Modulating Driver Alertness via Ambient Olfactory Stimulation: A Wearable Electroencephalography Study

Poor alertness levels and related changes in cognitive efficiency are common when performing monotonous tasks such as extended driving. Recent studies have investigated driver alertness decrement and possible strategies for modulating alertness with the goal of improving reaction times to safety critical events. However, most studies rely on subjective measures in assessing alertness changes, while the use of olfactory stimuli, which are known to be strong modulators of cognitive states, has not been commensurately explored in driving alertness settings. To address this gap, in the present study we investigated the effectiveness of olfactory stimuli in modulating the alertness state of drivers and explored the utility of electroencephalography (EEG) in developing objective brain-based tools for assessing the resulting changes in cortical activity. Olfactory stimulation induced a significant differential effect on braking reaction time. The corresponding effect to the cortical activity was characterized using EEG-derived metrics and the devised machine learning framework yielded a high discriminating accuracy (92.1%). Furthermore, neural activity in the alpha frequency band was found to be significantly associated with the observed drivers' behavioral changes. Overall, our results demonstrate the potential of olfactory stimuli to modulate the alertness state and the efficiency of EEG in objectively assessing the resulting cognitive changes.

Functional outcomes after transanal ileal pouch-anal anastomosis for ulcerative colitis: narrative review of the current literature

The transanal approach to ileal pouch-anal anastomosis (Ta-IPAA) for ulcerative colitis was introduced in 2015 and has since been shown to be a safe and feasible technique, although the impact of this approach on patient function remains unclear. A systematic literature review was performed to identify studies exploring functional outcomes and quality of life after Ta-IPAA. Seven papers were identified, which all demonstrated satisfactory functional outcomes after Ta-IPAA as measured by tools such as Cleveland Global Quality of Life (CGQOL), Oresland Score (OS), Pouch Functional Score (PFS), and Inflammatory Bowel Disease Questionnaire (IBDQ). Many gaps in the literature were identified including paucity of follow-up data beyond the 1-year mark, lack of fertility and fecundity assessment as functional outcomes, and limited evaluation of objective physiologic anal sphincter function. The Ta-IPAA therefore shows promise for good functional results in the short-term, although further research will be required to evaluate the stability of function over time as the technique becomes increasingly integrated into modern surgical practice.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Clinical standards for the diagnosis, treatment and prevention of TB infection

BACKGROUND: Tuberculosis (TB) preventive therapy (TPT) decreases the risk of developing TB disease and its associated morbidity and mortality. The aim of these clinical standards is to guide the assessment, management of TB infection (TBI) and implementation of TPT.METHODS: A panel of global experts in the field of TB care was identified; 41 participated in a Delphi process. A 5-point Likert scale was used to score the initial standards. After rounds of revision, the document was approved with 100% agreement.RESULTS: Eight clinical standards were defined: Standard 1, all individuals belonging to at-risk groups for TB should undergo testing for TBI; Standard 2, all individual candidates for TPT (including caregivers of children) should undergo a counselling/health education session; Standard 3, testing for TBI: timing and test of choice should be optimised; Standard 4, TB disease should be excluded prior to initiation of TPT; Standard 5, all candidates for TPT should undergo a set of baseline examinations; Standard 6, all individuals initiating TPT should receive one of the recommended regimens; Standard 7, all individuals who have started TPT should be monitored; Standard 8, a TBI screening and testing register should be kept to inform the cascade of care.CONCLUSION: This is the first consensus-based set of Clinical Standards for TBI. This document guides clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage TBI.

Putting the cart (antecedents) before the horse (absorptive capacity): the role of competitive antecedents to the absorptive capacity innovation process

Purpose

The purpose of this study is to theoretically and empirically advance a concept of competitive antecedents to absorptive capacity (AC) research and to explain their relationship to a firm’s innovative performance. A firm’s competitive antecedents involve a relative advantage in a firm’s ability to access external knowledge – (i.e. relative advantage in external knowledge flows) – and a relative advantage in appropriating these external knowledge flows (i.e. relative advantage in appropriability regime).

