Patient engagement with radiation therapists: Patient perspectives, challenges, and opportunities. A systematic review.

INTRODUCTION: Radiotherapy is a major component of cancer care and treatment is delivered almost exclusively by therapeutic radiographers/radiation therapists (RTTs). Numerous government and professional guidance publications have recommended a person-centred approach to healthcare through communication and collaboration between professionals, agencies, and users. With approximately half of patients undergoing radical radiotherapy experiencing some degree of anxiety and distress, RTTs are uniquely placed as frontline cancer professionals to engage with patients regarding their experience. This review seeks to map the available evidence of patient reported views of their experience of being treated by RTTs and any impact, this treatment had on the patient's frame of mind or perception of treatment. METHODS: In line with the principles of the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) systematic review methodology, a review of relevant literature was conducted. Electronic databases MEDLINE, PROQUEST, EMBASE and CINAHL were searched. RESULTS: Nine hundred and eighty-eight articles were identified. Twelve papers were included in the final review. CONCLUSION: Increased time with, and continuity of RTTs during treatment has a positive influence on patients' perspectives of RTTs. A positive patient perspective of their engagement with RTTs can be a strong predictor of overall satisfaction in radiotherapy. IMPLICATIONS FOR PRACTICE: RTTs should not underestimate the impact of their supportive role in guiding patients through treatment. A standardised method for integrating patients' experience and engagement with RTTs is lacking. Further RTT led research is required in this area.

UK reporting radiographers' perceptions of AI in radiographic image interpretation - Current perspectives and future developments.

INTRODUCTION: Radiographer reporting is accepted practice in the UK. With a national shortage of radiographers and radiologists, artificial intelligence (AI) support in reporting may help minimise the backlog of unreported images. Modern AI is not well understood by human end-users. This may have ethical implications and impact human trust in these systems, due to over- and under-reliance. This study investigates the perceptions of reporting radiographers about AI, gathers information to explain how they may interact with AI in future and identifies features perceived as necessary for appropriate trust in these systems. METHODS: A Qualtrics® survey was designed and piloted by a team of UK AI expert radiographers. This paper reports the third part of the survey, open to reporting radiographers only. RESULTS: 86 responses were received. Respondents were confident in how an AI reached its decision (n = 53, 62%). Less than a third of respondents would be confident communicating the AI decision to stakeholders. Affirmation from AI would improve confidence (n = 49, 57%) and disagreement would make respondents seek a second opinion (n = 60, 70%). There is a moderate trust level in AI for image interpretation. System performance data and AI visual explanations would increase trust. CONCLUSIONS: Responses indicate that AI will have a strong impact on reporting radiographers' decision making in the future. Respondents are confident in how an AI makes decisions but less confident explaining this to others. Trust levels could be improved with explainable AI solutions. IMPLICATIONS FOR PRACTICE: This survey clarifies UK reporting radiographers' perceptions of AI, used for image interpretation, highlighting key issues with AI integration.

Complex roles of glutamate in the Gibbs-Ng model of one-trial aversive learning in the new-born chick.

