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Background: Brain tumors present unique challenges to patient and family quality of life (QOL). Cognitive dysfunction is common and functionally limiting, with no established treatments. These studies evaluate feasibility and preliminary efficacy of behavioral interventions developed for neuro-oncology patients. Study 1: A randomized controlled trial (N=25 primary brain tumor patients) compared an adapted version of Goal Management Training (GMT, a neuroscience-based integration of mindfulness and strategy training) and a newly-designed supportive psychoeducational intervention (Brain Health Program, BHP) to standard of care. Each intervention comprised 8 individual sessions and at-home practice between sessions. GMT patients’ executive functions improved immediately (p=.077, d=1.13), with maintenance at 4-month follow-up (p=.046, d=1.09). Both intervention groups reported improvements in everyday cognitive functioning immediately (p=.049; d’s GMT=0.43, BHP=0.79) and at follow-up (p=.001; d’s GMT=0.22, BHP=1.01). BHP patients also reported improved mood (p’s=.026 & .012, d’s=0.61 & 0.62). Study 2: Following a needs assessment about cognitive concerns and QOL in brain metastases patients (N=109) and caregivers (N=31), we developed a novel, brief (3 sessions + homework) Cognitive Support Program to provide education and strategy-training in key areas of concern: executive functions, memory, and communication. Options include caregiver co-training, and in-person or web-based delivery. Preliminary data from a pilot trial in progress demonstrate objective and subjective improvements. Conclusions: Cognitive rehabilitation may be a feasible and effective option for primary or metastatic brain tumor patients, addressing a need that is largely unmet in standard cancer care. Further development and larger trials appear warranted, with capacity for remote delivery recommended.
This study assessed variation in coverage of maternal pertussis vaccination, introduced in England in October 2012 in response to a national outbreak, and a new infant rotavirus vaccination programme, implemented in July 2013. Vaccine eligible patients were included from national vaccine coverage datasets and covered April 2014 to March 2015 for pertussis and January 2014 to June 2016 for rotavirus. Vaccine coverage (%) was calculated overall and by NHS England Local Team (LT), ethnicity and Index of Multiple Deprivation (IMD) quintile, and compared using binomial regression. Compared with white-British infants, the largest differences in rotavirus coverage were in ‘other’, white-Irish and black-Caribbean infants (−13·9%, −12·1% and −10·7%, respectively), after adjusting for IMD and LT. The largest differences in maternal pertussis coverage were in black-other and black-Caribbean women (−16·3% and −15·4%, respectively). Coverage was lowest in London LT for both programmes. Coverage decreased with increasing deprivation and was 14·0% lower in the most deprived quintile compared with the least deprived for the pertussis programme and 4·4% lower for rotavirus. Patients’ ethnicity and deprivation were therefore predictors of coverage which contributed to, but did not wholly account for, geographical variation in coverage in England.
In 2013–2014, the Public Health Agency of Sweden developed a web-based participatory surveillance system, Hӓlsorapport, based on a random sample of individuals reporting symptoms weekly online, to estimate the community incidence of self-reported acute gastrointestinal (AGI), acute respiratory (ARI) and influenza-like (ILI) illnesses and their severity. We evaluated Hӓlsorapport's acceptability, completeness, representativeness and its data correlation with other surveillance data. We calculated response proportions and Spearman correlation coefficients (r) between (i) incidence of illnesses in Hӓlsorapport and (ii) proportions of specific search terms to medical-advice website and reasons for calling a medical advice hotline. Of 34 748 invitees, 3245 (9·3%) joined the cohort. Participants answered 81% (139 013) of the weekly questionnaires and 90% (16 351) of follow-up questionnaires. AGI incidence correlated with searches on winter-vomiting disease [r = 0·81, 95% confidence interval (CI) 0·69–0·89], and ARI incidence correlated with searches on cough (r = 0·77, 95% CI 0·62–0·86). ILI incidence correlated with the web query-based estimated incidence of ILI patients consulting physicians (r = 0·63, 95% CI 0·42–0·77). The high response to different questionnaires and the correlation with other syndromic surveillance systems suggest that Hӓlsorapport offers a reasonable representation of AGI, ARI and ILI patterns in the community and can complement traditional and syndromic surveillance systems to estimate their burden in the community.
