Variations in Concurrent Validity of Two Independent Inertial Measurement Units Compared to Gold Standard for Upper Body Posture during Computerised Device Use.

Inertial measurement units (IMUs) may provide an objective method for measuring posture during computer use, but research is needed to validate IMUs' accuracy. We examine the concurrent validity of two different IMU systems in measuring three-dimensional (3D) upper body posture relative to a motion capture system (Mocap) as a potential device to assess postures outside a laboratory environment. We used 3D Mocap and two IMU systems (Wi-Fi and Bluetooth) to capture the upper body posture of twenty-six individuals during three physical computer working conditions (monitor correct, monitor raised, and laptop). Coefficient of determination (R2) and root-mean-square error (RMSE) compared IMUs to Mocap. Head/neck segment [HN], upper trunk segment [UTS], and joint angle [HN-UTS] were the primary variables. Wi-Fi IMUs demonstrated high validity for HN and UTS (sagittal plane) and HN-UTS (frontal plane) for all conditions, and for HN rotation movements (both for the monitor correct and monitor raised conditions), others moderate to poor. Bluetooth IMUs for HN, and UTS (sagittal plane) for the monitor correct, laptop, and monitor raised conditions were moderate. Frontal plane movements except UTS (monitor correct and laptop) and all rotation had poor validity. Both IMU systems were affected by gyroscopic drift with sporadic data loss in Bluetooth IMUs. Wi-Fi IMUs had more acceptable accuracy when measuring upper body posture during computer use compared to Mocap, except for trunk rotations. Variation in IMU systems' performance suggests validation in the task-specific movement(s) is essential.

Carboplatin dosing in the treatment of ovarian cancer: An NRG oncology group study.

OBJECTIVE: To determine the effects of using National Comprehensive Cancer Network (NCCN) guidelines to estimate renal function on carboplatin dosing and explore adverse effects associated with a more accurate estimation of lower creatinine clearance (CrCl). METHODS: Retrospective data were obtained for 3830 of 4312 patients treated on GOG182 (NCT00011986)-a phase III trial of platinum-based chemotherapy for advanced-stage ovarian cancer. Carboplatin dose per patient on GOG182 was determined using the Jelliffe formula. We recalculated CrCl to determine dosing using Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (with/without NCCN recommended modifications) formulas. Associations between baseline CrCl and toxicity were described using the area under the receiver operating characteristic curve (AUC). Sensitivity and positive predictive values described the model's ability to discriminate between subjects with/without the adverse event. RESULTS: AUC statistics (range, 0.52-0.64) showed log(CrClJelliffe) was not a good predictor of grade ≥3 adverse events (anemia, thrombocytopenia, febrile neutropenia, auditory, renal, metabolic, neurologic). Of 3830 patients, 628 (16%) had CrCl <60 mL/min. Positive predictive values for adverse events ranged from 1.8%-15%. Using the Cockcroft-Gault, Cockcroft-Gault with NCCN modifications, and MDRD (instead of Jelliffe) formulas to estimate renal function resulted in a >10% decrease in carboplatin dosing in 16%, 32%, and 5.2% of patients, respectively, and a >10% increase in carboplatin dosing in 41%, 9.6% and 12% of patients, respectively. CONCLUSION: The formula used to estimate CrCl affects carboplatin dosing. Estimated CrCl <60 mL/min (by Jelliffe) did not accurately predict adverse events. Efforts continue to better predict renal function. Endorsing National Cancer Institute initiatives to broaden study eligibility, our data do not support a minimum threshold CrCl <60 mL/min as an exclusion criterion from clinical trials.

The effect of older age on treatment outcomes in women with advanced ovarian cancer receiving chemotherapy: An NRG-Oncology/Gynecologic Oncology Group (GOG-0182-ICON5) ancillary study.

