Corrected Age at Bayley Assessment and Developmental Delay in Extreme Preterms.

BACKGROUND AND OBJECTIVES: Research on outcomes of prematurity frequently examines neurodevelopment in the toddler years as an end point, but the age range at examination varies. We aimed to evaluate whether the corrected age (CA) at Bayley-III assessment is associated with rates of developmental delay in extremely preterm children. METHODS: This retrospective cohort study included children born at <29 weeks' gestation who were admitted in the Canadian Neonatal Network between 2009 and 2017. The primary outcomes were significant developmental delay (Bayley-III score <70 in any domain) and developmental delay (Bayley-III score <85 in any domain). To assess the association between CA at Bayley-III assessment and developmental delay, we compared outcomes between 2 groups of children: those assessed at 18 to 20 months' CA and 21-24 months. RESULTS: Overall, 3944 infants were assessed at 18-20 months' CA and 881 at 21-24 months. Compared with infants assessed at 18-20 months, those assessed at 21-24 months had higher odds of significant development delay (20.0% vs 12.5%; adjusted odds ratio, 1.75; 95% confidence interval [CI], 1.41-2.13) and development delays (48.9% vs 41.7%, adjusted odds ratio 1.33; 95% CI, 1.11-1.52). Bayley-III composite scores were on average 3 to 4 points lower in infants evaluated at 21-24 months' CA (for instance, adjusted mean difference and 95% CI for language: 3.49 [2.33-4.66]). Conversely, rates of cerebral palsy were comparable (4.6% vs 4.7%) between the groups. CONCLUSIONS: Bayley-III assessments performed at 21-24 months' CA were more likely to diagnose a significant developmental delay compared with 18- to 20-month assessments in extremely preterm children.

Variations in Site-Specific Costs for Infants Born Extremely Preterm in Canadian Neonatal Intensive Care Units.

OBJECTIVE: To quantify site-specific costs and their association with survival without major morbidity (SWMM) in Canada for neonates <28 weeks of gestation admitted to large tertiary neonatal intensive care units. METHODS: We conducted a retrospective analysis of infants born at <28 weeks of gestation and admitted to Canadian Neonatal Network sites from 2010 through 2021. Sites that cared for at least 50 eligible infants by gestational age in weeks over the study period were included. Using a validated costing algorithm that assessed physician, nursing, respiratory therapy, diagnostic imaging, transfusions, procedural, medication, and certain indirect costs, we calculated site and resource-specific costs in 2017 Canadian dollars (CAD) and evaluated their relationship with SWMM. RESULTS: Seven sites with 8180 (range 841-1605) eligible neonates with a mean (SD) gestation of 25.4 [1.3] weeks were included. Survival to discharge or transfer was 85.3% with a mean (SD) length of stay of 75 (46) days. The mean (SD) total and daily costs per neonate varied between $94 992 ($60 283) and $174 438 ($130 501) CAD and $1833 ($916) to $2307 ($1281) CAD, respectively. Between sites, there was no relationship between costs and SWMM. CONCLUSIONS: There was marked variation in costs and SWMM between sites in Canada with universal health care. The lack of concordance between both outcomes and costs among sites may provide possibilities for outcomes improvement and cost containment.

The Healthy Eating Assessment Tool (HEAT): A Simplified 10-Point Assessment of CHILD-2 Dietary Compliance for Children and Adolescents with Dyslipidemia.

Traditional dietary assessment tools used to determine achievement of cholesterol-lowering dietary targets, defined in the Cardiovascular Health Integrated Lifestyle Diet (CHILD-2), are time intensive. We sought to determine the utility of the Healthy Eating Assessment Tool (HEAT), a simplified 10-point dietary assessment tool, in relation to meeting dietary cut points of the CHILD-2, as well as its association with markers of adiposity and lipid variables. We performed a 2-year single-center, prospective cross-sectional study of pediatric patients with dyslipidemia. HEAT score associations with meeting CHILD-2 fat targets were modest. Only patients with the highest HEAT scores (good 43%, excellent 64%) met the CHILD-2 cut point of <25% total fat calories (p = 0.03), with a non-significant trend for limiting the percentage of daily saturated fat to <8% (excellent 64%), and no association with cholesterol intake. There were more consistent associations with markers of adiposity (body mass index z-score r = -0.31, p = <0.01 and waist-to-height ratio r = -0.31, p = <0.01), and there was no independent association with lipid levels. While fat-restricted diets are safe, they are not particularly effective for treatment of dyslipidemia or for weight management alone. The HEAT may be a more useful and simplified way of assessing and tracking broader dietary goals in clinical practice.

