scholarly journals Psychosocial Risk Profiles Among American and Dutch Families Affected by Pediatric Cancer

2020 ◽  
Vol 45 (4) ◽  
pp. 463-473
Author(s):  
Christina M Sharkey ◽  
Sasja A Schepers ◽  
Sarah Drake ◽  
Ahna L H Pai ◽  
Larry L Mullins ◽  
...  
Keyword(s):  
Pediatric Cancer ◽  
Risk Group ◽  
The United States ◽  
Elevated Risk ◽  
Low Risk ◽  
Psychosocial Risk ◽  
Risk Level ◽  
Stress Reactions ◽  
Risk Profiles ◽  
Child Problems

Abstract Objective Little is known about relations between domains of psychosocial risk among pediatric cancer populations. The Psychosocial Assessment Tool 2.0 (PAT2.0) is one internationally validated screening measure that can examine these relations. This study aimed to examine risk profiles and predictors of these patterns exhibited by American and Dutch families. Methods Caregivers of children newly diagnosed with cancer (N = 262; nUSA=145, nNL=117) completed the PAT2.0 as part of larger studies conducted in the United States and the Netherlands. Latent profile analysis and multinomial logistic regression examined differences in demographic and medical variables across risk profiles. Domains assessed included Family Structure/Resources, Child Problems, Sibling Problems, Family Problems, Caregiver Stress Reactions, and Family Beliefs. Results Four groups were identified: “Low-Risk” (n = 162) defined by generally low risk across domains; “Moderate-Caregiver” (n = 55) defined by elevated Caregiver Stress Reactions domain; “Moderate-Children” (n = 25) defined by elevated Child Problems and/or Sibling Problems, and “Elevated-Risk” (n = 20) marked by generally high overall risk. Dutch families had higher odds of being in the Elevated-Risk group, compared to the Low-Risk group. Caregiver age, gender, and educational attainment predicted group membership. Families classified as Targeted or Clinical had higher odds of being in the Moderate or Elevated risk groups. Conclusion The PAT2.0 appears to identify largely similar patterns of risk, suggesting that families experience common psychosocial difficulties in both American and Dutch societies. The two Moderate groups demonstrated specific risk sources, suggesting that evaluation of domain patterns, rather than reliance on PAT2.0 risk level, could be of clinical benefit.

“Yes, I can hear you now …” Online working with probationers in the Netherlands: New opportunities for the working alliance

2021 ◽  
pp. 026455052110508
Author(s):  
Annelies Sturm ◽  
Sylvana Robbers ◽  
Renée Henskens ◽  
Vivienne de Vogel
Keyword(s):  
The Netherlands ◽  
Working Alliance ◽  
Probation Officers ◽  
Low Risk ◽  
Risk Level ◽  
Personal Contact ◽  
Risk Profiles ◽  
Travel Costs ◽  
Remote Supervision ◽  
General Experience

Since the start of the COVID-19 pandemic, online supervision has increased markedly, including within the Dutch probation services. In the present research, we systematically collected and analysed both clients and probation officers’ experiences of working online in the prior year. Although the clients were generally positive about remote supervision, some expressed that they missed the personal contact. According to most of the probation officers, remote working is flexible (efficient, saves time, travel costs), appropriate for certain phases of the probation process (especially at a later stage when a working alliance has been established) and particularly suitable for probationers with mild problems and low risk profiles. The general experience was that conversations are both more pragmatic and business-like, which, in turn, can produce both strengths and limitations. Once a foundation has been established, it appears to be possible to continue working remotely with clients, albeit the probation officers stressed that this depended on the type of client, type of offence and risk level.

scholarly journals A home-based longitudinal study of vocalization behaviors across infants at low and elevated risk of autism

2021 ◽  
Vol 6 ◽  
pp. 239694152110576
Author(s):  
Shari L. DeVeney ◽  
Anastasia Kyvelidou ◽  
Paris Mather
Keyword(s):  
Longitudinal Study ◽  
High Risk ◽  
Risk Group ◽  
Developmental Change ◽  
Empirical Support ◽  
Autism Spectrum ◽  
Elevated Risk ◽  
Low Risk ◽  
Home Based ◽  
Early Developmental

