A prospective observational registry evaluating clinical outcomes of Radium-223 treatment in a nonstudy population.

The ALSYMPCA study established a 3.6 month Overall Survival (OS) benefit in metastatic Castration Resistant Prostate Cancer (mCRPC) patients treated with Radium-223 dichloride (Ra-223) over placebo. Here we report clinical outcomes of Ra-223 treatment in a nonstudy population. In this prospective registry, patients from 20 Dutch hospitals were included prior to Ra-223 treatment. Clinical parameters collected included previous treatments and Adverse Events. Primary outcome was 6 months Symptomatic Skeletal Event (SSE)-free survival, while secondary outcomes included Progression-Free Survival (PFS) and Overall Survival (OS). Of the 305 patients included, 300 were evaluable. The mean age was 73.6 years, 90% had ≥6 bone metastases and 74.1% were pretreated with Docetaxel, 19.5% with Cabazitaxel and 80.5% with Abiraterone and/or Enzalutamide. Of all patients, 96.7% were treated with Ra-223 and received a median of 5 cycles. After a median follow-up of 13.2 months, 6 months SSE-free survival rate was 83%, median PFS was 5.1 months and median OS was 15.2 months. Six months SSE-free survival rate and OS were comparable with those reported in ALSYMPCA. "Previous Cabazitaxel treatment" and "bone-only metastases" were independent predictors of a shorter and longer PFS, respectively, while above-median LDH and "bone-only metastases" were independent predictors of shorter and longer OS, respectively. Toxicity was similar as reported in the ALSYMPCA trial. These results suggest that in a nonstudy population, Ra-223 treatment is well-tolerated, equally effective as in the ALSYMPCA population and that patients not previously treated with Cabazitaxel benefit most from Ra-223.

Real-world outcomes of radium-223 dichloride for metastatic castration resistant prostate cancer.

Aim: Timing of radium-223 (Ra-223) in metastatic castration-resistant prostate cancer (mCRPC) remains challenging due to alternative options and short window of opportunity. Methods: Ra-223 treated patients in the CAPRI-registry were included. Outcomes were evaluated based on treatment line of Ra-223. Results: Out of 285 patients, 49% received Ra-223 in line ≥3. 51% completed six Ra-223 injections and 34% had a symptomatic skeletal event after first Ra-223 without differences between subgroups. After correction of known prognostic factors Ra-223 in line ≥3 (HR: 3.267; 95% CI: 1.689-6.317; p < 0.01) remained associated with worse OS. Conclusion: In the Netherlands, Ra-223 was mainly started as second or third mCRPC-treatment in 2014-2018. Later timing of Ra-223 did affect OS, but not treatment completion and occurrence of symptomatic skeletal events.

Performance of ANN, SVM and MLH techniques for land use/cover change detection at Sultan Marshes wetland, Turkey.

Wetlands are among the most productive ecosystems that provide services ranging from flood control to climate change mitigation. Wetlands are also critical habitats for the survival of numerous plant and animal species. In this study, we used satellite remote sensing techniques for classification and change detection at an internationally important wetland (Ramsar Site) in Turkey. Sultan Marshes is located at the center of semi-arid Develi closed basin. The wetlands have undergone significant changes since the 1980s due to changes in water flow regimes, but changes in recent years have not been sufficiently explored yet. In this study, we focused on the changes from 2005 to 2012. Two multispectral ASTER images with spatial resolution of 15 m, acquired on June 11, 2005 and May 20, 2012, were used in the analyses. After geometric correction, the images were classified into four information classes, namely water, marsh, agriculture, and steppe. The applicability of three classification methods (i.e. maximum likelihood (MLH), multi-layer perceptron type artificial neural networks (ANN) and support vector machines (SVM)) was assessed. The differences in classification accuracies were evaluated by the McNemar's test. The changes in the Sultan Marshes were determined by the post classification comparison method using the most accurate classified images. The results showed that the highest overall accuracy in image classifications was achieved with the SVM method. It was observed that marshes and steppe areas decreased while water and agricultural areas expanded from 2005 to 2012. These changes could be the results of water transfers to the marshes from neighboring watershed.

