Effects of dosimetric inadequacy on local control and toxicities in the patients with T4 nasopharyngeal carcinoma extending into the intracranial space and treated with intensity.modulated radiotherapy plus chemotherapy

Background:To protect neurological tissues,underdosing occurs in most cases of T4 nasopharyngeal carcinoma(NPC) with intracranial extension.In this study,we aimed to evaluate the effect of dosimetric inadequacy on local control and late neurological toxicities for patients treated with intensity-modulated radiotherapy(IMRT) plus chemotherapy.Methods:We prospectively enrolled patients who had non-metastaticT4 NPC with intracranial extension treated between January 2009 and November 2013.The prescribed dose was 66.0-70.4 Gy to the primary planning target volume(primary gross tumor volume [GTVp;i.e.,the nasopharyngeal tumor] +5.0 mm).Dose-volume histogram parameters were calculated,including minimum point dose(D_(min)) and dose to 95% of the target volume(D95).All patients received chemotherapy with the cisplatin,5-fluorouracil,and docetaxel regimen.Survivals were estimated using the Kaplan-Meier method and compared using the log-rank test.Results:In total,41 patients were enrolled.The local partial response rate was 87.8% after induction chemotherapy.With a median follow-up of 51 months,7 patients experienced failure in the nasopharynx;the 3-year local failure-free survival and overall survival rates of the 41 patients were 87.4% and 90.2%,respectively.The actual mean D_(min) to the GTVp was 55.2 Gy(range 48.3-67.3 Gy),and D95 was 61.6 Gy(range 52.6-69.0 Gy).All doses received by neurological organs remained well within their dose constraints.No patients developed temporal lobe necrosis or other neurological dysfunctions.Conclusions:With relative underdosed IMRT plus effective chemotherapy,the patients achieved satisfactory local control with few late toxicities of the central nervous system.Determining the acceptable extent of dosimetric inadequacy requires further exploration.

Examining Social Media and Technology Attitudes in Older-Aged and Middle-Aged Adults: Relationship With Cognitive Flexibility and Sense of Inadequacy

The main purpose of this study is to reveal the relationship between the perceived cognitive flexibility and sense of inadequacy of older adults and middle adults with their attitudes towards social media use and technology.Of the participants,210(68.2%)were female and 98(31.8%)were male.The sample consisted of 49.4%of middle adults aged between 50-59 years,and a total of 308 adults,50.6%of whom were older adults aged 60 and over.“Personal Information Form”,“Sense of Inadequacy Scale”,“Cognitive Flexibility Scale”,and“Media and Technology Use and Attitudes Scale”were used to collect data in the research.According to the findings of the study,older-and middle-aged adults differed in their sense of inadequacy and cognitive flexibility capacity.A significant difference was found between social media use and technology attitudes of older and middle adults.The findings were discussed within the framework of the relevant literature.

Prevalence and Predictors of Hemodialysis Inadequacy among Patients on Maintenance Hemodialysis in Mwanza, Tanzania

Introduction: The burden of chronic kidney disease (CKD) is rapidly increasing in Tanzania. There is a rapid expansion of hemodialysis (HD) services to meet this demand. The quality of HD services, which is usually termed HD inadequacy, is under-reported. Therefore, the objective of this study was to determine the prevalence of HD inadequacy using two equations, urea reduction ratio (URR) and Kt/V and its associated factors. The correlation between URR and Kt/V for the diagnosis of HD inadequacy is also determined. Materials and Methods: This was a prospective longitudinal study conducted from March to July 2021 in 98 patients with CKD who underwent maintenance HD at Bugando Medical Centre in Mwanza, Tanzania. Demographic, laboratory, and clinical information was collected and analyzed. The HD inadequacy was estimated by using both the URR and the Kt/V equations. The correlation between the two equations was analyzed by using Cohen’s kappa. Results: The majority (69.4%) of the study participants were male and the mean age was 59 (48 - 68) years. The median hemoglobin level was 10 (8.9 - 11.2) g/dl, and the pre-dialytic urea was 15 (10.6 - 21.3) mmol/L. The prevalence of HD inadequacy was 36 (36.7%). The predictors of HD inadequacy were older age (>50 years) (OR = 3.6, 95 % CI 1.0 - 12.6, p = 0.04), moderate or severe anemia (OR = 4.7, 95 % CI 1.5 - 14.4, p = 0.006) and short duration of HD (OR = 3.1, 95 % CI 1.0 - 9.1, p = 0.04). There was a strong agreement between URR and Kt/V in the diagnosis of HD inadequacy (Kappa = 0.887). Conclusion and Recommendations: HD inadequacy is common, and most predictors can be prevented. Clinicians should use a personalized approach in making sure that anemia is appropriately treated and HD prescription is adhered to for better clinical outcomes among patients with HD.