Background and Aims: The purpose of this exploratory study was to expand existing literature on prelinguistic vocalizations by reporting results of the first home-based longitudinal study examining a wide variety of behaviors and characteristics, including early vocalizations, across infants at low and elevated risk of autism spectrum disorder (ASD). The study of vocalizations and vocalization changes across early developmental periods shows promise in reflecting early clinically significant differences across infants at low and elevated risk of ASD. Observations of early vocalizations and their differences during infancy could provide a reliable and essential component of an early developmental profile that would lower the average diagnostic age for ASD. However, studies employing observation of vocalization behaviors have been limited and often conducted in laboratory settings, reducing the external generalization of the findings. Methods: The present study was conducted to determine the consistency of previous findings with longitudinal data collected in home environments. Infants in the present study represented elevated risk from two etiological backgrounds, (a) infants born prematurely and with low birth weight and (b) infants who had an older sibling diagnosed with ASD. All data were collected in the infants’ homes and compared with data collected from infants with low likelihood of ASD. The study included 44 participants (31 in the low-risk sample, 13 in the high-risk sample) with vocalization behaviors observed at 6- and 12-months through 20-min semi-structured play interactions with caregivers. Observations were video-recorded and later coded for speech and non-speech vocalizations. Results: Differences in the 6-month vocalization behaviors were not statistically significant across risk levels of ASD. By 12 months; however, risk group differences were evident in the total number of vocalizations overall with specific differences across groups representing moderate to large, clinically relevant effects. Infants at low risk of ASD demonstrated significantly greater developmental change between 6- and 12-months than did the infants at high risk. Data were also reviewed for differences across high-risk group etiologies. Conclusions: The present study was unique and innovative in a number of ways as the first home-based longitudinal study examining infant vocal behaviors across low and high risk of ASD. Many of the present study findings were consistent with previous cross-sectional investigations of infants at elevated risk for ASD, indicating support for further home-based longitudinal study in this area. Findings also indicated some preliminary subgroup differences between high-risk etiologies of ASD. Vocalization differences across high risk groups had not been previously addressed in the literature. Implications: Vocalization differences are notable by 12-months of age between infants at low and elevated risk of ASD and infants at high risk demonstrated reduced developmental changes between 6- and 12-months compared to the infants at low risk. Observation of early infant vocalization behaviors may reasonably occur in the home, providing early childhood professionals and researchers with empirical support for data collection of child-caregiver interactions in this setting. Potential differences across high-risk etiologies warrant further investigation.

scholarly journals mGlu5 receptor availability in youth at risk for addictions: effects of vulnerability traits and cannabis use

2020 ◽  
Vol 45 (11) ◽  
pp. 1817-1825 ◽  
Author(s):  
Sylvia M. L. Cox ◽  
Maria Tippler ◽  
Natalia Jaworska ◽  
Kelly Smart ◽  
Natalie Castellanos-Ryan ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Elevated Risk ◽  
Low Risk ◽  
Cannabis Use ◽  
Binding Potential ◽  
Excitatory Neurotransmitter ◽  
Mglu5 Receptor ◽  
Positron Emission

Abstract The excitatory neurotransmitter glutamate has been implicated in experience-dependent neuroplasticity and drug-seeking behaviors. Type 5 metabotropic glutamate (mGlu5) receptors might be particularly important. They are critically involved in synaptic plasticity and their availability has been reported to be lower in people with alcohol, tobacco, and cocaine use disorders. Since these reductions could reflect effects of drug use or pre-existing traits, we used positron emission tomography to measure mGlu5 receptor availability in young adults at elevated risk for addictions. Fifty-nine participants (age 18.5 ± 0.6) were recruited from a longitudinal study that has followed them since birth. Based on externalizing traits that predict future substance use problems, half were at low risk, half were at high risk. Cannabis use histories varied markedly and participants were divided into three subgroups: zero, low, and high use. Compared to low risk volunteers, those at elevated risk had lower [11C]ABP688 binding potential (BPND) values in the striatum, amygdala, insula, and orbitofrontal cortex (OFC). Cannabis use by risk group interactions were observed in the striatum and OFC. In these regions, low [11C]ABP688 BPND values were only seen in the high risk group that used high quantities of cannabis. When these high risk, high cannabis use individuals were compared to all other participants, [11C]ABP688 BPND values were lower in the striatum, OFC, and insula. Together, these results provide evidence that mGlu5 receptor availability is low in youth at elevated risk for addictions, particularly those who frequently use cannabis.

