Epidemiology and outcomes of previously undiagnosed diabetes in older women with breast cancer: an observational cohort study based on SEER-Medicare

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Background In breast cancer, diabetes diagnosed prior to cancer (previously diagnosed) is associated with advanced cancer stage and increased mortality. However, in the general population, 40% of diabetes is undiagnosed until glucose testing, and evidence suggests one consequence of increased evaluation and management around breast cancer diagnosis is the increased detection of previously undiagnosed diabetes. Biological factors – for instance, higher insulin levels due to untreated disease - and others underlying the association between previously diagnosed diabetes and breast cancer could differ in those whose diabetes remains undiagnosed until cancer. Our objectives were to identify factors associated with previously undiagnosed diabetes in breast cancer, and to examine associations between previously undiagnosed diabetes and cancer stage, treatment patterns, and mortality. Methods Using Surveillance, Epidemiology, and End Results-Medicare, we identified women diagnosed with breast cancer and diabetes between 01/2001 and 12/2005. Diabetes was classified as previously diagnosed if it was identified within Medicare claims between 24 and 4 months before cancer diagnosis, and previously undiagnosed if it was identified from 3 months before to ≤ 3 months after cancer. Patients were followed until 12/2007 or death, whichever came first. Multivariate analyses were performed to examine risk factors for previously undiagnosed diabetes and associations between undiagnosed (compared to previously diagnosed) diabetes, cancer stage, treatment, and mortality. Results Of 2,418 patients, 634 (26%) had previously undiagnosed diabetes; the remainder had previously diagnosed diabetes. The mean age was 77.8 years, and 49.4% were diagnosed with in situ or stage I disease. Age > 80 years (40% of the cohort) and limited health system contact (primary care physician and/or preventive services) prior to cancer were associated with higher adjusted odds of previously undiagnosed diabetes. Previously undiagnosed diabetes was associated with higher adjusted odds of advanced stage (III/IV) cancer (Odds Ratio = 1.37: 95% Confidence Interval (CI) 1.05 – 1.80; P = 0.02), and a higher adjusted mortality rate due to causes other than cancer (Hazard Ratio = 1.29; 95% CI 1.02 – 1.63; P = 0.03). Conclusions In breast cancer, previously undiagnosed diabetes is associated with advanced stage cancer and increased mortality. Identifying biological factors would require further investigation

fMRI evidence for a cortical hierarchy of pitch pattern processing

Pitch patterns, such as melodies, consist of two levels of structure: a global level, comprising the pattern of ups and downs, or contour; and a local level, comprising the precise intervals that make up this contour. An influential neuropsychological model suggests that these two levels of processing are hierarchically linked, with processing of the global structure occurring within the right hemisphere in advance of local processing within the left. However, the predictions of this model and its anatomical basis have not been tested in neurologically normal individuals. The present study used fMRI and required participants to listen to consecutive pitch sequences while performing a same/different one-back task. Sequences, when different, either preserved (local) or violated (global) the contour of the sequence preceding them. When the activations for the local and global conditions were contrasted directly, additional activation was seen for local processing in right planum temporale and posterior superior temporal sulcus (pSTS). The presence of additional activation for local over global processing supports the hierarchical view that the global structure of a pitch sequence acts as a “framework” on which the local detail is subsequently hung. However, the lateralisation of activation seen in the present study, with global processing occurring in left pSTS and local processing occurring bilaterally, differed from that predicted by the neuroanatomical model. A re-examination of the individual lesion data on which the neuroanatomical model is based revealed that the lesion data equally well support the laterality scheme suggested by our data. While the present study supports the hierarchical view of local and global processing, there is an evident need for further research, both in patients and neurologically normal individuals, before an understanding of the functional lateralisation of local and global processing can be considered established

Socio-economic predictors of stunting in preschool children – a population-based study from Johannesburg and Soweto

Background. Stunting continues to be a child public health concern in many African countries, including South Africa. This study uses data from the Birth to Twenty study, held in Johannesburg, to investigate a range of household-level socioeconomic and social support predictors of stunting in children aged less than 30 months.Design. Logistical regression models were constructed using aconceptual framework to investigate the association between early life measures of socio-economic status and stunting

Burnout in therapy radiographers in the United Kingdom

The 2007 UK National Radiotherapy Advisory Group (NRAG) report indicated the number and type of staff available is one of the ‘rate limiting’ steps in improving productivity in radiotherapy departments. Retaining well trained, satisfied staff, is key to meeting the objectives of the report; burnout is an important factor linked to satisfaction and attrition. Results of a survey measuring burnout in a sample of Radiation Therapists (Therapy Radiographers) are presented and considered against norms for the health sector and burnout in therapists from Canada and the US

