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OBJECTIVES/SPECIFIC AIMS: In patients with recurrent glioblastoma (GBM) who undergo a second surgery following standard chemoradiotherapy, histopathologic examination of the resected tissue often reveals a combination of viable tumor and treatment-related inflammatory changes. However, it remains unclear whether the degree of viable tumor Versus “treatment effect” in these specimens impacts prognosis. We sought to determine whether the percentage of viable tumor Versus “treatment effect” in recurrent GBM surgical samples, as assessed by a trained neuropathologist and quantified on a continuous scale, is associated with overall survival. METHODS/STUDY POPULATION: We reviewed the records of 47 patients with histopathologically confirmed GBM who underwent surgical resection as the first therapeutic modality for suspected radiographic progression following standard radiation therapy and temozolomide. The percentage of viable tumor Versus “treatment effect” in each specimen was estimated by one neuropathologist who was blinded to patient outcomes. RESULTS/ANTICIPATED RESULTS: After adjusting for other known prognostic factors in a multivariate Cox proportional hazards model, there was no association between the degree of viable tumor and overall survival (HR 0.83; 95% CI, 0.20–3.4; p=0.20). DISCUSSION/SIGNIFICANCE OF IMPACT: These results suggest that, in patients who undergo resection for recurrent GBM following standard first-line chemoradiotherapy, histopathologic quantification of the degree of viable tumor Versus “treatment effect” present in the surgical specimen has limited prognostic influence and clinical utility.
Introduction: Unnecessary imaging of adult cervical spine (C-spine) injury patients in the Emergency Department (ED) is a concern. Guidance for C-spine image ordering exists; however, the effectiveness and safety of their implementation in the ED is not well studied. This review examines their implementation and effectiveness at reducing C-spine imaging in adults presenting to the ED with stable neck trauma. Methods: Six electronic databases and the grey literature were searched. Comparative studies examining interventions to reduce C-spine imaging were eligible for inclusion. Two independent reviewers screened for study eligibility, assessed study quality, and extracted data. Data were analyzed using RevMan (Version 5.3) to explore the effectiveness of these interventions in safely reducing C-Spine radiography. Results: A total of 848 unique citations were screened of which six before-after studies and one randomized controlled trial were included. The study population varied with respect to injury severity (i.e., stability status). None of the studies were assessed as high quality. The interventions employed included locally developed guidelines and clinical decision rules, specifically the National X-radiography Utilization Study (NEXUS) criteria and the Canadian C-Spine Rule (CCR). Various implementation strategies, such as teaching sessions, pocket reminder cards, posters and computerized decision support were used. Several studies used multi-faceted interventions. Overall, of the five study groups that examined change in x-ray ordering, three groups reported a significant reduction in c-spine radiography. The remaining two showed no change in imaging. A pooled estimate of the effectiveness of the interventions was prohibited by significant heterogeneity. Conclusion: The evidence regarding the effectiveness of interventions to reduce C-spine imaging in adult ED patients with stable neck trauma is inconclusive. Given the national and international focus on improving appropriateness and reducing unnecessary imaging through campaigns such as Choosing Wisely®, additional interventional research in this field is warranted.