Cognitively Impaired Older Adults: Risk Profiles for Institutionalization

2003 ◽  
Vol 15 (4) ◽  
pp. 351-366 ◽  
Author(s):  
Laurel A. Strain ◽  
Audrey A. Blandford ◽  
Lori A. Mitchell ◽  
Pamela G. Hawranik
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
High Risk ◽  
Risk Group ◽  
Disruptive Behaviors ◽  
High Risk Group ◽  
Low Risk ◽  
Cognitively Impaired ◽  
Risk Profiles ◽  
Medium Risk

Background: This study focused on the identification of risk profiles for institutionalization among older adults diagnosed with cognitive impairment-not dementia or dementia in 1991/92 and subsequent institutionalization in the following 5-year period. Methods: Data were from a sample of 123 individuals aged 65+ and their unpaid caregivers in Manitoba, Canada. Cluster analysis was conducted using baseline characteristics of age, cognition, disruptive behaviors, ADLs/IADLs, use of formal in-home services, and level of caregiver burden. Results: Three distinct groups emerged (high-risk [n = 12], medium risk [n = 40], and low risk [n = 71]). The high-risk group had the poorest cognitive scores, were the most likely to exhibit disruptive behaviors, were the most likely to need assistance with ADLs and IADLs, and had the highest level of burden among their caregivers. Follow-up of the groups validated the risk profiles; 75% of the high-risk group were institutionalized within the next 5 years, compared to 45% of the medium-risk group and 21% of the low-risk group. Discussion: The risk profiles highlight the diversity among individuals with cognitive impairment and the opportunity for differential targeting of services for the distinct needs of each group.

Risk-stratified systemic surveillance in uveal melanoma

2019 ◽  
pp. bjophthalmol-2018-313569 ◽  
Author(s):  
Jacquelyn M Davanzo ◽  
Elaine M Binkley ◽  
James F Bena ◽  
Arun D Singh
Keyword(s):  
High Risk ◽  
Uveal Melanoma ◽  
Risk Group ◽  
Low Risk ◽  
Risk Level ◽  
High Risk Patients ◽  
Socioeconomic Variables ◽  
Unknown Risk ◽  
Risk Patients ◽  
Socioeconomic Data

Background/AimMolecular prognostication provides clinically applicable prognostic information for patients with uveal melanoma. Most ocular oncologists recommend intensive metastatic surveillance for patients with high-risk tumours. However, socioeconomic variables may limit a patient’s ability to adhere to recommended surveillance. We aim to analyse socioeconomic data from patients with uveal melanoma who underwent molecular prognostication to determine which variables influence adherence.MethodsThis was a retrospective review of 107 consecutive patients who were diagnosed and treated for uveal melanoma from January 2014 to June 2015. Patients were categorised into low/unknown risk and high risk for metastasis. The low-risk group was followed with hepatic ultrasonography every 6 months. The high-risk group was followed with more frequent hepatic imaging or incorporation of hepatic CT/MRI into the surveillance protocol. Adherence to surveillance recommendations was recorded for the first 2 years following primary treatment. Socioeconomic data including age at diagnosis, baseline systemic staging, gene expression profile status, marital status, insurance, distance of primary residence, median household income and Charlson Comorbidity Index score were recorded. Frequency/modality of imaging and metastatic status were also recorded.ResultsHigh-risk patients were more likely to develop metastasis than low-risk/unknown-risk patients (p<0.001). High-risk patients were more likely to have scans at baseline (p=0.008) and to have expected scans relative to low-risk/unknown-risk patients (p<0.001). There was no significant relationship between the likelihood of adhering to recommended surveillance and the other variables analysed.ConclusionsPrognostic risk level is a significant predictor of surveillance and remains significant after adjustment for socioeconomic variables. Adherence to surveillance recommendations for high-risk patients may translate into improved survival.

