Survey of Palliative Care Use in Primary Malignant Bone Tumors: A National Cancer Database Review

Background/Objectives: Palliative care (PC) has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Design/Setting and Subjects: Patients diagnosed with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma) between 2004 and 2018 were identified in the National Cancer Database. Cross tabulations with chi-square analysis were performed to evaluate frequencies of PC use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of PC. Results: Around 24,401 patients were identified. Overall, 2.52% had any form of PC utilization. Of those receiving PC, 55.5-65.1% were treated with only noncurative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of PC utilization were decreased for patients with chordomas, patients living >24 miles from the treatment facility, or patients with private insurance, Medicare, or unknown insurance status. Odds of PC utilization were increased in patients with greater tumor diameter or unknown tumor size, tumors in midline, increased tumor grade, stage IV tumors, or living in urban areas. Conclusion: PC use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, and if the tumor is midline, and in patients living in urban areas. However, overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of PC.

Do mitochondrial DNA haplogroups play a role in susceptibility to tuberculosis?

BACKGROUND AND OBJECTIVES

Mitochondrial DNA has a unique role in ATP production and subsequent mitochondrial reactive oxygen species (ROS) production in eukaryotic cells and there is a potential role for ROS and oxygen burst against Mycobacterium tuberculosis, an intracellular pathogen. This study aimed to determine whether the frequency of different mitochondrial haplogroups was significantly different in patients with tuberculosis (TB) compared with a normal population.

METHODS

Mitochondrial DNA haplogroups M, N, J and K were studied by PCR-restriction fragment length polymorphism and sequencing. Cases were 54 patients with confirmed smear positive pulmonary TB. Controls were 256 healthy persons.

RESULTS

There were no statistically significant differences between those with TB and the control group.

CONCLUSIONS

There was no statistically significant association between mtDNA haplogroups and the presence of TB infection.

Neuroglobin protects PC12 cells against oxidative stress

Neuroglobin (Ngb) is a newly discovered globin in the vertebrate brain that exhibits neuroprotection against hypoxic/ischemic injury. Hypoxic/ischemic brain injury is associated with accumulation of reactive oxygen species (ROS) and/or reactive nitrogen species (RNS), and antioxidants or ROS scavengers promote cell survival. Therefore, Ngb may serve as a scavenger of toxic reactive species, such as hydrogen peroxide. To examine the anti-oxidative role of neuroglobin, PC12 cells were transfected with wild type and mutant (H64 V/H96A) Ngb for 48 h and then treated with H2O2 (0.1, 0.2 and 0.4 mM) for 6 h. Ngb siRNA decreased the H2O2-induced Ngb expression and exacerbated H2O2-induced cell injury. Transient transfection of Ngb induced dose-dependent increases in Ngb protein expression and did not alter SOD, GPX, and catalase activities. Overexpression of wild type Ngb, but not of mutant Ngb, significantly attenuated H2O2-induced ROS/RNS accumulation and lipid peroxidation, decreased H2O2-induced mitochondrial dysfunction and apoptosis, and promoted overall cell survival. Thus, Ngb plays a protective role against oxidative stress, which appears to be primarily mediated by intrinsic Ngb antioxidant properties.

Neuroglobin protects PC12 cells against beta-amyloid-induced cell injury

Excessive accumulation of amyloid beta (Abeta) has been proposed as a pivotal event in the pathogenesis of Alzheimer's disease. Possible mechanisms underlying Abeta-induced neuronal cytotoxicity include excess production of reactive oxidative species (ROS) and apoptosis. Neuroglobin (Ngb), a newly discovered globin in vertebrates that exhibits neuroprotective functions, may have a potential role in scavenging ROS. To examine the potential protective role of Ngb in Abeta-induced cytotoxicity, PC12 cells were treated with Abeta (1-42 fragment) for 24h. Abeta treatments increased ROS production in PC12 cells. Overexpression of Ngb but not Ngb mutant in the PC12 cells significantly attenuated Abeta-induced ROS production and lipids peroxidation. Furthermore, overexpression of Ngb also attenuated Abeta-induced mitochondrial dysfunction and apoptosis, and promoted cell survival in PC12 cells. Therefore, Ngb may act as an intracellular ROS scavenger, and such antioxidant properties may play a protective role against Abeta-induced cell injury.

