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In recent years, the use of both molecular targeting agents (MTAs) and immune-checkpoint inhibitors (ICIs) tend to occupy important positions in systemic anticancer therapy (SACT). The objective of this study is to describe the predictors of SACT include both MTAs and ICIs near the end of life (EOL) and the effect on EOL care in patients with advanced cancer.
We analyzed all patients who died of advanced cancer from August 2016 to August 2019, and we analyzed the survival time of patients who underwent anticancer agents excluded due to the loss of information about the last administration of SACT. The primary endpoint of this study was to identify predictors during the last administration of SACT near EOL.
In a multivariate analysis, the Eastern Cooperative Oncology Group performance status (ECOG-PS) (ORs 33.781) was significantly related factors within 14 days of death from the last administration of SACT. Age (ORs 0.412), ECOG-PS (ORs 11.533), primary cancer site of upper GI cancers (ORs 2.205), the number of comorbidities (ORs 0.207), MTAs (ORs 3.139), and ICIs (ORs 3.592) were significantly related factors within 30 days of death. The median survival time (MST) of patients with PS 3–4 was 29 days, while that of patients with both PS 0–2 was 76 days. The prevalence rate of delirium with MTAs was 17.5%, which was significantly lower than that of patients without it (31.8%). The prevalence rate of the mean dose of opioids in patients with ICIs was 97.9 mg/day, which was significantly higher than that of patients without it (44.9 mg/day).
Age, ECOG-PS, primary cancer site, the number of comorbidities, MTAs, and ICIs use were significant associated with SACT near EOL. Information on these factors may aid clinical decision making in referral to palliative care institutes.
It has been indicated that the health impact of COVID-19 is potentially greater in individuals from lower socioeconomic status than in the overall population.
To examine how the spread of COVID-19 has altered the general public's mental health, and whether such changes differ in relation to individual income.
An online longitudinal survey was conducted at three different time periods during the pandemic. We recruited 1993 people aged 20–70 years, living in the Tokyo metropolitan area in Japan. Participants’ mental health was measured with the six-item version of the Kessler Psychological Distress Scale; the existence of severe psychological distress was ascertained through the cut-off data. Multiple logistic and mixed-model ordinal logistic regression analyses were performed, with income as the independent variable.
Of the participants, 985 were male, with a mean age of 50.5 (±15.8) years. Severe psychological distress percentages for each tested period were 9.3%, 11.2% and 10.7% for phases 1, 2 and 3, respectively. Between phases 1 and 2 or phases 2 and 3, the group that earned <£15 000 had significantly higher propensity to develop severe psychological distress than the group that earned ≥£45 000 (odds ratio 2.09, 95% CI 0.95–4.56 between phases 1 and 2; odds ratio 3.00, 95% CI 1.01–9.58 between phases 2 and 3).
Although there has been significant deterioration in mental health among citizens during the COVID-19 pandemic, this was more significant among those with lower income. Therefore, mental health measures that focus on low socioeconomic groups may be necessary.
We have found a class of circular radio objects in the Evolutionary Map of the Universe Pilot Survey, using the Australian Square Kilometre Array Pathfinder telescope. The objects appear in radio images as circular edge-brightened discs, about one arcmin diameter, that are unlike other objects previously reported in the literature. We explore several possible mechanisms that might cause these objects, but none seems to be a compelling explanation.
This paper considers the estimation of dynamic causal effects using a proxy structural vector-autoregressive model with possibly nonstationary regressors. We provide general conditions under which the asymptotic normal approximation remains valid. In this case, the asymptotic variance depends on the persistence property of each series. We further provide a consistent asymptotic covariance matrix estimator that requires neither knowledge of the presistence properties of the variables nor pretests for nonstationarity. The proposed consistent covariance matrix estimator is robust and is easy to implement in practice. When all regressors are indeed stationary, the method becomes the same as the standard procedure.
