Are lower rates of surgery amongst older women with breast cancer in the UK explained by co-morbidity?

Background: Around 60% of women greater than or equal to 80 years old, in the UK do not have surgery for their breast cancer (vs<10% of younger age groups). The extent to which this difference can be accounted for by co-morbidity has not been established. Methods: A Cancer Registry/Hospital Episode Statistics-linked data set identified women aged greater than or equal to 65 years diagnosed with invasive breast cancer (between 1 April 1997 and 31 March 2005) in two regions of the UK (n=23 038). Receipt of surgery by age was investigated using logistic regression, adjusting for co-morbidity and other patient, tumour and treatment factors. Results: Overall, 72% of older women received surgery, varying from 86% of 65–69-year olds to 34% of women aged greater than or equal to 85 years. The proportion receiving surgery fell with increasing co-morbidity (Charlson score 0=73%, score 1=66%, score 2+=49%). However, after adjustment for co-morbidity, older age still predicts lack of surgery. Compared with 65–69-year olds, the odds of surgery decreased from 0.74 (95% CI: 0.66–0.83) for 70–74-year olds to 0.13 (95% CI: 0.11–0.14) for women aged greater than or equal to 85 years. Conclusion: Although co-morbidity is associated with a reduced likelihood of surgery, it does not explain the shortfall in surgery amongst older women in the UK. Routine data on co-morbidity enables fairer comparison of treatment across population groups but needs to be more complete

Para um desenvolvimento de competências interculturais

El grupo de Galapro “Intercomprensión e interculturalidad”, está compuesto por participantes de lenguas romances, en su mayoría formadores, que han decidido relacionar de alguna manera la intercomprensión entre las lenguas de una misma familia con cuestiones relacionadas con la diversidad de culturas y costumbres. El objetivo marcado es la realización de un artículo o trabajo que analice un aspecto concreto de la interculturalidad en una sesión del Chat de una plataforma anterior, denominada Galanet, donde se investigaba y ponía en práctica la intercomprensión. Concretamente, hemos decidido tratar las formas de la cortesía en este lugar y entre lenguas/culturas distintas. Pero para ello, presentaremos primero una serie de características que nos sitúen en esa nueva forma de comunicación que es el Chat. Tras los análisis concretos de distintos aspectos de la cortesía (traducción e interculturalidad, otros aspectos y las negaciones y sus respuestas) propondremos algunas aplicaciones didácticas posibles en base a todo lo estudiado. En concreto, ofrecemos un cuestionario para los participantes en chats de diversas lenguas para conocer las representaciones sobre la interculuralidad y la cortesía que manejan. Algunos de los objetivos de estas propuestas didácticas podrían ser: encontrar modos de potenciar la interculturalidad, conocer las costumbres y modos lingüísticos corteses y descorteses de otras culturas para evitar el conflicto, deconstruir mitos y anular estereotipos, etc. Los materiales utilizados para componer este artículo han sido en primer lugar, ejemplos de Chats extraídos de Galanet que trataban diferencias culturales y/o lingüísticas. Entre ellos tenemos, una sesión que se ocupaba de lo no verbal y lo gestual entre extranjeros, otra que trataba sobre los falsos amigos, un Chat denominado “Agua”, pero que se dedicaba a las interferencias entre lenguas romances y experiencias en el extranjero de los participantes y finalmente, el Chat “Comida” que es el que hemos elegido para realizar nuestro análisis y que incluye varios temas “interculturales” como el orden de las comidas o la forma de leer la hora. Además de esta base de datos que recopila ejemplos empíricos se han incluido en los foros otros artículos de carácter teórico, como aquel que trata las formas de gestionar el conflicto en los chats y foros , varias fichas de lectura tomadas de Galanet y Galapro y se nos ha animado a visitar los ficheros específicos de esta segunda plataforma que trataban sobre la intercomprensión

Effects of postnatal smoke exposure on laryngeal chemoreflexes in newborn lambs

Laryngeal chemoreflexes (LCR), which are elicited by the contact of liquids such as gastric refluxate with laryngeal mucosa, may trigger some cases of sudden infant death syndrome. Indeed, while LCR in mature mammals consist in lower airway protective responses, previous animal data have shown that LCR in immature newborns can include laryngospasm, apnea, bradycardia and desaturation. The present study was aimed at testing the hypothesis that postnatal exposure to cigarette smoke is responsible for enhancing cardiorespiratory inhibition observed with LCR. Eight lambs were exposed to cigarette smoke (20 cig/day) during 16 days and compared to seven control lambs. Urinary cotinine/creatinine ratio was measured at a level relevant to previously published levels in infants. On D15-D16, 0.5 ml of HCl (pH 2), milk, distilled water or saline was injected onto the larynx via a chronic supra-glottal catheter during sleep. Results showed that exposure to cigarette smoke significantly enhanced apneas and bradycardias during LCR while significantly decreasing swallowing and arousal. These results were observed independently of the state of alertness and of the experimental solution tested. In conclusion, 15 day-postnatal exposure to cigarette smoke increases cardiorespiratory inhibition and decreases lower airway protective mechanisms in non-sedated, full-term lambs

Distinct contributions of extrastriate body area and temporoparietal junction in perceiving one's own and others' body.

