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Parent-Adolescent Relationship Quality, Sexual Health Communication, and Willingness to Support Pre-Exposure Prophylaxis for HIV: A Qualitative Study
Full text linkPurpose: Pre-exposure prophylaxis (PrEP) for HIV is a safe and highly effective prevention method, yet use among U.S. adolescents at risk for HIV has been low. Little is known about how sexual health communication (SHC) and the quality of parent-adolescent relationships influence parents' hypothetical willingness to support their adolescent using PrEP.
Methods: We conducted 34 in-depth interviews with parents of adolescents recruited from four U.S. urban clinical sites between 2018 and 2019. We then used applied thematic analysis informed by two theories to determine parents' hypothetical willingness (more vs. less willing) and to identify related themes, focusing on differences between more versus less willing parents.
Results: Parents were diverse with respect to race/ethnicity (68% Black/African American, 18% Hispanic). Most were cisgender men (44%) or women (41%). Approximately half (n = 19, 56%) were more willing. Four themes related to willingness were identified: (1) relationship quality, (2) acceptance of sexual and gender-diverse (SGD) identities, (3) sex positivity of SHC, and (4) general positivity about PrEP. Responses from more willing parents tended toward higher relationship quality, more acceptance of SGD identities, more sex positivity, and PrEP positivity; conversely, less willing parents tended toward the opposite ends of each theme. HIV risk perception did not consistently impact willingness, as both more and less willing parents largely perceived their adolescent's HIV risk as low.
Discussion: Parents who were more willing to support their adolescent hypothetically using PrEP tended to describe high-quality relationships, acceptance of SGD identities, sex positivity of SHC, and general positivity about PrEP
Oblique Genomics Mixture of Experts: Prediction of Brain Disorder With Aging-Related Changes of Brain’s Structural Connectivity Under Genomic Influences
Full text linkDuring the process of brain aging, the changes of white matter structural connectivity are closely correlated with the cognitive traits and brain function. Genes have strong controls over this transition of structural connectivity-altering, which influences brain health and may lead to severe dementia disease, e.g., Alzheimer's disease. In this work, we introduce a novel deep-learning diagram, an oblique genomics mixture of experts(OG-MoE), designed to address the prediction of brain disease diagnosis, with awareness of the structural connectivity changes over time, and coupled with the genomics influences. By integrating genomics features into the dynamic gating router system of MoE layers, the model specializes in representing the structural connectivity components in separate parameter spaces. We pretrained the model on the self-regression task of brain connectivity predictions and then implemented multi-task supervised learning on brain disorder predictions and brain aging prediction. Compared to traditional associations analysis, this work provided a new way of discovering the soft but intricate inter-play between brain connectome phenotypes and genomic traits. It revealed the significant divergence of this correlation between the normal brain aging process and neurodegeneration
Second edition ICCR dataset for testicular germ cell tumours: a reporting guide for histopathological diagnosis of orchiectomy specimens
No full textTo summarise the content and significance of the recently published second edition International Collaboration on Cancer Reporting (ICCR) histopathology dataset for testicular germ cell tumours, covering the Orchiectomy specimen dataset. We highlight key updates from the first editions, including alignment with the 5th edition World Health Organization (WHO) Classification, revised staging criteria, clarified core data elements versus non-core elements and the evidentiary basis underpinning these changes. A review of the ICCR 2nd edition dataset for Orchiectomy specimens of primary testicular tumours was performed, focusing on their development by an international expert committee using a consensus-based approach. Core (required) and non-core (recommended) data elements were identified along with the level of evidence supporting each, following National Health and Medical Research Council (NHMRC) criteria. Changes from the first edition were extracted by comparing dataset content and notes, informed by up-to-date literature through July 2024. The 2nd edition Orchiectomy dataset provides an integrated, harmonised framework for reporting testicular germ cell tumours. The dataset incorporates the WHO 5th Edition Classification of Urinary and Male Genital Tumours. Pathological staging criteria have been updated to align with the 8th edition Union for International Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) definitions. The second edition of this dataset includes changes to align the dataset with the WHO Classification of Tumours, Urinary and Male Genital Tumours, 5th edition, 2022. The