Ototoxicity prognostic models in adult and pediatric cancer patients: a rapid review.

PURPOSE: A cornerstone of treatment for many cancers is the administration of platinum-based chemotherapies and/or ionizing radiation, which can be ototoxic. An accurate ototoxicity risk assessment would be useful for counseling, treatment planning, and survivorship follow-up in patients with cancer. METHODS: This systematic review evaluated the literature on predictive models for estimating a patient's risk for chemotherapy-related auditory injury to accelerate development of computational approaches for the clinical management of ototoxicity in cancer patients. Of the 1195 articles identified in a PubMed search from 2010 forward, 15 studies met inclusion for the review. CONCLUSIONS: All but 1 study used an abstraction of the audiogram as a modeled outcome; however, specific outcome measures varied. Consistently used predictors were age, baseline hearing, cumulative cisplatin dose, and radiation dose to the cochlea. Just 5 studies were judged to have an overall low risk of bias. Future studies should attempt to minimize bias by following statistical best practices including not selecting multivariate predictors based on univariate analysis, validation in independent cohorts, and clearly reporting the management of missing and censored data. Future modeling efforts should adopt a transdisciplinary approach to define a unified set of clinical, treatment, and/or genetic risk factors. Creating a flexible model that uses a common set of predictors to forecast the full post-treatment audiogram may accelerate work in this area. Such a model could be adapted for use in counseling, treatment planning, and follow-up by audiologists and oncologists and could be incorporated into ototoxicity genetic association studies as well as clinical trials investigating otoprotective agents. IMPLICATIONS FOR CANCER SURVIVORS: Improvements in the ability to model post-treatment hearing loss can help to improve patient quality of life following cancer care. The improvements advocated for in this review should allow for the acceleration of advancements in modeling the auditory impact of these treatments to support treatment planning and patient counseling during and after care.

Women's labor, fertility, and the introduction of modern technology in a rural Maya village.

PIP: The introduction of mechanized technology into a rural Maya agricultural community in the mid 1970s markedly increased the technology with which maize could be ground and water collected, which in turn introduced a possible savings in the time spent working. This study investigated the response of female fertility to the introduction of this labor-saving technology. Using two proximate determinants of female fertility, the association between the advent of modern technology and changes in the age at which women give birth to their first child and the length of mothers' birth intervals was examined. Analyses showed that women begin their reproductive careers at a younger age after the laborsaving technology was introduced. Estimate of the median age at first birth from the distribution function dropped from 21.2 years before the introduction to 19.5 years after the introduction of the technology. In addition, modeling results show that the probability of a woman giving birth to her first child doubles for any age after the introduction of laborsaving technology. However, changes in birth intervals are less conclusive since the differences of smoothed probability distributions are not significant. Moreover, findings indicate that women who initiate reproduction at a younger age can potentially have longer reproductive careers and larger families.^ieng

How maya women respond to changing technology : The effect of helping behavior on initiating reproduction.

In the mid 1970s labor-saving technology was introduced into a Maya subsistence agricultural community that markedly increased the efficiency with which maize could be ground and water collected. This increased efficiency introduces a possible savings in the time that women allocate to work, which can be reapportioned to child care, food production, domestic work, or leisure. An earlier study suggested that this labor-saving technology had a positive effect in decreasing the age at which these Maya women begin their reproductive careers. Although there is a statistical association between the age at which women bear their first child and the introduction of modern technology, this association does not demonstrate that the decline in age at first birth is causally related to the presence of technology. This paper pursues two objectives to evaluate this potential causal relationship in greater detail. First, a theory relating technological change to the initiation of a reproductive career is briefly developed in order to make qualitative predictions about behavioral changes as a response to changing technology. Second, these predictions are then tested against time allocation data recently collected in this same Maya community.We suggest that both of the conditions necessary to initiate reproduction-fecundity and access to mates-fundamentally depend on the amount of help that a girl provides to her family. Further, the help that a girl provides can be affected by technological changes. Analyses show that when modern technology is available, unmarried young women do not change the time allocated to domestic tasks and child care, and allocate more time to low-energy leisure activities. This lack of perceived benefit to working more and a potential concomitant shift towards a positive energy balance may in part explain why Maya women leave home and initiate reproduction at a younger age after labor-saving technology is introduced.