Radiation therapy of breast cancer in the Nahe Breast Center: first results of an analysis in the context of health services research.

BACKGROUND: The first evaluation of radiotherapy results in patients with breast cancer treated as part of a multimodal oncologic therapy in the Nahe Breast Center is presented. Analysis of the results was performed using an in-practice registry. PATIENTS AND METHODS: From September 2016 to December 2017, 138 patients (median age 62.5 years; range 36-94 years) with breast cancer (right side, n = 67; left side, n = 71) received adjuvant radiation therapy. Of these, 103 patients received gyneco-oncologic care at the Nahe Breast Center, and 35 were referred from outside breast centers. The distribution into stages was as follows: stage I, n = 48; stage II, n = 68; stage III, n = 19; stage IV, n = 3. Neoadjuvant chemotherapy was given to 19 and adjuvant chemotherapy to 50 patients. Endocrine treatment was given to 120 patients. Both 3D conformal (n = 103) and intensity-modulated (n = 35) radiotherapy were performed with a modern linear accelerator. RESULTS: With a median follow-up of 60 months (1-67), local recurrence occurred in 4/138 (2.9%) and distant metastasis in 8/138 (5.8%) patients; 7/138 (5.1%) patients died of their tumors during the follow-up period. The actuarial 5­year local recurrence-free survival of all patients was 97.1%, and the actuarial 5­year overall survival of all patients was 94.9%. We observed no grade 3 or 4 radiogenic side effects. CONCLUSION: The results of radiotherapy for breast carcinoma at the Nahe Breast Center are comparable to published national and international results. In particular, the local recurrence rates in our study, determined absolutely and actuarially, are excellent, and demonstrate the usefulness of radiotherapy.

A mixed methods partner-focused cost and budget impact analysis to deploy implementation strategies for school-based prevention.

BACKGROUND: Obtaining information on implementation strategy costs and local budget impacts from multiple perspectives is essential to data-driven decision-making about resource allocation for successful evidence-based intervention delivery. This mixed methods study determines the costs and priorities of deploying Enhanced Replicating Effective Programs (REP) to implement the Michigan Model for Health™, a universal school-based prevention intervention, from key shareholder perspectives. METHODS: Our study included teachers in 8 high schools across 3 Michigan counties as part of a pilot cluster randomized trial. We used activity-based costing, mapping key Enhanced REP activities across implementation phases. We included multiple perspectives, including state agencies, regional education service agencies, lead organization, and implementers. We also conducted a budget impact analysis (BIA, assessing the potential financial impact of adopting Enhanced REP) and a scenario analysis to estimate replication and account for cost variability. We used an experimental embedded mixed methods approach, conducting semi-structured interviews and collecting field notes during the trial to expand and explain the cost data and the implications of costs across relevant perspectives. RESULTS: Based on trial results, we estimate costs for deploying Enhanced REP are $11,903/school, with an estimated range between $8263/school and $15,201/school. We estimate that adding four additional schools, consistent with the pilot, would cost $8659/school. Qualitative results indicated misalignment in school and teacher priorities in some cases. Implementation activities, including training and implementation facilitation with the health coordinator, were sometimes in addition to regular teaching responsibilities. The extent to which this occurred was partly due to leadership priorities (e.g., sticking to the district PD schedule) and organizational priorities (e.g., budget). CONCLUSIONS: Previous research findings indicate that, from a societal perspective, universal prevention is an excellent return on investment. However, notable misalignment in cost burden and priorities exists across shareholder groups. Our results indicate significant personal time costs by teachers when engaging in implementation strategy activities that impose an opportunity cost. Additional strategies are needed to improve the alignment of costs and benefits to enhance the success and sustainability of implementation. We focus on those perspectives informed by the analysis and discuss opportunities to expand a multi-level focus and create greater alignment across perspectives. TRIAL REGISTRATION: ClinicalTrials.gov NCT04752189. Registered on 12 February 2021.

Lessons from natural flight for aviation: then, now and tomorrow.

Powered flight was once a capability limited only to animals, but by identifying useful attributes of animal flight and building on these with technological advances, engineers have pushed the frontiers of flight beyond our predecessors' wildest imaginations. Yet, there remain many key characteristics of biological flight that elude current aircraft design, motivating a careful re-analysis of what we have learned from animals already, and how this has been revealed experimentally, as well as a specific focus on identifying what remains unknown. Here, we review the literature to identify key contributions that began in biology and have since been translated into aeronautical devices or capabilities. We identify central areas for future research and highlight the importance of maintaining an open line of two-way communication between biologists and engineers. Such interdisciplinary, bio-informed analyses continue to push forward the frontiers of aeronautics and experimental biology alike.

Universal Urogynecologic Consultation and Screening for Fecal Incontinence in Pregnant Women With a History of Obstetric Anal Sphincter Injury: A Cost-Effectiveness Analysis.