Effect of Chinese medicinal herbal residues compost on tomato and Chinese cabbage plants: Assessment on phytopathogenic effect and nutrients uptake.

Chinese medicinal herbal residues (CMHRs) are known for their antipathogenic properties due to the presence of bioactive compounds. Hence, CMHRs could be used as a potential resource to produce biofertilizer with antipathogenic properties for agricultural applications. In this study, a novel approach was used by utilizing the waste-derived biofertilizer, i.e., CMHRs compost (CMHRC) as a nutrient supplier as well as an organic bioagent against Alternaria solani (A. solani) and Fusarium oxysporum (F. oxysporum) on tomato (Lycopersicon esculentum) and Chinese cabbage (Brassica rapa subsp. Chinensis) plants. The experiments were conducted under greenhouse conditions using locally collected acidic soil wherein 2%, 5% and 10% CMHRC (dry weight) along with 5% food waste compost were used as treatments. In addition, only soil and soil with phytopathogens were used as control treatments. The results suggested that amending the compost into acidic soil significantly increased the pH to a neutral level along with enhanced uptake of nutrients. Among all the treatments, 5% CMHRs compost addition increased the tomato plant biomass production to 4.9 g/pot (dry weight) compared to 2.2 g/pot in control. A similar trend was observed in Chinese cabbage plants and the improved plant biomass production could be attributed to the combined effect of strong nutrient absorption ability by healthy roots and enhanced nutrient supply. At 5% CMHRC application rate, the nitrogen uptake by tomato and Chinese cabbage plants increased by 78% and 62%, respectively, whereas phosphorous uptake increased by 75% and 25%, respectively. The reduction in A. solani by 48% and F. oxysporum by 54% in the post-harvested soil of 5% CMHRC treatment against the control demonstrated the anti-phytopathogenic efficiency of CMHRC compost. Hence, the present study illustrates the beneficiary aspects of utilizing CMHRs to produce biofertilizer with anti-phytopathogenic properties which can be safely used for tomato and Chinese cabbage plant growth.

Quantitative Assessment and Spatial Analysis of Metals and Metalloids in Soil Using the Geo-Accumulation Index in the Capital Town of Romblon Province, Philippines.

The municipality of Romblon in the Philippines is an island known for its marble industry. The subsurface of the Philippines is known for its limestone. The production of marble into slab, tiles, and novelty items requires heavy equipment to cut rocks and boulders. The finishing of marble requires polishing to smoothen the surface. During the manufacturing process, massive amounts of particulates and slurry are produced, and with a lack of technology and human expertise, the environment can be adversely affected. Hence, this study assessed and monitored the environmental conditions in the municipality of Romblon, particularly the soils and sediments, which were affected due to uncontrolled discharges and particulates deposition. A total of fifty-six soil and twenty-three sediment samples were collected and used to estimate the metal and metalloid (MM) concentrations in the whole area using a neural network-particle swarm optimization inverse distance weighting model (NN-PSO). There were nine MMs; e.g., As, Cr, Ni, Pb, Cu, Ba, Mn, Zn and Fe, with significant concentrations detected in the area in both soils and sediments. The geo-accumulation index was computed to assess the level of contamination in the area, and only the soil exhibited contamination with zinc, while others were still on a safe level. Nemerow's pollution index (NPI) was calculated for the samples collected, and soil was evaluated and seen to have a light pollution level, while sediment was considered as "clean". Furthermore, the single ecological risk (Er) index for both soil and sediment samples was considered to be a low pollution risk because all values of Er were less than 40.

Impact of total solids content on biochar amended co-digestion of food waste and sludge: Microbial community dynamics, methane production and digestate quality assessment.

This study evaluates the impact of biochar addition on the performance of anaerobic co-digestion of food waste (FW) and sewage sludge at different total solids (TS) contents (2.5 %, 5.0 %, and 7.5 %). Biochar co-digestion improved hydrolysis and acidogenesis by neutralizing volatile fatty acids (VFAs) reducing its inhibitions (2.6-fold removal), which elevated the soluble chemical oxygen demand (sCOD) degradation by 2.5 folds leading to a higher cumulative methane production compared to the control. This increase corresponded to an improvement of methane yields by ∼21 %-33 % (242-340 mL/gVSadd) at different TS contents. The biochar surface area offered substantial support for direct interspecies electron transfer (DIET) activity, and biofilm-mediated growth of methanogens i.e., Methanosarcina, Methanosata, and Methanobrevibacter. The biochar-enriched digestate improved the seed germination index, and bioavailability of plant nutrients such as N, P, K, and NH4+-N. This study reports an improved biochar-mediated anaerobic co-digestion for efficient and sustainable FW valorization.