Glutamate is the most widespread excitatory transmitter in the CNS and is probably involved in LTP, a neural phenomenon which may be associated with learning and memory formation. Intracerebral injection of large amounts of glutamate between 5 min and 2.5 min after passive avoidance learning in young chicks inhibits short-term memory, which occurs between 0 and 10 min post-learning in a three-stage model of memory formation first established by Gibbs and Ng(25) [Physiol. Behav. 23:369-375; 1979]. This effect may be attributed to non-specific excitation. Blockade of glutamate uptake by L-aspartic and beta-hydroxamate also abolishes this stage of memory, provided the drug is administered within 2.5 min of learning. Interference with either production of percursors for transmitter glutamate in astrocytes or with glutamate receptors is also detrimental to memory formation, but the effects appear much later. After its release from glutamatergic neurons, glutamate is, to a large extent, accumulated into astrocytes where it is converted to glutamine, which can be returned to glutamatergic neurons and reutilized for synthesis of transmitter glutamate, and partly oxidized as a metabolic substrate. The latter process leads to a net loss of transmitter glutamate which can be compensated for by de novo synthesis of a glutamate precursor alpha-ketoglutarate (alpha KG) in astrocytes, a process which is inhibited by the astrocyte-specific toxin fluoroacetate (R. A. Swanson, personal communication). Intracerebral injection of this toxin abolishes memory during an intermediate stage of memory processing occurring between 20 and 30 min post-training (50) [Cog. Brain Res, 2:93-102; 1994]. Injection of methionine sulfoximine (MSO), a specific inhibitor of glutamine synthetase, which interferes with the re-supply of transmitter glutamate to neurons by inhibition of glutamine synthesis in astrocytes, has a similar effect. This effect of MSO is prevented by intracerebral injection of glutamate, glutamine, or a combination and alpha KG and alanine. MSO must be administered before learning, but does not interfere with acquisition since short-term memory remains intact. Administration of either the NMDA antagonist AP5, the AMPA antagonist DNQX, or the metabotropic receptor antagonist MCPF, also induces amnesia. Memory loss in each case does not occur until after 70 min post-training, during a protein synthesis-dependent long-term memory stage which begins at 60 min following learning. However, to be effective, AP5 must be administered within 60 s following learning, MCPG before 15 min post-learning, and DNQX between 15 and 25 min after learning. Together, these findings suggest that learning results in an immediate release of glutamate, followed by a secondary release of this transmitter at later stages of processing of the memory trace, and that one or both of these increases in extracellular glutamate concentration are essential for the consolidation of long-term memory. Since both fluoroacetate and MSO act exclusively on glial cells, the findings also show that neuronal-glial interactions are necessary during the establishment of memory.

Effects of gonadal steroids on attack and on memory processing in the domestic chick.

Testosterone is known to facilitate attack and to affect memory processing in young domestic chicks. The two effects are known to have very different latencies following subcutaneous injection of the steroid. Here we show that, in males, the effect on attack is specific to androgens and that estradiol is almost entirely ineffective. The facilitation of attack by testosterone is also very greatly reduced in females. By contrast, for the hormone-dependent changes in a passive avoidance task which reflect changes in memory and attentional processing, estradiol acts at much lower doses than any androgen tested and similar changes are produced by testosterone in both male and female chicks.

Daily boron intake from the American diet.

Interest in boron as a naturally occurring trace element nutrient from the food supply is increasing. Mounting evidence suggests that boron is essential to human beings. This study explores the major food and beverage contributors of boron and estimates of daily boron intake from the American diet. Previous estimates in the literature of dietary boron consumption are based on limited foods and population segments. In this study we provide a more comprehensive assessment of boron consumption by the US population. A boron nutrient database of 1,944 individual foods was developed. These foods represent 95.3% by weight of all foods consumed in the US Department of Agriculture 1989-1991 Continuing Survey of Food Intakes by Individuals (1989-1991 CSFII). The Boron Nutrient Database (version 1.0) was then linked to the 3-day food records of 11,009 respondents to the 1989-1991 CSFII to generate the average daily boron intake for each person. The weighted 5th percentile, median, mean, and 95th percentile boron intakes, respectively, are 0.43, 1.02, 1.17 and 2.42 mg/day for men; 0.33, 0.83, 0.96 and 1.94 mg/day for women; and 0.40, 0.86, 1.01 and 2.18 mg/day for pregnant women. For vegetarian adults, these intakes are 0.46, 1.30, 1.47 and 2.74 mg/day for men and 0.33, 1.00, 1.29 and 4.18 mg/day for women. The top 2 boron contributors, coffee and milk, are low in boron, yet they make up 12% of the total boron intake by virtue of the volume consumed. Among the top 50 boron contributors, peanut butter, wine, raisins, peanuts, and other nuts are high in boron. As more data become available on daily boron requirements, the results of this study may be used to assess whether Americans' daily intake of boron is adequate.