Trends of drug resistant Mycobacterium tuberculosis in a tertiary tuberculosis center in Iran

OBJECTIVE

To determine the drug resistance pattern to first line antituberculous drugs in National Research Institute of Tuberculosis and Lung Disease and to compare resistant rates with previous studies.

METHODS

An anterograde cross-sectional study was performed. The study includes all adults with documented pulmonary tuberculosis (TB) that were hospitalized in National Research Institute of Tuberculosis and Lung Disease in Tehran, from June 2003 to September 2004. Demographic characteristic, TB categories, and drug susceptibility test results were recorded. Two previous studies regarding drug susceptibility in Iran were selected as historical controls.

RESULTS

One hundred and ninety-six new cases and 68 previously treated patients were enrolled in the study. The strains of 61% of new patients and 21% of previously treated patients were fully sensitive to all drugs. The most common resistance was streptomycin (27%) followed by isoniazid (23%) in new cases. Multiple drug resistant strains were noted in 2.6% (95% CI 0.8% to 5.8%) of new cases versus 56% (95% CI 43% to 68%) in previously treated group. The frequency of primary drug resistance to isoniazid was 9.8%-15% or streptomycin 9.8%-13% in the previous studies (p<0.00001).

CONCLUSION

While these rates may not reflect the true prevalence of drug resistance on a national scale, it does partially demonstrate some defects in the existing tuberculosis control program. The significant increase of isoniazid and streptomycin resistance in the last few years would present a serious challenge to effective management of TB.

Multicultural minds. A dynamic constructivist approach to culture and cognition

The authors present a new approach to culture and cognition, which focuses on the dynamics through which specific pieces of cultural knowledge (implicit theories) become operative in guiding the construction of meaning from a stimulus. Whether a construct comes to the fore in a perceiver's mind depends on the extent to which the construct is highly accessible (because of recent exposure). In a series of cognitive priming experiments, the authors simulated the experience of bicultural individuals (people who have internalized two cultures) of switching between different cultural frames in response to culturally laden symbols. The authors discuss how this dynamic, constructivist approach illuminates (a) when cultural constructs are potent drivers of behavior and (b) how bicultural individuals may control the cognitive effects of culture.

Multicultural minds. A dynamic constructivist approach to culture and cognition

The authors present a new approach to culture and cognition, which focuses on the dynamics through which specific pieces of cultural knowledge (implicit theories) become operative in guiding the construction of meaning from a stimulus. Whether a construct comes to the fore in a perceiver's mind depends on the extent to which the construct is highly accessible (because of recent exposure). In a series of cognitive priming experiments, the authors simulated the experience of bicultural individuals (people who have internalized two cultures) of switching between different cultural frames in response to culturally laden symbols. The authors discuss how this dynamic, constructivist approach illuminates (a) when cultural constructs are potent drivers of behavior and (b) how bicultural individuals may control the cognitive effects of culture.

Motivated cultural cognition: the impact of implicit cultural theories on dispositional attribution varies as a function of need for closure

The authors propose that need for closure (NFC) leads attributors to respond to an ambiguous social event by increasing reliance on implicit theories received from acculturation. Hence, the influence of NFC should be shaped by chronically accessible knowledge structures in a culture, and, likewise, the influence of culture should be moderated by epistemic motives such as NFC. The specific hypotheses drew on past findings that North American and Chinese attributors possess differing implicit social theories, North Americans conceiving of individuals as autonomous agents and Chinese conceiving of groups as autonomous. The present studies found the predicted pattern that among North American participants, NFC increased attributions to personal but not group dispositions. Among Chinese participants, NFC increased attributions to group but not personal dispositions. The findings are discussed in light of an emerging dynamic account of culture and cognition.

Evaluation of infants with subdural hematoma who lack external evidence of abuse

OBJECTIVE

Advances in radiologic technique have increased the recognition of subdural hematoma. No study to date has addressed the role of child protective investigation into the cause and management of subdural hematoma in children who lack other indicators of abuse.

METHODS

Medical records, radiology studies, and social service notes for all infants and children referred for child abuse investigation who had any form of intracranial hemorrhage were reviewed. The study covered the 12 months of 1997. All referrals were to the Suncoast Child Protection Team (St Petersburg, FL).