Individuals with primary brain tumors experience a range of physical, cognitive and psychosocial sequelae which impact their independence, safety and quality of life. These impairments may be addressed through rehabilitation intervention. Despite acknowledgement that timely rehabilitation services over the course of the disease process is of benefit, few outpatient neuro-oncology treatment teams include a rehabilitation professional. Purpose: The aims are: (1) to describe a rehabilitation consultation model of care integrated into outpatient neuro-oncology treatment for individuals with primary brain tumors; and (2) to describe the characteristics of individuals referred for rehabilitation services. Methods: This retrospective descriptive study examined data from 200 individuals that received rehabilitation consultation from January 2015 to March 2016 at Princess Margaret Hospital, Pencer Brain Tumor Centre. Information on patient demographics, referral characteristics, and number of patient care visits was collected. Descriptive statistics were calculated. Preliminary Results: Of all patients, (n=195), the most common diagnosis is glioblastoma, 39% (n=76), and 50% are 50-69 years of age (M=55, SD=15.0). The most common reason for initial referral was decline in physical functioning, strength and balance (41%). In 77% of cases, patients were seen immediately at the time of referral. In total, 540 consultations were completed (face-to-face=230, telephone=310) with 2.78 on average (SD=4.0) per patient. Conclusion: Given the range of symptoms that individuals with primary brain tumors experience coupled with changes in functional status as the disease progresses, integrated and timely rehabilitation consultation is feasible.
In Sweden, acute gastrointestinal illness (AGI) incidence, severity, impact on productivity, related healthcare usage and associated costs are not ascertained. We measured these in 2013–2014 using a population-based cohort reporting weekly. We defined AGI as ⩾3 episodes of loose stools or vomiting/24 h; or loose stools or vomiting with ⩾2 other gastrointestinal symptoms. After each AGI episode, we collected information about perceived severity, healthcare use and absenteeism. We calculated incidence rates, AGI absenteeism and costs comprising direct healthcare costs and productivity loss due to work/school absenteeism. A total of 3241 participants reported 1696 AGI episodes [incidence 360/1000 person-years, 95% confidence interval (CI) 326–395; highest in the <5 years age group]. In the <5 years age group, 31% of episodes were perceived as mild, 61% as moderate and 8% as severe; 9·4% led to primary-care consultations, and 1·4% to hospital admissions. In the ⩾5 years age group, 18% of episodes were perceived as mild, 64% as moderate and 18% as severe; 6·4% led to primary-care consultations, and 1·9% to hospital admissions. AGI caused 8 891 000 days of absenteeism (95% CI 6 009 000–12 780 000). AGI cost €1 005 885 000 (95% CI 754 309 000–1 257 195 000) nationally for the year. In Sweden, a minority of cases perceive AGI as a mild illness. AGI is a burden on the healthcare system and causes productivity loss, with high costs. Countries may consider these estimates when prioritizing health interventions.
Although rates of anxiety tend to decrease across late life, rates of anxiety increase among a subset of older adults, those with mild cognitive impairment (MCI) or dementia. Our understanding of anxiety in dementia is limited, in part, by a lack of anxiety measures designed for use with this population. This study sought to address limitations of the literature by developing a new measure of anxiety for cognitively impaired individuals, the anxiety in cognitive impairment and dementia (ACID) Scales, which includes both proxy (ACID-PR) and self-report (ACID-SR) versions.
The ACID-SR and ACID-PR were administered to 45 residents, aged 60 years and older, of three long-term care (LTC) facilities, and 38 professional caregivers at these facilities. Other measures of anxiety, and measures of depression, functional ability, cognition, and general physical and mental health were also administered.
Initial evaluation of its psychometric properties revealed adequate to good internal consistency for the ACID-PR and ACID-SR. Evidence for convergent validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by moderate-to-strong associations with measures of worry, depressive symptoms, and general mental health. Discriminant validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by weak correlations with measures of cognition, functional ability, and general physical well-being.
The preliminary results suggest that the ACID-SR and ACID-PR can obtain reliable and valid measures of anxiety among individuals with cognitive impairment. Given the subjective nature of anxiety, it may be prudent to collect self-report of anxiety symptoms even among those with moderate cognitive impairment.
It is unknown which intervention strategies are used or effective to increase influenza vaccine uptake by healthcare workers (HCWs) in acute hospitals in England. We undertook a survey in acute hospitals, described strategies employed from 2008 to 2012 and used multivariable binomial regression to identify those effective. Eighty out of 166 trusts responded and reported 25 strategies. Every intervention showed increased use: peer vaccination from 3·8% to 38·8% (+921%); educational DVDs from 3·8% to 22·5% (+492%); Twitter from 2·5% to 12·5% (+400%) and Facebook from 1·3% to 6·3% (+384%). Peer vaccination increased uptake by 7·3% [95% confidence interval (CI) 1·1–13·6, P = 0·02] overall; educational DVDs by 9·7% overall (95% CI 1·8–17·6, P = 0·02), 11·9% in non-doctor, non-nurse HCWs (95% CI 0·9–22·8, P = 0·03). For doctors, using a champion doctor increased uptake by 17·8% (95% CI 7·6–28·0, P < 0·01). No intervention increased uptake by nurses. Increasing uptake requires multi-intervention strategies targeted at different HCW groups.