Modelling the effects of meteorological parameters on water temperature using artificial neural networks.

Water temperature affects all biological and chemical processes in water; therefore, it is an extremely important water quality parameter. Meteorological factors are among the most important factors that affect water temperatures. The aim of this study is to develop an artificial neural network (ANN) model to investigate the effects of meteorological parameters on water temperatures at Kizilirmak River in Turkey. Water temperature data were collected from gauging stations on Kizilirmak River, and meteorological data were acquired from the nearest meteorological stations. Air temperature, wind speed, relative humidity, and previous water temperatures were formed the input parameters. The model output included water temperatures. All data were available for the 1995-2007 period, with occasional missing records. The activation functions of the ANN model and the number of neurons in the hidden layer were selected by trial-and-error method to find the best results. The root mean square error and the correlation coefficient between observed and simulated water temperatures were used to assess the model success. The best results were obtained by using sigmoid activation function and scaled conjugate gradient algorithm. This study showed that meteorological data can be used to simulate water temperature with ANN model for Kizilirmak River.

Optimization of solid content, carbon/nitrogen ratio and food/inoculum ratio for biogas production from food waste.

Biogas production from food waste has been used as an efficient waste treatment option for years. The methane yields from decomposition of waste are, however, highly variable under different operating conditions. In this study, a statistical experimental design method (Taguchi OA9) was implemented to investigate the effects of simultaneous variations of three parameters on methane production. The parameters investigated were solid content (SC), carbon/nitrogen ratio (C/N) and food/inoculum ratio (F/I). Two sets of experiments were conducted with nine anaerobic reactors operating under different conditions. Optimum conditions were determined using statistical analysis, such as analysis of variance (ANOVA). A confirmation experiment was carried out at optimum conditions to investigate the validity of the results. Statistical analysis showed that SC was the most important parameter for methane production with a 45% contribution, followed by F/I ratio with a 35% contribution. The optimum methane yield of 151 l kg-1 volatile solids (VS) was achieved after 24 days of digestion when SC was 4%, C/N was 28 and F/I were 0.3. The confirmation experiment provided a methane yield of 167 l kg-1 VS after 24 days. The analysis showed biogas production from food waste may be increased by optimization of operating conditions.

Use of Landsat land surface temperature and vegetation indices for monitoring drought in the Salt Lake Basin Area, Turkey.

The main purpose of this paper is to investigate multitemporal land surface temperature (LST) changes by using satellite remote sensing data. The study included a real-time field work performed during the overpass of Landsat-5 satellite on 21/08/2011 over Salt Lake, Turkey. Normalized vegetation index (NDVI), vegetation condition index (VCI), and temperature vegetation index (TVX) were used for evaluating drought impact over the region between 1984 and 2011. In the image processing step, geometric and radiometric correction procedures were conducted to make satellite remote sensing data comparable with in situ measurements carried out using thermal infrared thermometer supported by hand-held GPS. The results showed that real-time ground and satellite remote sensing data were in good agreement with correlation coefficient (R2) values of 0.90. The remotely sensed and treated satellite images and resulting thematic indices maps showed that dramatic land surface temperature changes occurred (about 2°C) in the Salt Lake Basin area during the 28-year period (1984-2011). Analysis of air temperature data also showed increases at a rate of 1.5-2°C during the same period. Intensification of irrigated agriculture particularly in the southern basin was also detected. The use of water supplies, especially groundwater, should be controlled considering particularly summer drought impacts on the basin.

Physically based vs. data-driven models for streamflow and reservoir volume prediction at a data-scarce semi-arid basin.

