To what extent are members of an online panel willing to share different data types? A conjoint experiment

Recently, the idea of ‘data fusion’, that is, of combining different types of data, became quite popular because of the advances of new technologies. In particular, several studies started investigating the possibility of combining survey data with other data types in order to get a more complete or accurate picture of the reality and/or to reduce survey burden. One key element, then, is the willingness of people to share different types of data, beyond survey answers. In this article, we investigate to what extent members from an opt-in online panel in Spain are willing to share different types of information that have in general not been studied before in the literature: records of their surrounding sound (audiotracking), information from their email inbox (in different ways, sharing the email credentials, using an email plug-in or redirecting emails, partially or totally), sensorial reactions measured by a wearable device (neuroscience) and public information about them available online. We use a choice-based conjoint analysis in order to study the level of willingness depending on the incentives offered in exchange, and we present the level of willingness by gender and age groups. Overall, we find huge differences in the level of willingness across data types. Increasing the incentives, on the contrary, does not improve the willingness so much, even if there is a positive trend. Some differences are observed across gender and age groups but most of them are not statistically significant.

Incorporating a Nebulizer System Into High-Flow Nasal Cannula Improves Comfort in Infants With Bronchiolitis

BACKGROUND

High-flow nasal cannula (HFNC) is increasingly used to provide respiratory support in infants with bronchiolitis. The delivery of aerosol therapy through a jet nebulizer is widely indicated despite its controversial efficacy and poor tolerability.

METHODS

This randomized cross-over study aimed to evaluate the comfort and satisfaction of the delivery of aerosol therapy using a nebulization system integrated into HFNC compared with the standard practice of using a jet nebulizer with a face mask. The COMFORT-Behavior (COMFORT-B) scale, a visual analog scale, and a numeric rating scale were used by health professionals and caregivers to assess subjects' levels of comfort and satisfaction.

RESULTS

A total of 113 nebulizations (64 via nebulizer with HFNC; 49 via jet nebulizer) were delivered to the 6 subjects included in the study. Use of the nebulizer with HFNC showed increased comfort and satisfaction during nebulization compared to use of the jet nebulizer, as measured by the COMFORT-B scale, the visual analog scale, and the numeric rating scale, with the following median (interquartile range) scores: 10.7 (7-16) versus 14.5 (10-20) (P = .006), 8.5 (6-10) versus 7 (4-9) (P = .02), and 3.84 (3.61-4.07) versus 1.83 (1.58-2.08) (P < .001), respectively. Correlation between the COMFORT-B scale and the visual analog scale using Spearman's rho was -0.757 (P < .001). The intraclass correlation coefficient for the COMFORT-B scale, visual analog scale, and numeric rating scale, as measured by 2 different nurses, was between 0.75 and 0.87.

CONCLUSIONS

The use of a nebulizer incorporated into HFNC therapy results in an increased level of comfort and satisfaction compared to the use of a conventional jet nebulizer in subjects with bronchiolitis who required HFNC therapy. Further studies are needed to determine whether aerosol therapy delivered through HFNC improves the clinical course of this pathology.

The role of posttraumatic stress and posttraumatic growth on online information use in breast cancer survivors

OBJECTIVE

Changes perceived as both positive (eg, posttraumatic growth [PTG]) and negative (eg, posttraumatic stress symptoms [PTSS]) have been associated with intensive Internet use among breast cancer survivors. In this multicenter study, we analyzed the role of PTG and PTSS on the amount of time spent looking for online cancer information, its content, and its psychological impact.

METHODS

Posttraumatic stress symptoms and PTG were assessed in 182 breast cancer survivors by using the Post-traumatic Stress Disorder Checklist and Post-traumatic Growth Inventory questionnaires. Subjects also completed a questionnaire about their behavior when looking for online illness-related information (ie, time spent, type of contents, and psychological impact).

RESULTS

Posttraumatic stress symptoms positively correlated with the amount of time spent looking for cancer-related information, including both medical and psychosocial content. By contrast, PTG showed no relationships with the amount of time, but with a predominant search for cancer-related psychosocial information. The psychological impact of online information was associated with participants' levels of PTG and/or PTSS. Whereas PTG was related to a decrease of women's hope, PTSS was linked to the perception of being less conscious or inadequately informed about the illness, thereby increasing feelings of distress.