OBJECTIVE: To assess the effect of age on overall survival (OS) in women with ovarian cancer receiving chemotherapy. Secondary objectives were to describe the effect of age on treatment compliance, toxicities, progression free survival (PFS), time from surgery to chemotherapy, and rates of optimal cytoreduction. METHODS: Women enrolled in GOG 0182-ICON5 with stage III or IV epithelial ovarian cancer (EOC) who underwent surgery and chemotherapy between 2001 and 2004 were included. Patients were divided into ages <70 and ≥ 70 years. Baseline characteristics, treatment compliance, toxicities, and clinical outcomes were compared. RESULTS: We included a total of 3686 patients, with 620 patients (16.8%) ≥ 70 years. OS was 37.2 months in older compared to 45.0 months in younger patients (HR 1.21, 95% CI, 1.09-1.34, p < 0.001). Older patients had an increased risk of cancer-specific-death (HR 1.16, 95% CI, 1.04-1.29) as well as non-cancer related deaths (HR 2.78, 95% CI, 2.00-3.87). Median PFS was 15.1 months in older compared to 16.0 months in younger patients (HR 1.10, 95% CI, 1.00-1.20, p = 0.056). In the carboplatin/paclitaxel arm, older patients were just as likely to complete therapy and more likely to develop grade ≥ 2 peripheral neuropathy (35.7 vs 19.7%, p < 0.001). Risk of other toxicities remained equal between groups. CONCLUSIONS: In women with advanced EOC receiving chemotherapy, age ≥ 70 was associated with shorter OS and cancer specific survival. Older patients receiving carboplatin and paclitaxel reported higher rates of grade ≥ 2 neuropathy but were not more likely to suffer from other chemotherapy related toxicities. Clintrials.gov: NCT00011986.

Improving Risk Assessment for Metastatic Disease in Endometrioid Endometrial Cancer Patients Using Molecular and Clinical Features: An NRG Oncology/Gynecologic Oncology Group Study.

Objectives: A risk assessment model for metastasis in endometrioid endometrial cancer (EEC) was developed using molecular and clinical features, and prognostic association was examined. Methods: Patients had stage I, IIIC, or IV EEC with tumor-derived RNA-sequencing or microarray-based data. Metastasis-associated transcripts and platform-centric diagnostic algorithms were selected and evaluated using regression modeling and receiver operating characteristic curves. Results: Seven metastasis-associated transcripts were selected from analysis in the training cohorts using 10-fold cross validation and incorporated into an MS7 classifier using platform-specific coefficients. The predictive accuracy of the MS7 classifier in Training-1 was superior to that of other clinical and molecular features, with an area under the curve (95% confidence interval) of 0.89 (0.80-0.98) for MS7 compared with 0.69 (0.59-0.80) and 0.71 (0.58-0.83) for the top evaluated clinical and molecular features, respectively. The performance of MS7 was independently validated in 245 patients using RNA sequencing and in 81 patients using microarray-based data. MS7 + MI (myometrial invasion) was preferrable to individual features and exhibited 100% sensitivity and negative predictive value. The MS7 classifier was associated with lower progression-free and overall survival (p ≤ 0.003). Conclusion: A risk assessment classifier for metastasis and prognosis in EEC patients with primary tumor derived MS7 + MI is available for further development and optimization as a companion clinical support tool.

Trait-mediated competition drives an ant invasion and alters functional diversity.

The assumption that differences in species' traits reflect their different niches has long influenced how ecologists infer processes from assemblage patterns. For instance, many assess the importance of environmental filtering versus classical limiting-similarity competition in driving biological invasions by examining whether invaders' traits are similar or dissimilar to those of residents, respectively. However, mounting evidence suggests that hierarchical differences between species' trait values can distinguish their competitive abilities (e.g. for the same resource) instead of their niches. Whether such trait-mediated hierarchical competition explains invasions and structures assemblages is less explored. We integrate morphological, dietary, physiological and behavioural trait analyses to test whether environmental filtering, limiting-similarity competition or hierarchical competition explain invasions by fire ants on ant assemblages. We detect both competition mechanisms; invasion success is not only explained by limiting similarity in body size and thermal tolerance (presumably allowing the invader to exploit different niches from residents), but also by the invader's superior position in trait hierarchies reflecting competition for common trophic resources. We find that the two mechanisms generate complex assemblage-level functional diversity patterns-overdispersion in some traits, clustering in others-suggesting their effects are likely missed by analyses restricted to a few traits and composite trait diversity measures.