Trends in mitigation of industrial waste: Global health hazards, environmental implications and waste derived economy for environmental sustainability.

Majority of industries, in order to meet the technological development and consumer demands generate waste. The untreated waste spreads out toxic and harmful substances in the environment which serves as a breeding ground for pathogenic microorganisms thus causing severe health hazards. The three industrial sectors namely food, agriculture, and oil industry are among the primary organic waste producers that affect urban health and economic growth. Conventional treatment generates a significant amount of greenhouse gases which further contributes to global warming. Thus, the use of microbes for utilization of this waste, liberating CO2 offers an indispensable tool. The simultaneous production of value-added products such as bioplastics, biofuels, and biosurfactants increases the economics of the process and contributes to environmental sustainability. This review comprehensively summarized the composition of organic waste generated from the food, agriculture, and oil industry. The linkages between global health hazards of industrial waste and environmental implications have been uncovered. Stare-of-the-art information on their subsequent utilization as a substrate to produce value-added products through bio-routes has been elaborated. The research gaps, economical perspective(s), and future research directions have been identified and discussed to strengthen environmental sustainability.

A review on integrated approaches for municipal solid waste for environmental and economical relevance: Monitoring tools, technologies, and strategic innovations.

Rapid population growth, combined with increased industrialization, has exacerbated the issue of solid waste management. Poor management of municipal solid waste (MSW) not only has detrimental environmental consequences but also puts public health at risk and introduces several other socioeconomic problems. Many developing countries are grappling with the problem of safe disposing of large amounts of produced municipal solid waste. Unmanaged municipal solid waste pollutes the environment, so its use as a potential renewable energy source would aid in meeting both increased energy needs and waste management. This review investigates emerging strategies and monitoring tools for municipal solid waste management. Waste monitoring using high-end technologies and energy recovery from MSW has been discussed. It comprehensively covers environmental and economic relevance of waste management technologies based on innovations achieved through the integration of approaches.

Recovery of resources from industrial wastewater employing electrochemical technologies: status, advancements and perspectives.

In the last two decades, water use has increased at twice the rate of population growth. The freshwater resources are getting polluted by contaminants like heavy metals, pesticides, hydrocarbons, organic waste, pathogens, fertilizers, and emerging pollutants. Globally more than 80% of the wastewater is released into the environment without proper treatment. Rapid industrialization has a dramatic effect on developing countries leading to significant losses to economic and health well-being in terms of toxicological impacts on humans and the environment through air, water, and soil pollution. This article provides an overview of physical, chemical, and biological processes to remove wastewater contaminants. A physical and/or chemical technique alone appears ineffective for recovering useful resources from wastewater containing complex components. There is a requirement for more processes or processes combined with membrane and biological processes to enhance operational efficiency and quality. More processes or those that are combined with biological and membrane-based processes are required to enhance operational efficiencies and quality. This paper intends to provide an exhaustive review of electrochemical technologies including microbial electrochemical technologies. It provides comprehensive information for the recovery of metals, nutrients, sulfur, hydrogen, and heat from industrial effluents. This article aims to give detailed information into the advancements in electrochemical processes to energy use, improve restoration performance, and achieve commercialization. It also covers bottlenecks and perspectives of this research area.

Food waste and sewage sludge co-digestion amended with different biochars: VFA kinetics, methane yield and digestate quality assessment.