Physically based or data-driven models can be used for understanding basinwide hydrological processes and creating predictions for future conditions. Physically based models use physical laws and principles to represent hydrological processes. In contrast, data-driven models focus on input-output relationships. Although both approaches have found applications in hydrology, studies that compare these approaches are still limited for data-scarce, semi-arid basins with altered hydrological regimes. This study aims to compare the performances of a physically based model (Soil and Water Assessment Tool (SWAT)) and a data-driven model (Nonlinear AutoRegressive eXogenous model (NARX)) for reservoir volume and streamflow prediction in a data-scarce semi-arid region. The study was conducted in the Tersakan Basin, a semi-arid agricultural basin in Türkiye, where the basin hydrology was significantly altered due to reservoirs (Ladik and Yedikir Reservoir) constructed for irrigation purposes. The models were calibrated and validated for streamflow and reservoir volumes. The results show that (1) NARX performed better in the prediction of water volumes of Ladik and Yedikir Reservoirs and streamflow at the basin outlet than SWAT (2). The SWAT and NARX models both provided the best performance when predicting water volumes at the Ladik reservoir. Both models provided the second best performance during the prediction of water volumes at the Yedikir reservoir. The model performances were the lowest for prediction of streamflow at the basin outlet (3). Comparison of physically based and data-driven models is challenging due to their different characteristics and input data requirements. In this study, the data-driven model provided higher performance than the physically based model. However, input data used for establishing the physically based model had several uncertainties, which may be responsible for the lower performance. Data-driven models can provide alternatives to physically-based models under data-scarce conditions.

Multi-temporal assessment of land surface temperatures as an indicator of land use/cover changes and climate variability in the Develi Basin, Turkey.

Land surface temperature (LST) is an important parameter that reflects land surface processes of water and energy balance and has been used in assessment of land use/cover changes. However, the use of LST in monitoring changes in non-urban areas such as agricultural areas and wetlands is still limited. In this study, we aim to determine the spatial and temporal changes in LST in a semi-arid agricultural basin in Turkey (Develi Basin), where land use/cover and climatic conditions showed considerable variability since 1980s. Irrigated agriculture have expanded in the basin since 1987, after the construction of a large irrigation project. The basin hosts an internationally important wetland, called the Sultan Marshes, affected negatively by irrigation expansion. The study covers a 39-year period from 1984 to 2022. Four Landsat Thematic Mapper (TM) images acquired in 1984, 1987, 2003, and 2007 and two Landsat 8 OLI/TIRS images acquired in 2014 and 2022 were used in the analyses. The land use/cover changes were evaluated based on Normalized Difference Vegetation Index (NDVI). LST was estimated through top-of-atmosphere brightness temperature from thermal bands of Landsat images. Climate variability from 2014 to 2022 was analyzed with statistical methods. The results indicated that Develi Basin faced both spatial and temporal land use/cover changes. The area covered with natural steppe vegetation and water bodies decreased in the basin. In contrast, the sparsely and densely vegetated soil covers, which mostly denote agricultural areas, increased. Changes in LST values were observed from 1984 to 2022 as a result of climatic factors and land use/cover changes. LST changes were variable across different land use/cover types; LST decreased in irrigated areas and increased in lakes that went dry over years. LST changes proved useful for evaluating land use/cover changes and climatic variations in agricultural basins.

Qualitative study of the consequences of vaccine-induced immune thrombocytopenia and thrombosis: the experiences of family members.

OBJECTIVES: To explore the experiences of family members of patients who died or survived following a diagnosis of vaccine-induced immune thrombocytopenia and thrombosis (VITT). DESIGN: A semistructured qualitative study, conducted via Zoom. SETTING: Participants discussed their experiences during hospitalisation and following discharge. PARTICIPANTS: Sixteen family members of patients with VITT (survivors=11; bereaved=5), recruited via a Facebook support group and advertising on Twitter. RESULTS: Analysis identified two themes common to both groups of participants: the stress of hospitalisation and the experience of multiple losses. A third theme, living with VITT, was unique to the survivor group and a fourth, battling against the system, was predominantly reported by bereaved participants. CONCLUSIONS: This is a significantly challenged group of people, with multiple emotional, financial, social and psychological losses. These losses have been compounded by experiences of limited governmental and societal recognition of the problems they face.

Living with vaccine-induced immune thrombocytopenia and thrombosis: a qualitative study.