Differences in upper body posture between individuals with and without chronic idiopathic neck pain during computerised device use: A 3D motion analysis study.

BACKGROUND: Computer use is associated with poor postures and increased risk of developing neck pain. Evaluating differences in working posture of individuals with and without chronic neck pain may assist the development of strategies to lessen or prevent pain. OBJECTIVE: To identify if upper body kinematics differs between individuals with and without chronic idiopathic neck pain during four conditions (tablet, laptop, and desktop computer sitting and standing). METHODS: Three-dimensional (3D) motion capture measured upper body kinematics in 44 individuals with chronic idiopathic neck pain > 90 days (Cases n = 22) and without pain (Control n = 22), during a typing task under four conditions: tablet, laptop, desktop computer (sitting and standing). Differences between groups were evaluated using generalised linear mixed models. RESULTS: Across all conditions and compared to controls, cases had significantly less flexion between their head-neck and upper trunk segments (between group mean difference 7.15°, 2.1, 12.2, p = .006), greater upper trunk flexion relative to the laboratory (-6.15°, -10.9, -1.3, p = .012), greater shoulder flexion bilaterally (left 12.35°, 6.7, 17.9, p < .001; right 13.49°, 7.9, 19.1, p < .001) and less right elbow flexion (-6.87°, -12.1, -1.7, p = .010). Approaching significance, the case group had less left elbow flexion (between group mean difference -5.36°, -10.9, 0.1, p = .056) and a smaller mean craniocervical angle for the seated desktop condition (group x condition interaction -6.37°; 95% CI -12.7, -0.1, p = .052). SIGNIFICANCE: Individuals with neck pain consistently used different upper body postures compared to individuals without pain when working on computerised devices under varying workstation conditions. This finding suggests that people with neck pain work in potentially aggravating postures that may be associated with their pain.

Effect of Inpatient Integrative Medicine Consultation on 30-Day Readmission Rates: A Retrospective Observational Study at a Major U.S. Academic Hospital.

Objectives: The prevalence of inpatient integrative medicine (IM) consult services is increasing among academic health care institutions. The diversity of services between institutions, as well as the novel nature of such interventions, makes it challenging for health care administrators to determine the cost/benefit of adding such a program to their institution. The main purpose of this study was to examine the performance of the new University of California, Los Angeles (UCLA) East-West (EW) consult service as measured by 30-day readmission rates and lengths of stay. Design: This is a retrospective observational case-control study with participants matched to themselves. Setting: UCLA Santa Monica Hospital, a 281-bed academic tertiary care hospital near Los Angeles, California. Subjects: Patients who had received an EW consultation during the inaugural 20 months of the program (2018-2020), and who had been hospitalized in the prior 2 years from the date of their first EW consult. Intervention: Inpatient East-West consultation, which may include counseling, acupuncture and/or trigger point injections depending on medical necessity. Outcome Measures: Thirty-day readmission rates and lengths of hospital admission were compared between the hospitalization that included an EW consult (which included the use of acupuncture and/or trigger point injections when appropriate) and any prior admissions during the 2 years before that EW consult. Secondary outcomes included quantitative analysis of average number of treatments and qualitative assessment of integrative treatment(s) received, conditions treated, and reasons that EW treatment may have been deferred during a consult. Results: One hundred sixty-five unique patients met the study criteria. The EW consultation was associated with clinically relevant, statistically significant decreased 30-day readmission rates (33.0% vs. 4.6%, p < 0.001, odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06-0.17). This effect was similar when limiting the analysis to pain-related admissions (32.3% vs. 3.4%, p < 0.001, OR = 0.07, 95% CI 0.03-0.16). Hospital admissions with EW consults were found to have a statistically significant increased length of stay (7.03 days vs. 5.40 days, p < 0.001). Conclusion: The EW medicine, an example of IM, correlates with a reduced risk of 30-day readmission and with modestly increased lengths of stay.

Evidence for the Effectiveness of Feedback from Wearable Inertial Sensors during Work-Related Activities: A Scoping Review.