Introduction: Low back pain (LBP) is an extremely frequent emergency department (ED) presentation. Although LBP imaging often results in no change to the ED management, does not identify abnormalities, and has documented risks (e.g., radiation exposure), advanced imaging (i.e., computed tomography [CT], magnetic resonance imaging [MRI]) for patients with LBP has become increasingly frequent in the ED. The objective of this review was to identify and examine the effectiveness and safety of interventions aimed at reducing imaging in the ED for LBP patients. Methods: Six bibliographic databases and grey literature were searched. Comparative studies assessing interventions aimed at reducing ED imaging for adult patients with LBP were eligible for inclusion. Two reviewers independently screened study eligibility, completed data extraction, and assessed the quality of included studies. Due to a limited number of studies and significant heterogeneity, a descriptive analysis was performed. Results: The search yielded 510 unique citations of which three before-after studies were included. Quality assessment identified potential biases relating to comparability between the pre- and post-intervention groups, reliable assessment of outcomes, and an overall lack of information on the intervention (i.e., time point, description, intervention data collection). The interventions to reduce lumbar spine imaging varied considerably. Study interventions included: 1) clinical decision support (i.e., a specialized X-ray requisition form), which reported a 47.4% relative reduction of lumbar spine radiography referrals; 2) clinical decision guidelines, which reduced referrals by 43.8%; and 3) multidisciplinary protocols, which reported a reduction in the MRI referral rate by 26.1%. Despite reductions in simple imaging, CT use increased in two of the three studies. Conclusion: LBP has been identified as a key area of imaging overuse (e.g., Choosing Wisely recommendation). Yet, evidence of interventions’ effectiveness in reducing imaging for ED patients with LBP is sparse. While there is some evidence to suggest that interventions can reduce the use of simple imaging in LBP in the ED, unintended consequences have been reported and additional studies employing higher quality methods are strongly recommended.
Contrary to popular myth, majority of mentally ill women are mothers with increasing number of them seeking help. Little is known about their own experiences in this regard and the extent to which their needs are met.
To assess the barriers and facilitators in seeking help from mental health care providers in matters of pregnancy and parenting.
The study used qualitative design with social constructivist paradigm. A purposive sample of 30 mothers with severe mental illness was obtained. Data was collected through one-to-one in-depth semi-structured interviews. After verbatim transcription, inductive thematic analysis was used to explore transcripts.
Most women considered motherhood “central” to their lives and almost all of them experienced the burden of the “dual role”. Main barriers in seeking help were stigma, treatment side effects, wrong information and time constraints. Whereas self-advocacy, early engagement, education of women and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers as identified were early and direct communication, patient audience and basic guidance in regards to child health and parenting issues.
Women who are mothers and also users of mental health services face special challenges in managing the contradictory aspects of their dual identity. Hearing their voices are essential for service provision and ensuring adequate mental health needs. Early and direct intervention along with understanding and addressing critical areas are necessary for proper care of both the mother and child.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
Following implementation of automatic end dates for antimicrobial orders to facilitate antimicrobial stewardship at a large, academic children’s hospital, no differences were observed in patient mortality, length of stay, or readmission rates, even among patients with documented bacteremia.
The aim of this study was to compare sensory processing in typically developing children (TDC), children with Autism Spectrum Disorder (ASD), and those with sensory processing dysfunction (SPD) in the absence of an ASD. Performance-based measures of auditory and tactile processing were compared between male children ages 8–12 years assigned to an ASD (N=20), SPD (N=15), or TDC group (N=19). Both the SPD and ASD groups were impaired relative to the TDC group on a performance-based measure of tactile processing (right-handed graphesthesia). In contrast, only the ASD group showed significant impairment on an auditory processing index assessing dichotic listening, temporal patterning, and auditory discrimination. Furthermore, this impaired auditory processing was associated with parent-rated communication skills for both the ASD group and the combined study sample. No significant group differences were detected on measures of left-handed graphesthesia, tactile sensitivity, or form discrimination; however, more participants in the SPD group demonstrated a higher tactile detection threshold (60%) compared to the TDC (26.7%) and ASD groups (35%). This study provides support for use of performance-based measures in the assessment of children with ASD and SPD and highlights the need to better understand how sensory processing affects the higher order cognitive abilities associated with ASD, such as verbal and non-verbal communication, regardless of diagnostic classification. (JINS, 2015, 21, 444–454)
The occurrence, quantification, and distribution patterns of deformed wing virus (DWV) and sacbrood virus (SBV), (family Iflaviridae); black queen cell virus (BQCV), Israeli acute paralysis virus (IAPV), Kashmir bee virus (KBV), and acute bee paralysis virus (ABPV) (family Dicistroviridae), and chronic bee paralysis virus (CBPV) (unclassified), were characterised in 80 “healthy” honey bee (Apis mellifera Linnaeus; Hymenoptera: Apidae) colonies and 23 “unhealthy” colonies by employing reverse transcription polymerase chain reaction (RT-PCR) for virus identification and quantitative real-time polymerase chain reaction (qPCR) for quantification. All seven viruses were common but the most prevalent viruses were DWV, followed by BQCV and IAPV. For most viruses, prevalence in surviving but unhealthy colonies in spring did not differ from that of healthy baseline colony levels in fall suggesting spring prevalence level would not be a useful metric for diagnosis of factors contributing to colony loss. Sacbrood virus was the only virus that was more prevalent in unhealthy colonies from Manitoba, Canada than in healthy from colonies across Canada but did not differ from healthy colonies within Manitoba. Multiple infections were ubiquitous with a few colonies having simultaneous infection with as many as five viruses. Among the three viruses quantified by qPCR, DWV had the highest relative concentrations in pooled samples of worker bees. Deformed wing virus was the only virus within healthy colonies that differed in fall concentration among provinces and was at high levels in unhealthy colonies. Black queen cell virus was positively correlated with IAPV across all samples. Our study provides the first major baseline study of viruses in Canadian honey bees.