OBJECTIVES: To explore the experiences of people up to 18 months after being diagnosed with vaccine-induced immune thrombocytopenia and thrombosis (VITT). DESIGN: A semistructured qualitative study, conducted via Zoom, of a cohort of people with VITT. SETTING: Participants discussed their experiences of hospitalisation and following discharge. PARTICIPANTS: 14 individuals diagnosed with VITT, recruited via a Facebook support group and advertising on Twitter. RESULTS: Thematic analysis identified challenges of obtaining medical care and diagnosis; fear of the severity of symptoms and unclear prognosis; and lack of family support due to isolation imposed by the COVID-19 pandemic. Once home, participants experienced continued significant symptoms; fear of recurrence; inadequate medical knowledge of their condition; and difficulties coping with residual physical disabilities and psychosocial losses. Also reported were feelings of isolation and abandonment due to lack of government support. CONCLUSIONS: This is a significantly challenged group of people, with multiple health, financial, social and psychological losses. These losses have been compounded by experiences of limited governmental and societal recognition of the problems they face.

Modelling climate change impacts at a drinking water reservoir in Turkey and implications for reservoir management in semi-arid regions.

Climate change can have severe impacts on the water availability in semi-arid regions. In this study, we assessed the impact of climatic changes on water availability in the Altinapa Reservoir Watershed, located in the Konya province, south-central Turkey. Altinapa Reservoir supplies drinking water to Konya, a city of about 2 million population. We investigated possible changes in streamflow and reservoir storage over 2021-2098 under two representative concentration pathway scenarios (RCP4.5 and RCP8.5) developed based on GFDL-ESM2M, HadGEM2-ES, and MPI-ESM-MR global circulation models. We used a physically based model (SWAT-Soil and Water Assessment Tool) for understanding the hydrologic response of the basin to climatic changes. Results show that upward trends in air temperatures in the range of 0.01-0.04 °C/year and 0.005-0.06 °C/year are expected from 2021 to 2098 under the RCP4.5 and RCP8.5 scenarios, respectively. According to the HadGEM2-ES model, precipitation and streamflow would show a downward trend at a rate of 0.96 mm/year and 0.007 m3/s/year under the RCP4.5 scenario and at a rate of 1.62 mm/year and 0.01 m3/s/year under the RCP8.5 scenario, respectively. GFDL-ESM2M and MPI-ESM-MR models project upward trends in precipitation and streamflow under the RCP4.5 scenario (in the range of 0.64-1.28 mm/year and 0.0003-0.006 m3/s/year, respectively), and downward trends under the RCP8.5 scenario (in the range of 0.47-0.76 mm/year and 0.0015-0.003 m3/s/year, respectively). Reservoir storage is projected to increase slightly according to GFDL-ESM2M model and decrease according to the HadGEM2-ES, and MPI-ESM-MR models under both scenarios. Precipitation, streamflow, and reservoir storage predictions of GFDL-ESM2M and MPI-ESM-MR models are considerably lower than those observed in the basin in recent decades, showing that water resources will decrease in the future. The changes in water withdrawal patterns could cause further reductions in water availability. Good resilience to climate change can be achieved by a flexible water management system and by reducing water consumption and water losses in the watershed and from the reservoirs.

Impact of Natural Organic Matter Competition on the Adsorptive Removal of Acetochlor and Metolachlor from Low-Specific UV Absorbance Surface Waters.