Background: Wearable inertial sensor technology (WIST) systems provide feedback, aiming to modify aberrant postures and movements. The literature on the effects of feedback from WIST during work or work-related activities has not been previously summarised. This review examines the effectiveness of feedback on upper body kinematics during work or work-related activities, along with the wearability and a quantification of the kinematics of the related device. Methods: The Cinahl, Cochrane, Embase, Medline, Scopus, Sportdiscus and Google Scholar databases were searched, including reports from January 2005 to July 2021. The included studies were summarised descriptively and the evidence was assessed. Results: Fourteen included studies demonstrated a 'limited' level of evidence supporting posture and/or movement behaviour improvements using WIST feedback, with no improvements in pain. One study assessed wearability and another two investigated comfort. Studies used tri-axial accelerometers or IMU integration (n = 5 studies). Visual and/or vibrotactile feedback was mostly used. Most studies had a risk of bias, lacked detail for methodological reproducibility and displayed inconsistent reporting of sensor technology, with validation provided only in one study. Thus, we have proposed a minimum 'Technology and Design Checklist' for reporting. Conclusions: Our findings suggest that WIST may improve posture, though not pain; however, the quality of the studies limits the strength of this conclusion. Wearability evaluations are needed for the translation of WIST outcomes. Minimum reporting standards for WIST should be followed to ensure methodological reproducibility.

3D Biomechanics of Rugby Tackle Techniques to Inform Future Rugby Research Practice: a Systematic Review.

BACKGROUND: The tackle is the most common in-play event in rugby union and rugby league (the rugby codes). It is also associated with the greatest propensity for injury and thus accounts for the most injuries in the sport. It is therefore of critical importance to accurately quantify how tackle technique alters injury risk using gold-standard methodology of three-dimensional motion (3D) capture. OBJECTIVE: To examine the 3D motion capture methodology of rugby-style tackle techniques to provide recommendations to inform practice for future rugby code research and advance the knowledge of this field. STUDY DESIGN: Systematic review. METHODS: Articles published in English language, up to May 2020, were retrieved via nine online databases. All cross-sectional, correlational, observational, and cohort study designs using 3D motion capture of tackle techniques in rugby code players met inclusion criteria for this review. A qualitative synthesis using thematic analysis was pre-specified to identify five key themes. RESULTS: Seven articles met eligibility criteria. Participant demographic information (theme one) involved a total of 92 rugby union players, ranging in skill level and playing experience. Experimental task design information (theme two) included one-on-one, front-on (n=5) or side-on (n=1) contact between a tackler and a ball carrier, or a tackler impacting a tackle bag or bump pad (n=3). 3D data collection (theme three) reported differing sampling frequencies and marker sets. 3D data reduction and analysis (theme four) procedures could be mostly replicated, but the definitions of temporal events, joint modelling and filtering varied between studies. Findings of the studies (theme five) showed that the one-on-one tackle technique can be altered (n=5) when tackle height, leg drive and/or tackle speed is modified. A study reported tackle coaching intervention. CONCLUSIONS: This is the first review to evaluate 3D motion capture of rugby-style tackle technique research. A research framework was identified: (i) participant demographic information, (ii) experimental task design information, (iii) 3D motion capture data specifications, and (iv) 3D data reduction and analysis. Adherence of future 3D tackling research to these framework principles will provide critical scientific evidence to better inform injury reduction and performance practices in the rugby codes. TRIAL REGISTRATION: The review was registered with PROSPERO (registration number CRD42018092312 ).

Diversity of Pain Medicine Trainees and Faculty in the United States: A Cross-Sectional Analysis of Fellowship Training from 2009-2019.