The interaction between negatively charged all-inorganic silicon quantum dots (Si QDs) and bovine serum albumin (BSA) is studied. It is shown that a small difference in the size of Si QDs affects the structure of Si QD–BSA composites significantly. When the diameter of Si QDs is 4 nm, a heterodimer (~20 nm) composed of one Si QD and one BSA molecule is a preferable and stable structure. On the other hand, when the diameter is 7 nm, the size of the composites increases to ~50 nm. The Si QD–BSA composites exhibit stable photoluminescence in the near-infrared range in phosphate-buffered saline.
Since its inception in 1957, Malaysia’s Federal Court (FC) has often been embroiled in high-profile decisions that have dramatically shaped the rule of law and constitutional practice in Malaysia. Recent political change has renewed hope that the FC can reassert its early role as an independent and impartial arbiter of political conflict. This paper investigates determinants of the FC’s behaviour since 1960. It draws on a unique data set of 102 major political cases and socio-biographic profiles of the 73 judges who voted in these cases. After describing patterns of court decisions across time and judges, we test specifically for the impact on their decisions of the 1988 judicial crisis, length of time on the bench, the terms of successive prime ministers, and judges’ personal attributes, such as religion and ethnicity. Ethnicity, appointment after 1988, and the appointing prime minister proved to be closely associated with the direction of voting. We then position the results in the context of Malaysia’s evolving constitutional democracy and discuss their implications for students of comparative judicial politics.
Delivering adequate health care in the setting of the ongoing pandemic is challenging. Due to coronavirus disease 2019 (COVID-19), the Tokyo Metropolitan government has been forced to expand their acute health-care capacity corresponding to infectious diseases within a short period. Responding to this situation, health emergency and disaster experts of the Tokyo Disaster Medical Assistance Team took the initiative in creating a brief education course. We established the course for expanding infectious disease care capacity by a dedicated hands-on lecture for health professionals who are unfamiliar with infectious disease care in ordinary circumstances. Our lecture included the typical course of COVID-19, use of personal protective equipment, environmental sterilization, medical-ward zoning, and safe caregiving. Hospitals that received customized lectures reported by means of a questionnaire that the lectures were well suited to their needs. Currently, the health-care system in Tokyo has increased its capacity to meet the demand and has not been affected by COVID-19. Our experience shows that health emergency and disaster experts can assist hospitals in crisis by providing educational materials.
To analyse the Na content of bread by comparing the amount of salt and Na among the label, laboratory analysis and international guidelines.
Ten selected bakeries provided 3239 randomly selected samples of bread, which were weighed on-site. Triplicate samples were retrieved from each bakery (thirty samples) for analysis. Bread production was observed, and ingredient labels were queried to determine salt weights, which were used for comparison with the laboratory analysis. Flame photometry and the method for chlorides were utilised for analysing Na. Laboratory findings were compared to nine different international nutritional guidelines for Na consumption.
Florianopolis, south of Brazil.
Ninety independent bakeries locally producing Portuguese rolls were queried; rolls from ten conveniently selected bakeries were retrieved for further analysis.
The average weight of the rolls was 50·2 ± 5·3 g. The average amount of salt (g) per roll, by laboratory and label analyses, was 0·69 ± 0·0 and 0·62 ± 0·1 g, respectively. The mean level of Na (mg) reported on nutrient labels (478·2 ± 93·4/100 g) was significantly lower than by laboratory analysis (618·2 ± 73·8/100 g), P < 0·001. There was a difference for Na in rolls produced in the bakeries considering the unit weight of rolls (P ≤ 0·001) per 100 g (P = 0·026) and the mode of production. The consumption of two averaged units of rolls was equivalent to 51·7 % of the Brazilian guideline daily amount for Na for children and 31 % for adults.
The nutrient labels underreported Na values. This study strengthens the importance of monitoring Na of breads in Brazil.
The incidence of surgical site infection (SSI) is higher in spinal surgeries than in general orthopedic operations. In this study, we aimed to develop a scoring system with reduced health care costs for detecting spinal surgery patients at high risk for SSI.
Retrospective cohort study.
In total, 824 patients who underwent spinal surgery at 2 university hospitals from September 2005 to May 2011.