RESULTS

There were 19 investigations because of subdural hematoma. Eight children had retinal hemorrhage as well as other major findings of trauma, such as bruises and/or fractures; all 8 were victims of child abuse. Two infants had tiny subdurals adjacent to accidental linear skull fractures. Nine infants were investigated for the possibility of abuse that had no findings of trauma apart from the subdural hematoma. These 9 cases form the basis for this study. The age range was 11 days to 15 months. Inflicted cerebral trauma was the medical diagnosis in 8 of the 9 cases; 1 case had a final diagnosis of possible inflicted injury in a high-risk setting.

CONCLUSIONS

Infants with subdural hematoma but no other findings of abuse present a difficult challenge to child protection workers. Investigation by a medically oriented team can uncover the circumstances of the trauma in most instances and can usefully direct protective efforts. The high incidence of severe sequelae in infants with inflicted cerebral trauma warrants a vigorous approach.

Motivated cultural cognition: the impact of implicit cultural theories on dispositional attribution varies as a function of need for closure

The authors propose that need for closure (NFC) leads attributors to respond to an ambiguous social event by increasing reliance on implicit theories received from acculturation. Hence, the influence of NFC should be shaped by chronically accessible knowledge structures in a culture, and, likewise, the influence of culture should be moderated by epistemic motives such as NFC. The specific hypotheses drew on past findings that North American and Chinese attributors possess differing implicit social theories, North Americans conceiving of individuals as autonomous agents and Chinese conceiving of groups as autonomous. The present studies found the predicted pattern that among North American participants, NFC increased attributions to personal but not group dispositions. Among Chinese participants, NFC increased attributions to group but not personal dispositions. The findings are discussed in light of an emerging dynamic account of culture and cognition.

Choosing remedies after accidents: counterfactual thoughts and the focus on fixing "human error"

The present research is motivated by an interest in why organizational decision makers so often respond to accidents with remedy plans that focus narrowly on correcting human error rather than more environment-focused plans or more encompassing plans. We investigated the role of counterfactual thinking in the decision-making tendency toward human-focused plans. Our experiments indicated that even in a domain where human-focused remedies were not otherwise appealing, many participants decided on human-focused remedies after they had generated an "if only" conjecture about the accident. This reflects that human actions are often selected as the focus of "if only" conjectures and, importantly, that this focus "locks in" and carries through to subsequent remedy decisions. Our hypothesis that remedy plans are produced from "if only" thoughts was supported over several alternative interpretations. We discuss implications for research on the relation between counterfactual thinking and adaptive learning.

Impression valence constrains social explanations: the case of discounting versus conjunction effects

Discounting refers to a reduction in explanation plausibility in light of another explanation, whereas conjunction effects refer to an increase in plausibility of explanations judged in combination rather than in isolation. Explanation compatibility moderates these effects, such that discounting is greater for incompatible explanations and conjunction effects are greater for compatible explanations. Three experiments examined whether this effect reflects perceptions regarding (a) the prior statistical association of causal factors, (b) the sharing of common causal mechanisms, or (c) coherence with regard to global impressions. Results indicated that impression valence predicts and also directly influences discounting and conjunction effects independent of covariation and mechanism, underscoring the pervasive impact of impressions on attributions.

Long and Short Routes to Success in Electronically Mediated Negotiations: Group Affiliations and Good Vibrations

To understand why e-mail negotiations break down, we investigated two distinct elements of negotiators' relationships with each other: shared membership in a social group and mutual self-disclosure. In an experiment, some participants negotiated with a member of an outgroup (a student at a competitor university), whereas others negotiated with a member of an ingroup (a student at the same university). In addition, some negotiators exchanged personal information with their counterparts, whereas others did not. When neither common ingroup status nor a personalized relationship existed between negotiators, negotiations were more likely to end in impasse. These results are attributable to the positive influence of mutual self-disclosure and common group membership on negotiation processes and rapport between negotiators. Copyright 1999 Academic Press.

Medical technologist career commitment and satisfaction with job benefits

The purpose of this study was to determine the impact of career commitment on satisfaction with job-related benefits. A validated seven-point career commitment scale was used to measure career commitment. A 31-item benefits survey was used to collect data on satisfaction. In addition, salary information was collected. An analysis of variance was used to analyze the data. The high career commitment group was significantly more satisfied with 29 of the 31 benefits. There was no significant difference in salary among high, medium, and low career commitment groups. Low commitment individuals comprised only 11.5% of the respondents. The positive attitudes of the majority of medical technologists are a useful asset to the laboratory during this time of change in the practice of laboratory medicine.