OBJECTIVE: Diversity and equity in medicine remain pivotal to care delivery. Data analysis on sex and racial diversity of pain medicine fellowship trainees and faculty in the United States are scant. We sought to characterize demographic and retention patterns among pain medicine fellows and faculty, who represent the emerging chronic pain management workforce. DESIGN: cross-sectional retrospective analysis. METHOD: We conducted an analysis of data from the American Association of Medical Colleges (AAMC) and the United States Accreditation Council on Graduate Medical Education (ACGME)-approved residency and fellowship training-programs for each year from 2009 through 2019, inclusively. We compared changes in sex, racial/ethnicity composition and retention rates of fellows and faculty in the United States by practice setting. RESULTS: From 2009 to 2019, there was a 14% increase in the number of ACGME pain fellowship programs. From 2009 to 2019, the ratio of men to women pain fellows ranged from 5:1 to 3.7:1. Compared with their self-identified White peers, Asian (OR 0.44; 95% CI: 0.34-0.58), Black (OR 0.46; 95% CI: 0.30-0.72), and Native American/Alaskan Native (OR 0.26; 95% CI: 0.08-0.80) identifying individuals had significantly lower odds of being a pain fellow, P < 0.05. There was no significant difference in female (OR = 0.4, 95% CI: 0.148-1.09) and Black (OR 0.36; 95% CI: 0.11-1.12) program-directors. Pain-fellow in-state retention was 53%. CONCLUSIONS: The demographics of pain medicine training programs reflect a persistent male vs. female gap with underrepresentation of racial minorities. Further research is needed to elucidate reasons underlying these disparities.

Posture during the use of electronic devices in people with chronic neck pain: A 3D motion analysis project.

BACKGROUND: Non-neutral postures during computerised device use coupled with increased usage may increase the risk of neck pain. Greater knowledge of postures that individuals with neck pain adopt during computerised device use is warranted. OBJECTIVE: To evaluate neck and upper limb posture while using a tablet, laptop and desktop computer (sitting and standing) in individuals with chronic neck pain. METHODS: Differences in three-dimensional kinematic variables were assessed during four conditions: tablet, laptop, desktop computer (sitting and standing) in 22 individuals with chronic neck pain >3 months. Differences between kinematic variables were determined using one-way repeated measures ANOVA with Bonferroni post-hoc tests. RESULTS: Compared to the desktop (sitting), tablet and laptop use resulted in increased neck flexion (mean difference tablet - 14.42°, 95% CI - 19.88, -8.96, P < 0.001; laptop -7.19°, -12.08, -2.31, P = .020); upper trunk flexion (tablet -14.89°, -20.22, -9.56, P < 0.001; laptop -5.56°, -10.02, -1.09, P = .009) and tablet bilateral shoulder elevation (left 11.01 mm, 2.01, 20.04, P < .016; right 13.08 mm, 3.09, 23.11, P < .006). CONCLUSIONS: Tablet and laptop use resulted in greater neck flexion, bilateral shoulder elevation and upper trunk flexion compared to a standard desktop computer, suggesting individuals with chronic neck pain should be mindful of their posture when using these smaller devices. Future research should explore how differences in posture may influence neck pain.

Improvement of Model Predictive Current Control Sensing Strategy for a Developed Small Flux-Switching Permanent Magnet Motor.

This paper presents an improved control system for a small flux-switching permanent magnet motor (FSPM) to enhance its performance and torque sensing. The analytical magnetic circuit design was used to determine the related motor parameters, such as the air gap flux density, permeance coefficient (Pc), torque, winding turns, pole number, width, length, magnet geometry, and the current density of FSPM. The electromagnetic analysis of this motor was performed by software (ANSYS Maxwell) to optimize the motor performance. In this study, the performance of FSPM was investigated by the uniform design experimentation (UDE). For the control system, the model predictive current control (MPCC) is currently recognized as a high-performance control strategy, due to its quick response and simple principle. This model contained the nonlinear part of the system, to improve the torque ripple of FSPM. A modified MPCC strategy was proposed to improve the distortion of the current waveform and decrease the computational burden. The new modified control architecture was mainly composed of three parts, such as the estimation of electromotive force (EMF), current prediction, and optimal vector selection/vector duration. When the reference voltage vector was obtained, the three-phase duties were easily determined by the principle of space vector modulation (SVM). The results show the different strategy methods between the newly proposed modified MPCC and traditional proportional integral (PI) controller. In the control of FSPM, a modified MPCC strategy was able to achieve a better performance response and decrease the computational burden. At a low speed of 350 rpm, the proposed modified MPCC can achieve a better dynamic response. The nonlinear problem of the startup speed was also effectively resolved. The torque sensing performance of the simulation and the experimental test value were compared. The torque sensing performance of the simulation and the actual test value were also examined. In this study, the optimization focused not only on the motor design and fabrication, but also on an improved motor control strategy and torque sensing, in order to achieve the integrity of the FSPM system.