ICCR dataset includes the 5th edition Corrigenda, July 2024. It was agreed that this dataset is not suitable for non-germ cell tumours, with the hope that a new dataset, especially for sex-cord stromal tumours, would be developed. The 2nd edition Orchiectomy dataset represents an authoritative, up-to-date standard for pathology reporting of primary testicular germ cell tumours. By incorporating the WHO 5th edition classifications, current TNM staging and the latest evidence on prognostic factors, this dataset facilitates uniform reporting and prognostication. The ICCR dataset underscores core data required for patient management decisions (e.g., adjuvant therapy in Stage I disease, post-chemotherapy management) while providing flexibility through non-core elements for additional useful information. Adoption of this internationally vetted dataset will enhance consistency, assist multidisciplinary treatment planning and align pathology reports with modern consensus guidelines and classifications. The dataset can be used in both high-resource and limited-resource settings without compromising the essential reporting standards
National Evaluation of the Management of Melanoma Patients with Multiple Positive Sentinel Lymph Nodes
No full textIntroduction: Clinical trials for melanoma patients demonstrated safety of observation in lieu of completion lymph node dissection (CLND) following positive sentinel lymph node (SLN) biopsy. Patients with two or more positive SLNs were infrequently included in the trials, leaving uncertainty about their management. We aimed to (1) assess national trends of CLND use in patients with two or more positive SLNs; (2) examine factors associated with CLND use; and (3) examine overall survival outcomes.
Methods: Patients with stage I-III melanoma who underwent SLN biopsy between 2012 and 2021 were identified from the National Cancer Database. Factors associated with CLND were assessed by hierarchical logistic regression. Overall survival was estimated using Cox proportional hazards models.
Results: Among 151,442 patients (median age 61 years; 41.3% female) who underwent SLN biopsy, 5440 (3.6%) had two or more positive SLNs. CLND in patients with two or more positive SLNs decreased from 73% in 2012 to 14% in 2021, while immunotherapy utilization increased from 38% in 2012 to 76% in 2021. Patients with two or more positive SLNs were more likely to undergo CLND if they had melanoma in the head/neck region (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.39-2.95) or ulcerated lesions (OR 1.42, 95% CI 1.11-1.83). There was no difference in 3-year overall survival (70.5% for two or more positive SLNs with observation vs. 70.8% for two or more positive SLNs with CLND; hazard ratio 1.03, 95% CI 0.77-1.37) for observation vs. CLND.
Conclusion: Utilization of CLND declined for melanoma patients with two or more positive SLNs following major clinical trials, with no difference in overall survival for observation versus CLND. Evolving treatment recommendations have been rapidly incorporated into practice in the United States
3D printed collimators and dosimetry for spatially fractionated radiation therapy
Full text linkBackground: Spatially fractionated radiation therapy (SFRT) has shown incredible potential in sparing normal tissues and activating mechanisms of tumor control distinct from conventional radiotherapy. However, the optimal spatial configuration of SFRT as well as the optimal peak and valley dose values have not been established. This poses a barrier to widespread clinical implementation and efficacy.
Purpose: To facilitate greater SFRT optimization, this work establishes a simple, readily customizable, and cost-effective approach for fabricating SFRT collimators with different spatial configurations as well as peak and valley dose values.
Methods: The approach involves fabrication of custom SFRT collimators, each consisting of a 3D-printed plastic shell filled with tungsten. Once fabricated, the collimator dosimetry is characterized using a combination of Gafchromic film and ion chamber measurements. Monte Carlo simulations are used to verify SFRT dosimetry and assess positional uncertainties. The collimators are applied in preclinical mouse experiments demonstrating how they can be used to deliver SFRT.
Results: Five collimators were fabricated for use at kilovoltage energies and one collimator was fabricated for use at megavoltage energies. Across all collimators, the peak widths ranged from 1.2 to 10.1 mm and the valley widths ranged from 1.1 to 10.6 mm. For the kilovoltage collimators, the highest peak-to-valley dose ratio was 32.4 at the surface and this dropped to 29.5 at 10 mm depth. For the megavoltage collimator, at 95 cm SSD, the peak-to-valley dose ratio was 2.7 at 15 mm depth and this dropped to 2.2 at 100 mm depth. In the mouse experiments, out of multiple SFRT parameters, the mean tumor valley dose had the strongest correlation with change in tumor volume (p = 0.02). The Monte Carlo simulations indicated a 5 mm translation of the mouse tumor relative to the beam led to a 44.8% change in the mean tumor dose, underlying the importance of precise positioning for SFRT.