Effects of denervation on posterior cricoarytenoid muscle physiology and histochemistry.

The effects of chronic posterior cricoarytenoid muscle denervation were assessed at 3 and 7 months in 26 animals following resection of 10 cm of recurrent laryngeal nerve with stump ligation. The physiology of denervation was characterized by a decrease in contraction strength and an increase in contraction time. The reduction in contraction strength reflected the loss in muscle weight and atrophic changes in fiber density and diameter. A change in muscle composition occurred because of the increased susceptibility of fast-twitch (type 2) fibers to degeneration. However, the compositional change alone could not account for the slowing of muscle contraction. Muscle fibrosis was negligible at 3 months, but encompassed one third of the fiber population by 7 months. In view of the irreversible nature of fibrosis, this study suggested that clinical intervention to rescue denervated posterior cricoarytenoid muscle fibers should be delayed no longer than 7 months to improve the chances for full recovery.

Technical approach for reanimation of the chronically denervated larynx by means of functional electrical stimulation.

Functional electrical stimulation (FES) of the posterior cricoarytenoid (PCA) muscle to produce vocal fold abduction offers an alternative approach to current surgical therapies for bilateral vocal fold paralysis. The purpose of this study was to characterize the application of FES to chronically denervated PCA muscles. Specific goals were to develop a stimulus delivery system for the PCA muscle, determine a practical means of implantation, and identify stimulus parameters effective in activating chronically denervated muscle. Seventeen dogs were implanted with planar electrode arrays 3 months after unilateral recurrent laryngeal nerve resection. A nail-bed electrode array allowed discrete activation of the PCA muscle and gave the greatest abductions, with minimal charge dissipation. Muscle mapping revealed hot-spot regions on the PCA muscle surface, in which stimulation produced maximum abduction. A conservative stimulus paradigm effective in activating chronically denervated muscle was a 1-second pulse train of 2-millisecond-duration pulses, delivered at a tetanizing frequency of 30 Hz and an amplitude of 4 to 14 mA.

Recurrent laryngeal nerve avulsion for treatment of spastic dysphonia.

Treatment of spastic dysphonia by recurrent laryngeal nerve section has resulted in reproducibly good results in the early postoperative period in most patients. However, critical long-term follow-up has shown a high recurrence rate of adductor spasms by the third year after initial nerve section. A patient who developed recurring adductor spasms 1 year after nerve section was reexplored, with identification of neural regrowth into the distal segment of the recurrent laryngeal nerve. The technique of neural avulsion removing the distal nerve up to its insertion into the laryngeal muscles is described. Neural regrowth, which is just one of the possible mechanisms for recurrence of spastic dysphonia, should be prevented by this surgical modification. Twelve patients who have undergone neural avulsion primarily for spastic dysphonia are being followed up without recurrence of symptoms thus far. Although these results appear promising, this short follow-up that averages 1.5 years must be extended to firmly support these concepts.

Electrical pacing of the paralyzed human larynx.

This study represents the first attempt to electrically pace the paralyzed human larynx. The goal was to determine if electrical stimulation of the posterior cricoarytenoid muscle could produce functional abduction of the vocal fold in pace with inspiration. An external apparatus was used to sense inspiration and reanimate the unilaterally paralyzed larynx of a thyroplasty patient. Stimuli were delivered through a needle electrode to locate and pace the abductor muscle. The magnitude of electrically induced abduction was comparable to spontaneous movement on the normal side. The abduction was appropriately timed with inspiration: this finding demonstrated that this simple pacing system could effectively modulate stimulation with patient respiration.

Lateral laryngotomy for the removal of Teflon granuloma.