Scaling effects on Cu microstructure, resistivity, dielectric materials, and electromigration (EM) and time dependent dielectric break down (TDDB) reliabilities for Cu interconnects were reviewed. A simple empirical model of Cu resistivity related to Cu line area was presented. Cu line microstructures containing small grains mixed with large bamboo grains in Cu damascene lines from technology nodes below 65 nm were observed. As predicted in previous work, the EM lifetime was found to degrade by about 50% for every new generation even for the same current density. The Cu grain size was found to have a large impact on pure Cu and Cu alloy EM lifetime and activation energy Ea. Ea for pure Cu line capped with selective electroless CoWP on near-bamboo, bamboo-polycrystalline, to polycrystalline only line grain structures was reduced from 2.2 eV to 1.7 eV to 0.75 eV, respectively. Ea for 40 nm wide bamboo-polycrystalline lines capped with selective chemical vapor deposition (CVD) Co was found to be 1.7 eV. Using pure Cu and Cu(Al) or Cu(Mn) diluted impurity seed layers in 40 nm wide, bamboo-polycrystalline microstructure lines and above 100 nm wide, near bamboo-like grained lines, Cu-alloy lines enhanced EM lifetimes and increased QEM from 0.9 to 1. eV and 1.0 to 1.2 eV, respectively, compared to pure Cu lines. Inter-level TDDB testing on vias connecting M1 to M2 with a via chamfer angle that varied from 58o to 81o have very similar performance with intra-level M2 data with no vias tested at the same field. This result combined with the data from a separate study, which allowed the chamfer path to be isolated from the M2-level path, suggested that the failure took place preferentially along the weak cap/ILD interface at M2 and not at the via chamfer. TDDB acceleration data indicated that the root E model was overly conservative and a more aggressive model provided a better fit to the data. TDDB lifetimes correlated fairly well with the percentage of porosity in the dielectric materials.
Background: The assessment of social anxiety in late life has been examined in few studies (e.g. Gretarsdottir et al., 2004; Ciliberti et al., 2011). The present study describes the creation and initial psychometric evaluation of a new, content valid measure of social anxiety for older adults, the Older Adult Social-Evaluative Situations Questionnaire (OASES).
Methods: Psychometric properties of the OASES were evaluated in a community dwelling sample of older adults (N = 137; 70.8% female). Convergent validity was established by examining the relation between the OASES and the Liebowitz Social Anxiety Scale (LSAS), Social Phobia and Anxiety Inventory (SPAI), and Beck Anxiety Inventory (BAI). Discriminant validity was established by examining the relation between the OASES and measures of depression (Geriatric Depression Scale, GDS), perceived health status (Short Form Health Survey, SF-12), and demographic variables. The validity analyses of the OASES were based on a smaller sample with n values ranging from 98 to 137 depending on missing data on each questionnaire.
Results: Internal consistency, measured by Cronbach's α, for the OASES total score was 0.96. All items on the OASES were endorsed by participants. Convergent validity was demonstrated by medium to large correlations with the SPAI, LSAS, and BAI. Support for discriminant validity was evidenced by small to medium correlations between the OASES and GDS, SF-12, and demographic variables.
Conclusions: Evidence in support of convergent and discriminant validity of the OASES is discussed. Although the results from the present study suggest that this measure may assess anxiety in and avoidance of social situations salient to older adults, future studies are needed to further examine the psychometric properties of the OASES and replicate these results in both clinical and more diverse samples of older adults.
Epidemiological evidence suggests that monoclonal antibody type 2 positive (MAB 2+) Legionella pneumophila serogroup 1 (LP1) more often causes disease than do MAB 2− isolates, and there is evidence that MAB 2− LP1 grow less well in cells than do MAB 2+ bacteria. We tested the intracellular growth rates of ten randomly selected MAB 2− LP1 isolates, by using guinea-pig alveolar macrophages, and human monocyte-derived macrophages. Save a low virulence control, all ten MAB 2− isolates grew as well in cells as a virulent MAB 2+ isolate. Heterogeneity of MAB 2− LP1 growth in cells exists, making poor intracellular growth an unlikely explanation for why MAB 2+ LP1 appear to cause disease more often.