IMPORTANCE: Obstetric anal sphincter injuries (OASIS) predispose for the development of fecal incontinence (FI), but management of subsequent pregnancy after OASIS is controversial. OBJECTIVE: We aimed to determine if universal urogynecologic consultation (UUC) for pregnant women with prior OASIS is cost-effective. STUDY DESIGN: We performed a cost-effectiveness analysis of pregnant women with a history of OASIS modeling UUC compared with no referral (usual care). We modeled the route of delivery, peripartum complications, and subsequent treatment options for FI. Probabilities and utilities were obtained from published literature. Costs using a third-party payer perspective were gathered from the Medicare physician fee schedule reimbursement data or published literature converted to 2019 U.S. dollars. Cost-effectiveness was determined using incremental cost-effectiveness ratios). RESULTS: Our model demonstrated that UUC for pregnant patients with prior OASIS was cost-effective. Compared with usual care, the incremental cost-effectiveness ratio for this strategy was $19,858.32 per quality-adjusted life-year, below the willingness to pay a threshold of $50,000/quality-adjusted life-year. Universal urogynecologic consultation reduced the ultimate rate of FI from 25.33% to 22.67% and reduced patients living with untreated FI from 17.36% to 1.49%. Universal urogynecologic consultation increased the use of physical therapy by 14.14%, whereas rates of sacral neuromodulation and sphincteroplasty increased by only 2.48% and 0.58%, respectively. Universal urogynecologic consultation reduced the rate of vaginal delivery from 97.26% to 72.42%, which in turn led to a 1.15% increase in peripartum maternal complications. CONCLUSIONS: Universal urogynecologic consultation in women with a history of OASIS is a cost-effective strategy that decreases the overall incidence of FI, increases treatment utilization for FI, and only marginally increases the risk of maternal morbidity.

Gull dynamic pitch stability is controlled by wing morphing.

Birds perform astounding aerial maneuvers by actuating their shoulder, elbow, and wrist joints to morph their wing shape. This maneuverability is desirable for similar-sized uncrewed aerial vehicles (UAVs) and can be analyzed through the lens of dynamic flight stability. Quantifying avian dynamic stability is challenging as it is dictated by aerodynamics and inertia, which must both account for birds' complex and variable morphology. To date, avian dynamic stability across flight conditions remains largely unknown. Here, we fill this gap by quantifying how a gull can use wing morphing to adjust its longitudinal dynamic response. We found that it was necessary to adjust the shoulder angle to achieve trimmed flight and that most trimmed configurations were longitudinally stable except for configurations with high wrist angles. Our results showed that as flight speed increases, the gull could fold or sweep its wings backward to trim. Further, a trimmed gull can use its wing joints to control the frequencies and damping ratios of the longitudinal oscillatory modes. We found a more damped phugoid mode than similar-sized UAVs, possibly reducing speed sensitivity to perturbations, such as gusts. Although most configurations had controllable short-period flying qualities, the heavily damped phugoid mode indicates a sluggish response to control inputs, which may be overcome while maneuvering by morphing into an unstable flight configuration. Our study shows that gulls use their shoulder, wrist, and elbow joints to negotiate trade-offs in stability and control and points the way forward for designing UAVs with avian-like maneuverability.

Investigating the response scale of the EORTC QLQ-C30 in German cancer patients and a population survey.

BACKGROUND: The European Organization for research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) scales are scored on a 4-point response scale, ranging from not at all to very much. Previous studies have shown that the German translation of the response option quite a bit as mäßig violates interval scale assumptions, and that ziemlich is a more appropriate translation. The present studies investigated differences between the two questionnaire versions. METHODS: The first study employed a balanced cross-over design and included 450 patients with different types of cancer from three German-speaking countries. The second study was a representative survey in Germany including 2033 respondents. The main analyses included compared the ziemlich and mäßig version of the questionnaire using analyses of covariance adjusted for sex, age, and health burden. RESULTS: In accordance with our hypothesis, the adjusted summary score was lower in the mäßig than in the ziemlich version; Study 1: - 4.5 (95% CI - 7.8 to - 1.3), p = 0.006, Study 2: - 3.1 (95% CI - 4.6 to - 1.5), p < 0.001. In both studies, this effect was pronounced in respondents with a higher health burden; Study 1: - 6.8 (95% CI - 12.2 to - 1.4), p = 0.013; Study 2: - 4.5 (95% CI - 7.3 to - 1.7), p = 0.002. CONCLUSIONS: We found subtle but consistent differences between the two questionnaire versions. We recommend to use the optimized response option for the EORTC QLQ-C30 as well as for all other German modules. TRIAL REGISTRATION: The study was retrospectively registered on the German Registry for Clinical Studies (reference number DRKS00012759, 04th August 2017, https://www.drks.de/DRKS00012759 ).

Counseling on Complementary Methods in the Treatment of Side Effects of Oncological Therapies: A Project of the Breast and Bowel Center Nahe at the Hospital Sankt Marienwoerth Bad Kreuznach.

