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Purpose Radiation therapy is an important component of treatment for many childhood cancers. Depending upon the age and maturity of the child, pediatric radiation therapy often requires general anesthesia for immobilization, position reproducibility, and daily treatment delivery. We designed and clinically implemented a radiation therapy–compatible audiovisual system that allows children to watch streaming video during treatment, with the goal of reducing the need for daily anesthesia through immersion in video. Methods and materials We designed an audiovisual-assisted therapeutic ambience in radiation therapy (AVATAR) system using a digital media player with wireless streaming and pico projector, and a radiolucent display screen positioned within the child's field of view to him or her with sufficient entertainment and distraction for the duration of serial treatments without the need for daily anesthesia. We piloted this system in 25 pediatric patients between the ages of 3 and 12 years. We calculated the number of fractions of radiation for which this system was used successfully and anesthesia avoided and compared it with the anesthesia rates reported in the literature for children of this age. Results Twenty-three of 25 patients (92%) were able to complete the prescribed course of radiation therapy without anesthesia using the AVATAR system, with a total of 441 fractions of treatment administered when using AVATAR. The median age of patients successfully treated with this approach was 6 years. Seven of the 23 patients were initially treated with daily anesthesia and were successfully transitioned to use of the AVATAR system. Patients and families reported an improved treatment experience with the use of the AVATAR system compared with anesthesia. Conclusions The AVATAR system enables a high proportion of children to undergo radiation therapy without anesthesia compared with reported anesthesia rates, justifying continued development and clinical investigation of this technique.

To determine the short-term and long-term toxicity of abdominal and pelvic radiation therapy in a cohort of patients with inflammatory bowel disease (IBD). We hypothesize that with newer techniques, such as intensity-modulated radiation therapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT), patients with IBD can safely undergo abdominal and pelvic radiation, with low risk for major acute or late toxicity.Nineteen consecutive patients with IBD (14 with ulcerative colitis, 5 with Crohn disease) who were treated with abdominal or pelvic external beam radiation therapy at Stanford University from 1997 to 2011 were identified. Fourteen patients were treated with IMRT and 5 were treated with 3D-CRT. Treated sites included prostate (n=8), gastric/esophageal (n=5), rectal/anal (n=3), and liver (n=3) tumors. Charts were reviewed and toxicity was graded according to the Common Terminology Criteria for Acute Events version 4.0. Median follow-up was 32.5 months. Fisher exact test was used to determine if any clinical and/or treatment factors were associated with toxicity outcomes.Acute grade ≥3 toxicity occurred in 2 patients (11%). Late grade ≥3 toxicity occurred in 1 patient (6%). Acute grade ≥2 toxicity occurred in 28% of patients treated with IMRT versus 100% of patients treated with 3D-CRT (P=0.01). Acute grade ≥2 gastrointestinal toxicity was lower in patients treated with IMRT versus 3D-CRT (14% vs. 100%, respectively, P=0.002). Late grade ≥2 toxicity occurred in 21% of patients. Higher total dose (Gy) and biologically effective dose (Gy) were associated with increased rates of late grade ≥2 toxicity (P=0.02 and 0.03, respectively).These data suggest that select patients with IBD can safely undergo abdominal and pelvic radiation therapy. The use of IMRT was associated with decreased acute toxicity. Acute and late severe toxicity rates were low in this patient population with the use of modern radiation techniques.

Chordomas are slow-growing tumors of bone thought to arise in notochord remnants. They are rare, locally aggressive, and infiltrative tumors that can occur anywhere along the axial skeleton. Optimal surgery is often unattainable and multimodality treatment, which includes radiotherapy, is usually indicated. However, despite high-dose radiotherapy, tumors frequently recur. Local recurrence is the harbinger to mortality, through local progression or metastatic disease. There are currently no guidelines regarding the best management of recurrent chordoma. Stereotactic radiosurgery holds the promise to improve local control through its ability to escalate dose. Further research is needed to define the optimal patient selection, ideal dose, and target volume, and determine normal tissue tolerance for single or hypofractionated stereotactic radiosurgery.

Mantle cell lymphoma is a subtype of B cell non-Hodgkin lymphoma (NHL), which accounts for approximately 6% of all new cases of NHL in the USA.[1] The clinical course is variable, but in most cases...

Routine examination of goat milk was performed on 2911 udder halves as part of a milk quality monitoring program over 8 years in Connecticut and Rhode Island. Prevalence of mastitis, including both clinical and subclinical mastitis, was 36.4% (n = 1061) of all samples taken. The most prevalent mastitis agents were non-hemolytic Staphylococcus spp., 38.2% (n = 406); Staphylococcus aureus, 11.0% (n = 117) and Streptococcus spp., 4.1% (n = 43). Other than Streptococcus agalactiae, other isolates included Escherichia coli, 1.6% (n = 17) and Pseudomonas spp., 1.2% (n = 13). Samples that contained more than 1 × 106 somatic cells per milliliter but which did not grow mastitis pathogens were defined as culture-negative mastitis. Culture-negative mastitis accounted for 43.9% (n = 466) of samples considered mastitic. The results of this study demonstrate the prevalence of mastitis and of individual mastitis pathogens in Connecticut and Rhode Island. In addition, the detection of pathogen-free goat milk samples that contained more than 1 × 106 somatic cells per milliliter further demonstrates that elevated somatic cell counts alone are not a valid indication of mammary infection in goats.