The right temporoparietal cortex plays a critical role in body representation. Here, we applied repetitive transcranial magnetic stimulation (rTMS) over right extrastriate body area (EBA) and temporoparietal junction (TPJ) to investigate their causative roles in perceptual representations of one's own and others' body. Healthy women adjusted size-distorted pictures of their own body or of the body of another person according to how they perceived the body (subjective task) or how others perceived it (intersubjective task). In keeping with previous reports, at baseline, we found an overall underestimation of body size. Crucially, EBA-rTMS increased the underestimation bias when participants adjusted the images according to how others perceived their own or the other woman's body, suggesting a specific role of EBA in allocentric body representations. Conversely, TPJ-rTMS increased the underestimation bias when participants adjusted the body of another person, either a familiar other or a close friend, in both subjective and intersubjective tasks, suggesting an involvement of TPJ in representing others' bodies. These effects were body-specific, since no TMS-induced modulation was observed when participants judged a familiar object. The results suggest that right EBA and TPJ play active and complementary roles in the complex interaction between the perceptions of one's own and other people's body

Correction: Life and bladder cancer: protocol for a longitudinal and cross-sectional patient-reported outcomes study of Yorkshire (UK) patients

© Author(s) (or their employer(s)) 2019. This article was previously published with an error in figures. The correct figures are below: Figure 1: Study data flow for the longitudinal study (workstream 2). NCRAS, National Cancer Registration and Analysis. (Figure Presented). Figure 2: Study data flow for the cross-sectional study (workstream 3). CRFs, case report forms; PHE, Public Health England; PIS, patient information sheet. (Figure Presented)

Diel surface temperature range scales with lake size

Ecological and biogeochemical processes in lakes are strongly dependent upon water temperature. Long-term surface warming of many lakes is unequivocal, but little is known about the comparative magnitude of temperature variation at diel timescales, due to a lack of appropriately resolved data. Here we quantify the pattern and magnitude of diel temperature variability of surface waters using high-frequency data from 100 lakes. We show that the near-surface diel temperature range can be substantial in summer relative to long-term change and, for lakes smaller than 3 km2, increases sharply and predictably with decreasing lake area. Most small lakes included in this study experience average summer diel ranges in their near-surface temperatures of between 4 and 7°C. Large diel temperature fluctuations in the majority of lakes undoubtedly influence their structure, function and role in biogeochemical cycles, but the full implications remain largely unexplored

Myocardial histology and outcome after cardiopulmonary bypass of neonatal piglets

BACKGROUND: Early after neonatal cardiac surgery hemodynamic dysfunction may be evident. However, still is not clear if dysfunction and outcome is related to visible myocardial alterations. The aim of the present study was the histological analysis of myocardial tissue of neonatal piglets after cardiopulmonary bypass (CPB) and cardioplegic arrest. METHODS: Neonatal piglets (younger than 7 days) were connected to CPB for 180 min, including 90 min of cardioplegic heart arrest at 32 °C. After termination of CPB the piglets were observed up to 6 h. During this observational period animals did not receive any inotropic support. Some piglets died within this period and formed the non-survivors group (CPB-NS group) and the remaining animals formed the CPB-6 h group. Myocardial biopsies (stained with H&E) were scored from 0 to 3 regarding histological alterations. Then, the histological data were evaluated and compared to the probes of animals handled comparable to previous piglets but without CPB (non-CPB group; n = 3) and to sibling piglets without specific treatment (control; n = 5). RESULTS: In the first hours after CPB six piglets out of 10 died (median 3.3 h). The animals of CPB-6 h group (n = 4) were sacrificed at the end of experiments (6 h after CPB). Although the myocardial histological score of CPB-6 h group and CPB-NS group were higher than non-CPB group (2.0 ± 0.8, 1.5 ± 0.9, and 0.8 ± 0.3 respectively), these differences were statistically not significant. But compared to control animals (score 0.3 ± 0.5) the scores of CPB-6 h and CPB-NS groups were significantly higher (p < 0.05). Between the left and the right ventricular tissue there were no significant differences. CONCLUSIONS: Myocardial tissue alterations in newborn piglets are related to the surgical trauma and potentiated by cardiopulmonary bypass and ischemia. However, outcome is not related to the degree of tissue alteration

Ejection Time-Corrected Systolic Velocity Improves Accuracy in the Evaluation of Myocardial Dysfunction: A Study in Piglets

