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Vampires : a hunter's guide
From legends of Vlad the Impaler to Twilight and HBO's True Blood, vampire stories permeate society. Learn the truth behind the fiction in this tell-all of the hunters who protect humanity from the vampiric threat!. For centuries, vampires have wandered the shadows: watching, stalking, preying. But thanks to a group of dedicated and powerful hunters, the vampire threat has remained largely suppressed, evidence of their existence confined to the whispers of myth and folklore. But covens across the world have grown weary. The undead are preparing to rise up and claim their rightful place in society.
Book
Readability Analysis of Online Breast Cancer Surgery Patient Education Materials from National Cancer Institute-Designated Cancer Centers Compared with Top Internet Search Results
Background
The National Institutes of Health (NIH) recommends patient education materials reflect the average reading grade level of the US population. Due to the importance of shared decision-making in breast cancer surgery, this study evaluates the reading level of patient education materials from National Cancer Institute-designated cancer centers (NCI-DCC) compared with top Internet search results.
Methods
Online materials from NCI-DCC and top Internet search results on breast cancer, staging, surgical options, and pre- and postoperative expectations were analyzed using three validated readability algorithms: Simplified Measure of Gobbledygook Readability Formula, Coleman–Liau index, and Flesch–Kincaid grade level. Mean readability was compared across source groups and information subcategories using an unpaired
t
-test with statistical significance set at
p
< 0.05. Mean readability was compared using a one-way analysis of variance.
Results
Mean readability scores from NCI-DCC and Internet groups ranged from a 9th–12th grade level, significantly above the NIH recommended reading level of 6th–7th grade. There was no significant difference between reading levels from the two sources. The discrepancy between actual and recommended reading level was most pronounced for “surgical options” at a 10th–12th grade level from both sources.
Conclusions
Patient education materials on breast cancer from both NCI-DCC and top Internet search results were written several reading grade levels higher than the NIH recommendation. Materials should be revised to enhance patient comprehension of breast cancer surgical treatment and guide patients in this important decision-making process to ultimately improve health outcomes.
Journal Article
A mobile health‐facilitated behavioural intervention for community health workers improves exclusive breastfeeding and early infant HIV diagnosis in India: a cluster randomized trial
Introduction India’s national AIDS Control Organization implemented World Health Organization’s option B+ HIV prevention of mother‐to‐child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health‐Facilitated Behavioral Intervention on the uptake of PMTCT services. Methods A cluster‐randomized trial of a mobile health (mHealth)‐supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV‐positive pregnant/postpartum clients (n = 1191)) were randomized to standard‐of‐care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention – specialized behavioural training plus a tablet‐based mHealth application to support ORW‐patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi‐level random‐effects logistic regression models. Results Of 1191 HIV‐positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC. Conclusions The COMBIND intervention was easily integrated into India’s existing PMTCT programme and improved early uptake of two PMTCT components that require self‐motivated health‐seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes.
Journal Article
Effect of Sampling Rate, Filtering, and Torque Onset Detection on Quadriceps Rate of Torque Development and Torque Steadiness
Quadriceps rate of torque development (RTD) and torque steadiness are valuable metrics for assessing explosive strength and the ability to control force over a sustained period of time, which can inform clinical assessments of knee function. Despite their widespread use, there is a significant gap in standardized methodology for measuring these metrics, which limits their utility in comparing outcomes across different studies and populations. To address these gaps, we evaluated the influence of sampling rates, signal filtering, and torque onset detection on RTD and torque steadiness. Twenty-seven participants with a history of a primary anterior cruciate ligament reconstruction (N = 27 (11 male/16 female), age = 23 ± 8 years, body mass index = 26 ± 4 kg/m2) and thirty-two control participants (N = 32 (13 male/19 female), age = 23 ± 7 years, body mass index = 23 ± 3 kg/m2) underwent isometric quadriceps strength testing, with data collected at 2222 Hz on an isokinetic dynamometer. The torque–time signal was downsampled to approximately 100 and 1000 Hz and processed using a low-pass, zero-lag Butterworth filter with a range of cutoff frequencies spanning 10–200 Hz. The thresholds used to detect torque onset were defined as 0.1 Nm, 1 Nm, and 5 Nm. RTD between 0 and 100 ms, 0 and 200 ms, and 40–160 ms was computed, as well as absolute and relative torque steadiness. Relative differences were computed by comparing all outcomes to the “gold standard” values computed, with a sampling rate of 2222 Hz, a cutoff frequency in the low-pass filter of 150 Hz, and torque onset of 1 Nm, and compared utilizing linear mixed models. While all combinations of signal collection and processing parameters reached statistical significance (p < 0.05), these differences were consistent between injured and control limbs. Additionally, clinically relevant differences (+/−10%) were primarily observed through torque onset detection methods and primarily affected RTD between 0 and 100 ms. Although measurements of RTD and torque steadiness were generally robust against diverse signal collection and processing parameters, the selection of torque onset should be carefully considered, especially in early RTD assessments that have shorter time epochs.
