Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

Adipose Tissue Deficiency and Chronic Inflammation in Diabetic Goto-Kakizaki Rats

Type 2 diabetes (T2DM) is a heterogeneous group of diseases that is progressive and involves multiple tissues. Goto-Kakizaki (GK) rats are a polygenic model with elevated blood glucose, peripheral insulin resistance, a non-obese phenotype, and exhibit many degenerative changes observed in human T2DM. As part of a systems analysis of disease progression in this animal model, this study characterized the contribution of adipose tissue to pathophysiology of the disease. We sacrificed subgroups of GK rats and appropriate controls at 4, 8, 12, 16 and 20 weeks of age and carried out a gene array analysis of white adipose tissue. We expanded our physiological analysis of the animals that accompanied our initial gene array study on the livers from these animals. The expanded analysis included adipose tissue weights, HbA1c, additional hormonal profiles, lipid profiles, differential blood cell counts, and food consumption. HbA1c progressively increased in the GK animals. Altered corticosterone, leptin, and adiponectin profiles were also documented in GK animals. Gene array analysis identified 412 genes that were differentially expressed in adipose tissue of GKs relative to controls. The GK animals exhibited an age-specific failure to accumulate body fat despite their relatively higher calorie consumption which was well supported by the altered expression of genes involved in adipogenesis and lipogenesis in the white adipose tissue of these animals, including Fasn, Acly, Kklf9, and Stat3. Systemic inflammation was reflected by chronically elevated white blood cell counts. Furthermore, chronic inflammation in adipose tissue was evident from the differential expression of genes involved in inflammatory responses and activation of natural immunity, including two interferon regulated genes, Ifit and Iipg, as well as MHC class II genes. This study demonstrates an age specific failure to accumulate adipose tissue in the GK rat and the presence of chronic inflammation in adipose tissue from these animals

Influences of club connectedness among young adults in Western Australian community-based sports clubs

Background: Along with physical benefits, community-based sport provides opportunities to enhance connectedness, an important protective factor of social and emotional health. However, young Australians participating in sport have been found to drink alcohol at higher levels than their non-sporting peers, and many clubs serve unhealthy food and beverages. This study explored the association between the dependent variable, level of alcohol consumption (AUDIT-C) and connectedness to club and other health behaviours among young people aged 18-30 years who play club sport in Western Australia. Methods: An online cross sectional survey measured levels of alcohol consumption (AUDIT-C), alcohol-related harm, connectedness (including volunteering and team cohesion), mental wellbeing, healthy food options and club sponsorship among young adults aged 18-30 years involved in sports clubs in Western Australia (n = 242). Relationships and association between the dependent variable (AUDIT-C) and independent variables were assessed. Results: Male sportspeople were more likely to drink alcohol at high-risk levels than females (p <.001), and respondents belonging to a club that received alcohol-related sponsorship were more likely to drink at high-risk levels (p =.019). Females were significantly more likely to want healthy food and beverage options provided at their clubs (p = 0.011). When all factors were considered team cohesion (p = 0.02), alcohol expectations (p = <.001), occurrences of experienced alcohol-related harm (p = <.001) and length of club membership (p = 0.18) were significant predictors of high-risk AUDIT-C (R 2 =.34, adjusted R 2 =.33, F (4, 156) = 20.43, p = <.001). High-risk AUDIT-C and club connectedness predicted strong team cohesion (R 2 =.39, adjusted R 2 =.39, F (2, 166) = 53.74, p = <.001). Conclusions: Findings from this study may inform policy and practice to enhance healthy behaviours among young adults participating in community sports clubs in Australia and other countries

Glycoinositolphospholipids from Leishmania braziliensis and L. infantum: Modulation of Innate Immune System and Variations in Carbohydrate Structure

