Interpreting out-of-pocket expenditures for cancer patients: The importance of considering baseline household income information

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Background: Few studies have examined cancer-related out-of-pocket costs (expenses resulting from cancer morbidity and treatment that are not covered by insurance) as a function of baseline household income. We report income-adjusted out-of-pocket cost ratios for 50 patients with lymphoma and 156 patients with breast cancer. Methods: Patients with lymphoma or breast cancer provided 3-month retrospective documentation of cancer-related out-of-pocket costs. Costs were adjusted for income by dividing monthly costs by monthly household income. Direct medical costs include costs related to medications, doctor visits, and hospital stays. Direct non-medical costs are cancer-related peripheral costs, such as transportation and meals. Indirect costs are costs due to lost income. Results: Of our study patients, 83% were Caucasian, 65% were married, 53% were employed, and 65% had at least a bachelor's degree. All patients were undergoing active treatment and had insurance. Mean monthly out-of-pocket costs for patients with lymphoma were slightly greater than for those with breast cancer ($1,888 vs $1,455, respectively). Among patients with an annual income of $30,000 or less, the total monthly out-of-pocket costs were more than 3 times the monthly household income for patients with lymphoma and equal to the monthly household income for patients with breast cancer. The total mean income-adjusted cost ratio was 1.75 for patients with aggressive non-Hodgkin lymphoma versus 0.42 and 0.61 for those with indolent non-Hodgkin lymphoma or Hodgkin disease, respectively. Conclusions: Cancer-related out-of-pocket expenses disproportionately affect lower-income individuals with lymphoma or breast cancer and are primarily driven by the financial burden of co-payments for medical care. Future studies should evaluate out-of-pocket costs in relation to household income to determine more accurately the economic burden of cancer.

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No significant financial relationships to disclose.

Diet and cognitive function in later life: a challenge for nutrition epidemiology

BACKGROUND

As the proportion of old and very old people in the population increases, new research on the influence of diet on health and nutritional needs in later life will be needed. Dietary assessment methods that rely on short-term memory or lengthy interviews, such as the 24-h recall and diet history methods, could have some limitations in this age group. There is some support for the use of food frequency questionnaires (FFQs) in older people, although their validity in the older old and in those with more advanced cognitive decline has not been extensively assessed.

SUBJECTS/METHODS

In a study designed to assess the validity of a modified FFQ in men and women over 65 years, 50 men and 47 women completed two FFQs, and 42 men and 41 women completed one FFQ followed by a 4-day weighed diet diary. Digit span forward (a test of short-term memory) and verbal fluency (a test of executive function) tests were used to assess the possible influence of cognitive function on repeatability and validity of the FFQ.

RESULTS

The FFQ was found to have good repeatability for most nutrients and reasonable validity for some but not all nutrients. Cognitive function assessed prior to the dietary assessment showed no relationship with repeatability, but there was some evidence that validity was lower in those with lower executive function.

CONCLUSIONS

Dietary assessment in healthy older people without overt cognitive decline can be achieved, but development and testing of methods of data collection for each target population and nutrient of interest are particularly important in this age group to ensure valid results. The possibility that cognitive decline influences dietary assessment needs to be borne in mind in the interpretation of observational studies of the influence of dietary intake on cognition in later life.

Fluorescence decay-time constants in organic liquid scintillators

The fluorescence decay-time constants have been measured for several scintillator mixtures based on phenyl-o-xylylethane (PXE) and linear alkylbenzene (LAB) solvents. The resulting values are of relevance for the physics performance of the proposed large-volume liquid scintillator detector Low Energy Neutrino Astronomy (LENA). In particular, the impact of the measured values to the search for proton decay via p-->K(+)nu is evaluated in this work.

Bleach activates a redox-regulated chaperone by oxidative protein unfolding

Hypochlorous acid (HOCl), the active ingredient in household bleach, is an effective antimicrobial produced by the mammalian host defense to kill invading microorganisms. Despite the widespread use of HOCl, surprisingly little is known about its mode of action. In this study, we demonstrate that low molar ratios of HOCl to protein cause oxidative protein unfolding in vitro and target thermolabile proteins for irreversible aggregation in vivo. As a defense mechanism, bacteria use the redox-regulated chaperone Hsp33, which responds to bleach treatment with the reversible oxidative unfolding of its C-terminal redox switch domain. HOCl-mediated unfolding turns inactive Hsp33 into a highly active chaperone holdase, which protects essential Escherichia coli proteins against HOCl-induced aggregation and increases bacterial HOCl resistance. Our results substantially improve our molecular understanding about HOCl's functional mechanism. They suggest that the antimicrobial effects of bleach are largely based on HOCl's ability to cause aggregation of essential bacterial proteins.

Biodegradation of high phenol containing synthetic wastewater by an aerobic fixed bed reactor

The continuous aerobic degradation of phenol, mixed with readily degradable synthetic wastewater was studied over a period of 400 days at 25+/-5 degrees C temperature in a fixed bed biofilm reactor using 'Liapor' clay beads as packing material. The phenol concentration added to the reactor ranged from 0.19 to 5.17g/l and was achieved by a gradual increase of phenol in wastewater, thus adapting the microbial flora to high contaminant concentrations. A maximal removal rate of 2.92g phenol/(ld) at a hydraulic retention time (HRT) of 0.95 days and a total organic loading rate (OLR) of 15.3g COD/(ld) with a phenol concentration of 4.9g/l was observed. However, this was not a stable rate at such high phenol loading. At the end of reactor operation on day 405, the phenol removal rate was 2.3g/(ld) at a influent phenol concentration of 4.9g/l. There were no phenol intermediates present in the reactor, as evident from corresponding COD, phenol removal and the absence of fatty acids. Omission of organic nitrogen compounds or of urea in influent feed was not favourable for optimal phenol removal. The phenol degradation profile that was studied in shake flasks indicated that the presence of a acetate which represent as an intermediate of phenol degradation retarded the phenol degradation. The highest phenol degradation rate observed in batch assays was 3.54g/(ld).