Design/methodology/approach

By drawing on network and market share explanations, hypotheses were developed in which a firm’s AC is argued to mediate the influence of these competitive antecedents on a firm’s innovations. In using linear and negative binomial estimation methods, a mediation analysis of the US biotechnology industry was conducted.

Findings

A firm’s competitive antecedents have a positive influence on a firm’s AC and that these influences indirectly impact a biotechnology firm’s product innovations.

Originality/value

While a firm’s innovation is widely attributed to its AC, this study’s concept of competitive antecedents shows that a firm’s competitive advantage lies upstream from its AC.

Fitting in as an outsider: a resource dependence theory approach to outside boards

Purpose

This study draws on resource dependence theory (RDT) to explain a board's governance function in the United States (US) nonprofit healthcare industry. Specifically, while various nonprofit research studies have appealed to agency theory (AT) to explain the monitoring role of an outside board, RDT offers an alternative explanation that emphasizes an outside board's resource gathering role.

Design/methodology/approach

In drawing on the nonprofit GuideStar database, a fixed effect (FE) panel estimation was conducted on a sample of 230 US Non Profit Healthcare Organizations (NPHCOs). This panel estimation examines the relationship between the composition of an outside board and an NPHCO’s revenue and public support performance.

Findings

A key finding of this study is that the composition of an outside board involving its' number, compensation and gender impacts an NPHCO’s revenue and public support.

Research limitations/implications

This study shows that the composition of an outside board impacts an NPHCO’s ability to gain access to external resources. As NPHCOs face increasing pressure to seek external forms of revenue support, this study suggests that boards should favor a larger number, compensation and female representation of outside members.

Practical implications

The composition of an outsider board can offer external sources of revenue support that lower the poor's requirements for financial assistance and thus affirm an NPHCO’s identity as a charitable organization.

Originality/value

As an NPHCO’s identity as a charitable organization is dependent on serving the medical needs of the poor, an outside board not only introduces a resource gathering function that is absent in the monitoring explanations of AT, but that this resource gathering function is important to affirming this identity.

The perceived impact of Covid-19 on periodontal practice in the United Kingdom: A questionnaire study

INTRODUCTION

COVID-19 has impacted dentistry in unprecedented ways.

OBJECTIVE

The following research aimed to investigate the impact of the COVID-19 pandemic on periodontal practice in the United Kingdom using the COM-B (Capability Opportunity Motivation-Behaviour) model as the basis for a questionnaire.

BASIC RESEARCH DESIGN

An online survey link was sent to all members of the British Society of Periodontology and Implant Dentistry. A total of 358 responses were received and analysed.

RESULTS

The great majority of participants thought that the pandemic had an impact on their profession, while only 4.7 % had no concerns. The main worries related to financial concerns and ability to provide appropriate levels of care. More than 80 % of respondents agreed that their establishment was compliant with infection control procedures. Some participants felt benefits mainly in terms of more time for CPD activities. It was felt that some of the changes needed will need to be sustained long-term.

CONCLUSIONS

Respondents were generally worried. However, they perceived they had the physical and psychological ability to effect changes to their practice, higher than the physical and social opportunities that they were afforded. Although the COVID-19 pandemic is causing profound changes and worries for the profession of Periodontology, clinicians are clear about their capability to control the situation and feel they have the motivation to make the required changes.

CLINICAL SIGNIFICANCE

COVID-19 has presented clinicians with novel challenges. Investigating the professional response to change and expected impact is of interest in the current climate as we navigate the 'new normal'. Assessing the results could be useful in informing support strategies moving forward.

Looking forward instead of backward

Purpose

According to behavioral research, aspirations influence a firm's search – exploitive and explorative – for solutions that satisfy a firm's goals. Yet, such goal seeking behavior is adaptive to a firm's past experiences and not to a manager's expectations of its firm's future. A manager's expectations are often explained in terms of their confidence in future events. The purpose of this study is to address the following research question: how does a manager's confidence influence its expectations of a firm's future performance and goals; and how do these future expectations influence a firm's exploitive/explorative search?