This study aimed to assess the effect of correcting for the impact of heart rate (HR) or ejection time (ET) on myocardial velocities in the long axis in piglets undergoing hypoxia. The ability to eject a higher volume at a fixed ET is a characteristic of contractility in the heart. Systolic velocity of the atrioventricular annulus displacement is directly related to volume changes of the ventricle. Both ET and systolic velocity may be measured in a single heartbeat. In 29 neonatal pigs, systolic velocity and ET were measured with tissue Doppler techniques in the mitral valve annulus, the tricuspid valve annulus, and the septum. All ejection time corrected velocities (S(ET), mean ± SEM, cm/s) decreased significantly during hypoxia (Smva(ET) 15.5 ± 0.2 to 13.2 ± 0.3 (p < 0.001), Sseptal(ET) 9.9 ± 0.1 to 7.8 ± 0.2 (p < 0.001), Stva(ET) 12.1 ± 0.2 to 9.8 ± 0.3 (p < 0.001)). The magnitude of change from baseline to hypoxia was greater for ejection time corrected systolic velocities than for RR-interval corrected velocities (mean ± SEM, cm/s); ΔSmva(ET) 2.3 ± 2.0 vs. ΔSmva(RR) 1.6 ± 1.1 (p = 0.02), ΔSseptal(ET) 2.1 ± 1.0 vs. ΔSseptal(RR) 1.6 ± 1.0 (p < 0.01), ΔStva(ET) 2.3 ± 1.1 vs. ΔStva(RR) 1.8 ± 1.3 (p = 0.04). The receiver operator characteristic (ROC) showed superior performance of S(ET) compared with uncorrected velocities. The decrease in S(ET) during hypoxia was not influenced by important hemodynamic determinants. ET-corrected systolic velocity improves accuracy and decreases variability in the evaluation of systolic longitudinal function and contractility during global hypoxia in neonatal pigs compared with systolic velocity alone. It is robust toward hemodynamic changes. This novel method has the potential of becoming a useful tool in clinical practice

Rasch scaling procedures for informing development of a valid Fetal Surveillance Education Program multiple-choice assessment

<p>Abstract</p> <p>Background</p> <p>It is widely recognised that deficiencies in fetal surveillance practice continue to contribute significantly to the burden of adverse outcomes. This has prompted the development of evidence-based clinical practice guidelines by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and an associated Fetal Surveillance Education Program to deliver the associated learning. This article describes initial steps in the validation of a corresponding multiple-choice assessment of the relevant educational outcomes through a combination of item response modelling and expert judgement.</p> <p>Methods</p> <p>The Rasch item response model was employed for item and test analysis and to empirically derive the substantive interpretation of the assessment variable. This interpretation was then compared to the hierarchy of competencies specified a priori by a team of eight subject-matter experts. Classical Test Theory analyses were also conducted.</p> <p>Results</p> <p>A high level of agreement between the hypothesised and derived variable provided evidence of construct validity. Item and test indices from Rasch analysis and Classical Test Theory analysis suggested that the current test form was of moderate quality. However, the analyses made clear the required steps for establishing a valid assessment of sufficient psychometric quality. These steps included: increasing the number of items from 40 to 50 in the first instance, reviewing ineffective items, targeting new items to specific content and difficulty gaps, and formalising the assessment blueprint in light of empirical information relating item structure to item difficulty.</p> <p>Conclusion</p> <p>The application of the Rasch model for criterion-referenced assessment validation with an expert stakeholder group is herein described. Recommendations for subsequent item and test construction are also outlined in this article.</p

Measuring the ICF components of impairment, activity limitation and participation restriction: an item analysis using classical test theory and item response theory

The International Classification of Functioning, Disability and Health (ICF) proposes three main health outcomes, Impairment (I), Activity Limitation (A) and Participation Restriction (P), but good measures of these constructs are needed The aim of this study was to use both Classical Test Theory (CTT) and Item Response Theory (IRT) methods to carry out an item analysis to improve measurement of these three components in patients having joint replacement surgery mainly for osteoarthritis (OA). A geographical cohort of patients about to undergo lower limb joint replacement was invited to participate. Five hundred and twenty four patients completed ICF items that had been previously identified as measuring only a single ICF construct in patients with osteoarthritis. There were 13 I, 26 A and 20 P items. The SF-36 was used to explore the construct validity of the resultant I, A and P measures. The CTT and IRT analyses were run separately to identify items for inclusion or exclusion in the measurement of each construct. The results from both analyses were compared and contrasted. Overall, the item analysis resulted in the removal of 4 I items, 9 A items and 11 P items. CTT and IRT identified the same 14 items for removal, with CTT additionally excluding 3 items, and IRT a further 7 items. In a preliminary exploration of reliability and validity, the new measures appeared acceptable. New measures were developed that reflect the ICF components of Impairment, Activity Limitation and Participation Restriction for patients with advanced arthritis. The resulting Aberdeen IAP measures (Ab-IAP) comprising I (Ab-I, 9 items), A (Ab-A, 17 items), and P (Ab-P, 9 items) met the criteria of conventional psychometric (CTT) analyses and the additional criteria (information and discrimination) of IRT. The use of both methods was more informative than the use of only one of these methods. Thus combining CTT and IRT appears to be a valuable tool in the development of measures