The essential role of the lipophosphoglycan (LPG) of Leishmania in innate immune response has been extensively reported. However, information about the role of the LPG-related glycoinositolphospholipids (GIPLs) is limited, especially with respect to the New World species of Leishmania. GIPLs are low molecular weight molecules covering the parasite surface and are similar to LPG in sharing a common lipid backbone and a glycan motif containing up to 7 sugars. Critical aspects of their structure and functions are still obscure in the interaction with the vertebrate host. In this study, we evaluated the role of those molecules in two medically important South American species Leishmania infantum and L. braziliensis, causative agents of visceral (VL) and cutaneous Leishmaniasis (CL), respectively. GIPLs derived from both species did not induce NO or TNF-α production by non-primed murine macrophages. Additionally, primed macrophages from mice (BALB/c, C57BL/6, TLR2−/− and TLR4−/−) exposed to GIPLs from both species, with exception to TNF-α, did not produce any of the cytokines analyzed (IL1-β, IL-2, IL-4, IL-5, IL-10, IL-12p40, IFN-γ) or p38 activation. GIPLs induced the production of TNF-α and NO by C57BL/6 mice, primarily via TLR4. Pre incubation of macrophages with GIPLs reduced significantly the amount of NO and IL-12 in the presence of IFN-γ or lipopolysaccharide (LPS), which was more pronounced with L. braziliensis GIPLs. This inhibition was reversed after PI-specific phospholipase C treatment. A structural analysis of the GIPLs showed that L. infantum has manose rich GIPLs, suggestive of type I and Hybrid GIPLs while L. braziliensis has galactose rich GIPLs, suggestive of Type II GIPLs. In conclusion, there are major differences in the structure and composition of GIPLs from L. braziliensis and L. infantum. Also, GIPLs are important inhibitory molecules during the interaction with macrophages

Benthic community structure and ecosystem functions in above- and below-waterfall pools in Borneo

Waterfalls are geomorphic features that often partition streams into discrete zones. Our study examined aquatic communities, litter decomposition and periphyton growth rates for above- and below-waterfall pools in Ulu Temburong National Park, Brunei. We observed higher fish densities in below-waterfall pools (0.24 fish m−2 vs. 0.02 fish m−2 in above-waterfall pools) and higher shrimp abundance in above-waterfall pools (eight shrimp/pool vs. less than one shrimp/pool in below-waterfall pools). However, macroinvertebrate densities (excluding shrimp) were similar among both pool types. Ambient periphyton was higher in below-waterfall pools in 2013 (4.3 vs. 2.8 g m−2 in above-waterfall pools) and 2014 (4.8 vs. 3.4 g m−2 in above-waterfall pools), while periphyton growth rates varied from 0.05 to 0.26 g m−2 days−1 and were significantly higher in below-waterfall pools in 2014. Leaf litter decomposition rates (0.001 to 0.024 days−1) did not differ between pool types, suggesting that neither shrimp nor fish densities had consistent impacts on this ecosystem function. Regardless, this research demonstrates the varied effects of biotic and abiotic factors on community structure and ecosystem function. Our results have highlighted the importance of discontinuities, such as waterfalls, in tropical streams.</p

Human resource management and productivity in the "Trust Game Corporation"

Contemporary production activity is crucially determined by the performance of complex tasks with the characteristics of corporate trust games. In this paper, we outline a productivity paradox showing that, under reasonable conditions, the non cooperative solution, that yields a suboptimal firm output, is the equilibrium of corporate trust games when relational preferences are not sufficiently high. We show that tournaments and steeper pay for performance schemes may crowd out cooperation in presence of players preferences for relational goods. These findings help to explain firm investment in workers' relationships and the puzzle on the less than expected use of such schemes

Leading Mindfully: Two Studies of the Influence of Supervisor Trait Mindfulness on Employee Well-Being and Performance