CONCLUSIONS

Posttraumatic stress symptoms and PTG show relationships with the amount of time spent online, the type of information accessed online, and the psychological impact of Internet use. Health professionals should prescribe online information according to the psychological response to cancer. There is a need for professional-led online resources to provide patients with timely information as well as support sites to facilitate psychological adjustment.

Amplitude Integrated Electroencephalogram as a Prognostic Tool in Neonates with Hypoxic-Ischemic Encephalopathy: A Systematic Review

Introduction

Perinatal management and prognostic value of clinical evaluation and diagnostic tools have changed with the generalization of therapeutic hypothermia (TH) in infants with hypoxic-ischemic encephalopathy (HIE)

Aim

to ascertain the prognostic value of amplitude integrated electroencephalogram (aEEG) in neonates with HIE considering hours of life and treatment with TH.

Methods

A systematic review was performed. Inclusion criteria were studies including data of neonates with HIE, treated or not with TH, monitored with aEEG and with neurodevelopmental follow-up of at least 12 months. The period of bibliographic search was until February 2016. No language restrictions were initially applied. Consulted databases were MEDLINE, Scopus, CINHAL and the Spanish language databases GuiaSalud and Bravo. Article selection was performed by two independent reviewers. Quality for each individual paper selected was evaluated using QUADAS-2. Review Manager (RevMan) version 5.3 software was used. Forest plots were constructed to graphically show sensitivity and specificity for all included studies, separating patients treated or not with hypothermia. Summary statistics were estimated using bivariate models and random effects approaches with the R package MADA from summary ROC curves. Meta-regression was used to estimate heterogeneity and trends.

Results

from the 403 articles initially identified, 17 were finally included and critically reviewed. In infants not treated with hypothermia the maximum reliability of an abnormal aEEG background to predict death or moderate/severe disability was at 36 hours of life, when a positive post-test probability of 97.90% was achieved (95%CI 88.40 to 99.40%). Positive likelihood ratio (+LR) at these hours of life was 26.60 (95%CI 4.40 to 94.90) and negative likelihood ratio (-LR) was 0.23 (95%CI 0.10 to 0.44). A high predictive value was already present at 6 hours of life in this group of patients, with a positive post-test probability of 88.20% (95%CI 79.80 to 93%) and a +LR of 4.34 (95%CI 2.31 to 7.73). In patients treated with TH the maximum predictive reliability was achieved at 72 hours of life (post-test probability of 95.70%, 95%CI 84.40 to 98.50%). +LR at this age was 24.30 (95%CI 5.89 to 71.30) and–LR was 0.40 (95%CI 0.25 to 0.57). Predictive value of aEEG at 6 hours of life was low in these patients (59.10%, 95%CI 55.70 to 63%).

Conclusion

This study confirms that aEEG´s background activity, as recorded during the first 72 hours after birth, has a strong predictive value in infants with HIE treated or not with TH. Predictive values of traces throughout the following 72 hours are a helpful guide when considering and counselling parents about the foreseeable long-term neurological outcome

Abstract P1-09-07: Effects of breast cancer treatment on markers of metabolic syndrome in a predominantly hispanic patient population

Background: Adjuvant chemotherapy improves survival in early breast cancer, however has been reported to contribute to weight gain and insulin resistance. Hispanics are reported to have higher levels of insulin resistance and features of metabolic syndrome as compared to caucasians and as such may be at higher risk of metabolic decompensation during treatment of their cancer. We sought to evaluate the effects of adjuvant/ neo-adjuvant breast cancer treatment on markers of metabolic syndrome in a predominantly hispanic population. Study was funded by the institutions department of medicine seed grant funds.

Methods: We enrolled 35 consecutive patients who were about to commence adjuvant or neo-adjuvant chemotherapy for breast cancer. Patients with diabetes mellitus or hyperlipidemia were excluded. Fasting glucose, HBA1C, insulin levels, HDL cholesterol, triglyceride levels, waist circumference and blood pressure were measured before starting chemotherapy and then every 3 months for 1 year. Results were analyzed using repeated measures ANOVA for normally distributed data. For data that was not normally distributed, Friedmans non parametric test was utilized.

