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Background Childhood cancer and its treatment affects not only children’s health, but also children’s and families’ psychosocial function, relationship, emotion, and quality of life. Several studies in developed countries have been conducted to address this issue using the Family Adaptation and Cohesion Scales (FACES) III and the Situation-Specific Emotional Reaction Questionnaire (SSERQ). Screening psychosocial problems is crucial as part of cancer comprehensive care. Objective To investigate the dynamics of family functioning, parental cancer-related emotions, and to evaluate possible associations with the child's quality of life. Methods This cross-sectional study was done in child with cancer aged 0-18 years. Parents completed the validated Indonesian versions of three sets of questionnaires regarding subjects’ quality of life (PedsQL), family function (FACES III), and family cancer-related emotions (SSERQ). Validity and reliability tests were done to assess the Indonesian versions of the questionnaires. Results A total of 269 subjects were recruited. Parental proxy of PedsQL evaluations revealed that the 8-12-year-old age group had significantly lower score than the other groups (P=0.014). Solid tumor subjects had significantly lower PedsQL score compared to subjects with hematological malignancy (P=0.001). The FACES III questionnaire results showed that connected families tended to have better PedsQL score based on children’s evaluation compared to disengaged families (P=0.049). No significant difference was found between adaptability of family function and PedsQL score. The SSERQ revealed significant associations between negative emotions and lower PedsQL scores in the children (all P=0.000). Conclusions Parental proxy of PedsQL scores were significantly lower in older children (8 to 12 years). Children with connected families have significantly higher PedsQL scores than disengaged families, for the PedsQL children’s evaluation. Parents’ emotions (loneliness, helplessness, and uncertainty) experienced by a family member of a child with cancer are also correlated with lower PedsQL scores by both evaluations.

Efforts to build character in accordance with the culture of this nation are not only carried out through a series of teaching and learning activities in schools, but also through habituation in life. Such as religious, honest, disciplined, responsibility and so forth. In reality many students have extensive knowledge of science and technology but do not have soft skills in them. As a result students are only good at memorization and gain little skill when entering society. In realizing education in accordance with the ideals of the nation, the implementation of character education in schools is very necessary because the school is a forum in shaping the character of students. This study aims to (1) Describe the implementation (2) Describe supporting factors and inhibition factors of character education implementation through religious culture in developing the soft skills of students at SD Ar Rahman Kertosono. This research uses descriptive qualitative method approach. Data sources obtained through interviews, observations and documentation. In analyzing data researchers reduce data or summarize the main data, clarify and conclude the data obtained. This research uses source triangulation by conducting interviews with informants and then re-examine the data received by conducting interviews with other informants. The results showed that the implementation of character education at SD Ar Rahman Kertosono is through religious culture in accordance with the values of character education and mission vision of SD Ar Rahman. In addition, SD Ar Rahman also has a special program that contains assessments of students' non-academic activities. In the implementation of character education, students are always monitored and supervised by teachers and parents through performance books or connecting books. There are several supporting factors and factors inhibiting the implementation of character education through religious culture in developing students' soft skills including from the school, parents, students and external factors. The application of character education at SD Ar Rahman Kertosono has a very significant impact on students because students will unwittingly get used to doing positive things and applying them in daily life both in home life, school and society at large..