10.1007/s12671-012-0144-zMindfulness5136-4

EFFECTS OF BLOOD FLOW RESTRICTION ON MOTOR UNIT BEHAVIOR DURING A SINGLE HIGH-LOAD CONTRACTION

Lyric D. Richardson1, Alex A. Olmos1, Taylor K. Dinyer-McNeely1, Tony R. Montgomery1, Shane M. Hammer1, Kylie N. Sears1, Haley C. Bergstrom2, Pasquale J. Succi2, Ethan C. Hill3, Brenden L. Roth1, & Michael A. Trevino1 1Oklahoma State University, Stillwater, Oklahoma; 2University of Kentucky, Lexington, Kentucky; 3University of Central Florida, Orlando, Florida PURPOSE: To determine the effects of blood flow restriction (BFR) on motor unit (MU) behavior of the biceps brachii (BB) during a single high-load contraction. METHODS: Twelve recreationally active males (age = 25 ± 5 yrs) participated in this study. Surface electromyography (sEMG) was recorded from the BB during separate BFR and control (CON) visits. Following 3 maximal voluntary isometric contractions (MVCs) of the elbow flexors, participants randomly completed separate isometric trapezoidal muscle actions at 70% MVC with BFR and without (CON). For BFR, a cuff was inflated to 60% of the pressure required to completely occlude the brachial artery at rest. sEMG signals for the 70% MVCs were decomposed for analysis of MU: recruitment thresholds (RTs), action potential amplitudes (MUAPAMPS), initial firing rates (IFRs), and mean firing rates (MFRs). EMG amplitude (EMGRMS) at steady force was normalized (N-EMGRMS) to MVC EMGRMS. Y-intercepts (y-ints) and slopes were calculated for the MUAPAMP, IFR, and MFR vs. RT linear relationships. A terms and B terms were calculated for the MFR vs. MUAPAMP exponential relationships. Nine paired samples t-tests compared N-EMGRMS, y-ints and slopes for the MUAPAMP, IFR, and MFR vs. RT relationships, and A and B terms for the MFR vs. MUAPAMP relationships between BFR and CON. Alpha was ≤ 0.05. RESULTS: There were no coefficient differences for the MFRvs. RT relationships, or the MFR vs. MUAPAMP relationships. There were differences for the MUAPAMP (y-ints: p = 0.008, CON= -0.26 ± 0.39 mV, BFR = -0.71 ± 0.36 mV; slopes: p = 0.018, CON = 0.019 ± 0.013 mV/%MVC, BFR = 0.028 ± 0.012 mV/%MVC) and IFR (y-ints: p = 0.008, CON = 14.02 ± 3.39 pps, BFR = 17.52 ± 4.00 pps; slopes: p = 0.006; CON = -0.167 ± 0.053 pps/%MVC, BFR = -0.224 ± 0.058 pps/%MVC) vs. RT relationships, and N-EMGRMS (p = 0.011; CON = 60.73 ± 10.40 %, BFR = 75.53 ± 20.58 %). CONCLUSION: BFR increased IFRs of the lowest-threshold MUs compared to CON. Additionally, increased slopes for the MUAPAMP vs. RT relationships, greater N-EMGRMS at steady force, and no change in MFRs relative to RTs or MUAPAMPS suggests a greater reliance on MU recruitment to modulate force during the steady force-segment with BFR compared to CON. BFR during a single, high-load contraction may increase MU recruitment compared to a non-BFR contraction performed at the same relative load

Do risk factors explain the increased prevalence of type 2 diabetes among California Asian adults?

Asian subgroup-specific information on type 2 diabetes mellitus (DM) is scarce. Using the California Health Interview Survey 2007 data, we examined Chinese, Korean, Japanese, Filipinos, and Vietnamese adults (n = 3,688) and Caucasian adults (n = 33,981) for the prevalence of DM and risk factors. The age-adjusted prevalence of DM was the highest among Filipinos (8.05%) followed by Japanese (7.07%), Vietnamese (7.03%), and Koreans (6.3%). Chinese (5.93%) was the only Asian group studied whose prevalence was lower than Caucasians (5.94%). From multiple logistic regression, after adjusting for risk factors, Japanese had the highest likelihood of DM (OR = 1.75, CI = [1.12-2.73], P &lt; 0.05), followed by Filipinos (1.66, [1.13-2.43], P &lt; 0.01), and Koreans (1.59, [1.00-2.52], P &lt; 0.05), relative to Caucasians. Our results suggest that even after accounting for lifestyle and other risk factor differences between Caucasians and key Asian subgroups in California, Japanese, Filipinos, and Koreans have a 1.6-1.75 greater likelihood of DM compared to Caucasians