Influence of tobacco product wastes in a protected coastal reserve adjacent to urbanization.

The present study, conducted at the Kendall-Frost Mission Bay Marsh Reserve in San Diego, California, aimed to assess tobacco-related pollutants in urban waters, a topic with limited prior research. Across 26 events occurring between November 2019 and February 2022, encompassing both wet and dry seasons at two outfall sites (Noyes St. and Olney St.), water and sediment samples were subjected to analysis for nicotine and cotinine levels, with Noyes St. displaying wide variation in nicotine concentrations, reaching a peak of 50.75 ng/L in water samples, whereas Olney St. recorded a peak of 1.46 ng/L. Wet seasons consistently had higher nicotine levels in water, suggesting the possibility of tobacco litter entering the reserve through stormwater runoff. Cotinine was detected in both sites in both water and sediment samples; however, these levels were considerably lower in comparison to nicotine concentrations. Limited research assesses aquatic environmental pollution from tobacco use and disposal, especially in protected areas like urban natural reserves. This study was conducted at the Kendall-Frost Mission Bay Marsh Reserve in San Diego, California, to evaluate tobacco-related pollutants in San Diego's urban waters. Twenty-six sampling events between November 2019 and February 2022, spanning wet and dry seasons at two outfall sites, were conducted. Nicotine and cotinine, a major ingredient of tobacco and its metabolite, were analyzed in the collected water and sediment samples. Nicotine concentrations differed substantially between the outfall locations (Noyes St. and Olney St.), with Noyes St. displaying wide variations, averaging at 9.31 (±13.24) ng/L with a maximum concentration of 50.75 ng/L, and Olney St. at 0.53 (±0.41) ng/L with a maximum concentration of 1.46 ng/L in water samples. In both locations, the nicotine concentrations in water samples were higher during wet seasons than dry seasons, and this pattern was more significant at Noyes St. outfall than at Olney St. outfall, which received not only stormwater runoff but also was connected to Mission Bay. Although this pattern did not directly align with sediment nicotine levels at both sites, maximum nicotine concentration in Noyes St. sediments during wet seasons was approximately 120 times higher than in Olney St. sediments. Regarding cotinine, Noyes St. outfall water averaged 3.17 ng/L (±1.88), and Olney St. water averaged 1.09 ng/L (±1.06). Similar to nicotine, the cotinine concentrations were higher in Noyes St. water and sediment compared to Olney St., but overall, the cotinine concentrations in both water and sediment were much lower than the corresponding nicotine concentrations. The study identifies urban stormwater runoff as a potential source of nicotine and cotinine pollution in a protected reserve, implicating tobacco product litter and human tobacco use as contributing factors.

PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer.

BACKGROUND: While prostate multiparametric-magnetic resonance imaging (MP-MRI) has improved the diagnosis of clinically significant prostate cancer (CSPC), the complementary use of prostate-specific antigen (PSA) levels to risk-stratify for CSPC requires further study. The objective of this project was to determine if prostate MP-MRI and PSA can provide complementary insights into CSPC risk stratification. METHODS: In an IRB-approved study, pathologic outcomes from patients who underwent MR/US fusion-targeted prostate biopsy were stratified by various parameters including PSA, PSA density (PSAD), age, race, and PI-RADS v2 score. CSPC was defined as a Gleason score ≥7. Logistic regression was used to determine odds ratios (OR) with 95% confidence intervals (CI). P values were reported as two-sided with p < 0.05 considered statistically significant. ROC curves were generated for assessing the predictive value of tests and sensitivity + specificity optimization was performed to determine optimal testing cutoffs. RESULTS: A total of 327 patients with 709 lesions total were analyzed. PSAD and PI-RADS scores provided complementary predictive value for diagnosis of CSPC (AUC PSAD: 0.67, PI-RADS: 0.72, combined: 0.78, p < 0.001). When controlling for PI-RADS score, age, and race, multivariate analysis showed that PSAD was independently associated with CSPC (OR 1.03 per 0.01 PSAD increase, 95% CI 1.02-105, p < 0.001). The optimal cutoff of PSAD ≥ 0.1 ng/ml/cc shows that a high versus low PSAD was roughly equivalent to an increase in 1 in PI-RADS score for the presence of CSPC (4% of PI-RADS ≤3 PSAD low, 6% of PI-RADS 3 PSAD high vs. 5% of PI-RADS 4 PSAD low, 22% of PI-RADS 4 PSAD high vs. 29% of PI-RADS 5 PSAD low, 46% of PI-RADS 5 PSAD high were found to have CSPC). CONCLUSIONS: PSAD with a cutoff of 0.1 ng/ml/cc appears to be a useful marker that can stratify the risk of CSPC in a complementary manner to prostate MP-MRI.

Agreement between hand therapists and hand surgeons in the management of adults with closed metacarpal fractures.