Teflon injection has been used for vocal fold medialization following paralysis. Recently, numerous articles have discussed the complications of Teflon injection, including overinjection, airway obstruction. Teflon granuloma, and an abnormal mass effect creating a decreased vibratory character of the true vocal fold. Multiple techniques for Teflon removal have been described. This report details our experience with complete Teflon granuloma removal via a lateral laryngotomy under local anesthesia. Microscopic dissection of the entire granuloma and the paraglottic space was accomplished in all patients. Due to extensive destruction caused by the granuloma, the vocal ligament was resected in 3 patients; it was partially resected and reanastomosed in 1 case, and spared in 6 patients. Laryngeal reconstruction was accomplished with an inferiorly based sternohyoid muscle rotation flap and arytenoid adduction. Effortful speech secondary to pressed vocal quality resolved in all patients. Near-normal to normal vocal quality was obtained in 4 patients, with the average "voice desirability" improving 60% and the effective glottic width increasing 29%. Factors that contributed to a successful outcome included noninvolvement of the vocal ligament and sparing of the mucosal cover.

Long-term follow-up of recurrent laryngeal nerve avulsion for the treatment of spastic dysphonia.

Long-term follow-up of 3 to 7 years is reported on 18 patients who had undergone recurrent laryngeal nerve avulsion (RLNA) for the treatment of adductor spastic dysphonia (SD). Data on neural regrowth after previous recurrent laryngeal nerve section (RLNS) are presented in 2 of these 18 patients. We introduced RLNA as a modification of standard RLNS to prevent neural regrowth to the hemiparalyzed larynx and subsequent recurrence of SD. We have treated a total of 22 patients with RLNA, and now report a 3- to 7-year follow-up on 18 of these 22 patients. Resolution of symptoms was determined by routine follow-up assessment, perceptual voice analysis, and patient self-assessment. Sixteen of 18, or 89%, had no recurrence of spasms at 3 years after RLNA as determined at routine follow-up. Two of the 16 later developed spasms after medialization laryngoplasty for treatment of weak voice persistent after the avulsion. This yielded a total of 14 of 18, or 78%, who were unanimously judged by four speech pathologists to have no recurrence of SD at the longer follow-up period of 3 to 7 years. Two of these 4 patients were judged by all four analysts to have frequent, short spasms. The other 2 were judged by two of four analysts to have seldom, short spasms. Three of 18 patients presented with recurrent SD after previous RLNS. At the time of subsequent RLNA, each patient had evidence of neural regrowth at the distal nerve stump as demonstrated by intraoperative electromyography and histologic evaluation of the distal nerve stump. One remained free of SD following RLNA, 1 was free of spasms at 4 years after revision avulsion but developed spasms after medialization laryngoplasty, and the final patient developed spasms 3.75 years after revision RLNA. Medialization laryngoplasty with Silastic silicone rubber was performed in 6 of 18, with correction of postoperative breathiness in all 6, but with recurrence of spasm in 3. Spasms resolved in 1 of these with downsizing of the implant. We conclude that RLNA represents a useful treatment in the management of SD in patients not tolerant of botulinum toxin injections.

Multicountry estimation of dietary boron intake.

Dietary Reference Intakes are not yet established for boron (B), a naturally occurring trace element in the human diet. Estimated dietary B intakes provide useful information for planning and assessing diets in healthy populations. The countries selected for this study represent a wide variety of dietary patterns and have adequate nutrient databases (with the exception of B) and food consumption data. Large-scale nationwide survey data were provided by the US (1989-1991) and Germany (1985-1989). Survey data from rural agricultural communities of Mexico and Kenya were provided by the Human Nutrition Collaborative Research Support Program (1983-1986). A B nutrient database was created to include B concentrations for the foods consumed in each country. It incorporates B analytical data from various sources in the US, Finland, UK, Italy, Japan, and China. Each person's average daily B intake was estimated by linking the B database with the survey food records. Average dietary intake estimates were then generated for various age and sex groups. The estimates for adults in the US, Germany, Mexico and Kenya, respectively, are 1.11, 1.72, 2.12, and 1.95 mg B/d for males and 0.89, 1.62, 1.75, and 1.80 mg B/d for females. Foods that are major contributors to the B intake of each country were also identified.