Liability issues for occupational health nurses: an overview

Occupational health nurses need to be familiar with the Nurse Practice Act within their states. Most malpractice suits against nurses are based on negligence. The occupational health nurse should also be aware of potential liability for intentional torts, such as assault and battery, breach of patient confidentiality, and informed consent. The elements of a malpractice case are: a) the duty to conform to standard of care (which is usually established by expert testimony); b) breach of that duty, or the failure to conform to the standard of care; c) a causal connection between the breach of duty and the resulting injuries; and d) actual damages suffered by the patient-plaintiff.

Creating and implementing a chemical hygiene plan

January 31, 1991 was the deadline for laboratories to have developed and implemented their chemical hygiene plans (CHPs). OSHA may fine laboratories that do no comply--up to $2,500 per day. Managers have a responsibility to their employees to ensure a safe working environment, and the CHP is a useful tool for reducing risks and for informing employees about possible health hazards. Preparing a CHP does not have to be an arduous task--especially if you work from a model plan. This month's As We See It should help you refine (or develop) your CHP.

Perception of circular heading from optical flow

Observers viewed random-dot optical flow displays that simulated self-motion on a circular path and judged whether they would pass to the right or left of a target at 16 m. Two dots in two frames are theoretically sufficient to specify circular heading if the orientation of the rotation axis is known. Heading accuracies were better than 1.5 degrees with a ground surface, wall surface, and 3D cloud of dots, and were constant over densities down to 2 dots, consistent with the theory. However, there was an inverse relation between the radius of the observer's path and constant heading error, such that at small radii observers reported heading 3 degrees to the outside of the actual path with the ground and to the inside with the wall and cloud. This may be an artifact of a small display screen.

Perception of circular heading from optical flow

Observers viewed random-dot optical flow displays that simulated self-motion on a circular path and judged whether they would pass to the right or left of a target at 16 m. Two dots in two frames are theoretically sufficient to specify circular heading if the orientation of the rotation axis is known. Heading accuracies were better than 1.5 degrees with a ground surface, wall surface, and 3D cloud of dots, and were constant over densities down to 2 dots, consistent with the theory. However, there was an inverse relation between the radius of the observer's path and constant heading error, such that at small radii observers reported heading 3 degrees to the outside of the actual path with the ground and to the inside with the wall and cloud. This may be an artifact of a small display screen.

Converging operations on a basic level in event taxonomies

Research on object concepts has identified one level of abstraction as "basic" in cognition and communication. We investigated whether concepts for routine social events have a basic level by replicating the converging operations used to investigate object concepts. In Experiment 1, subjects were presented with event names from a taxonomy and were asked to list the actions comprising the event. Many more actions were listed at the middle than at the highest taxonomic level, without a further increase at the most specific level, paralleling the pattern of superordinate-, basic-, and subordinate-level object concepts. From these action lists, brief stories were composed for each event. In Experiment 2, subjects made pairwise similarity judgments on the stories. The mean similarity of events increased with specificity, as expected. But differentiation of categories (within-category similarity compared to between-category similarity) was highest for super-ordinates, contrary to results with object categories. In Experiment 3, subjects were fastest in recognizing actions as belonging to events named at the basic level. In Experiment 4, subjects predominantly chose basic-level terms to name stories. We conclude that event taxonomies do show basic-level structure, albeit a less sharply defined and less stable structure than in object taxonomies. The benefits and hazards of extending models of object concepts to other entities, such as social events, are discussed.

Age differences in perceiving the direction of self-motion from optical flow

Patterns of optical flow produced at the eye of a moving observer are important for the guidance of locomotion. This study examined age-related changes in the ability to perceive one's direction of self-motion, or heading, from optical flow, using computer displays that simulate translational or curvilinear movement parallel to a random-dot ground surface. We found small but significant decrements in performance with age, such that the mean heading threshold rises from 1.1 degrees in younger observers to 1.9 degrees in older observers for translation, and from 1.4 degrees to 2.9 degrees for curvilinear movement, under comparable dot density and speed conditions. The absence of an age by dot density interaction indicates that there is no age-related shift in strategy, but rather a general decline in the ability to detect and localize global optical flow patterns. The decrement appears to be due to higher level losses in the visual system rather than ocular or low-level sensory losses. The results may have implications for the control of high-speed locomotion and falls in older adults.