A novel biosignature identifies DCIS patients with a poor biologic subtype with an unacceptably high rate of local recurrence after breast conserving surgery and radiotherapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 513-513
Author(s):  
Frank Vicini ◽  
Chirag Shah ◽  
Pat W. Whitworth ◽  
Steven C Shivers ◽  
Fredrik Warnberg ◽  
...  
Keyword(s):  
Risk Group ◽  
Poor Response ◽  
Risk Groups ◽  
Recurrence Risk ◽  
Breast Conserving Surgery ◽  
Elevated Risk ◽  
Ffpe Tissue ◽  
Low Risk ◽  
Recurrence Rates ◽  
Significant Difference

513 Background: There is an unmet need to identify women diagnosed with DCIS who have a low recurrence risk and could omit radiotherapy (RT) after breast conserving surgery (BCS), or an elevated recurrence risk after treatment with BCS plus RT. DCISionRT and its response subtype (Rst) biosignature were evaluated in a contemporary cohort treated with BCS with or without RT to identify these risk groups. Methods: Pathology, clinical data, and FFPE tissue samples were evaluable for 485 women diagnosed with DCIS at centers in Sweden (1996-2004), the USA (1999-2008), and Australia (2006-2011). Patients were treated with BCS (negative margins) with or without whole breast RT. Ipsilateral breast tumor recurrence (IBTR) included DCIS or invasive breast cancer (IBC) that was local, regional, or metastatic. The patients were classified into Low and Elevated risk groups to assess IBTR and IBC rates. Patients in the Elevated risk group were categorized by two subtypes: a good response subtype (good Rst) or a poor response subtype (poor Rst) after BCS plus RT. Biosignatures were calculated using biomarkers (p16/INK4A, Ki-67, COX-2, PgR, HER2, FOXA1, SIAH2) assayed using IHC on FFPE tissue. Hazard ratios and 10-year risks were calculated using Cox proportional hazards (CPH) and Kaplan-Meier analyses. Results: In the DCISionRT Elevated risk group, RT was associated with significantly reduced recurrence rates, but only for those patients with a good Rst (Table, IBTR HR=0.18, p<0.001, IBC HR=0.15, p=0.003, n=241). For Elevated risk group patients with a poor Rst, no benefit to RT was noted (Table). Additionally, irrespective of RT, patients with a poor Rst had 10-year IBTR/IBC rates of 25%/16%, which were much higher than good Rst rates of 6.6%/4.5% (IBE HR=3.6, p=0.02, IBC HR=4.4, p=0.04, n=190). For patients in the Low risk group, there was no significant difference in 10-year IBTR/IBC rates with and without RT (Table, IBTR p=0.4, IBC p=0.9, n=177). The distribution of clinicopathologic risk factors (age <50 years, grade 3, size >2.5 cm) did not identify poor vs. good response subtypes, and multivariable analysis (n=485) indicated these traditional clinicopathologic factors and endocrine therapy were not significantly associated with IBTR (p≥0.22) or IBC (p≥0.34). Conclusions: Biosignatures identified a Low risk patient group with low 10-year recurrence rates with or without RT who may be candidates for omitting adjuvant RT. Biosignatures also identified an Elevated risk group receiving BCS plus RT with a poor response subtype that had unacceptably high recurrence rates, warranting potential intensified or alternate therapy.[Table: see text]

Prostate patterns of care.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 117-117
Author(s):  
Lindsay Burt ◽  
Dennis C. Shrieve ◽  
Jonathan D. Tward
Keyword(s):  
Radiation Treatment ◽  
Risk Group ◽  
New Technology ◽  
The United States ◽  
Low Risk ◽  
Patterns Of Care ◽  
7Th Edition ◽  
Patterns Of Care Study ◽  
Microsoft Office ◽  
Cancer Network