Design/methodology/approach

In drawing on cognition and legitimacy research, a conceptual model was developed to explain the antecedents and outcomes of a firm's “forward-looking” aspirations. The antecedents to a firm's forward-looking aspirations are attributed to a manager's overconfidence – anchoring, confirmation and availability – biases. In using strategic legitimacy explanations, these biases introduce distinct types of forward-looking (exploitive/explorative) search that legitimize/de-legitimize a manager's forward-looking aspirations.

Findings

A key finding of this study is that it introduces a strategic decision-making process in which a firm's exploitive/ explorative search is adaptive toward its forward-looking aspirations.

Research limitations/implications

This forward-looking strategic decision-making process offers research implications to understand how a firm's future goals and expectations can offer new understandings of their past experiences and traditions and explains how a manager's overconfidence biases can influence the assessment of a firm's social aspirational groups.

Practical implications

In addition, this study also offers practical implications in which illustrative examples are used to explain this study's forward-looking strategic decision-making process.

Originality/value

A distinct contribution of this study is that it introduces a forward-looking orientation that has not been previously examined the backward focus of behavioral research.

Associations between subcutaneous fat density and systemic inflammation differ by HIV serostatus and are independent of fat quantity

OBJECTIVES

Adipose tissue (AT) density measurement may provide information about AT quality among people living with HIV. We assessed AT density and evaluated relationships between AT density and immunometabolic biomarker concentrations in men with HIV.

DESIGN

Cross-sectional analysis of men enrolled in the Multicenter AIDS Cohort Study.

METHODS

Abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) density (Hounsfield units, HU; less negative = more dense) were quantified from computed tomography (CT) scans. Multivariate linear regression models described relationships between abdominal AT density and circulating biomarker concentrations.

RESULTS

HIV+ men had denser SAT (-95 vs -98 HU HIV-, P < 0.001), whereas VAT density was equivalent by HIV serostatus men (382 HIV-, 462 HIV+). Historical thymidine analog nucleoside reverse transcriptase inhibitor (tNRTI) use was associated with denser SAT but not VAT. In adjusted models, a 1 s.d. greater SAT or VAT density was associated with higher levels of adiponectin, leptin, HOMA-IR and triglyceride:HDL cholesterol ratio and lower hs-CRP concentrations in HIV- men. Conversely, in HIV+ men, each s.d. greater SAT density was not associated with metabolic parameter improvements and was significantly (P < 0.05) associated with higher systemic inflammation. Trends toward higher inflammatory biomarker concentrations per 1 s.d. greater VAT density were also observed among HIV+ men.

CONCLUSIONS

Among men living with HIV, greater SAT density was associated with greater systemic inflammation independent of SAT area. AT density measurement provides additional insight into AT density beyond measurement of AT quantity alone, and may have implications for metabolic disease risk.

Disclosure of cardiac variants of uncertain significance results in an exome cohort

This study examined the impact of disclosing subclassifications of genetic variants of uncertain significance (VUS) on behavioral intentions. We studied return of VUS results to 79 individuals with a cardiomyopathy-associated VUS, subclassified into VUS-high or VUS-low. Primary outcomes were perceived risk (absolute and comparative), perceived severity, perceived value of information, self-efficacy, decision regret, and behavioral intentions to share results and change behaviors. There was no significant difference between the 2 subclasses in overall behavioral intentions (t = 0.023, P = .982) and each of the individual items on the behavioral intentions scale; absolute (t = -1.138, P = .259) or comparative (t = -0.463, P = .645) risk perceptions; perceived value of information (t = 0.582, P = .563) and self-efficacy (t = -0.733, P = .466). Decision regret was significantly different (t = 2.148, P = .035), with VUS-low (mean = 17.24, SD = 16.08) reporting greater regret. Combining the subclasses, perceived value of information was the strongest predictor of behavioral intentions (β = 0.524, P < .001). Participants generally understood the meaning of a genetic VUS result classification and reported satisfaction with result disclosure. No differences in behavioral intentions were found, but differences in decision regret suggest participants distinguish subclasses of VUS results. The perceived value of VUS may motivate recipients to pursue health-related behaviors.

