A Comparison between Lynch Syndrome and Sporadic Colorectal Cancer Survivors’ Satisfaction with their Healthcare Providers

This study evaluated provider satisfaction in a sample of colorectal cancer (CRC) survivors with and without Lynch syndrome (LS). Participants were case–case-matched CRC survivors with (n=75) or without (n=75) LS (mean age of 55; range: 27–93). Participants completed a mailed questionnaire assessing demographics, clinical characteristics, healthcare utilization, psychosocial variables, and provider satisfaction. LS CRC survivors reported lower provider satisfaction scores on three subscales of the Primary Care Assessment Survey: communication (78.14 vs. 83.96; P\u3c0.05), interpersonal treatment (78.58 vs. 85.30; P\u3c0.05), and knowledge of the patient (60.34 vs. 69.86; P\u3c0.01). Among LS CRC survivors, predictors for mean communication and trust subscale scores were location of treatment and socioeconomic status. Higher mean depression scores also were associated with trust, while social support predicted higher satisfaction with communication. Sporadic CRC survivor satisfaction is driven largely by age (communication, interpersonal treatment) and patient anxiety (communication), while seeing a provider more often was associated with increased satisfaction with knowledge of the patient. LS CRC survivors reported lower levels of provider satisfaction than sporadic CRC survivors. LS survivors who received care at The University of Texas MD Anderson Cancer Center, a comprehensive cancer center (CCC), reported higher satisfaction than those receiving care at other institutions. Depressive symptoms and socioeconomic status may impact provider satisfaction ratings. Exploration of other potential predictors of provider satisfaction should be examined in this population. Additionally, further research is needed to examine the potential impact of provider satisfaction on adherence to medical recommendations in LS CRC survivors, particularly those being treated outside of CCCs

Patients educating health care providers on Lynch syndrome

Objective: Lynch syndrome (LS) patients are at an elevated risk for early-onset cancers, including endometrial and colorectal (CRC). Prior research has shown a deficit in provider knowledge of LS, which may affect patient satisfaction and adherence to recommended screening and surveillance regimens. Studies suggest patients with LS may educate providers perceived as lacking LS knowledge; however, little is known about these interactions. The goal of this study is to assess patient-reported outcomes from clinical interactions where LS patients educate their providers. Methods: Participants (n=55) were asked to complete an in-depth telephone interview. Results: Out of 55 participants, approximately two-thirds (n=37) reported engaging in educational interactions. Participants reported feeling satisfied with the provider response in over half of the reported educational interactions (n=24). Participants reported changes in their patient-provider relationship ranging from improvements in their relationship to termination of services. Conclusion: Patients with LS report educating providers on their diagnosis as well as their screening and surveillance requirements. Patient-reported outcomes of these educational interactions vary based on the provider’s response to the interaction. Providers should be open and receptive to these educational interactions and follow-up on the discussion to improve patient satisfaction

Fluorescence Efficiency and Visible Re-emission Spectrum of Tetraphenyl Butadiene Films at Extreme Ultraviolet Wavelengths

A large number of current and future experiments in neutrino and dark matter detection use the scintillation light from noble elements as a mechanism for measuring energy deposition. The scintillation light from these elements is produced in the extreme ultraviolet (EUV) range, from 60 - 200 nm. Currently, the most practical technique for observing light at these wavelengths is to surround the scintillation volume with a thin film of Tetraphenyl Butadiene (TPB) to act as a fluor. The TPB film absorbs EUV photons and reemits visible photons, detectable with a variety of commercial photosensors. Here we present a measurement of the re-emission spectrum of TPB films when illuminated with 128, 160, 175, and 250 nm light. We also measure the fluorescence efficiency as a function of incident wavelength from 120 to 250 nm.Comment: 15 pages, 9 figures, Submitted to Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipmen

Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer

Objectives: To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision-making (DM) style. Methods: This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences. Results: Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology-based sources of information. There was equal preference for a patient- or doctor-centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0-100). Conclusions: Women strongly preferred face to face information. Written formats were also helpful but not computer-based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret

Infrared Spectra of Cooling Flow Galaxies

We have taken K-band spectra covering 7 cooling flow clusters. The spectra show many of the 1-0S transitions of molecular Hydrogen, as well as some of the higher vibrational transitions, and some lines of ionized Hydrogen. The line ratios allow us to conclude that the rotational states of the first excited vibrational state are in approximate LTE, so that densities above 10^5/ cm^3 are likely, but there is evidence that the higher vibrational states are not in LTE. The lack of pressure balance between the molecular gas and the ionized components emphasizes the need for dynamic models of the gas. The ratios of the ionized to molecular lines are relatively constant but lower than from starburst regions, indicating that alternative heating mechanisms are necessary.Comment: 6 pages, 3 figure

Antigenic diversity is generated by distinct evolutionary mechanisms in African trypanosome species

Antigenic variation enables pathogens to avoid the host immune response by continual switching of surface proteins. The protozoan blood parasite Trypanosoma brucei causes human African trypanosomiasis ("sleeping sickness") across sub-Saharan Africa and is a model system for antigenic variation, surviving by periodically replacing a monolayer of variant surface glycoproteins (VSG) that covers its cell surface. We compared the genome of Trypanosoma brucei with two closely related parasites Trypanosoma congolense and Trypanosoma vivax, to reveal how the variant antigen repertoire has evolved and how it might affect contemporary antigenic diversity. We reconstruct VSG diversification showing that Trypanosoma congolense uses variant antigens derived from multiple ancestral VSG lineages, whereas in Trypanosoma brucei VSG have recent origins, and ancestral gene lineages have been repeatedly co-opted to novel functions. These historical differences are reflected in fundamental differences between species in the scale and mechanism of recombination. Using phylogenetic incompatibility as a metric for genetic exchange, we show that the frequency of recombination is comparable between Trypanosoma congolense and Trypanosoma brucei but is much lower in Trypanosoma vivax. Furthermore, in showing that the C-terminal domain of Trypanosoma brucei VSG plays a crucial role in facilitating exchange, we reveal substantial species differences in the mechanism of VSG diversification. Our results demonstrate how past VSG evolution indirectly determines the ability of contemporary parasites to generate novel variant antigens through recombination and suggest that the current model for antigenic variation in Trypanosoma brucei is only one means by which these parasites maintain chronic infections

Issues in Assessing Environmental Exposures to Manufactured Nanomaterials

Manufactured nanomaterials (MNs) are commonly considered to be commercial products possessing at least one dimension in the size range of 10−9 m to 10−7 m. As particles in this size range represent the smaller fraction of colloidal particles characterized by dimensions of 10−9 m to 10−6 m, they differ from both molecular species and bulk particulate matter in the sense that they are unlikely to exhibit significant settling under normal gravitational conditions and they are also likely to exhibit significantly diminished diffusivities (when compared to truly dissolved species) in environmental media. As air/water, air/soil, and water/soil intermedium transport is governed by diffusive processes in the absence of significant gravitational and inertial impaction processes in environmental systems, models of MN environmental intermedium transport behavior will likely require an emphasis on kinetic approaches. This review focuses on the likely environmental fate and transport of MNs in atmospheric and aquatic systems. Should significant atmospheric MNs emission occur, previous observations suggest that MNs may likely exhibit an atmospheric residence time of ten to twenty days. Moreover, while atmospheric MN aggregates in a size range of 10−7 m to 10−6 m will likely be most mobile, they are least likely to deposit in the human respiratory system. An examination of various procedures including the Derjaguin-Landau-Verwey-Overbeek (DLVO) theory of colloidal particle suspension stability in water indicates that more sophisticated approaches may be necessary in order to develop aquatic exposure models of acceptable uncertainty. In addition, concepts such as Critical Coagulation Concentrations and Critical Zeta Potentials may prove to be quite useful in environmental aquatic exposure assessments

Burden and Well-Being Among a Diverse Sample of Cancer, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease Caregivers

Three important causes of death in the U.S. (cancer, congestive heart failure [CHF], and chronic obstructive pulmonary disease [COPD]) are preceded by long periods of declining health; often, family members provide the majority of care for individuals who are living with serious illnesses and are at risk for impaired well-being

Caregiver Experience During Advanced Chronic Illness and Last Year of Life

Caregivers of patients with serious illness endure significant burden, yet it is not clear at what stage of advanced illness patient and caregiver needs are greatest. This study compared prevalence and predictors of caregiver esteem and burden during two different stages of patients’ illnesses – advanced chronic illness and the last year of life