We reviewed the medical records of 824 patients, and we examined 19 risk factors to identify high-risk patients. After narrowing down the variables by univariate analysis, multiple logistic analysis was performed for factors with P values <.2, using SSI as a dependent variable. Only factors that showed P values <.05 were included in the final models, and each factor was scored based on the β coefficient values obtained. The clinical prediction rules were thereby prepared.
“Emergency operation,” “blood loss >400 mL,” “presence of diabetes,” “presence of skin disease,” and “total serum albumin value <3.2 g/dL” were detected by multivariable modeling and were incorporated into the risk scores. Applying these 5 independent predictive factors, we were able to predict the infection incidence after spinal surgery.
Our present study could aid physicians in making decisions regarding prevention strategies in patients undergoing spinal surgery. Stratification of risks employing this scoring system will facilitate the identification of patients most likely to benefit from complex, time-consuming and expensive infection prevention strategies, thereby possibly reducing healthcare costs.
We performed family psychoeducation for depression, and investigated the association between the education and expressed emotion of patients’ families and relapse of depression.
Of 103 patients diagnosed with major depressive disorder, and their primary family members, 53 patients and their primary family members gave consent. The patients were randomly allocated to an intervention or control group, consisting of 24 and 30 patients, respectively. The intervention group underwent 4 educational sessions and education in coping techniques. The relapse rate was compared between the intervention and control groups. In addition, the subjects were divided into high- and low-EE groups based on the EE judgment, and the effect of psychoeducation was compared in each group.
The relapse rate during a 9-month period was 8.3% in the intervention group, being significantly lower than that (50%) in the control group. The relapse rate in the intervention group was slightly lower than that in the control group in the high-EE group, and significantly lower in the low-EE group. Regarding the influence of EE, in the control group, the relapse rate was 70% in the high-EE group, being significantly higher than that (40%) in the low-EE group. On multiple logistic regression analysis, psychoeducation (odds ratio: 25.53, 95% CI: 2.83-229.92) and the Hamilton score at the time of entry (odds ratio: 1.16, 95% CI: 1.045-1.298) were significantly associated with relapse.
It was suggested that the psychoeducation of families is very effective for the prevention of relapse in adult depressive patients.
There are no effective programs on return-to-work (RTW) despite an increase of stress related disorders. We developed an original rehabilitation program,’Ultra-short daily briefings care (USDBC)’. USDBC is based on a key concept of European Framework for Psychosocial Risk Management (PRIMA-EF; WHO, 2008) that provides the good practice guidelines at the workplace. We carried out USDBC at the worksite of Panasonic Healthcare Co., Ltd. to determine whether USDBC facilitates RTW.
To develop and establish the appropriate intervention that reduces depressive severity of sick-listed employees.
The aim of the study was to determine whether USDBC strengthen the sense of coherence (SOC; Antonovsky, 1985).
We compared two groups in a cross-sectional study design: 16 depressed RTW employees (USDBC group) vs. 121 healthy employees (control group) (Fig.1). USDBC group was received the instant face-to-face rehabilitation program in every workday (Fig.2). The primary outcome was the ability to cope with stress, measured by self-reported 13-items SOC scale for Japanese (Yamazaki, 1999).
In the USDBC group, significant changes were observed between baseline and measurement point in SOC score (40.3 vs. 54.4; 95% CI (20.6 to (7.5), whereas in the control group, no significant changes were observed (58.3 vs. 57.9; 95% CI (0.1 to 0.9) (Table.1).
The study suggests that USDBC strengthen the depressed employees’ SOC.
Participant now climt
Flow diagram showing the selection of USDBC group and control group
Intervention with USDBC
Depressive employees behave according to this flow in every workday.
Subjects’ characteristics and SOC.
USDBC group (n=l6)
39 (32 - 53)
Control group (n=121)
41 (21 - 59)
-0 1 to 0.9
In the USDBC goroup, significant change was found between baselne and tneasurment point. In the control group, no significant change was found.