BACKGROUND: Hand therapists often work in roles which require an advanced level of experience as Advanced Scope Practitioners (ASP). However, it is not known whether clinical decisions are similar between hand therapists and surgeons when managing simple hand fractures. OBJECTIVES: To determine the level of agreement between (i) a hand therapist and five hand surgeons and (ii) three hand therapists, for the management of adults with closed metacarpal fracture(s). DESIGN: A prospective, blinded, crossover inter-rater reliability study. METHOD: Patient volunteers with closed metacarpal fracture(s) were assessed independently in the first study (n = 90) by a hand therapist and one of five hand surgeons and in the second study (n = 57) by three hand therapists in a randomised order, with each practitioner recording whether the patient participant should be managed conservatively, trialled with conservative or offered surgical treatment. The level of agreement between the hand therapist and hand surgeons was calculated using Cohen's kappa coefficient and between the three hand therapists by calculating Fleiss' Kappa. The observed agreement was also calculated as the proportion of cases for which the assessors had agreement for management. RESULTS: There was good agreement between the hand therapist and surgeons (k = 0.68; 95% CI: 0.537-0.831) and amongst the three hand therapists (k = 0.663; 95% CI: 0.554-0.773) in determining the management of adults with closed metacarpal fracture(s). CONCLUSIONS: Hand therapists and surgeons make similar management decision for patients with metacarpal fractures supporting the role of hand therapists as ASP.

Methadone rotation for cancer pain: an observational study.

CONTEXT: Methadone is a useful option in the treatment of cancer pain. Despite its advantages, methadone use is complicated due to high interindividual variability in pharmacokinetics. Various rotation methods from other opioids have been proposed in mostly Caucasian populations. OBJECTIVES: This study aims to describe our experience with opioid rotation to methadone for management of cancer pain in a predominantly Asian population. METHODS: A retrospective review of 52 inpatients initiated on methadone for cancer pain from June 2015 to June 2018 was conducted. Our institution protocol for methadone rotation involves either one of two methods ('Stop-and-go' or the Edmonton 3-day rotation) based on the morphine-equivalent daily dose (MEDD), using an equianalgesic ratio of 10:1 for MEDD <1000 mg. To account for incomplete cross-tolerance, we further reduce the calculated dose by 30%. RESULTS: The majority of patients had mixed nociceptive-neuropathic pain (83%) and the predominant reason for methadone rotation was ineffective analgesia with other opioids (75%). The median MEDD before rotation was 104 mg. Effective analgesia (defined as a decrease in numerical rating scale (NRS) of ≥1 or attainment of NRS ≤3) was achieved within 3 days after rotation in 89% of patients. Patients with an MEDD ≤100 mg/day required a greater degree of uptitration of methadone dose after rotation compared with those with an MEDD >100 mg/day. CONCLUSION: Rotation to methadone according to our protocol is effective in achieving adequate analgesia in most patients experiencing nociceptive-neuropathic pain. Our results also suggest that a fixed equianalgesic ratio of 10:1 may be adequate for patients at low-to-moderate MEDD <400 mg/day.

Narratives, masks and COVID-19: A qualitative reflection.

Tracing explanatory narratives of mask-wearing throughout COVID-19, we argue that multiple narratives contribute to the global experience of COVID-19, making it as much a social and political object as it is a scientific one. This assumption drives our commitment to take seriously alternative narratives that do not conform to dominant ones in order to examine how structures of power might privilege particular types of 'truths' and with what consequences. We see this reflective piece as a re-articulation of social work's historic call to interrogate dominant ways of knowing, particularly the ways in which science obscures its own power and politics and sidelines other narratives in the process.

Preserving Endocrine Function in Premenopausal Women Undergoing Whole Pelvis Radiation for Cervical Cancer.

PURPOSE: Whole pelvis radiation therapy (WPRT) in premenopausal women with cervical cancer can cause permanent ovarian damage, resulting in premature menopause. Oophoropexy, often considered as an initial step, demonstrates safety of sparing 1 ovary at the cost of delay in initiating WPRT. Therefore, we dosimetrically compared volumetric modulated arc radiotherapy (VMAT) and intensity modulated proton therapy (IMPT) techniques to allow for ovarian-sparing WPRT. MATERIALS AND METHODS: Ten patients previously treated for cervical cancer at our institution were included in this institutional review board-approved analysis. A modified clinical treatment volume (CTV) was designed, sparing 1 ovary (left or right), as determined by the physician (ovarian-sparing CTV) and disease extent, including physical exam, positron emission tomography/computed tomography and magnetic resonance imaging. An ovarian-sparing planning target volume was determined as the ovarian-sparing CTV+5 mm for patients who were supine and 7 mm for those who were prone. All plans were calculated to a dose of 45 Gy with specific optimization goals for target volumes, while attempting to maintain a mean ovary dose (Dmean) < 15 Gy. Dosimetric goals were compared across the 2 modalities using the Mann-Whitney U test. RESULTS: Both treatment modalities were able to achieve primary clinical goal coverage to the uterus/cervix (P = .529, comparing VMAT versus IMPT), ovarian-sparing CTV (P = .796) and ovarian-sparing planning target volume (P = .004). All 10 IMPT plans were able to accomplish the ovary objective (14.0 ± 1.66 Gy). However, only 4 of the 10 VMAT plans were able to achieve a Dmean < 15 Gy to the prioritized ovary, with an average dose of 15.3 ± 4.10 Gy. CONCLUSION: Sparing an ovary in women undergoing WPRT for cervical cancer is dosimetrically feasible with IMPT without sacrificing coverage to important clinical targets. Future work will incorporate the brachytherapy dose to the ovarian-sparing CTV and assess the clinical response of this technique as a means to preserve ovarian endocrine function.