This work investigated the impact of the addition of different biochar types on mitigation of volatile fatty acid (VFA) accumulation, methane recovery and digestate quality in mesophilic food waste-sludge co-digestion. Four biochars derived from agricultural and sludge residues under different pyrolysis temperatures were compared. Specific biochar properties such as pH, surface area, chemical properties and presence of surface functional groups likely influenced biochar reactions during digestion, thereby resulting in a varying performance of different biochars. Miscanthus straw biochar addition led to the highest specific methane yield of 307 ± 0.3 mL CH4/g VSadded versus 241.87 ± 5.9 mL CH4/g VSadded from control with no biochar addition over 30 days of the co-digestion period. Biochar supplementation led to enhanced process stability which likely resulted from improved syntrophic VFA oxidation facilitated by specific biochar properties. Overall, a 21.4% increase in the overall methane production was obtained with biochar addition as compared to control. The resulting digestate quality was also investigated. Biochar-amended digester generated a digestate rich in macro- and micro-nutrients including K, Mg, Ca, Fe making biochar-amended digestate a potential replacement of agricultural lime fertilizer. This work demonstrated that the addition of specific biochars with desirable properties alleviated VFA accumulation and facilitated enhanced methane recovery, thereby providing a means to achieve process stability even under high organic loading conditions in co-digestions. Moreover, the availability of biochar-enriched digestate with superior characteristics than biochar-free digestate adds further merit to this process.

Assessment of mechanical properties of articular cartilage with quantitative three-dimensional ultrashort echo time (UTE) cones magnetic resonance imaging.

Conventional magnetic resonance imaging (MRI) is not capable of detecting signal from the deep cartilage due to its short transverse relaxation time (T2). Moreover, several quantitative MRI techniques are significantly influenced by the magic angle effect. The combinations of ultrashort echo time (UTE) MRI with magnetization transfer (UTE-MT) and Adiabatic T1ρ (UTE-AdiabT1ρ) imaging allow magic angle-insensitive assessments of all regions of articular cartilage. The purpose of this study was to investigate the correlations between quantitative three-dimensional UTE MRI biomarkers and mechanical properties of human tibiofemoral cartilage specimens. In total, 40 human tibiofemoral cartilage specimens were harvested from three male and four female donors (64 ± 18 years old). Cartilage samples were scanned using a series of quantitative 3D UTE Cones T2* (UTE-T2*), T1 (UTE-T1), UTE-AdiabT1ρ, and UTE-MT sequences in a standard knee coil on a clinical 3T scanner. UTE-MT data were acquired with a series of MT powers and frequency offsets to calculate magnetization transfer ratio (MTR), as well as macromolecular fraction (MMF) and macromolecular T2 (T2mm) through modeling. Cartilage stiffness and Hayes elastic modulus were measured using indentation tests. Correlations of 3D UTE Cones MRI measurements in the superficial layer, deep layer, and global regions of interest (ROIs) with mechanical properties were investigated. Cartilage mechanical properties demonstrated highest correlations with UTE measures of the superficial layer of cartilage. AdiabT1ρ, MTR, and MMF in superficial layer ROIs showed significant correlations with Hayes elastic modulus (p < 0.05, R = -0.54, 0.49, and 0.66, respectively). These UTE measures in global ROIs showed significant, though slightly lower, correlations with Hayes elastic modulus (p < 0.05, R = -0.37, 0.52, and 0.60, respectively). Correlations between other UTE MRI measurements (T2*, T1, and T2mm) and mechanical properties were non-significant. The 3D UTE-AdiabT1ρ and UTE-MT sequences were highlighted as promising surrogates for non-invasive assessment of cartilage mechanical properties. MMF from UTE-MT modeling showed the highest correlations with cartilage mechanics.

Assessment of an in vitro model of rotator cuff degeneration using quantitative magnetic resonance and ultrasound imaging with biochemical and histological correlation.

PURPOSE: Quantitative imaging methods could improve diagnosis of rotator cuff degeneration, but the capability of quantitative MR and US imaging parameters to detect alterations in collagen is unknown. The goal of this study was to assess quantitative MR and US imaging measures for detecting abnormalities in collagen using an in vitro model of tendinosis with biochemical and histological correlation. METHOD: 36 pieces of supraspinatus tendons from 6 cadaveric donors were equally distributed into 3 groups (2 subjected to different concentrations of collagenase and a control group). Ultrashort echo time MR and US imaging measures were performed to assess changes at baseline and after 24 h of enzymatic digestion. Biochemical and histological measures, including brightfield, fluorescence, and polarized microscopy, were used to verify the validity of the model and were compared with quantitative imaging parameters. Correlations between the imaging parameters and biochemically measured digestion were analyzed. RESULTS: Among the imaging parameters, macromolecular fraction (MMF), adiabatic T1ρ, T2*, and backscatter coefficient (BSC) were useful in differentiating between the extent of degeneration among the 3 groups. MMF strongly correlated with collagen loss (r=-0.81; 95% confidence interval [CI]: -0.90,-0.66), while the adiabatic T1ρ (r = 0.66; CI: 0.42,0.81), T2* (r = 0.58; CI: 0.31,0.76), and BSC (r = 0.51; CI: 0.22,0.72) moderately correlated with collagen loss. CONCLUSIONS: MMF, adiabatic T1ρ, and T2* measured and US BSC can detect alterations in collagen. Of the quantitative MR and US imaging measures evaluated, MMF showed the highest correlation with collagen loss and can be used to assess rotator cuff degeneration.