Although activated carbon adsorption is a very promising process for the removal of organic compounds from surface waters, the removal performance for nonionic pesticides could be adversely affected by co-occurring natural organic matter. Natural organic matter can compete with pesticides during the adsorption process, and the size of natural organic matter affects the removal of pesticides, as low-molecular-weight organics directly compete for adsorbent sites with pesticides. This study aims to investigate the competitive impact of low-molecular-weight organics on the adsorptive removal of acetochlor and metolachlor by four commercial powdered activated carbons. The adsorption features of selected powdered activated carbons were evaluated in surface water samples collected from the influent stream of the filtration process having 2.75 mg/L organic matter and 0.87 L/mg-m specific UV absorbance. The adsorption kinetics and capacities were examined by employing pseudo-first-order, pseudo-second-order, and intraparticle diffusion kinetic models and modified Freundlich and Langmuir isotherm models to the experimental data. The competitive removal of acetochlor and metolachlor in the presence of natural organic matter was evaluated for varied powdered activated carbon dosages on the basis of UV and specific UV absorbance values of adsorbed organic matter. The adsorption data were well represented by the modified Freundlich isotherm, as well as pseudo-second-order kinetics. The maximum organic matter adsorption capacities of the modified Freundlich isotherm were observed to be 120.6 and 127.2 mg/g by Norit SX Ultra and 99.5 and 100.6 mg/g by AC Puriss for acetochlor- and metolachlor-containing water samples, respectively. Among the four powdered activated carbons, Norit SX Ultra and AC Puriss provided the highest natural organic matter removal performances with 76 and 72% and 71 and 65% for acetochlor- and metolachlor-containing samples, respectively. Similarly, Norit SX Ultra and AC Puriss were very effective for adsorbing aromatic organics with higher than 80% specific UV absorbance removal efficiency. Metolachlor was almost completely removed by higher than 98% by Norit SX Ultra, Norit SX F Cat, and AC Puriss, even at low adsorbent dosages. However, an adsorbent dose of 100 mg/L and above should be added for all powdered activated carbons, except for Norit SX F Cat, for achieving an acetochlor removal performance of higher than 98%. The competition between low-molecular-weight organics (low-specific UV absorbance) and acetochlor and metolachlor was more apparent at low adsorbent dosages (10-75 mg/L).

How Vitamin D Levels of Children Changed During COVID-19 Pandemic: A Comparison of Pre-pandemic and Pandemic Periods

Objective: The synthesis of vitamin D is related to sun exposure, thus the restrictions during the Coronavirus disease-2019 (COVID-19) pandemic may have affected the levels of vitamin D in all age groups. The aim of this study was to evaluate vitamin D levels of healthy children and adolescents during the first year of the pandemic. Methods: The study group included healthy children and adolescents who were admitted for general check-ups and evaluated with 25(OH)D levels. Then, it was divided into two groups: Group 1 "pre-pandemic", and Group 2 "pandemic". Vitamin D levels were recorded from the hospital database and were compared according to age groups, gender, and the season, retrospectively. Results: The study group [mean age=90.29±59.45 median age=79 interquartile range (IQR): 102 months, male/female: 1409/1624] included 3033 children and adolescents (Group 1/Group 2 n=1864/1169). Although the mean 25(OH)D levels among preschool children did not differ between groups, the vitamin D levels of school-aged children and adolescents were significantly lower in the pandemic period than in the pre-pandemic period [Group 1 median=16.50 (IQR: 10.5) vs Group 2 median=15.9 (IQR: 11.3) in 6-12 age group (p=0.026); Group 1 median=13.30 (IQR: 10.2) vs Group 2 median=11.20 (IQR: 9.7) in 12-18 age group (p=0.003)]. Moreover, the 25(OH)D levels of adolescents showed seasonal variance with lower levels in winter, and unexpectedly, in summer. Conclusion: Pandemic-related restrictions have caused significant decreases in vitamin D levels of school-aged children and adolescents. We suggest that children and adolescents should be given vitamin D supplementation in order to maintain sufficient levels of vitamin D during the pandemic.

Integrated analysis of pain, health-related quality of life, and analgesic use in patients with metastatic castration-resistant prostate cancer treated with Radium-223.