To examine whether nutrient and food intakes among South Asian adult immigrants differ by length of residence in the USA.
Cross-sectional analysis to examine differences in nutrient and food intakes by length of residence in the USA. Dietary data were collected using an interviewer-administered, culturally appropriate FFQ, while self-reported length of residence was assessed using a questionnaire and modelled as tertiles.
The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.
Eight hundred and seventy-four South Asians (mean age=55 (sd 9) years; 47 % women; range of length of residence in the USA=2–58 years), part of the baseline examination of the MASALA study.
Intakes of fat, including saturated and trans fats, dietary cholesterol and n-6 fatty acids, were directly associated with length of residence, while intakes of energy, carbohydrate, glycaemic index and load, protein, dietary fibre, folate and K were inversely associated with length of residence (P trend <0·05). A longer length of residence in the USA was also associated with higher intakes of alcoholic beverages, mixed dishes including pizza and pasta, fats and oils, and lower intakes of beans and lentils, breads, grains and flour products, milk and dairy products, rice, starchy vegetables and sugar, candy and jam (P for differences across groups <0·05).
Length of residence in the USA influences diet and nutrient intakes among South Asian adult immigrants and should be considered when investigating and planning dietary interventions to mitigate chronic disease risk.
Socio-behavioural factors and pathogens associated with childhood diarrhoea are of global public health concern. Our survey in 696 children aged ⩽2 years in rural West Bengal detected rotavirus as sole pathogen in 8% (17/199) of diarrhoeic stool specimens. Other organisms were detected along with rotavirus in 11% of faecal specimens. A third of the children with rotavirus diarrhoea, according to Vesikari score, had severe illness. The top four rotavirus genotypes were G9P (28%), G1P (19%), G2P (14%) and G8P (8%). In the multivariate model, the practice of ‘drawing drinking water by dipping a pot in the storage vessel’ [adjusted odds ratio (aOR) 2·21, 95% confidence interval (CI) 1·03–4·74, P = 0·041], and ‘children aged ⩽6 months with non-exclusive breastfeeding’ (aOR 2·07, 95% CI 1·1–3·82, P = 0·024) had twice the odds of having diarrhoea. Incidence of rotavirus diarrhoea was 24/100 child-years in children aged >6–18 months, 19/100 child-years in children aged >18–24 months and 5/100 child-years in those aged ⩽6 months. Results have translational implications for future interventions including vaccine development.