A survey of dietary habits, exercise frequency and life style factors was administered before initiating treatment and at completion of the study.

Results:

Baseline characteristics: Of the 35 patients enrolled 31 were hispanics (89%). Median age was 47 years (33-68). 31 (82.8%) were over weight or obese. 13 (37%) had insulin resistance as assessed by HOMA (homeostatic model assessment)-IR, and 12 (34%) met the international diabetic federation (IDF) criteria for metabolic syndrome. 17% had stage 1, 52% had stage 2 and 31% had stage 3 disease. Most common chemotherapy regimen used was dose dense doxorubicin, cyclophosphamide and weekly paclitaxel.

No significant change was noted in the fasting glucose, HBA1C levels, insulin levels, HOMA-IR, weight or waist circumference at any point during the 1 year follow up. Triglyceride levels increased from a mean of 162.2mg/dl prior to therapy to 202.8mg/dl by 3 months, p=0.014. HDL-cholesterol fell from a mean of 50.6 mg/dl to 44mg/dl by 3 months, p=0.04.

Both triglyceride levels and HDL levels returned to baseline by 9 months and there was no change noted by 12 months. Overall 12 patients (34%) met the IDF criteria for metabolic syndrome before initiating adjuvant therapy as compared to 14 (40%) at 1 year.

Subgroup analysis of patients with preexisting metabolic syndrome, obesity or insulin resistance (HOMA-IR &gt;3.8) showed similar results.

Analysis of the survey data showed 22 of the 35 patients (62%) had improved their dietary and exercise habits over the course of the study.

Conclusions: Contrary to other studies, we did not find a significant difference in most of the parameters of metabolic syndrome in a predominantly hispanic patient population. A transient increase in triglyceride levels and a decline in HDL cholesterol level was noted at 3 months, however resolved by the 9th month of treatment. Our data suggests that life style modification may mitigate most of the metabolic adverse effects of therapy and women, at the time of diagnosis, may be particularly motivated to make such changes.

Citation Format: Gaur S, Ochoa C, Sanchez L, Nahleh Z. Effects of breast cancer treatment on markers of metabolic syndrome in a predominantly hispanic patient population. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-07.

Relative contribution of biological variation and technical variables to zone diameter variations of disc diffusion susceptibility testing

OBJECTIVES

Disc diffusion is still largely based on manual procedures. Technical variations originate from inoculum preparation, variations in materials, individual operator plate streaking and reading accuracy. Resulting measurement imprecision contributes to categorization errors. Biological variation resembles the natural fluctuation of a measured parameter such as antibiotic susceptibility around a mean value. It is deemed to originate from factors such as genetic background or metabolic state. This study analysed the relative contribution of different technical and biological factors to total disc diffusion variation.

METHODS

For calculation of relative error factor contribution to disc diffusion variability, five experiments were designed keeping different combinations of error factors constant. A mathematical model was developed to analyse the individual error factor contribution to disc diffusion variation for each of the tested drug-species combinations.

RESULTS

The contribution of biological variation to total diameter variance ranged from 10.4% to 98.8% for different drug-species combinations. Highest biological variation was found for Enterococcus faecalis WT and vancomycin (98.8%) and for penicillinase-producing Staphylococcus aureus and penicillin G (96.0%). Average imprecision of automated zone reading revealed that 1.4%-5.3% of total imprecision was due to technical variation, while materials, i.e. antibiotic discs and agar plates, contributed between 2.6% and 3.9%. Inoculum preparation and manual plate streaking contributed 6.8%-24.8% and 6.6%-24.3%, respectively, to total imprecision.

CONCLUSIONS

This study illustrates the relative contributions of technical factors that account for a significant part of total variance in disc diffusion. The highest relative contribution originated from the operator, i.e. manual inoculum preparation and plate streaking. Further standardization of inoculum preparation and plate streaking by automation could potentially increase the precision of disc diffusion and improve the correlation of susceptibility reports with clinical outcome.