Comparison of Choroidal Thickness Measurements Using Semiautomated and Manual Segmentation Methods.

SIGNIFICANCE: This study demonstrated that a semiautomated segmentation method could help inexperienced practitioners to obtain choroidal thickness as good as experienced practitioners. PURPOSE: The purpose of this study was to compare choroidal thickness measurements obtained by semiautomated and manual segmentation methods. METHODS: Optical coherence tomography images of 37 eyes from 37 healthy young subjects acquired by a spectral-domain optical coherence tomography device were reviewed retrospectively. Two naive examiners measured choroidal thickness using manual and semiautomated methods, whereas two experienced examiners used only the semiautomated method. The semiautomated method referred to a fully automated segmentation program customized based on MATLAB and followed manual verification. After highlighting the inner and outer choroidal boundaries through automated segmentation, examiners reviewed these boundaries in each B-scan and conducted manual revisions if segmentation errors occurred. After selecting points where correct boundary was located, the software used a spline fit to blend the corrected region with the rest of the boundary. All measurements were summarized in a 6-mm Early Treatment Diabetic Retinopathy Study grid. Operation time spent to complete retinal and choroidal segmentation on each eye was recorded. Between-examiner agreements, that is, intraclass correlation coefficient and coefficient of reproducibility (CoR), were calculated among four sets of semiautomated measurements, and within-examiner agreements were comparisons between manual and semiautomated results from the same naive examiners. Eyes with thin or thick choroids were also analyzed separately. RESULTS: The between-examiner and within-examiner agreements were excellent with intraclass correlation coefficient of 0.976 or greater. Pairwise within-examiner CoRs ranged from 17.4 to 47.1 µm. Pairwise between-examiner CoRs were between 13.0 and 38.9 µm. Eyes with thin choroid had better agreements than those with thick choroids. On average, naive examiners saved 3 to 5 minutes per eye using the semiautomated method. CONCLUSIONS: With the help of a dedicated software, inexperienced practitioners could obtain choroidal thickness measurements with accuracy similar to experienced practitioners. Processing time with the semiautomated method was also reduced.

Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial.

AIM: To determine if 'Defocus Incorporated Multiple Segments' (DIMS) spectacle lenses slow childhood myopia progression. METHODS: A 2-year double-masked randomised controlled trial was carried out in 183 Chinese children aged 8-13 years, with myopia between -1.00 and -5.00 D and astigmatism ≤1.50 D. Children were randomly assigned to wear DIMS (n=93) or single vision (SV) spectacle lenses (n=90). DIMS lens incorporated multiple segments with myopic defocus of +3.50 D. Refractive error (cycloplegic autorefraction) and axial length were measured at 6month intervals. RESULTS: 160 children completed the study, n=79 in the DIMS group and n=81 in the SV group. Average (SE) myopic progressions over 2 years were -0.41±0.06 D in the DIMS group and -0.85±0.08 D in the SV group. Mean (SE) axial elongation was 0.21±0.02 mm and 0.55±0.02 mm in the DIMS and SV groups, respectively. Myopia progressed 52% more slowly for children in the DIMS group compared with those in the SV group (mean difference -0.44±0.09 D, 95% CI -0.73 to -0.37, p<0.0001). Likewise, children in the DIMS group had less axial elongation by 62% than those in the SV group (mean difference 0.34±0.04 mm, 95% CI 0.22 to 0.37, p<0.0001). 21.5% children who wore DIMS lenses had no myopia progression over 2 years, but only 7.4% for those who wore SV lenses. CONCLUSIONS: Daily wear of the DIMS lens significantly retarded myopia progression and axial elongation in myopic children. Our results demonstrated simultaneous clear vision with constant myopic defocus can slow myopia progression. TRIAL REGISTRATION NUMBER: NCT02206217.