Nutrition interventions for low-income, elderly women.

OBJECTIVE: To help low-income, older South Carolinian women bring their food choices and nutritional practices in closer alignment with broadly accepted recommendations for healthful eating. METHODS: Included the creation of an infrastructure of collaborators to examine existing data, develop research questions, and collect and analyze focus group data. RESULTS: Include identification of socioenvironmental, personal, and behavioral factors affecting the nutritional health of elderly women used in the development of nutrition education modules and messages to be delivered through lay educators and videos. CONCLUSION: Effective nutrition interventions involving low-income, elderly women must use an ecological approach including behavioral and organizational change.

Patterns of tobacco and alcohol use among sedentary, exercising, nonathletic, and athletic youth.

Through a statewide random design, 7,846 9th to 12th grade students in 81 South Carolina public schools were selected to complete the Youth Risk Behavior Survey. Mantel-Haenszel Chi-Square, general linear models, and logistic regression were used to examine the relation between the independent variables of race, gender, and physical activity status with the dependent variables of tobacco and alcohol use while controlling for race, gender, and participation in physical education classes. The six physical activity levels ranged from sedentary nonathletes to athletes participating on two or more sports teams. Highly active athletes drank more frequently than did low-activity nonathletes (p = .002) and sedentary nonathletes (p = .006), and they were more likely to binge drink (p = .004). Athletic groups were less likely to smoke than were the nonathletic groups (p < .0001) with "sedentary nonathletes" the heaviest smokers of all groups. Athletes were more likely to use smokeless tobacco (p < .0001) than nonathletes although this difference disappeared when controlling for gender and race. This research supports other findings about prevalence of smokeless tobacco use among athletic youth. In addition, it reveals that athletic youth are at an increased risk of alcohol use and binge drinking. Possible factors such as the risk-taking tendencies of team sport athletes should be investigated.

Vasopressin modulates social recognition-related activity in the left temporoparietal junction in humans.

The neuropeptide vasopressin is a key molecular mediator of social behavior in animals and humans, implicated in anxiety and autism. Social recognition, the ability to assess the familiarity of others, is essential for appropriate social interactions and enhanced by vasopressin; however, the neural mechanisms mediating this effect in humans are unknown. Using functional magnetic resonance imaging (fMRI) and an implicit social recognition matching task, we employed a double-blinded procedure in which 20 healthy male volunteers self-administered 40 UI of vasopressin or placebo intranasally, 45 min before performing the matching task in the scanner. In a random-effects fMRI analysis, we show that vasopressin induces a regionally specific alteration in a key node of the theory of mind network, the left temporoparietal junction, identifying a neurobiological mechanism for prosocial neuropeptide effects in humans that suggests novel treatment strategies.

Level crossings and zero-field splitting in the {Cr8}-cubane spin cluster studied using inelastic neutron scattering and magnetization.

Inelastic neutron scattering (INS) in variable magnetic field and high-field magnetization measurements in the millikelvin temperature range were performed to gain insight into the low-energy magnetic excitation spectrum and the field-induced level crossings in the molecular spin cluster {Cr(8)}-cubane. These complementary techniques provide consistent estimates of the lowest level-crossing field. The overall features of the experimental data are explained using an isotropic Heisenberg model, based on three distinct exchange interactions linking the eight Cr(III) paramagnetic centers (spins s = 3/2), that is supplemented with a relatively large molecular magnetic anisotropy term for the lowest S = 1 multiplet. It is noted that the existence of the anisotropy is clearly evident from the magnetic field dependence of the excitations in the INS measurements, while the magnetization measurements are not sensitive to its effects.

Inhibition of RNA polymerase and formyltetrahydrofolate synthetase activity by 6-chloro-8-aza-9-cyclopentylpurine. Structure-activity relationships.