BACKGROUND: Increasingly, patients with cancer are asking for additional, complementary therapy options for treating the side effects of oncological therapy. Thus, the members of the Breast and Bowel Center Nahe at the Sankt Marienwörth Hospital Bad Kreuznach decided to define the content of this type of counseling for patients before treatment. METHODS: In 2018, a team of internal oncologists, gynecological oncologists, radio-oncologists, nutritionists, psycho-oncologists, and study nurses met several times to define the content of counseling. To inform the team, an intensive literature review was conducted. RESULTS: Counseling content was determined for complementary treatment options for the most frequent side effects of oncological therapies. Counseling sessions were formulated as frontal lectures (slide presentations), given at regular intervals for patients and relatives. These lectures were highly appreciated by patients. CONCLUSION: These counseling sessions increased patient understanding of both useful complementary measures and harmful measures they should not use.

Aerodynamic efficiency of gliding birds vs comparable UAVs: a review.

Here, we reviewed published aerodynamic efficiencies of gliding birds and similar sized unmanned aerial vehicles (UAVs) motivated by a fundamental question: are gliding birds more efficient than comparable UAVs? Despite a multitude of studies that have quantified the aerodynamic efficiency of gliding birds, there is no comprehensive summary of these results. This lack of consolidated information inhibits a true comparison between birds and UAVs. Such a comparison is complicated by variable uncertainty levels between the different techniques used to predict avian efficiency. To support our comparative approach, we began by surveying theoretical and experimental estimates of avian aerodynamic efficiency and investigating the uncertainty associated with each estimation method. We found that the methodology used by a study affects the estimated efficiency and can lead to incongruent conclusions on gliding bird aerodynamic efficiency. Our survey showed that studies on live birds gliding in wind tunnels provide a reliable minimum estimate of a birds' aerodynamic efficiency while simultaneously quantifying the wing configurations used in flight. Next, we surveyed the aeronautical literature to collect the published aerodynamic efficiencies of similar-sized, non-copter UAVs. The compiled information allowed a direct comparison of UAVs and gliding birds. Contrary to our expectation, we found that there is no definitive evidence that any gliding bird species is either more or less efficient than a comparable UAV. This non-result highlights a critical need for new technology and analytical advances that can reduce the uncertainty associated with estimating a gliding bird's aerodynamic efficiency. Nevertheless, our survey indicated that species flying within subcritical Reynolds number regimes may inspire UAV designs that can extend their operational range to efficiently operate in subcritical regimes. The survey results provided here point the way forward for research into avian gliding flight and enable informed UAV designs.

Load alleviation of feather-inspired compliant airfoils for instantaneous flow control.

Birds morph their wing shape to adjust to changing environments through muscle-activated morphing of the skeletal structure and passive morphing of the flexible skin and feathers. The role of feather morphing has not been well studied and its impact on aerodynamics is largely unknown. Here we investigate the aero-structural response of a flexible airfoil, designed with biologically accurate structural and material data from feathers, and compared the results to an equivalent rigid airfoil. Two coupled aero-structural models are developed and validated to simulate the response of a bioinspired flexible airfoil across a range of aerodynamic flight conditions. We found that the bioinspired flexible airfoil maintained lift at Reynolds numbers below 1.5 × 105, within the avian flight regime, performing similarly to its rigid counterpart. At greater Reynolds numbers, the flexible airfoil alleviated the lift force and experienced trailing edge tip displacement. Principal component analysis identified that the Reynolds number dominated this passive shape change which induced a decambering effect, although the angle of attack was found to effect the location of maximum camber. These results imply that birds or aircraft that have tailored chordwise flexible wings will respond like rigid wings while operating at low speeds, but will passively unload large lift forces while operating at high speeds.

Beliefs about thought probability: evidence for persistent errors in mindreading and links to executive control.

Four- to 10-year-olds' and adults' (N = 263) ability to inhibit privileged knowledge and simulate a naïve perspective were examined. Participants viewed pictures that were then occluded aside from a small ambiguous part. They offered suggestions for how a naïve person might interpret the hidden pictures, as well as rated the probability that a naïve person would think of several different pictures (with one picture being the actual item). Results indicated a significant increase between ages 4 and 7 years in attributing novel interpretations; however, all age groups overestimated the probability that a naïve person could guess the actual pictures. Individual differences in working memory and inhibitory control predicted participants' thought suggestions as well as aspects of their probability judgments.

Travel to, and use of, twenty-one Michigan trails.

OBJECTIVE AND METHODS: This study examined trail use among 857 trail users on 21 trails in Michigan from 2008 to 2011 using a valid and reliable intercept survey. RESULTS: Most of the 857 participants traveled to the trail from their home (92.6%), lived within 15 min of the trails (74.8%), and used active transport to travel to the trails 69.7%. The odds of active transport to the trails were greater among those who had not graduated high school (OR=3.49; 95% CI=1.02, 11.99) and high school graduates (OR=7.432; 95% CI=2.02, 27.30) compared to college graduates. Whites and adults also had greater odds of active transport than non-Whites (OR=3.160, 95% CI: 1.65, 6.05), and older adults (OR=1.75; 95% CI: 1.20, 2.54). The majority of respondents (89.7%) reported using trails for recreational purposes. A significantly greater proportion of females (73.3%) compared to males (64.7%) reported using the trail with others. CONCLUSIONS: The findings from this study might enable health and parks and recreation professionals to better promote physical activity on trails.