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Mobility disability affects approximately 13.7% of the United States population, representing the most common disability type. People with mobility disability experience disparities in cancer screening and higher prevalence of some cancers compared to the general population. We sought to explore the attitudes of people with pre-existing mobility disability about their cancer diagnosis.
We conducted open-ended individual interviews with 20 participants who had pre-existing mobility disability requiring use of an assistive device or assistance with performance of activities of daily living (ADLs), subsequently diagnosed with cancer (excluding skin cancers). Interviews reached data saturation and were transcribed verbatim for conventional content analysis.
Concerns coalesced around three major themes sense of control over health conditions, seeking support, and recommendations for other people with disability seeking cancer care. Some participants described feeling a loss of control over their cancer diagnchosocial needs of this population.Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic in South Africa while hepatitis C virus (HCV) infection is rare. Two nucleic acid amplification technology platforms, the Procleix Ultrio Elite assay on the Panther instrument (Elite) and the cobas MPX assay on the cobas 6800 or 8800 system (MPX), are used worldwide. In 2015 these were evaluated in South African context.
The sensitivity of HIV, HBV, and HCV was evaluated using reference panels and 2-fold dilutions of 51 positive plasma samples tested in 12 to 24 replicates. The 95% and 50% lower limits of detection (LOD) were estimated by probit analysis and window period (WP) risk days by the Weusten model. Specificity was established by testing 3646 blood donations individually and instrument performance by evaluating all runs.
Specificity was 99.94% for MPX and 99.97% for Elite. The following 95% LODs (95% confidence intervals [CIs]) were estimated for MPX and Elite, respectively HBV, 17.8 (10.9-33.9) and 47.9 (29.1-92.4) cp/mL; HCV, 21.9 (15.3-34.6) and 13.8 (8.9-24.0) cp/mL; and HIV, 8.3 (5.5-14.7) and 10.4 (6.9-18.2) cp/mL. On SA HBV and HIV dilution panels, relative sensitivity (range) of MPX was 3.20 (1.26-6.50) and 1.42 (0.26-2.72) fold higher than Elite. Downtime on cobas 6800 was 26 hours vs 6.6 hours on Panther (P < .001). We estimated infectious WPs for HBV, HCV, and HIV-1 at 13.8, 1.8, and 2.6 days for Elite and 10.3, 2.1, and 2.4 days for MPX.
Although MPX was significantly more sensitive for HBV, Elite was implemented due to instrument reliability during evaluation.
Although MPX was significantly more sensitive for HBV, Elite was implemented due to instrument reliability during evaluation.Numerous theoretical models of relationship distress suggest that strong, negative reactions to conflict are directly associated with lower levels of relationship satisfaction. Consistent with this supposition, substantial evidence links higher levels of subjective negative emotion, more pronounced and frequent expressions of negative affect, and higher levels of negative communication behaviors to lower levels of relationship satisfaction (e.g., Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). However, the evidence linking stress-related physiological responding during relationship conflict and relationship satisfaction is less compelling than would be anticipated based on theory. We propose that these theoretically unexpected but empirically well-replicated findings may be the result of different patterns in association between physiological reactivity and relationship satisfaction for couples with varying styles in how they typically perceive unwanted behavior in one another. The present study tests negative attributions for undesirable partner behaviors as a moderator of the association between heart rate reactivity (HRR) during relationship conflict and relationship satisfaction in a sample of 60 married couples. A significant interaction emerged between HRR and negative attributions of partner behavior in predicting relationship satisfaction such that higher levels of HRR were associated with lower levels of relationship satisfaction for individuals who typically made more negative attributions for undesirable partner behaviors, but with higher levels of relationship satisfaction for individuals who typically made fewer negative attributions for undesirable partner behaviors. Implications for conceptualizing reactivity during relationship conflict and couple interventions are discussed.A progressive increase in copy number variation (CNV) characterizes the natural history of cutaneous melanoma progression toward later disease stages, but our understanding of genetic drivers underlying chromosomal arm-level CNVs remains limited. To identify candidate progression drivers, we mined the TCGA SKCM dataset and identified HDGF as a recurrently amplified gene whose high mRNA expression correlates with poor patient survival. Using melanocyte-specific overexpression in the zebrafish BRAFV600E -driven MiniCoopR melanoma model, we show that HDGF accelerates melanoma development in vivo. Transcriptional analysis of HDGF compared to control EGFP tumors showed the activation of endothelial/angiogenic pathways. We validated this observation using an endothelial kdrlmCherry reporter line which showed HDGF to increases tumor vasculature. HDGF is frequently co-altered with the established melanoma driver SETDB1. Both genes are located on chromosome 1q, and their co-amplification is observed in up to 13% of metastatic melanoma. TCGA patients with both genes amplified and/or overexpressed have a worse melanoma specific survival. MK571 We tested co-expression of HDGF and SETDB1 in the MiniCoopR model, which resulted in faster and more aggressive melanoma development than either gene individually. Our work identifies the co-amplification of HDGF and SETDB1 as a functional driver of melanoma progression and poor patient prognosis.