Evo-devo mechanisms underlying the continuum between homology and homoplasy

The different manifestations of equivalence and similarity in structure throughout evolution suggest a continuous and hierarchical process that starts out with the origin of a morphological novelty, unit, or homologue. Once a morphological unit has originated, its properties change subsequently into variants that differ, in magnitude, from the original properties found in the common ancestor. We will look into the nature of morphological units and their degrees of modification, which will provide the starting point for restructuring the concept of "homology," keeping the use of homology as the identity of an anatomical part, and homogeny, as the specific variation of that anatomical part during evolution. We will also show that parallelism has a distinct placement within an evolutionary continuum between homology and homoplasy, whereas the phenomenon of evolutionary convergence is left outside this continuum. We will then provide some epistemological and developmental criteria to justify these distinctions, showing that there is a direct relation between the nature of these concepts and the constraints that developmental mechanisms impose on evolution. Finally, we will propose a hierarchical model that places homology, homogeny, homoplasy, and parallelism, as distinct phenomena within an evolutionary continuum.

Utility of noninvasive ventilation in high-risk patients during endoscopic retrograde cholangiopancreatography

Background:

There is little evidence on noninvasive ventilation (NIV) preventing respiratory complications in high-risk patients undergoing endoscopy procedures.

Objectives:

The objective of this study is to demonstrate that the application of NIV through a nasal interface can prevent the appearance of ventilatory alterations during endoscopic retrograde cholangiopancreatography (ERCP) in patients with risk factors associated with the development of hypoventilation.

Patients and Methods:

A non-randomized interventional study was performed on 37 consecutive high-risk patients undergoing ERCP. During the procedure, 21 patients received oxygen by nasal cannula (3 L/minute) and sixteen received NIV through a nasal mask. Arterial blood gas analyses were conducted before and immediately after the ERCP. An Acute Physiology and Chronic Health Evaluation (APACHE) score pre-ERCP was recorded. The complications during the procedure were recorded.

Results:

The groups with and without NIV were comparable. A post-ERCP pH of <7.35 was found in eight patients, who did not receive ventilatory support (38.1%) compared to zero patients in the NIV group (P = 0.006). A post-ERCP pCO₂ >45 mmHg was found in one case (6.3%) in the NIV-group and in nine cases in the nasal cannula group (42.9%; P = 0.01). The median pCO₂ post-ERCP was lower (36.5 ± 6.2 vs. 44.5 ± 6.8 mmHg) (P = 0.001) and median pH post-ERCP was higher (7.41 ± 0.4 vs. 7.34 ± 0.5) (P = 0.001) in patients treated with NIV. In the multivariate analysis, after adjusting for gender, the APACHE score, pH and pCO₂ pre-ERCP, age, propofol doses, and procedure duration, the following differences were maintained (pCO₂ difference = 5.54, 95% Confidence Interval (CI) =2.3 – 8.7, pH difference = 0.047, and 95% CI = 0.013 – 0.081). Among the 37 procedures, four complications occurred: One in the NIV group and three in the nasal cannula group. None of them was related to NIV.

Conclusions:

Our preliminary results demonstrate that in high-risk patients undergoing ERCP, hypercapnia and respiratory acidosis are frequent. NIV prevents the appearance of these complications.

[General anaesthesia and obstetric bleeding in caesarean section. One year's experience in a university hospital]

INTRODUCTION

Obstetric haemorrhage is an important worldwide cause of morbidity and mortality. General anaesthesia for caesarean section is rarely used. Our goal is to analyse the incidence, causes and risk factors associated with general anaesthesia for caesarean section, and the prevalence of obstetric haemorrhage (HO), its risk factors and predictors of post-caesarean HO together with the use of blood in our hospital population.

METHODS

A retrospective study was conducted on all caesarean section discharge reports from PACU in 2008.

RESULTS

General anaesthesia was required in 12.4% of the patients. Epidural catheter failure as a cause of general anaesthesia was infrequent (2.8%) and within the recommended standards.

CONCLUSIONS

The most frequent indications for caesarean section under general anaesthesia included mainly life-threatening emergencies, and the most important risk factors for general anaesthesia, including coagulation disorders, bleeding in the third trimester, foetal distress and severe pre-eclampsia. General anaesthesia is a risk factor for transfusion, as is abruptio placentae, placenta previa and pre-eclampsia.