Blood pressure and heart rate immediately after termination of short-term ventricular fibrillation

BACKGROUND

Implantable cardioverter/defibrillators (ICDs) can detect ventricular fibrillation (VF) and terminate it. For determining the optimal defibrillation threshold, ventricular fibrillation is repetitively induced and terminated with DC shocks. Depending on the protocol, several fibrillation/defibrillation sequences are mandatory before the final implantation of an ICD. This procedure provides an elegant human model of circulatory arrest and resuscitation.

PATIENTS AND METHODS

In anesthetized 73 patients (15 females) of on the average 60+/-11 years, the end-expiratory pressure was set to zero. Left ventricular pressure (LVP) was monitored with a microtip-catheter, central venous pressure (CVP) through a cannula which was advanced into the superior V. cava. ECG was recorded. After testing, a monoexponential function was found to best fit the time courses of LVP, CVP and heart rate. Data are mean+/-S.D.

RESULTS

After termination of circulatory arrest, peak LVP increased with a time constant tau of 9.2+/-4.2 beats, CVP decreased with tau=2.8+/-1.5 beats, and RR-intervals decreased with tau=4.3+/-3.5 beats. Correlations between prefibrillatory values and steady-state values after termination of fibrillation were high: peak LVP: r=0.78; CVP: r=0.95; RRI: r=0.82.

SUMMARY

After DC termination of VF, the heart 'finds' relatively quickly a steady-state rhythm at the prefibrillatory level (22 beats), thereby normalizing CVP almost in parallel (14 beats). Peak LVP plateaus only after about 40 beats, although reasonable arterial pressures are reached within the first beats. Our data are limited to periods of ventricular fibrillation of no longer than 60s, which limits the generalisability to the setting of clinical cardiac arrest.

Nuclear hBD-1 accumulation in malignant salivary gland tumours

Background

Whereas the antimicrobial peptides hBD-2 and -3 are related to inflammation, the constitutively expressed hBD-1 might function as 8p tumour suppressor gene and thus play a key role in control of transcription and induction of apoptosis in malignant epithelial tumours. Therefore this study was conducted to characterise proteins involved in cell cycle control and host defence in different benign and malignant salivary gland tumours in comparison with healthy salivary gland tissue.

Methods

21 paraffin-embedded tissue samples of benign (n = 7), and malignant (n = 7) salivary gland tumours as well as healthy (n = 7) salivary glands were examined immunohistochemically for the expression of p53, bcl-2, and hBD-1, -2, -3.

Results

HBD-1 was distributed in the cytoplasm of healthy salivary glands and benign salivary gland tumours but seems to migrate into the nucleus of malignant salivary gland tumours. Pleomorphic adenomas showed cytoplasmic as well as weak nuclear hBD-1 staining.

Conclusion

HBD-1, 2 and 3 are traceable in healthy salivary gland tissue as well as in benign and malignant salivary gland tumours. As hBD-1 is shifted from the cytoplasm to the nucleus in malignant salivary gland tumours, we hypothesize that it might play a role in the oncogenesis of these tumours. In pleomorphic adenomas hBD-1 might be connected to their biologic behaviour of recurrence and malignant transformation.

Effect of transport of growing nanoparticles on capacitively coupled rf discharge dynamics

We present experimental and numerical studies of the properties of a capacitively coupled 13.56MHz discharge in a mixture of Ar and C2H2 with growing nanosize particles. It is found that at the initial stage of the growth, nanoparticles are accumulated near the sheath-plasma boundaries, where the ionization by electrons is maximal. The nanoparticles suppress the ionization due to the absorbing fast electrons and stimulate a quick change of the plasma parameters followed by a transition between different modes of discharge operation. At that moment the peaked distribution of the dust particles transforms into a flat one.

Chitin purification from shrimp wastes by microbial deproteination and decalcification

Chitin was purified from Penaeus monodon and Crangon crangon shells using a two-stage fermentation process with anaerobic deproteination followed by decalcification through homofermentative lactic acid fermentation. Deproteinating enrichment cultures from sewage sludge and ground meat (GM) were used with a proteolytic activity of 59 and 61 mg N l(-1) h(-1) with dried and 26 and 35 mg N l(-1) h(-1) with wet P. monodon shells. With 100 g wet cells of proteolytic bacteria per liter, protein removal was obtained in 42 h. An anaerobic spore-forming bacterium HP1 was isolated from enrichment GM. Its proteolytic activity was 76 U ml(-1) compared to 44 U ml(-1) of the consortium. Glucose was fermented with Lactobacillus casei MRS1 to lactic acid. At a pH of 3.6, calcium carbonate of the shells was solubilised. After deproteination and decalcification of P. monodon or C. crangon shells, the protein content was 5.8% or 6.7%, and the calcium content was 0.3% or 0.4%, respectively. The viscosity of the chitin from P. monodon and C. crangon was 45 and 135 mPa s, respectively, whereas purchased crab shell chitin (practical grade) had a viscosity of 21 mPa s, indicating a higher quality of biologically purified chitin.