The CT Swirl Sign Is Associated with Hematoma Expansion in Intracerebral Hemorrhage

BACKGROUND AND PURPOSE

Hematoma expansion is an independent determinant of poor clinical outcome in intracerebral hemorrhage. Although the "spot sign" predicts hematoma expansion, the identification requires CT angiography, which limits its general accessibility in some hospital settings. Noncontrast CT, without the need for CT angiography, may identify sites of active extravasation, termed the "swirl sign." We aimed to determine the association of the swirl sign with hematoma expansion.

MATERIALS AND METHODS

Patients with spontaneous intracerebral hemorrhage between 2007 and 2014 who underwent an initial and subsequent noncontrast CT at a single center were retrospectively identified. The swirl sign, on noncontrast CT, was defined as iso- or hypodensity within a hyperdense region that extended across 2 contiguous 5-mm axial CT sections.

RESULTS

A total of 212 patients met the inclusion criteria. The swirl sign was identified in 91 patients with excellent interobserver agreement (κ = 0.87). The swirl sign was associated with larger initial hematoma (P < .001) and earlier initial CT (P < .001) and hematoma expansion (P = .028). Multivariable regression modeling demonstrated that if one assumed similar initial hematoma volume, onset-to-first scan, and time between CT scans, the median absolute hematoma growth was 5.77 mL (95% CI, 2.37-9.18 mL; P = .001) and relative growth was 35.6% (95% CI, 18.5%-52.6%; P < .001) higher in patients with the swirl sign compared with those without.

CONCLUSIONS

The NCCT swirl sign was reliably identified and is associated with hematoma expansion. We propose that the swirl sign be included in risk stratification of intracerebral hemorrhage and considered for inclusion in clinical trials.

Global variability in leaf respiration in relation to climate, plant functional types and leaf traits

Leaf dark respiration (Rdark ) is an important yet poorly quantified component of the global carbon cycle. Given this, we analyzed a new global database of Rdark and associated leaf traits. Data for 899 species were compiled from 100 sites (from the Arctic to the tropics). Several woody and nonwoody plant functional types (PFTs) were represented. Mixed-effects models were used to disentangle sources of variation in Rdark . Area-based Rdark at the prevailing average daily growth temperature (T) of each site increased only twofold from the Arctic to the tropics, despite a 20°C increase in growing T (8-28°C). By contrast, Rdark at a standard T (25°C, Rdark (25) ) was threefold higher in the Arctic than in the tropics, and twofold higher at arid than at mesic sites. Species and PFTs at cold sites exhibited higher Rdark (25) at a given photosynthetic capacity (Vcmax (25) ) or leaf nitrogen concentration ([N]) than species at warmer sites. Rdark (25) values at any given Vcmax (25) or [N] were higher in herbs than in woody plants. The results highlight variation in Rdark among species and across global gradients in T and aridity. In addition to their ecological significance, the results provide a framework for improving representation of Rdark in terrestrial biosphere models (TBMs) and associated land-surface components of Earth system models (ESMs).

Neck and shoulder muscle activity during standardized work-related postural tasks

The aim of the present study was to assess the activity levels of the sternocleidomastoid muscle and upper trapezius muscle during static postures under controlled and standardized conditions, and to determine whether the muscle activity differed between sexes. Electromyographic (EMG) activity was recorded unilaterally from the sternocleidomastoid and upper trapezius muscle in 17 participants whilst they were performing various postural tasks. EMG amplitude was measured by the root mean square values of the raw signals and normalized to peak maximum contractile values for each muscle (%MVC). The intensity of muscle activity was ranked as light (<3%MVC), moderate (3%MVC ≤ EMG ≤ 8%MVC), and substantial (>8%MVC). During most tasks the two muscles contracted light to moderately. Head leaning and shoulder shrugging postures yielded substantial muscle activity in both muscles. Muscle activity did not differ significantly between male and female participants (F = 3.1; p = 0.078). Our findings provided normative values, which will enhance future studies of muscle activity during work in a natural, unrestrained environment.