Journal Article
Chemotherapy refusal and subsequent survival in healthy older women with high genomic risk estrogen receptor-positive breast cancer
BackgroundPatients with estrogen receptor (ER)-positive, HER2-negative breast cancer (BC), and high-risk 21-gene recurrence score (RS) results benefit from chemotherapy. We evaluated chemotherapy refusal and survival in healthy older women with high-RS, ER-positive BC.Methods Retrospective review of the National Cancer Database (2010–2017) identified women ≥ 65 years of age, with ER-positive, HER2-negative, high-RS (≥ 26) BC. Patients with Charlson Comorbidity Index ≥ 1, stage III/IV disease, or incomplete data were excluded. Women were compared by chemotherapy receipt or refusal using the Cochrane–Armitage test, multivariable logistical regression modeling, the Kaplan–Meier method, and Cox’s proportional hazards modeling.Results 6827 women met study criteria: 5449 (80%) received chemotherapy and 1378 (20%) refused. Compared to women who received chemotherapy, women who refused were older (71 vs 69 years), were diagnosed more recently (2014–2017, 67% vs 61%), and received radiation less frequently (67% vs 71%) (p ≤ 0.05). Refusal was associated with decreased 5-year OS for women 65–74 (92% vs 95%) and 75–79 (85% vs 92%) (p ≤ 0.05), but not for women ≥ 80 years old (84% vs 91%; p = 0.07). On multivariable analysis, hazard of death increased with refusal overall (HR 1.12, 95% CI 1.04–1.2); but, when stratified by age, was not increased for women ≥ 80 years (HR 1.10, 95% CI 0.80–1.51).Conclusions Among healthy women with high-RS, ER-positive BC, chemotherapy refusal was associated with decreased OS for women ages 65–79, but did not impact the OS of women ≥ 80 years old. Genomic testing may have limited utility in this population, warranting prudent shared decision-making and further study.
Journal Article
Evaluation of a competency based medical curriculum in a Sub-Saharan African medical school
Background
Medical schools in Sub-Saharan Africa have adopted competency based medical education (CBME) to improve the quality of graduates trained. In 2015, Makerere University College of Health Sciences (MaKCHS) implemented CBME for the Bachelor of Medicine and Bachelor of Surgery (MBChB) programme in order to produce doctors with the required attributes to address community health needs. However, no formal evaluation of the curriculum has been conducted to determine whether all established competencies are being assessed.
Objective
To evaluate whether assessment methods within the MBChB curriculum address the stated competencies.
Methods
The evaluation adopted a cross-sectional study design in which the MBChB curriculum was evaluated using an
Essential Course Evidence Form
(ECEF) that was developed to collect information about each assessment used for each course. Information was collected on: (1) Assessment title, (2) Description, (3) Competency domain (4) Sub-competency addressed, (5) Student instructions, and (6) Grading method/details. Data were entered into a structured Access data base. In addition, face-to-face interviews were conducted with faculty course coordinators.
Results
The MBChB curriculum consisted of 62 courses over 5 years, focusing on preclinical skills in years 1–2 and clinical skills in years 3–5. Fifty-nine competencies were identified and aggregated into 9 domains. Fifty-eight competencies were assessed at least one time in the curriculum. Faculty cited limited training in assessment as well as large student numbers as hindrances to designing robust assessments for the competencies.
Conclusion
CBME was successfully implemented evidenced by all but one of the 59 competencies within the nine domains established being assessed within the MBChB curriculum at MaKCHS. Faculty interviewed were largely aware of it, however indicated the need for more training in competency-based assessment to improve the implementation of CBME.
Journal Article
The Addition of Chemoradiation to Adjuvant Chemotherapy is Associated With Improved Survival Following Upfront Surgical Resection for Pancreatic Cancer With Nodal Metastases
Background
It is unclear whether the addition of chemoradiation (CRT) to adjuvant chemotherapy (CT) following upfront resection of pancreatic ductal adenocarcinoma (PDAC) provides any benefit. While some studies have suggested a benefit to combined modality therapy (CMT) (adjuvant CT plus CRT), it is not clear if this benefit was related to increased CT usage in patients who received CMT. We sought to clarify the use of CMT in patients who underwent upfront resection of PDAC.
Methods
Patients with non-metastatic PDAC were retrospectively identified from the linked SEER-Medicare database. Those who underwent upfront resection were identified and divided into two cohorts – patients who received adjuvant CT and patients who received adjuvant CMT. Cohorts were compared. Univariate analysis described patient characteristics. Kaplan-Meier and multivariable Cox proportional hazards modeling were used to estimate overall survival (OS).