Group cognitive behavioural therapy for psychosis in the Asian context: a review of the recent studies.

The cardinal symptoms of psychosis include hallucination and delusion, which can be both distressing and disabling. International guidelines recommend cognitive behavioural therapy for psychosis (CBTp) as an adjunctive intervention to medication management. Considering the difficulty in the widespread dissemination of the individual CBTp, group CBTp is an alternative in improving patients' access to psychological intervention. Although it has been found feasible and effective in various studies, systematic review on group CBTp, particularly in Asia, was not identified. Hence, this systematic review tried to examine the recent evidence of group CBTp in Asia in order to shed light on its implementation in routine psychiatric care. A relevant literature search was conducted in three databases (Pubmed, Web of Knowledge, and PsycINFO) during the period from January 2000 to December 2018. A total of 114 journal articles were identified. After a full-text review, four studies met our inclusion and exclusion criteria. Despite methodological shortcomings, positive results were found in terms of improvements on psychotic symptoms, functioning, and quality-of-life. These encouraging results indicate the need for future research studies with more rigorous methodology, leading to a better understanding on the applicability and effectiveness of group CBTp in the Asian context.

A Supervised Learning Tool for Prostate Cancer Foci Detection and Aggressiveness Identification using Multiparametric magnetic resonance imaging/magnetic resonance spectroscopy imaging.

Prostate cancer is the most frequently diagnosed cancer in men in the United States. The current main methods for diagnosing prostate cancer include prostate-specific antigen test and transrectal biopsy. Prostate-specific antigen screening has been criticized for overdiagnosis and unnecessary treatment, and transrectal biopsy is an invasive procedure with low sensitivity for diagnosis. We provided a quantitative tool using supervised learning with multiparametric imaging to be able to accurately detect cancer foci and its aggressiveness. A total of 223 specimens from patients who received magnetic resonance imaging (MRI) and magnetic resonance spectroscopy imaging prior to the surgery were studied. Multiparametric imaging included extracting T2-map, apparent diffusion coefficient (ADC) using diffusion-weighted MRI, Ktrans using dynamic contrast-enhanced MRI, and 3-dimensional-MR spectroscopy. A pathologist reviewed all 223 specimens and marked cancerous regions on each and graded them with Gleason scores, which served as the ground truth to validate our prediction model. In cancer aggressiveness prediction, the average area under the receiver operating characteristic curve (AUC) value was 0.73 with 95% confidence interval (0.72-0.74) and the average sensitivity and specificity were 0.72 (0.71-0.73) and 0.73 (0.71-0.75), respectively. For the cancer detection model, the average AUC value was 0.68 (0.66-0.70) and the average sensitivity and specificity were 0.73 (0.70-0.77) and 0.62 (0.60-0.68), respectively. Our method included capability to handle class imbalance using adaptive boosting with random undersampling. In addition, our method was noninvasive and allowed for nonsubjective disease characterization, which provided physician information to make personalized treatment decision.

A phase II trial of gefitinib (Iressa, ZD1839) in stage IV and recurrent renal cell carcinoma.

PURPOSE: The epidermal growth factor receptor (EGFR) is overexpressed in 75 to 90% of renal cell carcinomas and may play a role in tumor initiation and progression. Gefitinib (Iressa, ZD1839) is a potent, selective EGFR-tyrosine kinase inhibitor. This trial was undertaken to assess the efficacy and toxicity of gefitinib in advanced renal cell carcinoma. EXPERIMENTAL DESIGN: Oral gefitinib, 500 mg once daily, was given continuously. A single-dose reduction to 250 mg daily was allowed for toxicity. The primary end point was response rate (defined as complete remission + partial remission + stable disease). Secondary end points were progression-free survival, overall survival, toxicity, and correlation of response with EGFR status. RESULTS: Twenty-one patients were enrolled on this study, and all are evaluable for response and toxicity. Patient characteristics were median age 61 (range, 35-78 years); 17 males, 4 females; median performance status 0 (range 0-2); median number of prior systemic therapies 1 (range, 0-3). The median and mean number of cycles of therapy received was 3 and 4.7 (range, 1-14+). The best response was stable disease in eight patients (38%). Median progression-free survival was 2.7 months. Median overall survival was 8.3 months. The difference in overall survival was significantly different between patients with progressive disease versus stable disease (6.1 months versus 16+ months; Log-Rank test P value < 0.0001). Three patients required a dose reduction, all for grade 3 diarrhea. There was no apparent correlation between EGFR status and stability of disease or progression of disease. CONCLUSIONS: Gefitinib is without significant conventional activity in renal cell carcinoma. The relation of "stable disease" to treatment or to disease-related prognostic heterogeneity remains to be defined.