Quinolizidine alkaloids obtained byPedicularis semibarbata (Scrophulariaceae) fromLupinus fulcratus (Leguminosae) fail to influence the specialist herbivoreEuphydryas editha (Lepidoptera)

Pedicularis semibarbata is apparently an obligate hemiparasite of coniferous trees. It is also a facultative parasite ofLupinus fulcratus from which we find that it obtains quinolizidine alkaloids, principally α-isolupanine. As a result, a single population ofP. semibarbata contains both alkaloidrich and alkaloid-free plants. The butterflyEuphydryas editha naturally oviposits on both plant types. This butterfly population, which is the principal herbivore attackingP. semibarbata at this site, is known to contain two morphs. Individuals of a specialist morph discriminate when ovipositing among individualP. semibarbata plants and produce offspring that survive better on accepted than on rejected plants. Those of a generalist morph accept allP. semibarbata plants and produce offspring that survive equally well on plants accepted or rejected by the discriminating morph. Because of the existence of this complex variation among the butterflies, the presence of naturally laid eggs on alkaloid-containing plants still leaves the possibility that the alkaloids may defend the plants against the specialist morph. In experiments on both oviposition preference and larval performance in early instars, we failed to detect any correlation between alkaloid content of a plant and either its acceptability to or suitability for the discriminating morph of the insect. Alkaloid presence in the host-plant population, achieved through root parasitism, is currently neither subject to strong insect-mediated selection nor a major cause of selection on the insects.

Would CLSI M53-A have helped in the diagnosis of HIV in Canada? Results of the performance of Canadian laboratories participating in a recent NLHRS proficiency testing panel containing HIV-1 antigen positive (antibody negative) and HIV-2 samples

INTRODUCTION

The Clinical and Laboratory Standards Institute recently published M53-A, Criteria for Laboratory Testing and Diagnosis of Human Immunodeficiency Virus (HIV) Infection; Approved Guideline (2011), which includes a state of the art algorithm for identifying HIV-1 acute and HIV-2 infections. To assess the ability of Canadian laboratories to detect these sample types and the impact of M53-A, the National Laboratory for HIV Reference Services distributed a special proficiency testing panel.

METHODS

HIVS425-2012Nov22 was sent to 42 laboratories across Canada. It contained one HIV negative sample (B), two HIV-1 positive samples (A and E), one HIV-2 positive sample (C) and one HIV-1/2 antibody negative-HIV-1 antigen positive sample (D). Data was collected and analyzed using DigitalPT; a standardized on-line tool.

RESULTS

Forty-one laboratories returned results. Sample B (HIV negative) was identified by 95% of laboratories (39/41) and samples A and E (HIV-1 positive) by 98% (40/41). No laboratory identified sample C as HIV-2 positive, although 85% (35/41) detected reactivity prompting a referral for further testing. The remaining laboratories identified sample C as HIV-1 positive (4), indeterminate (1) or gave no final status (1). Sample D (HIV antibody negative-antigen positive) was correctly identified by two laboratories as HIV-1 antigen positive while 78% (32/41) detected reactivity, recommending further testing. One laboratory did not provide a final status. Alarmingly, six laboratories called this sample HIV negative.

CONCLUSION

Although there is a high quality of HIV testing across Canada, introduction of the M53-A guideline would further improve the ability of laboratories to diagnose HIV-1 acute and HIV-2 infection.

