Objective Selection for Cancer Treatment: An Inverse Optimization Approach

The quality of radiation therapy treatment plans and the efficiency of the planning process are heavily affected by the choice of planning objectives. Although simple objectives enable efficient treatment planning, the resulting treatment quality might not be clinically acceptable; complex objectives can generate high-quality treatment, yet the planning process becomes computationally prohibitive. In “Objective Selection for Cancer Treatment: An Inverse Optimization Approach,” by integrating inverse optimization and feature selection techniques, Ajayi, Lee, and Schaefer propose a novel objective selection method that uses historical radiation therapy treatment data to infer a set of planning objectives that are tractable and parsimonious yet clinically effective. Although the objective selection problem is a large-scale bilevel mixed-integer program, the authors propose various solution approaches inspired by feature selection greedy algorithms and patient-specific anatomical characteristics.

Comparing Multi-Objective Local Search Algorithms for the Beam Angle Selection Problem

In intensity-modulated radiation therapy, treatment planners aim to irradiate the tumour according to a medical prescription while sparing surrounding organs at risk as much as possible. Although this problem is inherently a multi-objective optimisation (MO) problem, most of the models in the literature are single-objective ones. For this reason, a large number of single-objective algorithms have been proposed in the literature to solve such single-objective models rather than multi-objective ones. Further, a difficulty that one has to face when solving the MO version of the problem is that the algorithms take too long before converging to a set of (approximately) non-dominated points. In this paper, we propose and compare three different strategies, namely random PLS (rPLS), judgement-function-guided PLS (jPLS) and neighbour-first PLS (nPLS), to accelerate a previously proposed Pareto local search (PLS) algorithm to solve the beam angle selection problem in IMRT. A distinctive feature of these strategies when compared to the PLS algorithms in the literature is that they do not evaluate their entire neighbourhood before performing the dominance analysis. The rPLS algorithm randomly chooses the next non-dominated solution in the archive and it is used as a baseline for the other implemented algorithms. The jPLS algorithm first chooses the non-dominated solution in the archive that has the best objective function value. Finally, the nPLS algorithm first chooses the solutions that are within the neighbourhood of the current solution. All these strategies prevent us from evaluating a large set of BACs, without any major impairment in the obtained solutions’ quality. We apply our algorithms to a prostate case and compare the obtained results to those obtained by the PLS from the literature. The results show that algorithms proposed in this paper reach a similar performance than PLS and require fewer function evaluations.

Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors

Importance: Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. Objective: To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. Design: A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. Participants: A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. Intervention: None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care “6-Clicks” measure of daily activity. Results: Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. Conclusions and Relevance: Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.

Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors

Importance: Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. Objective: To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. Design: A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. Participants: A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. Intervention: None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care “6-Clicks” measure of daily activity. Results: Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. Conclusions and Relevance: Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.

Effect of Matrix Rhythm Therapy Along With Conventional Physiotherapy Management in Quadriplegic Patient: A Case Study

A 26-year old Yemeni girl with a gunshot injury with cervical spine fracture at C6-C7 Level injury in June 2018 with complete loss of sensation in all the limbs, motor loss below C3 level with loss of saddle sensation and anal tone. The patient sustained spinal cord injury at C6-7 levels and edema extending upto C3 level, resulting in quadriplesgia.She was airlifted in medevac from yemen to Sultan Qaboos Hospital Salalah Oman in 28th June 2018.The patient underwent extensive Neuro surgical procedures for cervical fracture and spinal decompression.Additionally, the patient received education and counseling, nursing and nutritional intervention, and comprehensive physical therapy treatment including Matrix Rhythm therapy and other conventional Physiotherapy management.We conclude that Physiotherapy management with other medical disciplines are crucial in recovary of the patient and to improve quality of life.