The addition of paclitaxel to doxorubicin and cisplatin and volume-directed radiation does not improve overall survival (OS) or long-term recurrence-free survival (RFS) in advanced endometrial cancer (EC): A randomized phase III NRG/Gynecologic Oncology Group (GOG) study.

OBJECTIVES: To determine if the addition of paclitaxel (P) to cisplatin and doxorubicin (CD) following surgical debulking and volume-directed radiation therapy improved long-term, recurrence-free survival (RFS) and overall survival (OS) in patients with advanced-stage endometrial cancer (EC). METHODS: Prospective, randomized GOG trial comparing (CD) (50 mg/m2)/(45 mg/m2) +/- (P) (160 mg/m2) following volume-directed radiation and surgery in advanced EC. A Kaplan-Meier (KM) analysis characterized the relationship between treatment arms and the OS outcome, a log-rank test assessed the independence of treatment with the OS outcome, and the treatment effect on estimated OS was determined using a Cox proportional hazards (PH) model stratified by stage. The PH assumption was assessed using a test of interaction between treatment variable and the natural logarithm of survival time. Adverse events, regardless of attribution, were graded. RESULTS: Since initial publication, 60 deaths occurred, leaving 311 patients alive with 290 (93.8%) recurrence- free. There was no significant decrease in the risk of recurrence or death associated with the CDP treatment regimen stratified for stage (p = 0.14, one-tail). The exploratory analysis for OS and the corresponding homogeneity tests for different effects across subgroups revealed only EFRT and EFRT & GRD status to have significantly different treatment effects (p = 0.027 and p = 0.017, respectively). Second primary malignancies were identified in 17/253 (6.4%) and 19/263 (7.0%) of patients treated with CD and CDP respectively. Breast (2.4%) followed by colon (1%) were the two cancers most frequently diagnosed in this setting. CONCLUSION: No significant difference between treatment arms was identified. Subgroup analysis both in the initial and current reports demonstrated a trend towards improved RFS and OS in patients treated with CDP and EFRT. This long-term analysis of outcomes also identified the necessity of providing on-going cancer screening to patients enrolled in trials.

Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma.

OBJECTIVE: To analyze clinical prognostic factors for survival after recurrence of high-grade, advanced-stage ovarian-peritoneal-tubal carcinoma and to develop a nomogram to predict individual survival after recurrence. METHODS: We retrospectively analyzed patients treated in multicenter Gynecologic Oncology Group protocols for stage III and IV ovarian-peritoneal-tubal carcinoma who underwent primary debulking surgery, received chemotherapy with paclitaxel and a platinum compound, and subsequently developed recurrence. Prognostic factors affecting survival were identified and used to develop a nomogram, which was both internally and externally validated. RESULTS: There were 4,739 patients included in this analysis, of whom, 84% had stage III and 16% had stage IV ovarian carcinoma. At a median follow-up of 88.8 months (95% CI 86.2-92.0 months), the vast majority of patients (89.4%) had died. The median survival after recurrence was 21.4 months (95% CI 20.5-21.9 months). Time to recurrence after initial chemotherapy, clear cell or mucinous histology, performance status, stage IV disease, and age were significant variables used to develop a nomogram for survival after recurrence, which had a concordance index of 0.67. The time to recurrence alone accounted for 85% of the prognostic information. Similar results were found for patients who underwent second look laparotomy and had a complete pathologic response or received intraperitoneal chemotherapy. CONCLUSION: For individuals with advanced-stage ovarian carcinoma who recur after standard first-line therapy, estimated survivals after recurrence are closely related to the time to recurrence after chemotherapy and prognostic variables can be used to predict subsequent survival. CLINICAL TRIAL REGISTRATION: ClinialTrials.gov, NCT00002568, NCT00837993, NCT00002717, NCT01074398, and NCT00011986.

Mobile phone-based UV fluorescence microscopy for the identification of fungal pathogens.