Seeing through the fog of ambiguity: Entrepreneurial judgments under decision settings of complexity

A most elemental concern of entrepreneurship pertains to how they make judgments under uncertainty. Empirical evidence has found that most new ventures result in failure, yet entrepreneurs tend to form judgments about their venture's success in highly optimistic terms. As entrepreneurs operate in a context of ambiguity, the concepts of “ambiguity” and “ambiguity aversion” from the decision sciences are drawn upon to develop a theoretical model of entrepreneurial overconfidence. In this proposed theoretical model, the entrepreneur operates under uncertain settings characterized by complexity. Complexity is argued to yield a distinct overconfidence bias in an entrepreneur's judgments of future events. This study concludes with its contributions and implications to entrepreneurial research.

Abstract P5-18-14: Cardiac monitoring during adjuvant trastuzumab therapy for breast cancer

Background: Adjuvant trastuzumab improves survival in HER2+ breast cancer. Cardiac toxicity is an important potential side effect. We report real world practice patterns in cardiac monitoring and outcomes during adjuvant trastuzumab therapy in Ontario.

Methods: A cohort of female patients diagnosed with early breast cancer from Jan 1, 2006 to Dec 31, 2007 and who received trastuzumab was identified retrospectively through linkage of provincial administrative and registry databases. Demographic, pathology, treatment, hospital admissions, claims for cardiac tests (MUGA or echo), and outcomes were extracted for individuals. Pre-existing cardiac disease (CHF, MI, angina, valve disorder, arrhythmia, cardiomyopathy) and risk factors (diabetes, lipid disorder, hypertension) were classified using ICD-10 codes. Appropriate cardiac monitoring definitions were based on published trials and expert opinion. Symptomatic cardiac toxicity was defined as a physician claim or hospital admission with a cardiac diagnosis occurring within 2 years of the first trastuzumab dose. Asymptomatic cardiac toxicity was defined as temporary or permanent cessation of trastuzumab with additional cardiac tests. Patients were categorized into treatment groups: G1 received at least 17 doses (standard 3-weekly administration for 51 weeks) with no complications; G2 stopped early for non-cardiac reasons (no additional cardiac tests); G3 had symptomatic or asymptomatic cardiac toxicity. Analyses of patient, treatment and system factors possibly affecting cardiac monitoring and toxicity were performed.

Results: 1,357 patients diagnosed with early breast cancer between 2006–7 received trastuzumab (median = 18 doses). 77% received anthracyclines; 4.1% had at least 1 cardiac risk factor. The majority (91%) had a baseline cardiac test, including 96% of those with cardiac risks. Geographic region was associated with baseline testing, but multivariable analysis of other factors including urbanicity, left lateral radiation, age, income, and anthracycline use, did not explain the variation in baseline testing patterns. The majority, 81%, had ≥3 cardiac tests, 62.2% had ≥4. Cardiac monitoring was deemed appropriate in 80.7% of patients without cardiac events, and 73.4% in those with symptomatic or asymptomatic cardiac events. Multivariable analysis revealed duration of trastuzumab to be the most significant factor associated with appropriateness of cardiac monitoring (G1 - OR 0.62, p = 0.018, 95% CI 0.45–0.92; G3 - OR 4.56, p &lt; 0.001, 95% CI 2.47–8.42). 297 patients (22%) experienced symptomatic (7%) or asymptomatic (15%) cardiac toxicity. Duration of trastuzumab (&lt;17 doses; OR 6.47, p &lt; 0.001, 95% CI 4.79–8.75) was associated with cardiac toxicity.

Conclusions: The majority of early breast cancer patients that received adjuvant trastuzumab in Ontario between 2006–7 had cardiac monitoring consistent with clinical trials. Cardiac toxicity in this real world population, as defined by our database analysis, was unexpectedly higher than reported in trials. Shorter duration of trastuzumab was associated with cardiac toxicity, likely reflecting the practice of stopping trastuzumab in the presence of cardiac events.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-18-14.