BACKGROUND: Radium-223 (Ra-223), an alpha-emitting radiopharmaceutical, established an improved overall survival and health-related quality of life (HRQoL) in symptomatic metastatic castration-resistant prostate cancer (mCRPC) patients. However, effects on pain were not specifically evaluated. Here we assess integrated HRQoL, pain, and opioid use in a contemporary, more extensively pretreated, symptomatic and asymptomatic mCRPC population. METHODS: mCRPC patients scheduled for Ra-223 treatment were included and analyzed for HRQoL, pain, and opioid use, using Functional Assessment of Cancer Therapy-Prostate (FACT-P) and Brief Pain Inventory-Short Form (BPI-SF) questionnaires and recording of opioid use and dosage, respectively. Primary outcome measure was the percentage of patients experiencing a complete pain response (score of 0 on the BPI-SF Worst pain item and no increase in daily use of analgesics). A complete or partial pain response (better BPI-SF score and decrease in opioid use) and a better or no change in HRQoL was evaluated as an integrated overall clinical response (IOCR). Secondary endpoints included the time to pain progression (TPP) and Total FACT-P deterioration (TTFD), defined as time from first Ra-223 treatment to clinical meaningful increase in BPI-SF Worst pain item score and Total FACT-P score, respectively. RESULTS: This registry included 300 patients, of whom 105 (35%) were evaluable for FACT-P and BPI-SF during Ra-223 treatment. Forty-five (43%) patients had pain at baseline (PAB) (BPI-SF Worst pain score 5-10 points) and 60 (57%) had no pain at baseline (no-PAB) (BPI-SF Worst pain score 0-4 points). Complete pain response was achieved in 31.4% of the patients, while 58% had an IOCR. The median TTP and TTFD were 5.6 and 5.7 months, respectively, while the difference between PAB and no-PAB patients was not significant. CONCLUSIONS: In contemporary, extensively pretreated mCRPC patients, Ra-223 treatment induced complete pain responses while integrated analysis of HRQoL, pain response, and opioid use demonstrated that the majority of patients derive clinical benefit.

Interaction of functional gastrointestinal disorders with postpartum conditions related to mother and baby.

BACKGROUND: Functional gastrointestinal disorders (FGID) may affect or may be affected by postpartum depression (PPD), mode of feeding and postpartum life quality. We aimed to evaluate the interaction between FGID and these parameters in infants. METHODS: The study group consisted of babies attending our outpatient clinics. There were three age groups: 4-6 weeks, 3-4 months and 6-7 months. Demographic data of the babies and mothers, and data of feeding were collected. For the diagnosis of FGID, Rome III criteria were used. Mothers were screened with the Edinburgh Depression Scale. Quality of life (QoL) scores were obtained by using the `Maternal Postpartum Quality of Life Questionnaire`. Factors affecting the presence of FGID, PPD and quality of life were analyzed. RESULTS: Two hundred thirteen infants were enrolled during the study period. FGID was present with similar rates in both genders and was lower (31.5%) in the 6-7 month-old group (p=0.001). Infantile colic was higher in girls (68.6% vs. 31.4%, p=0.016). In 4-6 week-old infants with infantile dyschesia, the delivery route was mostly cesarean (83.3% vs. 16.7%, p=0.006). Similarly, regurgitation was more frequent in 6-7 month-old infants born by cesarean (88.9% vs. 11.1%, p=0.035), and was more frequent in infants being exclusively breastfed (60.9%, p=0.037). QoL scores were lower in mothers with depression (20.9±3.4 vs. 23.9±3.6, p=0.003). Infantile colic was higher in mothers with depression, but not significantly (29.3% vs. 11.4%, p=0.057). CONCLUSIONS: Caesarian section delivery and breastfeeding were influential on infantile dyschesia and regurgitation subgroups. No other studied factor seemed to affect FGID.

Spatial/temporal distribution and multi-pathway cancer risk assessment of trihalomethanes in low TOC and high bromide groundwater.

