Adjuvant 5-Fluorouracil/leucovorin, capecitabine, and oxaliplatin-related regimens for stage II/III colon cancer patients 66 years or older.

Adjuvant chemotherapy of leucovorin-modulated 5-fluorouracil (5-FU/LV), capecitabine, and adding oxaliplatin to 5-FU/LV or capecitabine (FLOX/OX) have been standard regimens for high-risk stage II or III colon cancer (CC). We aimed to evaluate their patterns of use, association with survival, and rate of emergency room visit (ER) or hospitalization during the treatment period. High-risk stage II or III patients aged >65 years diagnosed between 2007 and 2015, underwent colectomy, and received any of these three regimens were selected from SEER and Texas Cancer Registry (TC) linked with Medicare data. Chi-square test, Kaplan-Meier survival curves, Cox regression, and logistic regression were used in data analysis. A total of 5621 (1080 stage II and 4541 stage III) patients with median age of 72 years were included in this study. For stage II, 24.4% used 5-FU/LV, 31.2% used capecitabine, and 44.4% used FLOX/OX; the respective numbers for stage III were 13.8%, 17.9%, and 68.3%. Patients aged <70 years, not in the West region, not in Medicare state-buy-in program, and with no comorbidity were more likely to use FLOX/OX. FLOX/OX was associated with improved overall survival (OS) in stage II and III patients and improved cancer-specific survival in stage III patients compared with 5-FU/LV. The survival benefit of FLOX/OX was sustained in stage III patients aged ≥70 years. Capecitabine had the lowest ER/hospitalization rate with 19.2% in stage II and 28.9% in III. The use of FLOX/OX was associated with improved survival compared with 5-FU/LV among CC patients. Capecitabine was associated with the lowest ER/hospitalization rate.

Reproductive planning, vitamin knowledge and use, and lifestyle risks of women attending pregnancy care with a severe mental illness.

OBJECTIVE: Women with severe mental illnesses are a vulnerable population and little is known about their reproductive planning needs. The aim of our study was to describe rates of unintended pregnancies, postpartum contraception, identify use and knowledge of prenatal/pregnancy vitamins and identify modifiable lifestyle risks. DESIGN: Mixed methods study incorporating a cross-sectional survey and prospective pregnancy data collection. SETTING: A multidisciplinary antenatal clinic in Australia. METHOD: Thirty-eight pregnant women with severe mental illnesses: schizophrenia, schizoaffective, bipolar and severe post-traumatic stress disorder. MAIN OUTCOME MEASURES: Unintended pregnancy rates, immediate postpartum contraception, use of prenatal and pregnancy vitamins and knowledge sources, obesity, and use and cessation rates for smoking, and substances, and comorbid medical conditions. RESULTS: Overall 42% of women had unintended pregnancy, with those with schizophrenia at most risk (56%). A long acting reversible contraception was inserted in 5 women (13%), with 45% having no immediate contraception prescribed prior to postnatal discharge. Women's main source of vitamin supplementation for pregnancy was from general practitioners. Prenatal folic acid use occurred in 37%, with rates differing for those with a diagnosis of bipolar disorder (52%) and schizophrenia (25%). Vitamin deficiencies occurred in pregnancy, with iron deficiency (ferritin <30 ng/mL) (n = 27, 73%) the most frequent. Overall 21% of women smoked cigarettes and 35% were obese. DISCUSSION: Addressing gaps in use of effective contraception, proactive reproductive planning and lifestyle management may improve outcomes for women with mental illnesses and their babies.Key pointsWomen with severe mental illnesses have complex health needs that require targeted reproductive counselling. This study adds to what is known by highlighting that:•Women with schizophrenia appear more likely to have unintended pregnancy.•Prenatal counselling for women with severe mental disorders should include recognition and optimisation of management for the high rates of pre-existing medical comorbidities, obesity and elevated nicotine and substance use.•Many women with severe mental illness need increased doses (5 mg) of prenatal folic acid due to psychotropic medication risk and obesity, as well as treatment for high rates of iron and vitamin D deficiency in pregnancy.

Feasibility of removable balloon implant for simultaneous magnetic nanoparticle heating and HDR brachytherapy of brain tumor resection cavities.

AIM: Hyperthermia (HT) has been shown to improve clinical response to radiation therapy (RT) for cancer. Synergism is dramatically enhanced if HT and RT are combined simultaneously, but appropriate technology to apply treatments together does not exist. This study investigates the feasibility of delivering HT with RT to a 5-10mm annular rim of at-risk tissue around a tumor resection cavity using a temporary thermobrachytherapy (TBT) balloon implant. METHODS: A balloon catheter was designed to deliver radiation from High Dose Rate (HDR) brachytherapy concurrent with HT delivered by filling the balloon with magnetic nanoparticles (MNP) and immersing it in a radiofrequency magnetic field. Temperature distributions in brain around the TBT balloon were simulated with temperature dependent brain blood perfusion using numerical modeling. A magnetic induction system was constructed and used to produce rapid heating (>0.2°C/s) of MNP-filled balloons in brain tissue-equivalent phantoms by absorbing 0.5 W/ml from a 5.7 kA/m field at 133 kHz. RESULTS: Simulated treatment plans demonstrate the ability to heat at-risk tissue around a brain tumor resection cavity between 40-48°C for 2-5cm diameter balloons. Experimental thermal dosimetry verifies the expected rapid and spherically symmetric heating of brain phantom around the MNP-filled balloon at a magnetic field strength that has proven safe in previous clinical studies. CONCLUSIONS: These preclinical results demonstrate the feasibility of using a TBT balloon to deliver heat simultaneously with HDR brachytherapy to tumor bed around a brain tumor resection cavity, with significantly improved uniformity of heating over previous multi-catheter interstitial approaches. Considered along with results of previous clinical thermobrachytherapy trials, this new capability is expected to improve both survival and quality of life in patients with glioblastoma multiforme.