A prototype 64-electrode stimulator in 65 nm CMOS process towards a high density epi-retinal prosthesis

This paper presents a highly flexible 64-electrode stimulator using 65 nm CMOS process fabricated as a stage towards a 1024-electrode epi-retinal prosthesis, which aims to restore partial vision in patients suffering from eye diseases such as retinitis pigmentosa (RP) and age-related macular degradation (AMD). The stimulator drives 64 electrodes with many flexible features, which are necessary before making a complete 1024-electrode implant chip. Each electrode driver can provide a bi-phasic stimulus current with fully programmable parameters such as amplitude, pulse duration, inter-phase gap, and stimulation rate. The electrode driver operates in an alternately pull-push manner with only one current source working at a time, which helps reduce headroom voltage while controlling charge balance at the active electrode. The stimulator varies both stimulus current amplitude and stimulation rate to represent phosphene brightness. The stimulus current amplitude starts from the tissue depolarization threshold with 64 different levels. The selection of active and return electrodes is arbitrary, any electrodes and any number of them can be selected at any time. The power consumption of the stimulator is 400 μW excluding the stimulus power. Measurement results verify correct operation. The stimulator is easily scaled up to drive 1024 electrodes.

Informational stories: a complementary strategy for patients and caregivers with brain metastases

Objective

We compared the efficacy of a story-based writing style with that of a fact-based writing style for educational material on brain metastases.

Methods

Identical informational content on four topics—radiation therapy, side effects, steroid tapering, and palliative care—was constructed into equivalent story-based and fact-based materials. The content and reader preference for style were evaluated using a questionnaire of 20 + 1 items. Cancer patients and caregivers were invited to evaluate the materials.

Results

A total of 47 participants completed the questionnaire. The recorded preferences for facts, stories, or both were 42%, 7%, and 51% respectively (p = 0.0004). The fact-based materials were rated superior in providing factual information (for example, discussion of treatment, side effects) and selected general characteristics (clarity of information, for instance). A rating trend suggested that story-based materials were superior in describing “how it feels to have brain metastases” (21/40 fact-based vs. 26/43 story-based) and “how brain metastases affected a spouse” (17/41 fact-based vs. 21/47 story-based), and in being “sensitive to the frustrations of a patient with brain metastases” (25/40 fact-based vs. 30/44 story-based).

Conclusions

Half the participants preferred to read both fact-based and story-based materials. A combined story-based and fact-based educational resource may be more effective in conveying sensitive information and should be further investigated.

Binge eating, mood, and quality of life in youth with type 2 diabetes: baseline data from the today study

OBJECTIVE

The current study examines the prevalence of binge eating and its association with adiposity and psychosocial functioning in a large, diverse sample of youth with type 2 diabetes.

RESEARCH DESIGN AND METHODS

In the TODAY study, 678 (mean age 14.0 years; 64.9% girls) of the 704 youth randomized to the study completed a self-report measure of eating disorder symptoms and were categorized as nonovereaters, overeaters, subclinical binge eaters, or clinical binge eaters.

RESULTS

Youth with clinical (6%) and subclinical (20%) levels of binge eating had significantly higher levels and rates of extreme obesity, global eating disorder and depressive symptoms, and impaired quality of life.

CONCLUSIONS

These findings highlight the importance of evaluating youth with type 2 diabetes for the presence of binge eating. Future research is needed to determine the cumulative effects of disordered eating, obesity, and psychosocial distress on adherence to lifestyle change recommendations and longitudinal response to treatment.

A fully flexible stimulator using 65 nm CMOS process for 1024-electrode epi-retinal prosthesis

This paper presents a fully flexible stimulator using 65 nm CMOS process for a 1024-electrode epi-retinal prosthesis. The stimulator can select any number of electrodes at any time and also supports both mono-polar and multi-polar stimulation. Furthermore, the stimulator supports a wide range of stimulus parameters. A novel feature is that the electrode driver operates in an alternately pull-push manner, which helps reduce headroom voltage while guaranteeing charge balance at the active electrode. The use of positive supplies instead of both positive and negative supplies simplifies CMOS circuit design. The current distribution between two nearby simultaneously active electrode groups was investigated and measurement result showed a maximum current crosstalk of 8%.