Prevalence of Inadequacy Intake for Older People:The Use of National Cancer Institute (NCI) Method

A purpose of dietary assessment is to evaluate the dietary intake of a group or a population. In Brazil few studies have been carried out to identify dietary intake of older people population. Then, the aim of this work is to estimate the distribution as well as estimate the prevalence of inadequacy of the usual intake in a representative sample of older population from Botucatu city, S?o Paulo, applying the NCI method. A sample of 365 older was used and some instruments to evaluate quality of life, activities of daily living and instrumental of daily living were applied as well as three 24-hour recalls. Data from the recalls were transformed in consumption of macro and micronutrients using NDSR software and were analyzed using NCI method in order to estimate the inadequacy prevalence. The energy and macronutrients intake of the studied population agree with their needs, however, the consumption of minerals and vitamins were below the recommendation even after including the covariates. This can reflects a monotone intake that is characteristic of this age and this inadequateness can be a serious public health problem that can carry on development of chronic diseases. Also, it is important to highlight that NCI method provides a good estimate of the usual intake.

Syllabus in the Light of Keeping Pace with the Times

Drawing up of syllabus plays a very important role in directing college English teaching. With the fast developing pace of the situation and the increasing requirements for undergraduates＇ English level, the available Syllabus is obviously far from satisfaction. This paper, from six perspectives, expounds the inadequacies and drawbacks of the Syllabus. It points out that college English teaching and the Syllabus need reform and should keep pace with the times.

Holistic Approach and Development

According to the holistic approach, factors relevant for the promotion of a desire of change should beaccommodated in a synchronized manner. Need to implement this approach is the topic of this paper. Putdifferently, the topic of research has to do with desired change through implementation of holistic approach.

The Application of Flipped Classroom Teaching Model in English Writing Course in Educational Informatization 2.0 Background

The absence or inadequacy of critical thinking is one of the prevalent problems in English teaching and learning in China, which gives rise to various problems in learners’ writing: digression from the topic, unoriginal or uncreative ideas, loose logic, logical fallacies, and lack of real content. Under such circumstances, the present paper proposes the “teaching-learning-assessing-testing Four in One” flipped classroom mode in Educational Informatization 2.0 Background to develop learners’ critical thinking ability relying on technical support provided by the researcher’s school and the mode is then applied in English writing course. The application of the mode has achieved some effects. It is applauded by learners and may thus have some implications for the development of learners’ critical thinking ability in writing courses.

Scientific Research in Universities of Vietnam in Present and Its Effects on Training Quality

In this paper, the author presented an overview of scientific research in universities of Vietnam in present and analyzed and assessed its effects on the quality of education in universities. The information to write this article was obtained in the references and from the management practice for the universities and the research institute.

Some Personal Comment About Behaviorist Approach

How an articulated mammal learns a foreign language has been a mystery for many years to language researchers. Language scholars have put forward different ways to explain this problem. Yet all of them are not perfect. Each of these theories has contributed both quantitively and qualitively to the different aspects of language learning. However, language learning and teaching doesn’t happen in a vaccum. It is affected by many factors. In vast rural areas in China, practically speaking, behaviorist approach fits in with the writer’s own experience. Some weaknesses of this approach are also discussed. Therefore what is important is to adapt, not to adopt blindly.