Attention bias (AB) is a biased information processing towards threat among competing stimuli occurred in early stage of sensory input. Substantial evidence indicates that AB is involved in the development and maintenance of anxiety and depressive disorders. However, little is known about the relationships between AB and individual differences of endocrine and neuropsychological functions.
Thirty healthy participants without major physical illness or axis I/II mental disorders as evaluated with the Mini-International Neuropsychiatric Interview, were enrolled. Participants completed a dot-probe task, the Temperament and Character Inventory (TCI), the Beck Depression Inventory-II (BDI-II), the Interpersonal Sensitivity Measure, and the Trail Making Test (TMT). Salivary cortisol levels were measured at three time points per day for consecutive 2 days: immediately and 30 min after awaking in the morning and before sleep at night. Correlation analyses were performed between AB and psychological measures, cortisol levels, and attention measures.
As predicted, AB significantly correlated with BDI-II and Harm avoidance sub-dimension of the TCI. Above all, when those variables that were significantly correlated with AB were included in a step-wise multivariate regression analysis, higher cortisol level at night remained the most influential predictor for AB.
Our results suggest that AB is significantly influenced not only by anxious personality traits and depressive symptoms but also by individual differences of attention function and stress hormonal levels. Particularly, AB modification approach might have a beneficial effect on anxiety in individuals who have high cortisol levels.
There is increasing recognition that pain often coexists with depression. the current survey was undertaken to ascertain patients’ and clinicians’ perceptions of pain as a physical symptom associated with depression.
Web-based surveys were undertaken for patients with depression, and for physicians treating patients with depression (psychiatrists, psychosomatic physicians, general internists).
848 patients aged 20–59 years entered the main survey, of whom 663 returned the completed survey (78.2%). of the respondents, 424 (64.0%) experienced at least one painful symptom, with almost three-quarters (72.1%) reporting that the pain affected mental symptoms and 68.6% indicating that it prevented recovery from depression itself. Among 337 patients who discussed their painful symptoms with their physician, 52.5% initiated the discussion.
456 physicians completed the physician survey. When asked about the influence of pain associated with depression, 61.7% of physicians indicated that they ask their patients about pain during a consultation, and 79.9% considered that painful symptoms might disturb the patients’ daily life and 52.8% felt that they would delay recovery from depression.
The survey provides further evidence of the association between depression and pain, highlighting the fact that pain is prevalent in this patient population. Increased patient and physician awareness of pain in association with depression and improved doctor-patient communication, enabling patients to discuss painful symptoms with their physicians, and vice-versa, should lead to better overall management and treatment strategies.
There has been little research on the association of attention-deficit/hyperactivity disorder (ADHD) with co-occurring physical diseases. The aim of this study was to examine the association between possible ADHD and physical multimorbidity (i.e. = 2 physical diseases) among adults in the English general population.
Data were analyzed from 7274 individuals aged = 18 years that came from the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed with the Adult Self-Report Scale (ASRS) Screener. Information was also obtained on 20 self-reported doctor/other health professional diagnosed physical health conditions present in the past 12 months. Multivariable logistic regression and mediation analyses were conducted to assess the associations.
There was a monotonic relation between the number of physical diseases and possible ADHD (ASRS score = 14). Compared to those with no diseases, individuals with = 5 diseases had over 3 times higher odds for possible ADHD (odds ratio [OR]: 3.30, 95% confidence interval [CI]: 2.48–4.37). This association was observed in all age groups. Stressful life events (% mediated 10.3–24.3%), disordered eating (6.8%), depression (12.8%), and anxiety (24.8%) were significant mediators in the association between possible ADHD and physical multimorbidity.
Adults that screen positive for ADHD are at an increased risk for multimorbidity and several factors are important in this association. As many adults with ADHD remain undiagnosed, the results of this study highlight the importance of detecting adult ADHD as it may confer an increased risk for poorer health outcomes, including physical multimorbidity.