Purpose/objectives: Rectal spacers have been shown to reduce rectal side effects in patients receiving prostate radiation. However, concerns remain regarding precise and reproducible gel injection. We evaluated efficacy and safety of a novel rectoprostatic spacer balloon that allows potential for controlled, adaptable deployment. This study tested co-primary hypotheses: (1) balloon spacer would result in ≥25% reduction of rectal V70 in >75% of subjects and (2) implantation procedure-related and rectal ≥grade 1 adverse events within 6 months (duration ≥2 days, Common Terminology Criteria for Adverse Events 4.0) would be noninferior in balloon versus control subjects., Methods and Materials: A total of 222 subjects were enrolled at 16 centers. All patients had T1-T3 prostate cancer without magnetic resonance imaging evidence of posterior extraprostatic invasion. Randomization was 2:1 (balloon: control) and subject-blinded. Patients underwent transperineal transrectal ultrasound axial and sagittal-guided fiducial placement ± balloon, followed by Intensity-Modulated Radiation Therapy (81 Gy in 1.8 Gy fractions or biologically equivalent hypofractionated dose). For efficacy comparisons, plans were generated by a central core lab on pre- and postimplant computed tomography scans., Results: The primary efficacy endpoint was met, with 97.9% of balloon subjects (139/142) having rectal V70 reduction >25% (P < .001). Mean V70 was 7.0 % pre- versus 1.1% postimplant. The primary safety endpoint was met with balloon subjects experiencing fewer ≥grade 1 events, 18% versus 23% (P < .001 for noninferiority). On predefined secondary endpoint of ≥grade 2 events, rates trended lower in balloon subjects (4.3% vs 6.5%, P = .527). Mean perirectal spacing was 19 ± 3.7 mm and maintained through radiation treatment (18 ± 3.9 mm). Balloon resorption was observed on 6-month computed tomography in 98.5% (133/135) of subjects. The Expanded Prostate Cancer Index quality of life instrument was collected throughout study, and did not differ statistically between the study arms., Conclusions: Biodegradable rectal spacer balloon was effective in significantly reducing dose to rectum, and associated with decreased cumulative rectal plus implantation-related adverse events. Balloon resorption was consistently observed by 6 months., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: A multicenter, double-arm, central core lab, retrospective study was performed to compare the rectal dosimetry of patients implanted with two injectable, biodegradable perirectal spacers, in conventional fractionation (CF), as well as ultrahypofractionation (UH) treatment plans., Methods and Materials: Fifty-nine patients were enrolled into the study in five centers: two centers in Europe, which implanted a biodegradable balloon spacer in a total of 24 subjects and three centers in the US, which implanted the SpaceOAR in 35 subjects. Anonymized CTs (pre and post-implantation) were reviewed by the central core lab. For VMAT CF plans rectal V50, V60, V70, and V80 were calculated. For UH plans, a corresponding rectal V22.6, V27.1, V31.37, and V36.25 were established representing 62.5%, 75%, 87.5%, and 100% of the 36.25 Gy prescribed dose., Results: For CF VMAT, a comparison between the balloon spacer and the SpaceOAR revealed a significant difference of 33.4% decrease in mean rectal V50 (71.9% vs. 38.5%, p < 0.001), 27.7% in mean rectal V60 (79.6% vs. 51.9%, p < 0.001), 17.1% difference in mean rectal V70 (84.1% vs. 67.0%, p = 0.001), and a significant difference of 3.0% (p = 0.019) in mean rectal V80 (87.2% vs. 84.2%). With UH analysis, the mean rectal dose reduction for the balloon spacer compared to the SpaceOAR was 79.2% and 53.3% for V27.1 (p < 0.001), 84.1% and 68.1% for V31.71 (p = 0.001), and 89.7% and 84.8% for V36.25 (p = 0.012), respectively., Conclusion: Rectal dosimetry is more favorable for treatment with the balloon spacer compared with SpaceOAR. Further research, particularly in the context of a prospective randomized clinical trial design, is needed to assess the acute and late toxicity experience as well as physician satisfaction with achieving symmetrical implantation, and ease of use in light of increasing clinical use., (© 2023 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

Importance: Hypofractionated radiation therapy (RT) for prostate cancer has been associated with greater acute grade 2 gastrointestinal (GI) toxic effects compared with conventionally fractionated RT., Objective: To evaluate whether a hyaluronic acid rectal spacer could (1) improve rectal dosimetry and (2) affect acute grade 2 or higher GI toxic effects for hypofractionated RT., Design, Setting, and Participants: This randomized clinical trial was conducted from March 2020 to June 2021 among 12 centers within the US, Australia, and Spain, with a 6-month follow-up. Adult patients with biopsy-proven, T1 to T2 prostate cancer with a Gleason score 7 or less and prostate-specific antigen level of 20 ng/mL or less (to convert to μg/L, multiply by 1) were blinded to the treatment arms. Of the 260 consented patients, 201 patients (77.3%) were randomized (2:1) to the presence or absence of the spacer. Patients were stratified by intended 4-month androgen deprivation therapy use and erectile quality., Main Outcomes and Measures: For the primary outcome, we hypothesized that more than 70% of patients in the spacer group would achieve a 25% or greater reduction in the rectal volume receiving 54 Gy (V54). For the secondary outcome, we hypothesized that the spacer group would have noninferior acute (within 3 months) grade 2 or higher GI toxic effects compared with the control group, with a margin of 10%., Results: Of the 201 randomized patients, 8 (4.0%) were Asian, 26 (12.9%) Black, 42 (20.9%) Hispanic or Latino, and 153 (76.1%) White; the mean (SD) age for the spacer group was 68.6 (7.2) years and 68.4 (7.3) years for the control group. For the primary outcome, 131 of 133 (98.5%; 95% CI, 94.7%-99.8%) patients in the spacer group experienced a 25% or greater reduction in rectum V54, which was greater than the minimally acceptable 70% (P < .001). The mean (SD) reduction was 85.0% (20.9%). For the secondary outcome, 4 of 136 patients (2.9%) in the spacer group and 9 of 65 patients (13.8%) in the control group experienced acute grade 2 or higher GI toxic effects (difference, -10.9%; 95% 1-sided upper confidence limit, -3.5; P = .01)., Conclusions and Relevance: The trial results suggest that rectal spacing with hyaluronic acid improved rectal dosimetry and reduced acute grade 2 or higher GI toxic effects. Rectal spacing should potentially be considered for minimizing the risk of acute grade 2 or higher toxic effects for hypofractionated RT., Trial Registration: ClinicalTrials.gov Identifier: NCT04189913.

