RESUMO
Malnutrition is prevalent among patients with nasopharyngeal carcinoma undergoing radiotherapy. This study examined the nutritional status and incidence of radiation-induced oral mucositis (RIOM) in patients with nasopharyngeal carcinoma. A retrospective analysis was conducted to compare the incidence of RIOM, Nutritional Risk Screening (NRS) 2002 score, weight, body mass index (BMI), and hemoglobin levels in 338 patients treated with induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) or treated with CCRT alone. The IC + CCRT group exhibited an increase in weight and BMI but a decrease in hemoglobin levels after IC compared with baseline (p < 0.001). Both groups showed differences in weight at Week 0 and BMI at Weeks 0-2 of radiotherapy (p < 0.05). The IC + CCRT group experienced an increase in NRS 2002 scores from Week 2 to Week 6 (p < 0.05). The hemoglobin levels of the IC + CCRT group were consistently lower throughout radiotherapy (p < 0.001). However, no significant difference was observed in the incidence of RIOM between the two groups (p = 0.246). Patients treated with IC + CCRT exhibited a higher nutritional risk during radiotherapy. Although the incidence of Grade III RIOM was high, no significant difference was found between the groups.
Assuntos
Neoplasias Nasofaríngeas , Humanos , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/tratamento farmacológico , Estudos Retrospectivos , Estado Nutricional , Incidência , Quimiorradioterapia/efeitos adversos , Hemoglobinas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
Understanding what led to desertification in the long-term is crucial for adaptation to climate change and pressures on resources in North Africa, but existing maps do not accurately show the extent of degraded land or the traditional water systems which underpinned cultivation. These products rely on recent vegetation trends and hindcasted statistical data. Desertification which occurred prior to the later twentieth century is poorly represented, if at all. However, large areas of abandoned fields are distinctive in satellite imagery as brightly reflectant and smooth surfaces. We present a new and open-source machine-learning workflow for detecting desertification using satellite data. We used Google Earth Engine and the random forest algorithm to classify five landcover categories including a class representing desertified fields. The input datasets comprised training polygons, a 12-band Sentinel-2 composite and derived tasselled cap components, and a Sentinel-1 VV-polarisation composite. We test our approach for a case study of Skoura oasis in southern Morocco with a resulting accuracy of 74-76% for the desertification class. We used image interpretation and archaeological survey to map the traditional irrigation systems which supply the oasis.
RESUMO
Autonomous artificial intelligence (AI) promises to increase healthcare productivity, but real-world evidence is lacking. We developed a clinic productivity model to generate testable hypotheses and study design for a preregistered cluster-randomized clinical trial, in which we tested the hypothesis that a previously validated US FDA-authorized AI for diabetic eye exams increases clinic productivity (number of completed care encounters per hour per specialist physician) among patients with diabetes. Here we report that 105 clinic days are cluster randomized to either intervention (using AI diagnosis; 51 days; 494 patients) or control (not using AI diagnosis; 54 days; 499 patients). The prespecified primary endpoint is met: AI leads to 40% higher productivity (1.59 encounters/hour, 95% confidence interval [CI]: 1.37-1.80) than control (1.14 encounters/hour, 95% CI: 1.02-1.25), p < 0.00; the secondary endpoint (productivity in all patients) is also met. Autonomous AI increases healthcare system productivity, which could potentially increase access and reduce health disparities. ClinicalTrials.gov NCT05182580.
RESUMO
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects the autonomic nervous system and can cause both orthostatic and non-orthostatic physical and cognitive symptoms. The goal of this study is to gain meaningful understanding of the cognitive impact of POTS on daily function and to record the strategies participants use to overcome the challenges to help direct occupational therapy treatment. Results show daily function is greatly and negatively impacted by cognitive symptoms resulting from POTS. Participants have discovered strategies and used adaptations to enable them to participate in their daily and meaningful tasks. Using the experiences of those who live with POTS every day to guide interventions, occupational therapy practitioners can better understand and help to improve the autonomy and independence of the clients they treat.
Assuntos
Terapia Ocupacional , Síndrome da Taquicardia Postural Ortostática , Cognição , Humanos , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/terapiaRESUMO
Symptoms associated with postural orthostatic tachycardia syndrome (POTS) hinder overall functionality. This study examined factors that impacted daily life and contributed to overall daily functionality in adults with POTS (n = 958, ages 18-60). Descriptive and multiple linear regression analyses indicated that participants with fewer challenges in ADLs, IADLs, work, school, leisure, and socializing had overall better functionality. Furthermore, 'younger age with exercise tolerance', 'having a job', and 'no falls in the last year' were predictors of better functionality. A comprehensive approach to addressing physical, environmental, and psychological factors could help improve overall functionality and enhance quality of life in individuals with POTS.
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Terapia Ocupacional , Síndrome da Taquicardia Postural Ortostática , Atividades Cotidianas , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/psicologia , Qualidade de Vida , Adulto JovemRESUMO
Postural Orthostatic Tachycardia Syndrome (POTS) often presents with chronic symptoms and impacts a wide variety of areas of occupation, including activities of daily living, sleep, work, school, leisure, play, and social participation. The Occupational Adaptation theory supports practitioners in offering clients opportunities to develop internal adaptive processes to achieve relative mastery in desired occupations. The present manuscript provides a foundation for Occupational Adaptation theory as an appropriate model for intervention in POTS with specific assessments and interventions to guide occupational therapy practitioners in implementing this approach. A case study describes the use of Occupational Adaptation in the clinical intervention of a college student with POTS.
Assuntos
Terapia Ocupacional , Síndrome da Taquicardia Postural Ortostática , Atividades Cotidianas , Humanos , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/terapiaRESUMO
Postural tachycardia syndrome (POTS) is a condition of orthostatic intolerance which often leads to significant functional deficits. This study explores narrative responses from a large cohort (n = 958) of individuals with POTS in describing daily life challenges and the use of strategies to manage these difficulties. Data was coded and emergent themes provided insight into daily life experiences including successful interventions and a wealth of gaps in treatment that remain unaddressed. This led to the development of clinical recommendations for occupational therapy treatment of individuals with POTS. Further research is indicated including clinical trials to demonstrate the efficacy of occupational therapy intervention.