Demographic and clinical risk factors are important in guiding vaccination policy for pneumococcal pneumonia. We present data on these variables from a population-based surveillance network covering adult bacteraemic pneumococcal pneumonia (BPP) in the Delaware Valley region from 2002 to 2004. Surveillance data were used with U.S. Census data and a community health survey to calculate stratified incidence rates. Missing data were handled using multiple imputation. Overall rates of adult BPP were 10·6 cases/100 000 person-years. Elevated rates were seen in the elderly (>65 years), Native Americans, African Americans, the less-educated (less than high-school education), the poor, smokers, and individuals with histories of asthma, cancer, or diabetes. Multivariable modelling suggested that income was more robustly associated with risk than African American race. Of methodological interest, this association was not apparent if census block-group median income was used as a proxy for self-reported income. Further research on socioeconomic risk factors for BPP is needed.
In this paper, we have reported the fabrication and characterization of nanowire electromechanical switches consisting of chemical-vapor-deposition grown silicon nanowires suspended over metal electrodes. The devices operate as transistors with the suspended part of the nanowire bent to touch metal electrode via electromechanical force by applying voltage. The reversible switching, large on/off current ratio, small subthreshold slope and low switching energy compared to current CMOSFET make the switches very attractive for logic device application. In addition, we have developed a physical model to investigate the switching characteristics and extract the material properties.
Learning and performance on a ballistic task were investigated in
children with spina bifida meningomyelocele (SBM), with either upper level
spinal lesions (n = 21) or lower level spinal lesions (n
= 81), and in typically developing controls (n = 35).
Participants completed three phases (20 trials each) of an elbow
goniometer task that required a ballistic arm movement to move a cursor to
one of two target positions on a screen, including (1) an initial
learning phase, (2) an adaptation phase with a gain
change such that recalibration of the ballistic arm movement was required,
and (3) a learning reactivation phase under the original gain
condition. Initial error rate, asymptotic error rate, and learning rate
did not differ significantly between the SBM and control groups. Relative
to controls, the SBM group had reduced volumes in the cerebellar
hemispheres and pericallosal gray matter (the region including the basal
ganglia), although only the pericallosal gray matter was significantly
correlated with motor adaptation. Congenital cerebellar dysmorphology is
associated with preserved motor skill learning on voluntary, nonreflexive
tasks in children with SBM, in whom the relative roles of the cerebellum
and basal ganglia may differ from those in the adult brain.
(JINS, 2006, 12, 598–608.)
We are developing a device, the MEMS flux concentrator, that will greatly decrease the effect of 1/f noise in magnetic sensors. It does this by modulating the incoming signal and thus shifting the operating frequency of the sensor. This is accomplished by placing flux concentrators on MEMS structures that oscillate at kHz frequencies. Depending upon the sensor, shifting the operating frequency reduces the 1/f noise by one to three orders of magnitude at one Hz. We have succeeded in fabricating the necessary MEMS structures and observing the desired kHz normal mode resonant frequency. Only microwatts are required to drive the motion. We have used spin valves for our magnetic sensors. The measured field enhancement provided by the flux concentrators agrees to within 3% with the value estimated from finite element calculations. Noise measurements provide strong evidence that the device is likely to reduce the effect of 1/f noise. Flip chip bonding is likely to allow us to fabricate complete, fully functioning sensors.
The cerebellum is part of a neural circuit involved in procedural
motor learning. We examined how congenital cerebellar malformations
affect mirror drawing performance, a procedural learning task that
involves learning to trace the outline of a star while looking at the
reflection of the star in a mirror. Participants were 88 children with
spina bifida myelomeningocele, a neural tube defect that results in
lesions of the spinal cord, dysmorphology of the cerebellum, and
requires shunt treatment for hydrocephalus, and 35 typically developing
controls. Participants completed 10 trials in the morning and 10 trials
following a 3-hr delay. Although children with spina bifida
myelomeningocele were initially slower at tracing and made more errors
than controls, all participants improved their performance of the task,
as demonstrated by increased speed and accuracy across trials.
Moreover, degree of cerebellar dysmorphology was not correlated with
level of performance, rate of acquisition, or retention of mirror
drawing. The results suggest that congenital cerebellar dysmorphology
in spina bifida does not impair motor skill learning as measured by
acquisition and retention of the mirror drawing task. (JINS,
2004, 10, 877–887.)