[Endovascular treatment of stenosis of the renal artery in transplanted kidney]

INTRODUCTION

The incidence of renal artery stenosis in the transplanted kidney (TRAS) varies between 2 and 23%, being the most frequent vascular complication following renal trasplantation. The delay in diagnosis and treatment can lead to functional graft loss. Percutaneous trasluminal angioplasty with stent (PTAS) is the treatment of choice to restore kidney perfusion.

MATERIALS AND METHODS

Retrospective review of renal transplant casuistic in our institution between September 2005 and August 2009. Were included patients with greater than 70% TRAS and impaired graft function, treated with PTAS. Follow-up at 3, 12 and 36 months was done with creatinine, glomerular filtration rate (GFR) and Doppler ultrasonography (DUS). Technical success was defined as correct stent placement associated with decreased flow, and clinical success as improve renal function during follow-up.

RESULTS

Incidence of TRAS was 7.3% (22/298), 60% PTAS subsidiary. 100% technical success and 84.6% clinical success, 15.4% without changes in renal function. 84% decreases flow rate greater than 70% by DUS, and 26% up to 60%. Wave changes from type III to type II were recorded in 69% and to type I in 33%.

CONCLUSIONS

The PTAS is a safe and effective procedure for the treatment of selected TRAS patients, as it preserves vascular permeability in short and medium term, ensuring the functionality of the graft. DUS is the method of choice for diagnosis and monitoring TRAS.

The role of a peri-urban forest on air quality improvement in the Mexico City megalopolis

Air quality improvement by a forested, peri-urban national park was quantified by combining the Urban Forest Effects (UFORE) and the Weather Research and Forecasting coupled with Chemistry (WRF-Chem) models. We estimated the ecosystem-level annual pollution removal function of the park's trees, shrub and grasses using pollution concentration data for carbon monoxide (CO), ozone (O(3)), and particulate matter less than 10 microns in diameter (PM(10)), modeled meteorological and pollution variables, and measured forest structure data. Ecosystem-level O(3) and CO removal and formation were also analyzed for a representative month. Total annual air quality improvement of the park's vegetation was approximately 0.02% for CO, 1% for O(3,) and 2% for PM(10), of the annual concentrations for these three pollutants. Results can be used to understand the air quality regulation ecosystem services of peri-urban forests and regional dynamics of air pollution emissions from major urban areas.

EUS-guided single-incision needle-knife biopsy: description and results of a new method for tissue sampling of subepithelial GI tumors (with video)

BACKGROUND

The diagnostic efficacy of current tissue sampling techniques for upper GI subepithelial tumors (SETs) appears to be limited. Better tissue acquisition techniques are needed to improve the diagnostic yield in this setting.

OBJECTIVE

Our purpose was to determine the safety and diagnostic yield of EUS-guided needle-knife incision and forceps biopsy (SINK biopsy) of upper GI SETs.

DESIGN

Retrospective database review.

SETTING

Academic tertiary-care referral center.

PATIENTS

This study involved 14 consecutive patients referred for EUS evaluation of upper GI SETs with previous unsuccessful attempts at tissue diagnosis by conventional forceps biopsy.

INTERVENTION

EUS-guided needle-knife incision and forceps biopsy.

MAIN OUTCOME MEASUREMENTS

The safety and diagnostic yield of this method, compared with EUS-guided fine-needle aspiration (EUS-FNA), when possible.

RESULTS

SINK biopsy provided tissue samples that were sufficient for definite histologic diagnosis in 13 of 14 cases (diagnostic yield 92.8%). There were 8 gastric GI stromal tumors. In 7 of 8, the size of SINK specimens allowed immunohistochemical analysis, and the evaluation of malignant potential was carried out by means of mitotic index determination in 5 cases (71.42%). SINK biopsies determined the pathological diagnosis of all (4 of 4) nonmesenchymal lesions. Eight patients underwent both EUS-FNA and SINK, with final histologic diagnosis determined in 6 of 8 cases (75%) by SINK versus 1 of 8 cases (12.5%) by EUS-FNA (Fisher exact test, P = .023). There were no procedure-related complications.

LIMITATIONS

A single-center, retrospective analysis with small sample size.

CONCLUSION

SINK biopsy appears to be an easy, safe, and effective technique for determining the definitive pathological diagnosis, evaluation of the malignant potential, and planning management of SETs. It could be a reliable alternative to conventional FNA, providing larger samples that improve the histologic yield.