Methylene Blue Near-Infrared Fluorescence Imaging in Breast Cancer Sentinel Node Biopsy

Introduction: Fluorescence-based navigation for breast cancer sentinel node biopsy is a novel method that uses indocyanine green as a fluorophore. However, methylene blue (MB) also has some fluorescent properties. This study is the first in a clinical series presenting the possible use of MB as a fluorescent dye for the identification of sentinel nodes in breast sentinel node biopsy. Material and methods: Forty-nine patients with breast cancer who underwent sentinel node biopsy procedures were enrolled in the study. All patients underwent standard simultaneous injection of nanocolloid and MB. We visualized and assessed the sentinel nodes and the lymphatic channels transcutaneously, with and without fluorescence, and calculated the signal-to-background ratio (SBR). We also analyzed the corresponding fluorescence intensity of various dilutions of MB. Results: In twenty-three patients (46.9%), the location of the sentinel node, or the end of the lymphatic path, was visible transcutaneously. The median SBR for transcutaneous sentinel node location was 1.69 (range 1.66–4.35). Lymphatic channels were visible under fluorescence in 14 patients (28.6%) prior to visualization by the naked eye, with an average SBR of 2.01 (range 1.14–5.6). The sentinel node was visible under fluorescence in 25 patients (51%). The median SBR for sentinel node visualization with MB fluorescence was 2.54 (range 1.34–6.86). Sentinel nodes were visualized faster under fluorescence during sentinel node preparation. Factors associated with the rate of visualization included diabetes (p = 0.001), neoadjuvant chemotherapy (p = 0.003), and multifocality (p = 0.004). The best fluorescence was obtained using 40 µM (0.0128 mg/mL) MB, but we also observed a clinically relevant dilution range between 20 µM (0.0064 mg/mL) and 100 µM (0.032 mg/mL). Conclusions: For the first time, we propose the clinical usage of MB as a fluorophore for fluorescence-guided sentinel node biopsy in breast cancer patients. The quenching effect of the dye may be the reason for its poor detection rate. Our analysis of different concentrations of MB suggests a need for a detailed clinical analysis to highlight the practical usefulness of the dye

Poland's 2011 Online Election Campaign: New Tools, New Professionalism, New Ways to Win Votes

This article analyzes the use of the online environment within the context of the Polish parliamentary election of 2011. Using traditional methods of content analysis, we find that parties tend to adhere to a professionalized model of campaigning, and adapting online tools to suit the objectives of the campaign. There also appears to be a recognition that their most likely visitors to these online presences would be converts, and so they attempt to mobilize supporters rather than convert browsers. New parties and candidates are more likely to target browsers, with the latter offering a more personalized experience to online visitors. Importantly, when analyzing the outcome of the contest, we find that being online matters for candidates when controlling for all other variables. Equally, the reach the candidate has, which may well influence their vote share, is dependent on offering a more personalized, representational image and having a frequently updated online presence that should encourage repeat visits. Cumulatively, we suggest the future of online campaigning must not only focus on having a presence, but on using it in a way that appeals to a range of visitors, encouraging repeat visits, and that this strategy could have a positive impact on election outcomes. © Taylor & Francis Group, LLC

Sensitivity of satellite altimetry data assimilation on weapon acoustic preset using MODAS

IEEE Journal of Oceanic Engineering, Vol. 32, No. 2, 453-468.The article of record as published may be located at http://dx.doi.org/10.1109/JOE.2006.888869The purpose of this research is to assess the benefit of assimilating satellite altimeter data for naval undersea warfare. To accomplish this, sensitivity of the weapon acoustic preset program (WAPP) for the Mk 48 variant torpedo to changes in the sound-speed profile (SSP) is analyzed with SSP derived from the modular ocean data assimilation system (MODAS). The MODAS fields differ in that one uses altimeter data assimilated from three satellites while the other uses no altimeter data. The metric used to compare the two sets of outputs is the relative difference in acoustic coverage area generated by WAPP. Output presets are created for five different scenarios, two antisurface warfare (ASUW) scenarios, and three antisubmarine warfare (ASW) scenarios, in each of three regions: the East China Sea, Sea of Japan, and an area south of Japan that includes the Kuroshio currents. Analysis of the output reveals that, in some situations, WAPP output is very sensitive to the inclusion of the altimeter data because of the resulting differences in the subsurface predictions. The change in weapon presets can be so large that the effectiveness of the weapon may be affected

Advancing racial equity and social justice for Black communities in US tobacco control policy.