This study aims (1) to determine the seasonal and spatial distribution of THMs formed in chlorinated groundwater containing low levels of organic matter (0.4-0.8 mg L-1) and low to high levels of bromine (40-380 µg L-1), and (2) to evaluate the multi-route cancer risks associated with them. The study was conducted in Kayseri (Turkey), where drinking water is supplied from groundwater after chlorination only. THM formation in 50 water samples from 18 storage tanks and 32 distribution points was investigated to evaluate the spatial and temporal changes in THM concentrations for 12 months. The lifetime cancer risk associated with exposure to THMs through multiple pathways (i.e., oral ingestion, dermal absorption, and inhalation) was estimated for males and females. For a 12 month sampling period, the minimum and maximum THM concentrations varied from 2 µg L-1 to 17 µg L-1 and from 2 µg L-1 to 29 µg L-1 in storage tanks and distribution points, respectively. The ranges of median concentrations of THM were 5 µg L-1 to 9 µg L-1 in storage tanks and 5 µg L-1 to 12 µg L-1 in distribution points. In all samples dibromochloromethane was the dominant species, followed by bromoform, chloroform, and bromodichloromethane. The average values of total cancer risk associated with exposure to THMs via oral ingestion, dermal absorption, and inhalation for females and males were 1.31 × 10-5 and 1.25 × 10-5 in storage tanks, and 1.46 × 10-5 and 1.39 × 10-5 in distribution points, respectively. Although THM concentrations were very low, cancer risk values are 1.0 × 10-6 < CR < 1.0 × 10-4, which are higher than the negligible risk level (1.0 × 10-6).

Is the axilla the right site for temperature measurement in children by chemical thermometer?

Although each method has its own advantages and disadvantages compared with the conservative mercury-in-glass thermometers, there are conflicting opinions about the optimal anatomic site for measuring body temperature as well about the variations in measurements with different methods. In this study, we aimed to assess the accuracy and reliability of measurements obtained from the axilla with the chemical thermometer (Tempa DOT TM) compared with the classic mercury-in-glass instruments. Sixty randomly selected pediatric patients who were admitted to our hospital were enrolled. Simultaneous temperature axillary measurements (n: 1300) were performed with the chemical thermometer and mercury-in-glass instruments. The mean results of the axillary mercury-in-glass thermometers and axillary chemical thermometer were 36.8 +/- 0.6 and 37.2 +/- 0.7, respectively. The Bland-Altman plot of differences suggests that 95% of the chemical thermometer (Tempa.DOT TM) readings were within limits of agreement (+0.37 and -1.24 degrees C) when mercury-in-glass thermometer is considered as the standard. Our results showed that limits of agreement were wide (+0.37 and -1.24 degrees C) between readings of axillary mercury-in-glass thermometers and chemical thermometers. Since approximately 20% of febrile patients with mercury-in-glass temperature were misdiagnosed as afebrile with measurements via chemical thermometer, we suggest that the axilla is not a suitable anatomic site for screening of fever with Tempa.DOT. Further studies involving larger study groups with similar age should be done to more definitely assess its screening value in pediatrics.

Interobserver Agreement of Interim and End-of-Treatment 18F-FDG PET/CT in Diffuse Large B-Cell Lymphoma: Impact on Clinical Practice and Trials.

We aimed to assess the interobserver agreement of interim PET (I-PET) and end-of-treatment PET (EoT-PET) using the Deauville score (DS) in first-line diffuse large B-cell lymphoma (DLBCL) patients. Methods: I-PET and EoT-PET scans of DLBCL patients were performed in the HOVON84 study (2007-2012), an international multicenter randomized controlled trial. Patients received R-CHOP14 and were randomized to receive rituximab intensification in the first 4 cycles or not. I-PET was performed after 4 cycles (for observational purposes), and EoT-PET after 6 or 8 cycles. Two independent central reviewers retrospectively scored all scans according to the DS system, masked to clinical outcomes. Results were dichotomized as negative (DS of 1-3) or positive (DS of 4-5). Besides percentage overall agreement (OA), we calculated agreement for positive and negative scores, expressed as positive agreement (PA) and negative agreement (NA), respectively. Results: 465 I-PET and 457 EoT-PET scans were centrally reviewed; baseline 18F-FDG PET or PET/CT was available in 75%-77%, and CT in the remaining cases. Percentage OA for I-PET and EoT-PET were 87.7% and 91.7% (P = 0.049), with NA of 92.0% and 95.0% (P = 0.091), and PA of 73.7% and 76.3% (P = 0.656), respectively. Conclusion: Interobserver agreement using DS in DLBCL patients in I-PET and EoT-PET yields high OA and NA. The lower PA suggests that EoT-PET/CT treatment evaluation in daily practice and I-PET-adapted trials may benefit from dual reads and central review, respectively.