Role of immediate reconstruction for elderly breast cancer patients

With rising numbers of elderly women developing breast cancer, treatment options must evolve which take into consideration quality of life and functional status. Although fewer women at all ages are undergoing mastectomy, for those elderly women who undergo mastectomy, reconstruction options should be offered. Over the past 5 years, increasing numbers of elderly women are electing immediate reconstruction (IM)

Breast specific gamma imaging: Role in evaluation of breast disease

Although mammography is the gold standard for screening for breast cancer, 10 to 15% of lesions are missed, and this is higher with dense breasts. Alternative diagnostic modalities are being developed. One of these, breast specific gamma imaging (BSGI), which is not effected by dense tissue, utilizes the increased metabolic activity of tumors to localize and distinguish benign from malignant processes in the breast. The test can be used for screening and diagnostic purposes

Risky Sex and HIV Acquisition Among HIV Serodiscordant Couples in Zambia, 2002-2012: What Does Alcohol Have To Do With It?

In this paper we evaluate the effects of heavy alcohol consumption on sexual behavior, HIV acquisition, and antiretroviral treatment (ART) initiation in a longitudinal open cohort of 1929 serodiscordant couples in Lusaka, Zambia from 2002 to 2012. We evaluated factors associated with baseline heavy alcohol consumption and its association with condomless sex with the study partner, sex outside of the partnership, and ART initiation using multivariable logistic regression. We estimated the effect of alcohol consumption on HIV acquisition using multivariable Cox models. Baseline factors significantly associated with women's heavy drinking (drunk weekly or more in 12-months before enrollment) included woman's older age (adjusted prevalence odds ratio [aPOR] = 1.04), partner heavy drinking (aPOR = 3.93), and being HIV-infected (aPOR = 2.03). Heavy drinking among men was associated with less age disparity with partner (aPOR per year disparity = 0.97) and partner heavy drinking (aPOR = 1.63). Men's being drunk daily (aOR = 1.18), women's being drunk less than monthly (aOR = 1.39) vs. never drunk and being in a male HIV-negative and female HIV-positive union (aOR = 1.45) were associated with condomless sex. Heavy alcohol use was associated with having 1 or more outside sex partners among men (aOR drunk daily = 1.91, drunk weekly = 1.32, drunk monthly = 2.03 vs. never), and women (aOR drunk monthly = 2.75 vs. never). Being drunk weekly or more increased men's risk of HIV acquisition (adjusted hazard ratio [aHR] = 1.72). Men and women being drunk weekly or more was associated (p < 0.1) with women's seroconversion (aHR = 1.42 and aHR = 3.71 respectively). HIV-positive women who were drunk monthly or more had lower odds of initiating ART (aOR = 0.83; 95% CI = 0.70-0.99) adjusting for age, months since baseline and previous pregnancies. Individuals in HIV-serodiscordant couples who reported heavy drinking had more outside sex partnerships and condomless sex with their study partner and were more likely to acquire HIV. HIV-positive women had lower odds of initiating ART if they were heavy drinkers

Nonexistence of marginally trapped surfaces and geons in 2+1 gravity

We use existence results for Jang's equation and marginally outer trapped surfaces (MOTSs) in 2+1 gravity to obtain nonexistence of geons in 2+1 gravity. In particular, our results show that any 2+1 initial data set, which obeys the dominant energy condition with cosmological constant \Lambda \geq 0 and which satisfies a mild asymptotic condition, must have trivial topology. Moreover, any data set obeying these conditions cannot contain a MOTS. The asymptotic condition involves a cutoff at a finite boundary at which a null mean convexity condition is assumed to hold; this null mean convexity condition is satisfied by all the standard asymptotic boundary conditions. The results presented here strengthen various aspects of previous related results in the literature. These results not only have implications for classical 2+1 gravity but also apply to quantum 2+1 gravity when formulated using Witten's solution space quantization.Comment: v3: Elements from the original two proofs of the main result have been combined to give a single proof, thereby circumventing an issue with the second proof associated with potential blow-ups of solutions to Jang's equation. To appear in Commun. Math. Phy

Observer Dependent Horizon Temperatures: a Coordinate-Free Formulation of Hawking Radiation as Tunneling