Results
3555 patients were identified; 856 (24%) received CT and 573 (16%) received CMT. The median number of CT doses was 11 for both groups. Patients who received CMT were younger, diagnosed in the earlier time frame, and had fewer comorbidities. The median OS was 21 months and 18 months for those treated with CMT and CT (P < .0001), respectively, but when stratified by nodal status, the association with improved OS in the CMT cohort was only observed in node-positive patients. On multivariable analysis, receipt of CMT and removal of >15 lymph nodes decreased the risk of death (P < .05).
Discussion
Receipt of CMT following upfront resection for PDAC was associated with improved survival, which was confined to node-positive patients. The role of adjuvant CMT in PDAC with nodal metastases warrants further study.
Journal Article
The Utility of Functional Data Analyses to Reveal Between-Limbs Asymmetries in Those With a History of Anterior Cruciate Ligament Reconstruction
Researchers have traditionally used motion capture to quantify discrete biomechanical data points (peak values) during hop testing. However, these analyses restrict the evaluation to a single time point (ie, certain percentage of stance) and provide only a narrow view of movement. Applying more comprehensive analyses may help investigators identify important characteristics that are masked by the discrete analyses often used to screen patients for activity.
To examine the utility of functional data analyses to reveal asymmetries that are undetectable using discrete (ie, single time point) evaluations in participants with a history of anterior cruciate ligament reconstruction (ACLR) who achieved clinical hop symmetry.
Cross-sectional study.
Laboratory.
Fifteen participants with unilateral ACLR (age = 21 ± 3 years, time from surgery = 4 ± 3 years) and 15 control participants without ACLR (age = 23 ± 2 years).
Lower extremity biomechanics during the triple-hop-for-distance task for the ACLR and contralateral limbs of patients and a representative limb of control participants were measured.
Peak sagittal-plane joint power, joint work, and power profiles were determined.
Using discrete analyses, we identified lower peak knee power and work in the ACLR limb compared with the contralateral and control limbs (P < .05) but were unable to demonstrate differences at the ankle or hip. Using functional data analyses, we observed asymmetries at the ankle, knee, and hip between the ACLR and contralateral or control limbs throughout stance (P < .05) and revealed that these asymmetries stemmed from knee power deficits that were prominent during early loading.
Despite achieving hop-distance symmetry, the ACLR limbs absorbed less power. Although this information was revealed using the discrete analyses, underlying asymmetries at the ankle and hip were masked. Using functional data analyses, we found interlimb asymmetries at the ankle, knee, and hip throughout ground contact and more fully elucidated the extent and source of asymmetries that can be used by clinicians and researchers alike to guide clinical decision making.
Journal Article
Morphology and Anabolic Response of Skeletal Muscles Subjected to Eccentrically or Concentrically Biased Exercise
Long-term eccentric exercise is known to promote muscle growth better than concentric exercise, but its acute effect on muscle is not well understood because of misinterpreted modeling and in situ and in vitro stretch protocols. Knowing if the initial bout of eccentric exercise promotes muscle growth and limits damage is critical to understanding the effect of this mode of exercise.
To directly evaluate the immediate effects of eccentric and concentric exercises on untrained muscle when fiber strains were physiological and exercise doses were comparable.
Controlled laboratory study.
Laboratory.
A total of 40 skeletally mature male Long-Evans rats (age = 16 weeks, mass = 452.1 ± 35.2 g) were randomly assigned to an eccentric exercise (downhill walking, n = 16), concentric exercise (uphill walking, n = 16), or control (no exercise, n = 8) group.
Rats were exposed to a single 15-minute bout of eccentric or concentric exercise on a motorized treadmill and then were euthanized at 6 or 24 hours postexercise. We harvested the vastus lateralis muscle bilaterally.
The percentage increase or decrease in protein abundance in exercised animals relative to that in unexercised control animals was evaluated as elevated phosphorylated p70
relative to total p70
. Fiber damage was quantified using immunoglobulin G permeability staining. One-way analysis of variance and post hoc Tukey tests were performed.
Rats exposed to eccentric exercise and euthanized at 24 hours had higher percentage response protein synthesis rates than rats exposed to eccentric exercise and euthanized at 6 hours (
= .02) or to concentric exercise and euthanized at 6 (
= .03) or 24 (
= .03) hours. We assessed 9446 fibers for damage and found only 1 fiber was infiltrated (in the concentric exercise group euthanized at 6 hours). Furthermore, no between-groups differences in immunoglobulin G fluorescent intensity were detected (
= .94).
Incorporating eccentric exercise is a simple, universally available therapeutic intervention for promoting muscle recovery. A single 15-minute dose of eccentric exercise to a novice muscle can better exert an anabolic effect than a comparable dose of concentric exercise, with very limited evidence of fiber damage.
Journal Article