Ultrashort echo time magnetic resonance imaging (UTE-MRI) of cortical bone correlates well with histomorphometric assessment of bone microstructure.

Ultrashort echo time magnetic resonance imaging (UTE-MRI) techniques have been increasingly used to assess cortical bone microstructure. High resolution micro computed tomography (µCT) is routinely employed for validating the MRI-based assessments. However, water protons in cortical bone may reside in micropores smaller than the detectable size ranges by µCT. The goal of this study was to evaluate the upper limit of UTE-MRI and compare its efficacy to µCT at determining bone porosity ex vivo. This study investigated the correlations between UTE-MRI based quantifications and histomorphometric measures of bone porosity that cover all pores larger than 1 µm. Anterior tibial midshaft specimens from eleven donors (51 ±â€¯16 years old, 6 males, 5 females) were scanned on a clinical 3 T-MRI using UTE magnetization transfer (UTE-MT, three power levels and five frequency offsets) and UTE-T2* sequences. Two-pool MT modeling and bi-component exponential T2* fitting were performed on the MRI datasets. Specimens were then scanned by µCT at 9 µm voxel size. Histomorphometry was performed on hematoxylin and eosin (H&E) stained slides imaged at submicron resolution. Macromolecular fraction from MT modeling, bi-component T2* fractions, and short component T2* showed strong correlations (R > 0.7, p < 0.01) with histomorphometric total and large-pores (>40 µm) porosities as well as with µCT-based porosity. UTE-MRI could also assess small pores variations with moderate correlations (R > 0.5, p < 0.01). The UTE-MRI techniques can detect variations of bone porosity comprised of pores below the range detectable by µCT. Such fine pore variations can contribute differently to the development of bone diseases or to the bone remodeling process, however, this needs to be investigated. In scanned specimens, major porosity changes were from large pores, therefore the µCT employment was likely adequate to validate UTE-MRI biomarkers.

Multimodal imaging assessment and histologic correlation of the female rat pelvic floor muscles' anatomy.

Pelvic floor disorders negatively impact millions of women worldwide. Although there is a strong epidemiological association with childbirth, the mechanisms leading to the dysfunction of the integral constituents of the female pelvic floor, including pelvic floor skeletal muscles, are not well understood. This is in part due to the constraints associated with directly probing these muscles, which are located deep in the pelvis. Thus, experimental models and non-invasive techniques are essential for advancing knowledge of various phenotypes of pelvic floor muscle injury and pathogenesis of muscle dysfunction, as well as developing minimally invasive approaches for the delivery of novel therapeutics. The most widely used animal model for pelvic floor disorders is the rat. However, the radiological anatomy of rat pelvic floor muscles has not been described. To remedy this gap, the current study provides the first detailed description of the female rat pelvic floor muscles' radiological appearance on MR and ultrasound images, validated by correlation with gross anatomy and histology. We also demonstrate that ultrasound guidance can be used to target rat pelvic floor muscles for possible interventional therapies.

Rotator cuff tendon assessment using magic-angle insensitive 3D ultrashort echo time cones magnetization transfer (UTE-Cones-MT) imaging and modeling with histological correlation.

