding brain sections, and sonograms in vivo. A large number of anatomic structures could be consistently depicted including cisterns, fissures, faix cerebri, tentorium cerebelli, ventricles, brainstem, cerebellum, basal ganglia, thalami, and corpus callosum. Pulsations of intracranial arteries, visible by real-time sonography, were of considerable help in identifying various structures. The investigation provides a reference of sonographic anatomy of the brain displayed in four clinically useful imaging planes.