The Grassmannian and the Twistor String: Connecting All Trees in N=4 SYM

We present a new, explicit formula for all tree-level amplitudes in N=4 super Yang-Mills. The formula is written as a certain contour integral of the connected prescription of Witten's twistor string, expressed in link variables. A very simple deformation of the integrand gives directly the Grassmannian integrand proposed by Arkani-Hamed et al. together with the explicit contour of integration. The integral is derived by iteratively adding particles to the Grassmannian integral, one particle at a time, and makes manifest both parity and soft limits. The formula is shown to be related to those given by Dolan and Goddard, and generalizes the results of earlier work for NMHV and N^2MHV to all N^(k-2)MHV tree amplitudes in N=4 super Yang-Mills.Comment: 26 page

Clay fine fissuring monitoring using miniature geo-electrical resistivity arrays

Abstract This article describes a miniaturised electrical imaging (resistivity tomography) technique to map the cracking pattern of a clay model. The clay used was taken from a scaled flood embankment built to study the fine fissuring due to desiccation and breaching process in flooding conditions. The potential of using a miniature array of electrodes to follow the evolution of the vertical cracks and number them during the drying process was explored. The imaging technique generated two-dimensional contoured plots of the resistivity distribution within the model before and at different stages of the desiccation process. The change in resistivity associated with the widening of the cracks were monitored as a function of time. Experiments were also carried out using a selected conductive gel to slow down the transport process into the cracks to improve the scanning capabilities of the equipment. The main vertical clay fissuring network was obtained after inversion of the experimental resistivity measurements and validated by direct observations

The All-Loop Integrand For Scattering Amplitudes in Planar N=4 SYM

We give an explicit recursive formula for the all L-loop integrand for scattering amplitudes in N=4 SYM in the planar limit, manifesting the full Yangian symmetry of the theory. This generalizes the BCFW recursion relation for tree amplitudes to all loop orders, and extends the Grassmannian duality for leading singularities to the full amplitude. It also provides a new physical picture for the meaning of loops, associated with canonical operations for removing particles in a Yangian-invariant way. Loop amplitudes arise from the "entangled" removal of pairs of particles, and are naturally presented as an integral over lines in momentum-twistor space. As expected from manifest Yangian-invariance, the integrand is given as a sum over non-local terms, rather than the familiar decomposition in terms of local scalar integrals with rational coefficients. Knowing the integrands explicitly, it is straightforward to express them in local forms if desired; this turns out to be done most naturally using a novel basis of chiral, tensor integrals written in momentum-twistor space, each of which has unit leading singularities. As simple illustrative examples, we present a number of new multi-loop results written in local form, including the 6- and 7-point 2-loop NMHV amplitudes. Very concise expressions are presented for all 2-loop MHV amplitudes, as well as the 5-point 3-loop MHV amplitude. The structure of the loop integrand strongly suggests that the integrals yielding the physical amplitudes are "simple", and determined by IR-anomalies. We briefly comment on extending these ideas to more general planar theories.Comment: 46 pages; v2: minor changes, references adde

Undiagnosed diabetes in breast, colorectal, lung, and prostate cancer: incidence and risk factors

This is the final version of the article. Available from Hindawi via the DOI in this record.Our study describes the incidence and risk factors for undiagnosed diabetes in elderly cancer patients. Using Surveillance, Epidemiology, and End Results-Medicare data, we followed patients with breast, colorectal, lung, or prostate cancer from 24 months before to 3 months after cancer diagnosis. Medicare claims were used to exclude patients with diabetes 24 to 4 months before cancer (look-back period), identify those with diabetes undiagnosed until cancer, and construct indicators of preventive services, physician contact, and comorbidity during the look-back period. Logistic regression analyses were performed to identify factors associated with undiagnosed diabetes. Overall, 2,678 patients had diabetes undiagnosed until cancer. Rates were the highest in patients with both advanced-stage cancer and low prior primary care/medical specialist contact (breast 8.2%, colorectal 5.9%, lung 4.4%). Nonwhite race/ethnicity, living in a census tract with a higher percent of the population in poverty and a lower percent college educated, lower prior preventive services use, and lack of primary care and/or medical specialist care prior to cancer all were associated with higher (P ≤ 0.05) adjusted odds of undiagnosed diabetes. Undiagnosed diabetes is relatively common in selected subgroups of cancer patients, including those already at high risk of poor outcomes due to advanced cancer stage