To evaluate the impact of a unique school-based program of exercise, health education, and behavior modification on health knowledge, health behaviors, coronary risk factors, and cardiovascular fitness in minority adolescents.A total of 346 students from an inner-city public high school participated in health promotion intervention or regular physical education volleyball classes. Subjects were African-American (47%), Asian-American (9%), Hispanic (21%), white (3%), and other (19%). The health promotion curriculum consisted of 11 weeks of daily circuit training exercise and health lecture-discussions.The groups were similar in age, height, weight, ethnicity, and socioeconomic status. Following intervention both boys (P.001) and girls (P.006) significantly improved health knowledge test scores. Significant benefits for girls included improved dietary habits (P.05), reduced cholesterol (P.004), and higher estimated V(O2)max (P.0001). There were no other significant changes in boys.The results suggest that a school-based health promotion program of exercise and health lecture-discussion is beneficial for multiethnic, inner-city adolescents, especially females.

PURPOSE The purpose was to evaluate the effects of a health promotion curriculum on health knowledge, behavior, cardiovascular fitness, and cardiovascular risk factors. METHODS A multi-ethnic, multi-cultural sample (n = 54) of 10th grade males and females participated in a study of cardiovascular health promotion and coronary risk factor reduction. The sample was comprised of Asian-Americans (39%), blacks (33%), Hispanics (11%), whites (2%), and others (15%). Intervention consisted of a 10-week health promotion curriculum of classroom education modules in physical activity, nutrition, smoking cessation, stress management and personal problem solving, and an exercise program of walking and running. A nonintervention control group served as a basis for comparison. Classroom and exercise sessions met on alternate days. RESULTS Following intervention, a significant treatment effect (P = .007) was observed in lowered total cholesterol, and significant within group improvements (P < .01) were observed in diet habits, percent body fat, and cardiovascular health knowledge. Comparisons of knowledge and social effects revealed higher cardiovascular health knowledge (P < .05) in subjects of nonsmoking compared to smoking parents, higher self-perception of health (P < .01) in more active vs less active subjects and better dietary habits (P < .07) in children whose parents were college educated compared to parents who did not attend college. CONCLUSIONS Preliminary findings suggest that a health promotion curriculum consisting of health education, behavior modification, and regular aerobic exercise lowers cholesterol, improves health behavior and increases health knowledge.

Background Attentional function is impaired in Alzheimer's disease (AD). Moreover, attention is mediated by acetylcholine. But, despite the widespread use of acetylcholinesterase inhibitors (AChE-I) to augment available acetylcholine in AD, measures of attentional function have not been used to assess the drug response. Objectives We hypothesized that as cholinergic augmentation impacts directly on the attentional system, higher-order measures of visual selective attention would be sensitive to effects of treatment using an AChE-I (donepezil hydrochloride). We also sought to determine whether these attentional measures were more sensitive to treatment than other measures of cognitive function. Methods Seventeen patients with AD (8 untreated, 9 treated with donepezil) were contrasted on performance of a selective cancellation task. Two signal detection parameters were used as outcome measures: decision strategy (beta, β) and discriminability (d-prime, d′). Standard screening and cognitive domain measures of vigilance, language, memory, and executive function were also contrasted. Results Treated patients judged stimuli more conservatively (p = 0.29) by correctly endorsing targets and rejecting false alarms. They also discriminated targets from distractors more easily (p = 0.58). The screening and neuropsychological measures failed to differentiate the groups. Conclusions Higher-order attentional measures captured the effects of donepezil treatment in small groups of patients with AD. The results suggest that cholinergic availability may directly affect the attentional system, and that these selective attention measures are sensitive markers to detect treatment response. Copyright © 2005 John Wiley & Sons, Ltd.

A multitarget visual cancellation test was administered to patients with Alzheimer's disease (AD) and age-matched healthy controls (HC). Attentional loads--physical similarity (number of features shared by target and distractors; 3 levels) and density (number of items per page; 3 levels)--were varied systematically. As physical similarity increased, both groups slowed their search, but whereas the HC group maintained accuracy, the AD group increased commission errors and tended to miss more targets. Increased density yielded slower search and more target omissions in the AD group. Commission errors are additional indicators of higher order attentional deficits, especially in early disease. The findings suggest that patients with AD may rely increasingly on physical features of stimuli during a search, leading to inefficient bottom-up processing strategies.