Objective: To identify the incidence of fetal heart rate (FHR) accelerations in the second stage of labor and the role of fetal electrocardiograph (ECG) in avoiding misidentification of maternal heart rate (MHR) as FHR., Design: Retrospective observational study., Setting: University hospital labor ward, London, UK., Sample: Cardiotocograph (CTG) tracings of 100 fetuses monitored using external transducers and internal scalp electrodes., Methods: CTG traces that fulfilled inclusion criteria were selected from an electronic FHR monitoring database., Main Outcome Measures: Rate of accelerations during external and internal monitoring as well as decelerations for a period of 60 minutes prior to delivery were determined. The role of fetal ECG in differentiating between MHR and FHR trace was explored., Results: Decelerations occurred in 89% of CTG traces during the second stage of labor. Accelerations indicating possible recording of FHR or MHR were found in 28.1 and 10.9% of cases recorded by an external ultrasound transducer as well as internal scalp electrode, respectively. Accelerations coinciding with uterine contractions occurred only in 11.7 and 4% of external and internal recording of FHR, respectively. Absence of 'p-wave' of the ECG waveform was associated with MHR trace., Conclusion: Decelerations were the commonest CTG feature during the second stage of labor. The incidence of accelerations coinciding with uterine contractions was less than half in fetuses monitored using a fetal scalp electrode. Analysing the ECG waveform for the absence of 'p-wave' helps in differentiating MHR from FHR., (© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.)

Objective: To determine whether treatment gap between supplemental beam radiation and brachytherapy implant affects rectal morbidity and likelihood of cure in the treatment of intermediate-risk prostate cancer., Materials and Methods: Five hundred sixty-eight patients with AJCC clinical stage T1c-T2a prostate cancer, Gleason score 7 to 9 and/or prostate-specific antigen (PSA) 10 to 20 ng/mL, were randomized to implantation with Pd-103 (90 vs. 115 Gy) with 44 Gy versus 20 Gy preimplant supplemental beam radiation, respectively. Treatment-related morbidity was monitored by mailed questionnaires, using a modified Radiation Therapy Oncology Group rectal morbidity criteria at 1, 3, 6, 12, 18, and 24 months. Patients who reported grade 1 or worse rectal morbidity were interviewed by telephone to clarify details regarding their rectal bleeding., Results: Persistent rectal bleeding occurred in 36 of the 548 evaluable patients (7%). The mean gap among rectal bleeders was 3.8 days and among nonbleeders was 4.8 days (P = 0.236). Higher R100 and external beam dose of 44 Gy were significant predictors of rectal bleeding on univariate and multivariate analysis. Log-rank analysis did not demonstrate any improvement in biochemical failure free survival (BFFS) with shorter gap interval. On univariate analysis, Gleason score >7, PSA >10, D90 <100%, and treatment gap were all predictive of biochemical failure. On multivariate analysis, only Gleason score, PSA, and D90 remained significant predictors of BFFS., Conclusion: Shorter gap intervals between supplemental beam radiation and brachytherapy implant are safe. Shorter gap intervals do not improve BFFS; however, they do allow for treatment completion in a more timely fashion.

Purpose: A higher percent of positive biopsy cores predicts poor biochemical failure-free survival. The highest dose covering at least 90% of the prostate is a standard method of measuring implant quality. We tested the hypothesis that the percentage of positive biopsy cores loses its adverse prognostic impact in patients who receive implants with a highest dose covering at least 90% of the prostate of 100% or greater of the prescription dose., Materials and Methods: A total of 568 patients with intermediate to high risk adenocarcinoma of the prostate who were previously treated with brachytherapy in a prospective, randomized study were evaluated. The relationship between the percentage of positive biopsy cores, the highest dose covering at least 90% of the prostate and biochemical failure was examined., Results: At a median followup of 50 months the rate of 5-year biochemical failure-free survival was 87% for the entire group and 92% vs 81% for patients with less than 50% vs 50% or greater positive biopsy cores (log rank p = 0.009). The mean highest dose covering at least 90% of the prostate was statistically lower in failing vs nonfailing cases (p = 0.03). Gleason score, prostate specific antigen, 50% or greater positive biopsy cores and the highest dose covering at least 90% of the prostate were the only statistically significant predictive factors for biochemical failure-free survival on multivariate Cox regression analysis. When regression analysis was restricted to the 237 patients who received implants with a highest dose covering at least 90% of the prostate of 100% or greater, 50% or greater positive biopsy cores lost predictive value but prostate specific antigen and Gleason score remained independent prognostic factors., Conclusions: A total of 50% or greater positive biopsy cores is an independent predictor of poor biochemical failure-free survival in patients treated with brachytherapy. High quality prostate brachytherapy, defined by a highest dose covering at least 90% of the prostate of 100% or greater, minimize the adverse effect of 50% or greater positive biopsy cores on time to biochemical failure.