The structural requirements for inhibition of bacterial RNA polymerase and rabbit liver formyltetrahydrofolate synthetase activity by a series of purine nucleoside analogs related to 6-chloro-8-aza-9-cyclopentylpurine (689) were investigated. To achieve an inhibitory effect, preincubation of the enzyme preparations with the purine analogs, prior to assay of enzyme activity, was required. The greatest inhibition was produced by analogs containing all three alterations of the purine nucleoside structure: the 6-halo, 8-aza, and 9-cyclopentyl groups. It is suggested that 689 inhibits the activity of enzymes involved in nucleic acid synthesis by a site-directed alkylation.

Long-stay patients in the London Borough of Tower Hamlets.

In September 1974 a study was made of all residents of the East London Borough of Tower Hamlets, aged 65 or more, who were known to have been receiving continuous medical and nursing care in hospital for more than a year. There were 91 geriatric and approximately 100 psychiatric patients, representing just under 1 per cent of the population over 65. Eighty geriatric and 15 psychiatric patients were studied in detail. Physical and mental incapacity were assessed on the basis of performance of practical tasks and simple tests of ability, and social incapacity from a study of social circumstances. Both geriatric and psychiatric patients showed extreme disability. Geriatric patients showed physical and intellectual incapacity, psychiatric patients intellectual incapacity. The commonest diagnosis among geriatric patients was dementia (70 per cent). Social factors, while unfavourable, did not in themselves account for prolonged hospital stay. The finding of only a very small number of long-stay patients handicapped by physical disability alone suggests that the majority of such patients are at home.

Dermatoses among poultry workers: "chicken poison disease".

To investigate the causes of skin eruptions affecting poultry workers, we reviewed our medical records and surveyed a southcentral Pennsylvania poultry processing plant. Examination of the records of routine patch test clinic patients seen from January, 1981, to July, 1982, revealed three poultry workers with allergic contact dermatitis and one with irritant contact dermatitis. We then examined one hundred fifty workers at a poultry processing plant, noting the presence of occupational dermatoses, with special interest in the occurrence of contact dermatitis. We found thirteen dermatoses in nine workers. These included Candida infections, irritant contact dermatitis, allergic contact dermatitis, abrasions and cuts, warts, and dyshidrotic eczema.

Hepatitis C virus infection in cocaine users--a silent epidemic.

Over a recent three year period, approximately 600 individuals responded to newspaper advertisements for research studies requiring healthy, cocaine using subjects. These subjects were screened using a standard phone interview in order to eliminate individuals with known medical or psychiatric illnesses that would exclude them from ongoing neuroimaging studies of drug abuse. Individuals were specifically asked about their hepatitis and HIV status. Of these, 170 subjects passed the phone screen, having no known medical or psychiatric illness outside of cocaine abuse/dependence and were willing to be further evaluated for the studies. These subjects were brought to the Medical College of Wisconsin's General Clinical Research Center and tested for, among other measures, hepatitis B, hepatitis C, and HIV. Of these, 144 completed the examination and all testing. In this cohort of assumed healthy subjects, 47 (33%) tested positive for antibodies to the hepatitis C virus (HCV). Only 7 (5%) tested positive for the hepatitis B surface antigen and 2 (1.4%) to HIV. The demographics of this cohort are 56% African-American, 81% male, 75% never-married, 55% unemployed with a mean age of 36 years. The percentage of subjects reporting any lifetime intravenous drug use among the HCV(+) and the HCV(-) cohorts was 77% vs. 29% respectively. Some routes of HCV transmission are still unclear and may reflect lifestyle or other factors related to cocaine use outside of parenteral drug use. Since almost all HCV infections become chronic, and many progress to chronic active hepatitis, cirrhosis, and ultimately hepatocellular carcinoma, these observations suggest a significant epidemic in an unsuspecting population with little regular access to health care. These individuals also form a large pool for the continued transmission of HCV to the general population. Additional public health interventions are suggested.