There is no consensus on the appropriate extent of oncological resection for tumours of the transverse colon. Concerns regarding tumour factors such as pattern of lymph node spread and technical factors such as anastomotic perfusion lead to a variety of procedures being performed.
A comprehensive search for published studies examining outcomes following segmental versus extended colectomy for transverse colon tumours was performed adhering to PRISMA (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Random effects methods were used to combine data.
Seven comparative series examining outcomes in 3395 patients were identified. Segmental colectomy results in shorter operating times (mean difference 15.80 min, 95% CI -20.98 to -10.62, P<0.001) and less ileus (OR 0.52, 95% CI 0.33-0.81, P=0.004). There was no difference in length of hospital stay (mean difference 1.53days, 95% CI -3.79 to 0.73, P=0.18). Extended colectomy results in a lower rate of anastomotic leak (OR 0.62, 95% CI 0.40-0.97, P=0.04). There are fewer nodes retrieved in segmental colectomy (mean difference 7.60 nodes, 95% CI -9.60 to -5.61, P<0.001) but no difference in disease recurrence (OR 0.88, 95% CI 0.59-1.34, P=0.56) or overall survival (OR 0.98, 95% CI 0.68-1.4, P=0.9).
Available data are limited due to a lack of randomized controlled trials. However, based on current evidence, segmental resection for transverse colon tumours is associated with less ileus but lower lymph node yields and higher anastomotic leak rates. Length of stay is similar. Oncological outcomes are equivalent.
Available data are limited due to a lack of randomized controlled trials. However, based on current evidence, segmental resection for transverse colon tumours is associated with less ileus but lower lymph node yields and higher anastomotic leak rates. Length of stay is similar. Oncological outcomes are equivalent.
ABO-incompatible red blood cell (RBC) transfusions and acute hemolytic reactions occur infrequently, yet resultant fatalities are reported to the US Food and Drug Administration (FDA) every year. We describe a 20-year retrospective study of reported mistransfusion cases to identify temporal trends, common causes, and corrective actions taken to prevent recurrence.
ABO-incompatible RBC transfusion-related fatalities reported to the FDA in 2000-2019 were reviewed for patient demographics, primary attributed cause, contributing factors, and corrective actions.
Eighty reported deaths after ABO-incompatible RBC transfusion occurred in the 20-year period. A decrease in the number of cases after 2008 was sustained through 2019 (mean 6 cases/y, 2000-2009 vs 2 cases/y, 2010-2019). The estimated rate of reported mistransfusion fatalities was 1 per 2 million RBC units transfused in 2000-2009 and 1 per 7.14 million RBC units in 2010-2019 (P < .0001). Administration errors (wrong patient or wrong unit transfused) and sample collection errors (wrong blood in tube [WBIT]) significantly decreased over time but remained the most common causes. In all WBIT cases, verification of patients' ABO type with a second sample or historical type was not performed before transfusion; 16 of 19 (84%) institutions that reported corrective actions subsequently instituted this requirement. In the other categories, 22 of 58 (38%) facilities reported plans for technological process improvements, such as electronic patient identification.
The rate of reported fatalities from ABO-incompatible RBC transfusion has significantly decreased in the past decade. Still, about two cases are reported each year, highlighting gaps in best practices and areas for improvement.
The rate of reported fatalities from ABO-incompatible RBC transfusion has significantly decreased in the past decade. Still, about two cases are reported each year, highlighting gaps in best practices and areas for improvement.
Guidelines recommend less intensive glycemic treatment and less frequent glucose monitoring for nursing home (NH) residents. However, little is known about the frequency of fingerstick (FS) glucose monitoring in this population. Our objective was to examine the frequency of FS glucose monitoring in Veterans Affairs (VA) NH residents with diabetes mellitus, type II (T2DM).
National retrospective cohort study in 140 VA NHs.
NH residents with T2DM and older than 65 years admitted to VA NHs between 2013 and 2015 following discharge from a VA hospital.
NH residents were classified into five groups based on their highest hypoglycemia risk glucose-lowering medication (GLM) each day no GLMs; metformin only; sulfonylureas; long-acting insulin; and any short-acting insulin. Our outcome was a daily count of FS measurements.
Among 17,474 VA NH residents, mean age was 76 (standard deviation (SD) = 8) years and mean hemoglobin A1c was 7.6% (SD = 1.5%). On day 1 after NH admission, 49% of NH residents were on shorrranted for many low hypoglycemia risk NH residents.
Although guidelines recommend less frequent glucose monitoring for NH residents, we found that many VA NH residents receive frequent FS monitoring. Given the uncertain benefits and potential for substantial patient burdens and harms, our results suggest decreasing FS monitoring may be warranted for many low hypoglycemia risk NH residents.
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