Pear psyllids (Hemiptera: Psylloidea: Psyllidae: Cacopsylla spp.) belong to the most serious pests of pear (Pyrus spp.). They damage pear trees by excessive removal of phloem sap, by soiling the fruits with honeydew which, in turn, provides a substrate for sooty mould, and by transmission of Candidatus Phytoplasma spp., the causal agents of the pear decline disease. The morphological similarity, the presence of seasonal dimorphism that affects adult colour, size and wing morphology and uncritical use of species names, led to much confusion in the taxonomy of pear psyllids. As a result, pear psyllids have been frequently misidentified. Many of the entries attributed to Cacopsylla pyricola and other species in the GenBank are misidentifications which led to additional, unnecessary confusion. Here we analysed DNA barcodes of 11 pear psyllid species from eastern Asia, Europe and Iran using four mitochondrial gene fragments (COI 658 bp, COI 403 bp, COI-tRNAleu-COII 580 bp and 16S rDNA 452 bp). The efficiency of identification was notably high and considerable barcoding gaps were observed in all markers. Our results confirm the synonymies of the seasonal forms of Cacopsylla jukyungi ( = C. cinereosignata, winter form) and C. maculatili ( = C. qiuzili, summer form) previously suggested based on morphology. Some previous misidentifications (C. chinensis from China, Japan and Korea = misidentification of C. jukyungi; C. pyricola and C. pyrisuga from East Asia = misidentification of C. jukyungi and C. burckhardti, respectively; C. pyricola from Iran = misidentification of C. bidens, C. pyri and Cacopsylla sp.) are also corrected. There is no evidence for the presence of European pear psyllid species in East Asia.
Natural disasters affect long-term health by directly disrupting or destroying health-care systems and social support. We examined the associations between social support and subjective symptoms (SS) among disaster victims living in their homes approximately 1–2 years after the Great East Japan Earthquake and tsunami on March 11, 2011, which devastated the northeastern Japan seaboard and far inland, focusing on Ishinomaki, Miyagi Prefecture.
The Health and Life Revival Council of Ishinomaki District conducted door-to-door household surveys between April 2012 and January 2013. Replies to 12 questions regarding social support, specifically emotional, informational, and instrumental, were investigated. SS prevalence was calculated as the proportion of those having any of 8 predetermined symptoms including back pain, neck stiffness, sleep difficulty, dizziness, heart palpitations, poor appetite, or stomachache. Logistic regression analysis by sex was used to obtain crude and adjusted odds ratios for the association between SS prevalence and forms of social support.
From 4023 households, self-reported data on 2593 individuals from 1709 households were obtained. SS prevalence was 29.1%. Adjusted logistic regression analysis revealed that instrumental support with others and emotional support with personal and others were specific associated with SS in men and women, respectively.
Our findings suggest that providing social support depending on needs is potentially effective in preventing SS in disaster areas.
Recently huge amount of dust Mdust ≃ 106−7M⊙ in galaxies at z = 7–8 has been discovered by ALMA observations. The suggested timescale of the dust production was a few–several×108 yr, while the stellar mass was several × 109M⊙. This amount of dust cannot be easily explained only by a supply from supernovae if we consider the dust destruction by reverse shocks. We propose that these values can be consistently explained if we take into account the grain growth in the interstellar medium (ISM). This scenario successfully reproduces the evolution of the dust mass, as well as the SFR, and stellar mass simultaneously. We conclude that even at such an early epoch of the Universe, the dust grain growth in the ISM plays a significant role in galaxies.
The spectral energy distribution (SED) model should treat the evolution of a galaxy from its birth. Dust in galaxies affects the formation and evolution of galaxies in various ways. For example, dust grains scatter and absorb stellar emitted ultraviolet (UV) photons and re-emit the radiation at infrared (IR) wavelengths. In this work, we construct a galaxy SED model based on our dust evolution model (Asano et al. 2013a,b, 2014) with a rigorous treatment of the chemical evolution. To reduce the computational cost, we adopt mega-grain approximation (MGA; (MGA; Inoue, 2005). MGA regards a high density dusty region as a huge size (10 pc) dust grain for calculating dust scattering. In this approximation, we can solve the radiative transfer easily and provide SEDs and attenuation curves of galaxies. This model can be used to fit any galaxy in the wavelength range of 10 nm-3 mm.