A cooperative venture improves laboratory services

In summary, the cooperative venture between the Office of Mental Health and the SUNY, Health Science Center has proved to be fruitful for both parties. It has achieved efficiency of volume by referral to one state-owned referral laboratory, yet has improved overall patient care.

Perception of translational heading from optical flow

Radial patterns of optical flow produced by observer translation could be used to perceive the direction of self-movement during locomotion, and a number of formal analyses of such patterns have recently appeared. However, there is comparatively little empirical research on the perception of heading from optical flow, and what data there are indicate surprisingly poor performance, with heading errors on the order of 5 degrees-10 degrees. We examined heading judgments during translation parallel, perpendicular, and at oblique angles to a random-dot plane, varying observer speed and dot density. Using a discrimination task, we found that heading accuracy improved by an order of magnitude, with 75%-correct thresholds of 0.66 degrees in the highest speed and density condition and 1.2 degrees generally. Performance remained high with displays of 63-10 dots, but it dropped significantly with only 2 dots; there was no consistent speed effect and no effect of angle of approach to the surface. The results are inconsistent with theories based on the local focus of outflow, local motion parallax, multiple fixations, differential motion parallax, and the local maximum of divergence. But they are consistent with Gibson's (1950) original global radial outflow hypothesis for perception of heading during translation.

Clotting, activated partial thromboplastin and coagulation times in monitoring heparin therapy

The automated-activated coagulation time, manual-activated coagulation time and the activated partial thromboplastin time were compared to the whole blood clotting time in the measurement of hypocoagulation of heparinized blood. The normal ranges and degree of reproducibility were determined for each clotting assay. Each method was examined for its sensitivity to various concentrations of heparin. In addition, blood samples from patients treated with heparin were assayed by all four methods and their results were compared. The results indicated that the manual-activated clotting time correlated best with the whole blood clotting time, was sensitive to low concentrations of heparin, formed a discernible clot within a convenient time period in blood containing high concentrations of heparin, was reproducible and was easily performed.

The zeta sedimentation ratio (ZSR) and activity of disease in rheumatoid arthritis

Zeta sedimentation ratios (ZSR) and modified Westergren erythrocyte sedimentation rates (ESR) were compared with an independent clinical assessment of disease activity in 100 patients with rheumatoid arthritis. The correlation between ZSR and ESR was good. Both methods correlated well with disease activity. The ZSR was more frequently elevated than the ESR in each category of disease activity, but the differences were slight. In addition to its practical advantages, the ZSR appears to be a satisfactory method for monitoring the activity of rheumatoid arthritis.

Zeta sedimentation ratio (ZSR), a replacement for the erythrocyte sedimentation rate (ESR)

The zeta sedimentation ratio (ZRS) was evaluated and found to have advantages over the erythrocyte sedimentation rate (ESR). The normal range for the ZSR proved to be 41 to 54%. Elevated ESR's obtained with the modified Westergren technic were also associated with an increased ZSR, except when amenia spuriously elevated the ESR. Reproducibility after storage was slightly better for the ZSR than for the ESR, But for optimal results the test should be performed within two hours of phlebotomy. Increased concentrations od EDTA anticoagulant may falsely elevate the ZSR, especially if the ZSR is initially elevated.

Immunologic and cytochemical properties of histiocytic and mixed histiocytic-lymphocytic lymphomas

Lymph nodes were biopsied from seven patients with the presumptive clinical diagnosis of lymphoma and studied for their ability to form spontaneous rosettes with sheep erythrocytes (T cell marker), for surface immunoglobulins (B cell marker), for cytochemical reactivity with peroxidase, alpha-naphthyl acetate and butyrate esterases, naphthol ASD chloroacetate esterase, acid phosphatase, periodic acid-Schiff, Sudan black B, and Wright-Giemsa on touch preparations, as well as in hematoxylin and eosin-stained sections. Lymph nodes from patients without hematologic malignancy served as control. Diagnoses of diffuse histiocytic lymphoma were made in five cases and diffuse mixed histiocytic-lymphocytic lymphoma in 2 cases. The cytochemical staining of the lymphoma cells were typical of lymphoid cells rather than macrophages. In five cases neoplastic cells contained surface immunoglobulins, suggesting a B cell origin, and in one case a paucity of cell surface markers was found. Cells from uninvolved nodes of lymphoma patients could not be differentiated from those of the control group.

Colitis cystica superficialis

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