Conclusions: This work establishes a novel approach for custom 3D printing of SFRT collimators and their subsequent characterization. The developed collimators are capable of SFRT delivery at both kilovoltage and megavoltage photon beam energies. This approach facilitates patient specific customization as well as optimization of the peak and valley doses for more effective SFRT
Interprofessional Teaching Model for Enhancing Musculoskeletal Examination: Does the Learning Event Length Matter?
No full textEvaluating School‐Based Substance Use Services: Insights From a Systematic Review
Full text linkBackground: Substance use among youth can have lifelong consequences and therefore requires early and targeted services for those at risk. Schools possess a unique opportunity to provide substance use services to youth for both prevention and intervention. However, limited research exists on the school-based substance use services and their effectiveness.
Methods: Using PRISMA guidelines, online databases were searched for studies done between 2004 and 2024 on school-based substance use services, their outcomes, and the characteristics of those administering them.
Findings: Results showed school-based substance use services being offered in multiple settings. Screening and intervention were the most common services provided. Although specific outcomes varied by study, including academic performance, perceptions, and actions, most were positive.
Implications for school health policy, practice, and equity: Schools should create strategic plans for feasible and sustainable substance use services. Use of the screening, brief intervention, and referral to treatment (SBIRT) framework can be used to organize these efforts. Establishing robust referral networks is of particular importance for schools.
Conclusions: This review highlights opportunities for schools to focus on screening and brief intervention for in-school services while also building a strong referral network for times when treatment is necessary
Advances in non‐germ cell tumours of the testis: focus on new molecular developments in sex cord‐stromal tumours
No full textTesticular sex cord-stromal tumours (TSCSTs) represent ~4%-8% of all testicular neoplasms. Most show a Leydig or Sertoli cell phenotype and exhibit benign clinical behaviour. However, a subset of ~10% is malignant and clinically problematic, as TGCTs do not respond to systemic therapy. Classification of TSCSTs has relied on morphology, with several entities being defined based on their resemblance to more common ovarian counterparts (e.g. granulosa cell tumours). In recent years, multiple clinicopathologic and molecular studies have improved our understanding of the mechanisms that underlie pathogenesis and progression in TSCSTs, providing data that can be useful to refine classification and prognostication. In this review, we summarise the major recent advances in TSCSTs, focusing on molecular alterations and biomarkers relevant for diagnosis, classification and prognosis
Treatment‐related changes in the prostate: past, present and future therapies
No full textA broad spectrum of therapies is available for the management of prostate cancer, ranging from well-established interventions like radical prostatectomy, androgen deprivation therapy (ADT) and radiation therapy (RT), to emerging modalities such as focal ablative treatments and targeted molecular therapies. These therapies can induce profound histologic alterations in both benign and malignant prostate tissue. Hormonal and radiation therapies are particularly known for their distinctive and often extensive morphologic effects, which have been well documented across needle biopsies, transurethral resection of the prostate (TURP) or enucleation specimens and prostatectomy samples. Novel ablative techniques-including cryotherapy, high-intensity focused ultrasound (HIFU), photodynamic therapy (PDT) and interstitial laser thermotherapy-are gaining traction, yet the histologic consequences of these newer modalities are still being characterized. These treatment-induced changes can obscure residual carcinoma, complicate tumour grading and staging and sometimes render traditional parameters such as Gleason scoring unreliable. As therapies evolve, pathologists must remain informed about the spectrum of post-treatment changes to accurately interpret prostate specimens. Diagnostic accuracy hinges not only on recognizing these morphologic effects but also on integrating clinical history, particularly when treatment details are not readily available. This review provides an overview of current and investigational prostate cancer therapies, their histologic impact and practical guidance for post-treatment evaluation
Qualitative Research Checklist
No full textThis worksheet combines qualitative reporting criteria into a checklist that can be utilized by authors and reviewers to ensure each element is addressed within the methods description of qualitative research