<p>Supplementary data includes appendix of extracted Radiomic features. Figure S1 shows a summary of patient characteristics. Figure S2 shows the radiomic analysis workflow. Figure S3 shows representative cases from heterogeneity phenotypes. Figure S4 shows independent validation of intrinsic imaging phenotypes of tumor heterogeneity.</p>
In Brief OBJECTIVE: To estimate objectively the proficiency of obstetrican–gynecologist (ob–gyn) residents in third-degree perineal tear repair. METHODS: A total of 40 ob–gyn residents from 13 residency programs demonstrated their technique of perineal laceration repair on a modified beef tongue model. Two faculty members with expertise in repairing obstetric anal sphincter injury evaluated the residents using a checklist. The checklist identified three key steps of the procedure, including 1) repair of the internal anal sphincter; 2) selection of proper suture material; and 3) repair of the external anal sphincter, further evaluated using three subcomponents. RESULTS: The overall pass rate was 42.5% (17/40). Many residents missed critical steps of the repair. Year of training (P=.763), parent residency program (P=.5), and prior experience (P=.48) had no significant effect on the pass rate. There was greater than 90% concordance between the evaluators (r=0.9, P<.001). Satisfaction with the modified beef tongue model was higher than with current training methods in their program (7.81 compared with 6.92 on a scale of 1–10, P=.001). CONCLUSION: Ob–gyn residents demonstrated substandard skill in repairing anal sphincter laceration. The low pass rate of 42.5% suggests lack of adequate training in repair. The model had a high resident satisfaction, and high interobserver correlation was noted using the checklist. Thus, identification and evaluation of key steps using a standardized checklist may lead to standardization of repair and ensures consistency and quality. LEVEL OF EVIDENCE: III Lack of adequate knowledge in repair of third-degree perineal tear is highlighted when residents are evaluated using a standardized checklist for perineal laceration repair.
<div>AbstractPurpose:<p>Identifying imaging phenotypes and understanding their relationship with prognostic markers and patient outcomes can allow for a noninvasive assessment of cancer. The purpose of this study was to identify and validate intrinsic imaging phenotypes of breast cancer heterogeneity in preoperative breast dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) scans and evaluate their prognostic performance in predicting 10 years recurrence.</p>Experimental Design:<p>Pretreatment DCE-MRI scans of 95 women with primary invasive breast cancer with at least 10 years of follow-up from a clinical trial at our institution (2002–2006) were retrospectively analyzed. For each woman, a signal enhancement ratio (SER) map was generated for the entire segmented primary lesion volume from which 60 radiomic features of texture and morphology were extracted. Intrinsic phenotypes of tumor heterogeneity were identified via unsupervised hierarchical clustering of the extracted features. An independent sample of 163 women diagnosed with primary invasive breast cancer (2002–2006), publicly available via The Cancer Imaging Archive, was used to validate phenotype reproducibility.</p>Results:<p>Three significant phenotypes of low, medium, and high heterogeneity were identified in the discovery cohort and reproduced in the validation cohort (<i>P</i> < 0.01). Kaplan–Meier curves showed statistically significant differences (<i>P</i> < 0.05) in recurrence-free survival (RFS) across phenotypes. Radiomic phenotypes demonstrated added prognostic value (<i>c</i> = 0.73) predicting RFS.</p>Conclusions:<p>Intrinsic imaging phenotypes of breast cancer tumor heterogeneity at primary diagnosis can predict 10-year recurrence. The independent and additional prognostic value of imaging heterogeneity phenotypes suggests that radiomic phenotypes can provide a noninvasive characterization of tumor heterogeneity to augment personalized prognosis and treatment.</p></div>
Objective To examine the feasibility of adapting active video games (AVGs) for nonambulatory wheelchair users at functionally diverse levels and to examine these AVGs as a method for increasing energy expenditure (EE) for 3 young adults with severe (SEV), moderate (MOD), and no upper extremity limitation (NL). Design Case study. Setting Residential special education school for youth and young adults with physical disabilities. Participants Two young adults with spastic cerebral palsy (SEV, MOD) and one young adult with spina bifida (NL). All participants were nonambulatory wheelchair users. Methods Each participant performed Wii bowling and tennis and an adapted upper extremity version of a Dance Dance Revolution (DDR) game pad. Main Outcome Measurements EE was measured through indirect calorimetry (VO 2 ). Heart rate data were collected with the use of a Polar Heart Rate Monitor. Results SEV and MOD participants showed a higher percentage increase in EE for the Wii games (SEV, 25.6%; MOD, 30.8%) compared with DDR (SEV, 10.8%; MOD, 29.1%), whereas the participant with NL had a greater EE increase for the DDR (173.5%) compared with Wii (59.5%). Conclusions AVGs showed clinically significant increases in EE for all 3 participants and can be performed by nonambulatory wheelchair users ranging from those with NL to those with SEV upper extremity limitation with the appropriate adaptations.
The purpose of this report is to discuss the scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities.Evidence is provided that supports integration of health promotion and fitness strategies in physical therapy clinical management. Physical therapists' roles in community-based adapted sports and fitness interventions and reimbursement considerations are discussed.Physical therapists are in a unique position to provide expertise in the design and implementation of health promotion and fitness programs for youth with disabilities. These programs are important to promote active, healthy lifestyles and reduce comorbidities associated with sedentary behaviors and unhealthy weight, which are often seen in youth with disabilities.Pediatric physical therapists should incorporate health promotion and fitness strategies into practice.
Abstract Background: The U.S. Preventive Services Task Force recently issued an updated draft recommendation statement to initiate breast cancer screening at age 40, reflecting well-documented disparities in breast cancer–related mortality that disproportionately impact younger Black women. This study applied a novel approach to identify hotspots of breast cancer diagnosed before age 50 and/or at an advanced stage to improve breast cancer detection within these communities. Methods: Cancer registry data for 3,497 women with invasive breast cancer diagnosed or treated between 2012 and 2020 at the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) and who resided in the HFGCCRI catchment area, defined as New Castle County, Delaware, were geocoded and analyzed with spatial intensity. Standardized incidence ratios stratified by age and race were calculated for each hotspot. Results: Four hotspots were identified, two for breast cancer diagnosed before age 50, one for advanced breast cancer, and one for advanced breast cancer diagnosed before age 50. Younger Black women were overrepresented in these hotspots relative to the full-catchment area. Conclusions: The novel use of spatial methods to analyze a community cancer center catchment area identified geographic areas with higher rates of breast cancer with poor prognostic factors and evidence that these areas made an outsized contribution to racial disparities in breast cancer. Impact: Identifying and prioritizing hotspot breast cancer communities for community outreach and engagement activities designed to improve breast cancer detection have the potential to reduce the overall burden of breast cancer and narrow racial disparities in breast cancer.
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