The US Food and Drug Administration (FDA) applies the Population Health Standard in tobacco product review processes by weighing anticipated health benefits against risks associated with a given commercial tobacco product at the population level. However, systemic racism (ie, discriminatory policies and practices) contributes to an inequitable distribution of tobacco-related health benefits and risks between white and Black/African Americans at the population level. Therefore, Black-centered, antiracist data standards for tobacco product review processes are needed to achieve racial equity and social justice in US tobacco control policy. Regardless of whether FDA implements such data standards, non-industry tobacco scientists should prioritise producing and disseminating Black-centred data relevant to FDA's regulatory authority. We describe how systemic racism contributes to disparities in tobacco-related outcomes and why these disparities are relevant for population-level risk assessments, then discuss four possible options for Black-centred data standards relevant to tobacco product review processes

Proton magnetic resonance spectroscopy changes in a longitudinal schizophrenia study: a pilot study in eleven patients

Beata Galińska-Skok,1 Agata Szulc,2 Aleksandra Małus,1 Beata Konarzewska,1 Urszula Cwalina,3 Eugeniusz Tarasów,4 Napoleon Waszkiewicz1 1Department of Psychiatry, Medical University of Białystok, Choroszcz, Poland; 2Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszków, Poland; 3Department of Statistics and Medical Informatics, Medical University of Białystok, Białystok, Poland; 4Department of Radiology, Medical University of Białystok, Białystok, Poland Purpose: Investigation of the longitudinal effect of schizophrenia on changes in various brain-metabolite levels and their relationships with cognitive deficits that have not been fully explained yet.Methods: Five years subsequent to their first examination for their first episode of schizophrenia, eleven patients from an original group of 30 were reexamined. Their cognitive functions were assessed with the Wisconsin Card Sorting Test. Magnetic resonance imaging and proton magnetic resonance spectroscopy were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the left frontal lobe, left temporal lobe, and the left thalamus. The study had a naturalistic design, and patients were treated with various antipsychotics.Results: No significant statistical differences between the baseline and follow-up in N-acetylaspartate (NAA:creatine plus phosphocreatine [Cr] and NAA/H2O) levels were observed in any region of interest. We found a significant statistical correlation between 5-year difference in frontal NAA/Cr levels and duration of the last antipsychotic treatment in this period (R=0.908, P=0.012). We found a trend (P=0.068) toward lower choline-containing compounds (Cho/Cr ratio) in the temporal lobe over 5 years and a trend (P=0.079) in higher glutamate–glutamine–GABA (Glx/H2O) levels in the left thalamus. The patients showed social and clinical improvement at follow-up examination, and there were no changes in Wisconsin Card Sorting Test results.Conclusion: The observed tendency toward decline in choline ratio might have been due to decreased temporal cell density or impaired neuron-membrane or myelin functions. A tendency for higher Glx levels suggest the involvement of thalamus dysfunction in the chronic schizophrenia process. The lack of NAA decrease might have been due to effective antipsychotic treatment. Further longitudinal studies on large patient groups are required to confirm these metabolic changes in schizophrenia. Keywords: first-episode schizophrenia, proton magnetic resonance spectroscopy, longitudinal study, cognitive functioning, N-acetylaspartate, cholin

The evaluation of pharmaceutical pictograms among elderly patients in community pharmacy settings – a multicenter pilot study

Piotr Merks,1,2,* Damian Świeczkowski,3,* Marcin Balcerzak,4 Ewelina Drelich,4 Katarzyna Białoszewska,5 Natalia Cwalina,3 Jerzy Krysinski,1 Miłosz Jaguszewski,3 Annie Pouliot,6 Regis Vaillancourt6 1Department of Pharmaceutical Technology, Collegium Medicum in Bydgoszcz, Nicolaus University in Torun, Bydgoszcz-Torun, Poland; 2Piktorex Sp. z.o.o., Warsaw, Poland; 3First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland; 4Farenta Polska, Warsaw, Poland; 5Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland; 6Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada *These authors contributed equally to this work Introduction: The search for new ways to optimize the use of medications by patients has led the pharmaceutical community to promote the idea of introducing pictograms into routine practice. The main intention of pictograms is to ease patient adherence and to reduce potential risks or errors associated with the use of medications. Purpose: To evaluate a series of pharmaceutical pictograms for patient comprehension. Patients and methods: The study was conducted in community pharmacies within a European Union country that belongs to the professional research network. Structured interviews were used to evaluate the pictograms for patient comprehension. This consisted of an assessment of the following: the transparency and translucency of the pictograms, health literacy, and pictogram recall. Participants were also given the opportunity to provide feedback on how to improve the pictograms. The primary endpoint was pictogram comprehension. Secondary outcomes included recall of the pictograms and pictogram translucency. Results: The study included 68 patients with whom face-to-face interviews were performed. Low transparency results (≤25%) and extensive patient feedback in initial interviews led to the withdrawal of certain pictograms (n=15) from the evaluation. Among the pictograms included in the final stage of our research, 22 pictograms (62.8%) obtained an acceptable transparency level ≥66%. All pictograms passed the short-term recall test with positive results. Conclusion: A majority of the designed and modified pictograms reached satisfactory guessability scores. Feedback from patients enabled modification of the pictograms and proved that patients have an important voice in the discussion regarding the design of additional pictograms. Keywords: pharmaceutical pictograms, elderly population, health literacy, community pharmacy, Polan