117 Background: The aim of this study is to describe initial treatment of men diagnosed with prostate cancer in the United States (US) between 2004 and 2011. Methods: Subjects with adenocarcinoma of the prostate were identified using the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results (SEER) Program between 2004 and 2011. Subjects were staged according the American Joint Committee on Cancer (AJCC) 7th edition criteria. The National Comprehensive Cancer Network (NCCN) risk group classifications were used to stratify subjects into low risk (LR) including very low risk, intermediate risk (IR), high risk (HR) and very high (VHR) groups. Surgical intervention was grouped into no surgery, prostatectomy or other which included cyroablative therapy, hyperthermia, laser ablation, TURP, etc. Descriptive statistics and analysis were performed using Microsoft Office 2013 Excel. Results: There were 306,694 PC subjects with sufficient data to be risk categorized. Overall, 35.0% of subjects had LR, 36.1% had IR, 22.5% had HR, 1.2% had VHR, 0.6% had node positive and 4.6% had metastatic disease. Table 1 reveals the surgical and radiation treatment distribution for each risk group. Between 2004 and 2011 the use of prostatectomy, no treatment and external beam RT (EBRT) increased and the use of brachy including brachy monotherapy and brachytherapy in combination with EBRT decreased. Age is a strong influence on treatment delivered. Conclusions: This patterns of care study shows the heterogeneity of therapy for PC stratified by risk group in a contemporary series. Trends in treatment may reflect the development of new technology and findings from randomized trials. [Table: see text]

scholarly journals Elevated circulating CD16+ monocytes and TLR4+ monocytes in older adults with multiple cardiometabolic disease risk factors

2021 ◽  
Author(s):  
Melissa M Markofski ◽  
Michael G Flynn
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Disease Risk ◽  
Risk Group ◽  
Elevated Risk ◽  
Low Risk ◽  
Metabolic Risk ◽  
Men And Women ◽  
Inflammatory Monocytes ◽  
Markers Of Inflammation

We endeavored to examine relationships between circulating monocyte phenotype and cardio-metabolic disease risk, in healthy, older adults. We performed a secondary data analysis on men and women, 55-75 yr, who were assigned to groups based on cardio-metabolic risk factors other than age. Subject in the low risk group (n=16, 12 females) had fewer than three risk factors. Subjects in the elevated risk group (n=29, 19 females) had three or more risk factors. Along with baseline screening for fitness and body composition, resting blood samples were assessed for markers of inflammation including: monocyte phenotype (inflammatory monocytes), monocyte cell-surface TLR4 expression, and serum C-reactive protein. The low risk group had a smaller (19.3% difference; p<0.0001) waist circumference and lower body fat weight (36.3%; p<0.0001), but higher V02max (45.5%; p=0.0019). There were no mean differences (p>0.05) between the low and elevated risk groups for BMI, serum cholesterol, fasting glucose, or leg press 1RM. The low risk group had lower CRP (114.7%, p=0.0002), higher CD14+CD16- (classical) monocytes (6.7%; p=0.0231) and fewer CD14+CD16+ (inflammatory) monocytes (46.2%; p=0.0243) than the elevated risk group. The low risk group also had a lower percentage of CD14+CD16- monocytes that were positive for TLR4 (14.0%; p=0.0328). Older men and women with fewer cardio-metabolic risk factors had lower serum and cellular markers of inflammation and higher aerobic capacity.

Regulating Medical Devices in the United States

2020 ◽  
Author(s):  
Patricia J. Zettler ◽  
Erika Lietzan
Keyword(s):  
United States ◽  
Medical Device ◽  
Medical Devices ◽  
Complete Information ◽  
The United States ◽  
Risk Level ◽  
Management Tools ◽  
Medical Technologies ◽  
The Us ◽  
Medical Device Regulation

This chapter assesses the regulation of medical devices in the United States. The goal of the US regulatory framework governing medical devices is the same as the goal of the framework governing medicines. US law aims to ensure that medical devices are safe and effective for their intended uses; that they become available for patients promptly; and that manufacturers provide truthful, non-misleading, and complete information about the products. US medical device law is different from US medicines law in many ways, however, perhaps most notably because most marketed devices do not require pre-market approval. The chapter explores how the US Food and Drug Administration (FDA) seeks to accomplish its mission with respect to medical devicecough its implementation of its medical device authorities. It starts by explaining what constitutes a medical device and how the FDA classifies medical devices by risk level. The chapter then discusses how medical devices reach the market, the FDA's risk management tools, and the rules and incentives for innovation and competition. It concludes by exploring case studies of innovative medical technologies that challenge the traditional US regulatory scheme to consider the future of medical device regulation.

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