We reformulate the Hamilton-Jacobi tunneling method for calculating Hawking radiation in static, spherically-symmetric spacetimes by explicitly incorporating a preferred family of frames. These frames correspond to a family of observers tied to a locally static timelike Killing vector of the spacetime. This formulation separates the role of the coordinates from the choice of vacuum and thus provides a coordinate-independent formulation of the tunneling method. In addition, it clarifies the nature of certain constants and their relation to these preferred observers in the calculation of horizon temperatures. We first use this formalism to obtain the expected temperature for a static observer at finite radius in the Schwarzschild spacetime. We then apply this formalism to the Schwarzschild-de Sitter spacetime, where there is no static observer with 4-velocity equal to the static timelike Killing vector. It is shown that a preferred static observer, one whose trajectory is geodesic, measures the lowest temperature from each horizon. Furthermore, this observer measures horizon temperatures corresponding to the well-known Bousso-Hawking normalization.Comment: 11 pages, 1 2-part figure, references added, appendix added, discussion streamline

Delta-Aminolevulinic Acid-Mediated Photodiagnoses in Surgical Oncology: A Historical Review of Clinical Trials.

Fluorescence imaging is an emerging clinical technique for real-time intraoperative visualization of tumors and their boundaries. Though multiple fluorescent contrast agents are available in the basic sciences, few fluorescence agents are available for clinical use. Of the clinical fluorophores, delta aminolevulinic acid (5ALA) is unique for generating visible wavelength tumor-specific fluorescence. In 2017, 5ALA was FDA-approved for glioma surgery in the United States. Additionally, clinical studies suggest this agent may have utility in surgical subspecialties outside of neurosurgery. Data from dermatology, OB/GYN, urology, cardiothoracic surgery, and gastrointestinal surgery show 5ALA is helpful for intraoperative visualization of malignant tissues in multiple organ systems. This review summarizes data from English-language 5ALA clinical trials across surgical subspecialties. Imaging systems, routes of administration, dosing, efficacy, and related side effects are reviewed. We found that modified surgical microscopes and endoscopes are the preferred imaging devices. Systemic dosing across surgical specialties range between 5 and 30 mg/kg bodyweight. Multiple studies discussed potential for skin irritation with sun exposure, however this side effect is infrequently reported. Overall, 5ALA has shown high sensitivity for labeling malignant tissues and providing a means to visualize malignant tissue not apparent with standard operative light sources

Leave Me Alone With Your Symptoms! Social Exclusion at the Workplace Mediates the Relationship of Employee's Mental Illness and Sick Leave

Although a substantial part of employees suffers from a mental illness, the work situation of this population still is understudied. Previous research suggests that people with a mental illness experience discrimination in the workplace, which is known to have detrimental effects on health. Building on the stereotype content model and allostatic load theory, the present study investigated whether employees with a mental illness become socially excluded at the workplace and therefore show more days of sick leave. Overall, 86 employees diagnosed with a mental disorder were interviewed and completed online-surveys. Path analyses supported the hypotheses, yielding a serial mediation: The interview-rated severity of the mental disorder had an indirect effect on the days of sick leave, mediated by the symptomatic burden and the social exclusion at the workplace. In the light of the costs associated with absenteeism the present paper highlights the harmfulness of discrimination. Organizations and especially supervisors need to be attentive for signs of exclusion within their teams and try to counteract as early as possible

Adverse Psychological Effects of Patients in Medical Isolation Due to Healthcare-Associated Infections

Background: Patients placed in medical isolation due to healthcare-associated infections experience adverse psychological effects that can impact their quality of life. Objectives: The purpose of this integrative literature review was to identify the adverse effects of patients in medical isolation as well as explore coping strategies that can be used to decrease these adverse effects. Method: An integrative literature review was conducted using the databases of CINAHL, PsychInfo, PubMed, and PsychArticles. Search terms included adverse effects, negative effects, effects, adverse outcomes, negative outcomes, isolation precautions, contact isolation, droplet isolation, airborne isolation, isolation, coping and psychology. Results: Five common adverse psychological effects of patients placed in medical isolation were identified across the eight studies reviewed. Those included depression, anxiety, anger, stress and dissatisfaction of care were identified. The coping tools used to decrease the adverse effects of medical isolation including support of family, adequate knowledge, and contact with the outside world. Conclusion: Further studies are needed with a larger number of participants to more accurately understand the potential outcomes of the coping strategies used to decrease the adverse effects of patients in medical isolation