Tetanus antibody protection among HIV-infected US-born patients and immigrants

INTRODUCTION

Public health initiatives to immunize children and adults have effectively reduced the number of tetanus cases in the USA. However, in the Third National Health and Nutrition Examination Survey (NHANES III), immigrants from Mexico had a 67% nonprotective anti-tetanus antibody (ATA) level. Less work has been conducted among other vulnerable populations such as human immunodeficiency virus (HIV)-infected patients. The objective of this study was to measure ATA levels among the HIV immigrant population compared with US-born HIV-infected patients.

METHODS

A convenience sample of 158 HIV-infected individuals was recruited to determine the levels of ATA. A nonprotective level of ATA was defined as below 0.15 IU/ml.

RESULTS

Among the HIV-infected patients, 72% (114/158) were born in the USA. A total of 17% (27/158) lacked protective levels of ATA. A total of 6.1% (7/114) of those born in the USA lacked protection, compared to 45% (20/44) born outside the USA (p < 0.0001).

CONCLUSION

The results illustrate that the country of birth is an important predictor of ATA protection, even among HIV-infected patients.

Role of Tc-99m DMSA (V) scanning and serum calcitonin monitoring in the management of medullary thyroid carcinoma

INTRODUCTION

Medullary thyroid carcinoma (MTC) is a rare disease. Serum calcitonin levels and Tc-99m DMSA (V) scans are used in the follow-up of these patients after surgical resection. We present our experience in the follow-up of these patients at a tertiary institution.

METHODS

A retrospective review of the medical records was performed. Patients with histologically-proven MTC, and who had serum calcitonin assays and DMSA (V) scans in their postoperative follow-up, were included.

RESULTS

There were 17 patients with 56 DMSA (V) scans. Four out of seven patients with elevated preoperative calcitonin measurements had calcitonin normalisation within six months of surgery, and have remained disease-free. Two patients had persistently elevated calcitonin levels after six months, which predated positive DMSA (V) scans. Results of DMSA (V) scans and serum calcitonin levels were concordant in 38 of 48 instances (79.2 percent) and discordant in 10 of 48 instances (20.8 percent). Sensitivity of DMSA (V) scans for detecting recurrence was 71.4 percent. There were no false-positive scans.

CONCLUSION

Serum calcitonin level is a sensitive and specific indicator of disease recurrence in postoperative follow-up of patients with MTC. Early (within six months) normalisation of calcitonin levels postsurgery may predict subsequent disease-free status. Discordant results between serum calcitonin levels and DMSA (V) scans may be due to undetectable lesions and follow-up scans or alternative radionuclide imaging may be required.

Pain characteristics and demographics of patients attending a university-affiliated pain clinic in Toronto, Ontario

BACKGROUND

Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices.

OBJECTIVE

The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university-affiliated tertiary care pain clinic in Toronto, Ontario.

METHODS

Data were collected on 1242 consecutive new patients seen over a three-year period at the Comprehensive Pain Program in central Toronto.

RESULTS

Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35- to 49-year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three-quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral.

CONCLUSIONS

The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.

Is there a link between breast cancer and abortion: a review of the literature

The hormonal changes that take place in pregnancy cause breast tissue to proliferate and differentiate. Abortion interrupts this process and may leave the proliferated, undifferentiated breast tissue at higher risk of carcinogenesis. This review explains the supposed difference in effects of induced and spontaneous abortion upon the breast tissue and examines the literature for a link with breast cancer. Additional subcategories examined include parity, number of abortions, gestation, and maternal age at abortion. A comparison of retrospective and prospective studies is made and possible sources of bias are identified. There is no evidence to support a link between spontaneous abortion and breast cancer. Absence of a link with induced abortion is less clear, and further research should concentrate on investigating any relationship. We suggest that prospective research is used, with point of entry at first termination.