Gestational diabetic mellitus (GDM) pregnancies have an increased risk of macrosomic infants and large placental mass, though the mechanisms explaining each of these is uncertain. We sought to evaluate the contribution of apoptosis to placental size and the expression of glucose transporters (SLC2A) in GDM pregnancies. Maternal age and pre-pregnancy body weight were documented. Newborn weights were recorded after delivery. Placentas 37–40-week gestation from control patients (no pregnancy complication) (n = 5), or with GDM (n = 5) were weighed immediately after delivery. Villous samples (4 mm diameter) were collected and divided into specimens; one was fixed in 4% paraformaldehyde for immunostaining using terminal deoxynucleotidyl transferase dUTP-mediated nick-end labeling (TUNEL) and activated caspase-3. The other specimen was snap frozen in liquid nitrogen and stored at −80°C for active caspase-3, poly(ADP-ribose) polymerase (PARP), SLC2A1 and SLC2A3 gene expression analysis. Our results showed that maternal age and pre-pregnancy body weight were significantly higher in the GDM group when compared with those from the controls (P < 0.05). The mean neonatal birth weight and placenta weight were significantly higher in the GDM group compared with that from the controls (P < 0.05). The apoptotic index of placentas (0.05 ± 0.01 v. 0.17 ± 0.04, P < 0.04), active caspase-3 polypeptide fragments and PARP protein were significantly decreased in GDM placentas as compared with controls. Further, the level of placental SLC2A1 protein expression was ∼3-fold higher in GDM placentas. Our results suggest that reduced apoptosis in GDM placentas may contribute to increased placental tissue, which together with enhanced SLC2A1 expression, could play a role in fetal macrosomia.
The gastric-adapted bacterium Helicobacter pylori plays an important role in gastritis and ulcer disease, but no phenotypic typing scheme presently exists for this organism. With a view to the development of genotypic typing, we have compared isolates of H. pylori from gastritis or ulcer patients with those from subjects exhibiting no disease. Variation was analysed at the urease genes, ureA and ureCD, by employing PCR-generated probes in genomic Southern blot hybridizations. Whilst ureA restriction fragments provided a fourfold subgrouping of strains, ureCD fragments were considerably more discriminatory. Twenty-four combined ureACD profiles were generated with Hind III, subdividing the 64 strains into 11 types and 13 single profiles. The most prevalent profile (UI) was found in 33% of strains, almost all from gastritis or ulcer patients. On the other hand strains isolated from asymptomatic individuals had the most diverse ureACD profiles. A key finding from this set of isolates was that strains of H. pylori associated with general gastroduodenal disease were genetically more homogeneous than strains carried by people without disease symptoms.
The interaction of an Nd:YAG laser, operating at 532 nm with 40 ps pulse duration, with human teeth was studied. The results show that teeth were significantly modified at an energy fluence of about 11 J/cm2. Various surface morphologies of enamel and dentine were recorded. Features on enamel include crater (conical form) in the central part and cauliflower morphology at the periphery, whereas on dentine the crater looks like a stretched dome between sharp edges. The behavior of the enamel-dentine junction area showed different morphology with respect to both tooth enamel and dentine alone. Finally, the junction channel showed a removal of collagen fibers and the formation of a needle-like bottom structure. Generally, this investigation showed that the picosecond Nd:YAG laser can ablate a tooth surface practically instantaneously, implying that large tooth surfaces can be processed in short time.
Interaction of a Nd:YAG laser, operating at wavelengths of 1064 nm (23.6 J cm−2 fluence) or 532 nm (25.9 J cm−2 fluence), and pulse duration of 40 ps, with a titanium-based medical implant Ti6Al4V alloy was studied. Surface damage thresholds were estimated to be 0.9 J cm−2 and 0.25 J cm−2 at laser wavelengths 1064 nm and 532 nm, respectively. At both laser wavelengths, the energy absorbed was mostly converted into thermal energy, forming craters, albeit about 50 times deeper at 1064 nm than at 532 nm. Periodic surface structures (PSS) were also formed with both laser wavelengths, concentric, and radial at micrometer scale (3 µm to 15 µm period), parallel at nanometer scale (800 nm period with the 1064 nm laser, 400 nm with the 532 nm laser). In the case of the 532 nm laser, the concentric structures enlarge their period with accumulating laser pulse count. These features can help roughening of the implant surface and improve bio-compatibility.