BACKGROUND: Rotator cuff tendons (RCTs) are challenging to image due to the "magic angle effect" and their short T2 . PURPOSE: To assess the degree of magic angle sensitivity of human RCTs and to utilize a 3D ultrashort echo time Cones sequence with magnetization transfer preparation (UTE-Cones-MT) and two-pool quantitative MT modeling with histological correlation. We hypothesized that MT parameters would be less sensitive to the magic angle compared with conventional T2 measurements. STUDY TYPE: Prospective imaging pathologic correlation. SPECIMEN: Twenty cadaveric rotator cuff tendons were imaged at five sample orientations ranging from 0-90° relative to the B0 field. FIELD STRENGTH/SEQUENCE: 3T/3D UTE-Cones-MT and Carr-Purcell-Meiboom-Gill (CPMG). ASSESSMENT: Two-pool quantitative MT modeling parameters and T2 values were calculated in regions of interest drawn by a medical physicist. Histopathological analysis was performed and mild and severe tendinopathy groups were assigned by a histopathologist and histotechnician. STATISTICAL TESTS: Coefficients of variations (CVs) were calculated for measures between the different orientations and group means were compared for each measure. RESULTS: CVs of T2 and macromolecular fractions between orientations were 26.14 ± 16.82% and 6.18 ± 2.77% (mean ± SD), respectively. T2 measurements at 0°, 27°, 70°, and 90° showed significant differences between the two histological groups (P = 0.004, 0.008, 0.003, and 0.015, respectively), but not at 55° (P = 0.611). Mean T2 value ranges between orientations for the mild and severe tendinopathy groups were 15.27-30.32 msec and 20.81-35.85 msec, respectively, showing overlap despite statistically significant differences (P = 0.003). Macromolecular fractions at all angles showed significant differences between the two groups (P < 0.0001). Mean fraction ranges between orientations for the mild and severe tendinopathy groups were 14.32-17.17% and 10.00-13.75% respectively (P < 0.0001) with no overlap. DATA CONCLUSION: Compared with T2 , macromolecular fraction obtained with the 3D UTE-Cones-MT technique is resistant to the magic angle effect and is more sensitive to RCT degeneration. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.

Application of recombinant Pediococcus acidilactici BD16 (fcs +/ech +) for bioconversion of agrowaste to vanillin.

Biotechnological production of vanillin is gaining momentum as the natural synthesis of vanillin that is very expensive. Ferulic acid (FA), a costly compound, is used as the substrate to produce vanillin biotechnologically and the making process is still expensive. Therefore, this study investigated the practical use of an agrobiomass waste, rice bran, and provides the first evidence of a cost-effective production of vanillin within 24 h of incubation using recombinant Pediococcus acidilactici BD16 (fcs +/ech +). Introduction of two genes encoding feruloyl CoA synthetase and enoyl CoA hydratase into the native strain increased vanillin yield to 4.01 g L-1. Bioconversion was monitored through the transformation of phenolic compounds. A hypothetical metabolic pathway of rice bran during the vanillin bioconversion was proposed with the inserted pathway from ferulic acid to vanillin and compared with that of other metabolic engineered strains. These results could be a gateway of using recombinant lactic acid bacteria for industrial production of vanillin from agricultural waste.

Age disparity in palliative radiation therapy among patients with advanced cancer.

PURPOSE/OBJECTIVE: Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population. METHODS AND MATERIALS: We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy. RESULTS: The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001). CONCLUSIONS: Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end of life.

Visual function and vision-related quality of life after macular hole surgery with short-duration, 3-day face-down positioning.

OBJECTIVE: To investigate the relationship of vision-related quality of life (VRQOL) and visual function in patients undergoing macular-hole (MH) repair with and without cataract surgery and short-duration, 3-day prone posturing. Previous communications have assessed VRQOL in European and Japanese populations, but this is the first study to investigate VRQOL after MH surgery in a Canadian population. DESIGN: Prospective interventional case series. PARTICIPANTS: We studied 20 consecutive eyes in 19 patients with stage 2 and 3 idiopathic macular holes. Of those, 15 received combined cataract and MH surgery, and 5 received MH repair alone. METHODS: Patients completed the self-administered National Eye Institute 25-item Visual Function Questionnaire before and after surgery. All patients received full ocular examinations pre- and postsurgery. Along with the questionnaire scores, we examined macular-hole closure rates, complications, postoperative visual acuity, and intraocular pressure. RESULTS: Macular-hole closure was achieved in 20 of 20 eyes (100%). Mean postoperative logMAR decreased (i.e., improved) by -0.303 (95% CI, -0.501-- -0.105, p = 0.0047). The Visual Function Questionnaire composite score rose from 82.019 ± 12.612 SD to 88.499 ± 7.963 SD (p = 0.012). Subscale scores, including general vision, near activities, mental health, role difficulties, and dependency were all significantly improved (p < 0.05). No complications or intraocular pressure increases were observed. CONCLUSIONS: Macular-hole surgery followed by short-duration, 3-day face-down positioning significantly improved VRQOL and visual acuity in a group of Canadian patients. The use of VRQOL tools alongside anatomic outcomes provide a more comprehensive overview of patients' experiences and satisfaction after surgical intervention.