Bayesian Parametric Modeling of Time to Tuberculosis Co-Infection of HIV/AIDS Patients Under Antiretroviral Therapy Treatment at Jimma University Medical Center, Ethiopia

Background: Tuberculosis is the most common opportunistic infection among HIV/AIDS patients, including those following Antiretroviral Therapy treatment. The risk of Tuberculosis infection is higher in people living with HIV/AIDS than in people who are free from HIV/AIDS. Many studies focused on prevalence and determinants of Tuberculosis in HIV/AIDS patients without taking into account the censoring aspects of the time to event data. Therefore, this study was undertaken with aim to model time to Tuberculosis co-infection of HIV/AIDS patients following Antiretroviral Therapy treatment using Bayesian parametric survival models.Methods: A data of a retrospective cohort of HIV/AIDS patients under Antiretroviral Therapy treatment follow-up from January 2016 to December 2020 until Tuberculosis was clinically diagnosed or until the end of the study was collected from Antiretroviral Therapy treatment center of Jimma University Medical Center, Ethiopia. In order to identify the risk factors which have association with Tuberculosis co-infection survival time, Bayesian parametric Accelerated failure time survival models were fitted to the data using Integrated Nested Laplace Approximation methodology.Results: About 26.37% of the study subjects had been co-infected with tuberculosis during the study period. Among the parametric Accelerated failure time models, the Bayesian log-logistic Accelerated failure time model was found to be the best fitting model for the data.Conclusions: Tuberculosis co-infection survival time was significantly associated with place of residence, smoking, drinking alcohol, family size, WHO clinical stages, functional status, CD4 count, BMI and hemoglobin level. The finding of this study provide timely information on the risk factors associated with TB co-infection survival time for healthy policy makers and planners.

Unhoused Persons: Perspectives on Perceived Benefits of Music Therapy

There is limited literature to support the use of music therapy with unhoused persons and more research is needed to deepen the understanding of music therapy with this population. This researcher aimed to gather information from music therapists who work with unhoused persons to gain more perspective on the perceived benefits of the music therapy treatment process. Three music therapists were interviewed; interviews were then transcribed and coded to find themes regarding perceived benefits of music therapy with unhoused persons. The four themes derived from the data were increased resilience factors, facilitating connections, creating a safe space, and increased expression. Findings support music therapy attending to many levels of human need for unhoused individuals. These findings can be used as recommendation for practice and program development for the use of music therapy with unhoused persons and also point to a need for more research to understand the benefits of specific music therapy techniques and treatment methods with unhoused persons and subgroups of the unhoused community.

Progressive Supranuclear Palsy-a Mirror Image of Parkinson’s Disease, A Literature Review of Rehabilitation Strategies

Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease which mimic similar to Parkinsonism. PSP advances much quicker than in PD yet no effective medication or therapy to manage PSP available. This literature review aimed to discover the recent advances in the physical therapy treatment options for PSP. Databases such as PubMed, Elsevier and SAGE journal searched for both published and unpublished studies. Last 10-year studies were included in this review. Limited clinical trial conducted in this population due to which a structured protocol or rehabilitation strategies is missing for this condition. Balance exercise and gait training showed potential benefit and music-cued walking demonstrated participant’s satisfaction.

Determination of Factors Influencing Physical Therapy Treatment Compliance

Background: Compliance to long term therapy is the extent to which a person's behavior - taking medication, following a diet or executing lifestyle changes, corresponds with agreed recommendations from a health care provider. Aim: To determine the factors influencing physical therapy treatment compliance and relation of age and gender on compliance. Study Design: Observational study. Methodology: Study conducted for 6 months in public sector hospitals of twin cities of Pakistan. Non-probability convenient sampling technique was used. Data was collected by interviewing the patients, using self-structured questionnaire. 141 patients attending physical therapy treatment in outpatient department for more than three days and willing to participate in the study, were included in the study. Patient who visited OPD for first time, pediatric patient and indoor patients were excluded. Data was analyzed by SPSS software, version 25 as qualitative variables were expressed as frequencies and percentages. Results: Most of patient could not adhere to physical therapy because of unavailability of time (60.28%), lengthy follow up (46.10%), boredom with exercise (23.4%), unavailability of respective gender (23.4%), long distance between home and hospital (20.6%), Physical contact with therapist during session (15.6%) and fear of modality (7.8%). Most patients within age group of 29-42 and 43-56 responded that frequent visits to hospital to attend multiple sessions of physical therapy were the reason they left physical therapy sessions and had unavailability of time to attend physical therapy sessions. Conclusion: We concluded that frequent visits to hospital to attend multiple sessions of physical therapy and unavailability of time are two main factors that led to poor compliance to physical therapy treatment. Keywords: Barriers, Compliance and Physical Therapy Treatment