Multi-class motor imagery EEG classification using collaborative representation-based semi-supervised extreme learning machine.

Both labeled and unlabeled data have been widely used in electroencephalographic (EEG)-based brain-computer interface (BCI). However, labeled EEG samples are generally scarce and expensive to collect, while unlabeled samples are considered to be abundant in real applications. Although the semi-supervised learning (SSL) allows us to utilize both labeled and unlabeled data to improve the classification performance as against supervised algorithms, it has been reported that unlabeled data occasionally undermine the performance of SSL in some cases. To overcome this challenge, we propose a collaborative representation-based semi-supervised extreme learning machine (CR-SSELM) algorithm to evaluate the risk of unlabeled samples by a new safety-control mechanism. Specifically, the ELM model is firstly used to predict unlabeled samples and then the collaborative representation (CR) approach is employed to reconstruct the unlabeled samples according to the obtained prediction results, from which the risk degree of unlabeled sample is defined. A risk-based regularization term is then constructed accordingly and embedded into the objective function of the SS-ELM. Experiments conducted on benchmark and EEG datasets demonstrate that the proposed method outperforms the ELM and SS-ELM algorithm. Moreover, the proposed CR-SSELM even offers the best performance while SS-ELM yields worse performance compared with its supervised counterpart (ELM). Graphical abstract This paper proposes a collaborative representation-based semi-supervised extreme learning machine (CR-SSELM) algorithm to evaluate the risk of unlabeled samples by a new safety-control mechanism. It is aim to solve the safety problem of SS-ELM method that SS-ELM yields worse performance than ELM. With the help of safety mechanism, the performance of our method is still better than supervised ELM method.

Sparse Representation-Based Extreme Learning Machine for Motor Imagery EEG Classification.

Classification of motor imagery (MI) electroencephalogram (EEG) plays a vital role in brain-computer interface (BCI) systems. Recent research has shown that nonlinear classification algorithms perform better than their linear counterparts, but most of them cannot extract sufficient significant information which leads to a less efficient classification. In this paper, we propose a novel approach called FDDL-ELM, which combines the discriminative power of extreme learning machine (ELM) with the reconstruction capability of sparse representation. Firstly, the common spatial pattern (CSP) algorithm is adopted to perform spatial filtering on raw EEG data to enhance the task-related neural activity. Secondly, the Fisher discrimination criterion is employed to learn a structured dictionary and obtain sparse coding coefficients from the filtered data, and these discriminative coefficients are then used to acquire the reconstructed feature representations. Finally, a nonlinear classifier ELM is used to identify these features in different MI tasks. The proposed method is evaluated on 2-class Datasets IVa and IIIa of BCI Competition III and 4-class Dataset IIa of BCI Competition IV. Experimental results show that our method achieved superior performance than the other existing algorithms and yielded the accuracies of 80.68%, 87.54%, and 63.76% across all subjects in the above-mentioned three datasets, respectively.

Pregnancy experiences of Western Australian women attending a specialist childbirth and mental illness antenatal clinic.

Our purpose was to explore the pregnancy experiences of Australian women attending a specialized childbirth and mental illness (CAMI) antenatal clinic. A qualitative exploratory design was selected to give voice to women with severe mental illness receiving antenatal care. Telephone interviews with 41 women, 24 primiparous and 17 multiparous, were analyzed using thematic analysis. Three themes emerged: "building relationships," "acknowledging me as a person with special needs," and "respecting and understanding without stigma." Findings offer insight into care experiences possible within a multidisciplinary model developed to address psychiatric and obstetric needs of pregnant women with severe mental illness.

Vitamin D deficiency among newly resettled refugees in Massachusetts.

Previous studies have indicated that vitamin D deficiency is widespread among immigrants and refugees. This study sought to determine the prevalence of vitamin D deficiency among a large and diverse cohort of refugees in Massachusetts to assess its significance for routine refugee health screening of refugees. 25-hydroxyvitamin D levels for 2,610 refugees screened between 2007 and 2009 were used to estimate vitamin D status and to examine the relationship between deficiency or insufficiency and age, gender, regional origin, and season of testing. Among those tested, 78 % were either vitamin D insufficient or deficient. Insufficiency or deficiency was most prevalent in refugees from the Middle East (89 %) and lowest in those from the Caribbean (59 %). Risk was higher among women than among men from some regions, such as the Middle East, but not others. For women, the likelihood of deficiency increased with age, while for men, the likelihood of deficiency was similar for preschool children and men at the height of their working years. The high overall prevalence of vitamin D deficiency suggests that empiric supplementation or treatment may be preferred to testing until more is known about the long-term epidemiology of vitamin D deficiency and its consequences.

Motherhood and mental illness: Part 1 - toward a general understanding.

BACKGROUND: Mental illness is common among women of childbearing age, and fertility rates of women with mental illness are close to those of the general population. General practitioners will see most of the women who may be seeking advice and management of their mental illnesses before, during or after a pregnancy. OBJECTIVE: This article reviews the current approaches to the management of mental illness in and around pregnancy, and provides practical advice regarding pregnancy related issues in women with mental health disorders. DISCUSSION: The GP is ideally placed to give information and encourage appropriate treatment choices in women with mental illness. Given the multifaceted complexities, the optimal approach is holistic and collaborative. Specialist opinion must be sought early and a multidisciplinary approach with access to specialist care offered if possible. Continuity of care, especially in the context of a trusting therapeutic relationship, is considered optimal.