BACKGROUND AND OBJECTIVE: Dermatophytes are fungi that cause infections in hair, skin, and nails. Potassium Hydroxide (KOH) microscopy is the most frequently used method for identifying dermatophytes. KOH helps in the visualization of the hyphae as it clears the debris present in the specimen but needs a trained eye for final diagnosis of the infection. Fluorescence microscopy using staining agents, such as calcofluor white (CFW) or blankophor, is a better method for identification of dermatophytes but is not used in clinics due to the cost and complexity of fluorescence microscopes. The objective of the present work is to develop a simple low-cost mobile phone-based device for the identification of fungal pathogens in skin samples. MATERIALS AND METHODS: A fluorescence spectrometer was used to establish the excitation/emission peaks of fluorescence intensity of CFW and KOH and Methyl Cellulose, a surrogate of fungi used for system development. A transillumination microscopy prototype was fabricated using off-the-shelf components, 3D printing and a mobile phone. The system was optically characterized using contrast resolution targets and verified using fungi isolate samples. An isolate of Trichophyton (T) rubrum was grown for 10-14 days for formation of fungal colonies. The surface of a single colony was gently scraped with a sterile loop and transferred to a glass slide. CFW with KOH was added to the T. rubrum and covered with cover slip for microscopic examination. The images of T. rubrum obtained with the prototype device were compared to those obtained using a commercial microscope. RESULTS: The excitation/emission wavelength pair for CFW was found to be 370/430 nm. The proposed device design is a transillumination microscopy setup using a mobile phone. It consists of a 365 nm LED as the excitation source, a 3V battery to power the LED, a slide to hold the sample, a lens for magnification and a phone to capture and store the images of the sample. The fabricated prototype has a resolution of 70 to 99 µm, a 2% to 30% distortion, and 60% contrast value for well illuminated samples. Images of T. rubrum samples obtained under brightfield illumination clearly show the long septate hyphae of the dermatophyte. As expected, images of the same samples with CFW and KOH show blue fluorescence, which results from the binding of the CFW to the chitin and cellulose in the fungal hyphae. These images are similar to those obtained with a commercial microscope. SUMMARY AND CONCLUSIONS: The concept and design of a mobile phone-based fluorescence microscope to identify dermatophytes has been demonstrated in a prototype and laboratory samples. The concept and design offer a simple, low-cost, compact but robust method for identification of fungal pathogens. This method is shown to be feasible for detecting fluorescence accurately and imaging the fungal structure at a resolution of 100 µm or better. Lasers Surg. Med. 51:201-207, 2019. © 2018 Wiley Periodicals, Inc.

Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer? An NRG Oncology/Gynecologic Oncology Group study.

PURPOSE: To determine the relationship between chemotherapy dose modification (dose adjustment or treatment delay), overall survival (OS) and progression-free survival (PFS) for women with advanced-stage epithelial ovarian carcinoma (EOC) and primary peritoneal carcinoma (PPC) who receive carboplatin and paclitaxel. METHODS: Women with stages III and IV EOC and PPC treated on the Gynecologic Oncology Group phase III trial, protocol 182, who completed eight cycles of carboplatin with paclitaxel were evaluated in this study. The patients were grouped per dose modification and use of granulocyte colony stimulating factor (G-CSF). The primary end point was OS; Hazard ratios (HR) for PFS and OS were calculated for patients who completed eight cycles of chemotherapy. Patients without dose modification were the referent group. All statistical analyses were performed using the R programming language and environment. RESULTS: A total of 738 patients were included in this study; 229 (31%) required dose modification, 509 did not. The two groups were well-balanced for demographic and prognostic factors. The adjusted hazard ratios (HR) for disease progression and death among dose-modified patients were: 1.43 (95% CI, 1.19-1.72, P < 0.001) and 1.26 (95% CI, 1.04-1.54, P = 0.021), respectively. Use of G-CSF was more frequent in dose-modified patients with an odds ratio (OR) of 3.63 (95% CI: 2.51-5.26, P < 0.001) compared to dose-unmodified patients. CONCLUSION: Dose-modified patients were at a higher risk of disease progression and death. The need for chemotherapy dose modification may identify patients at greater risk for adverse outcomes in advanced stage EOC and PPC.