Suicide Attempt by Pacemaker System Abuse: A Case Report with Comments on the Psychological Adaptation of Pacemaker Patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72997/1/j.1540-8159.1980.tb04333.x.pd

Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?

To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits. Data Sources/Data Collection . Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses ( N =1,132 patients, 277 surgeons). Study Design . Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation. Principal Findings . Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts ( p <.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient–physician communication was significantly ( p <.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge. Conclusions . Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71991/1/j.1475-6773.2008.00843.x.pd

Development of a Practical Model for Targeting Patient Decision Support Interventions to Promote Colorectal Cancer Screening in Vulnerable Populations

We sought to develop a practical model for predicting probability of colorectal cancer (CRC) screening completion in a diverse safety-net population and a subsequent framework for targeting screening promotion interventions. Data used to construct the models was prospectively collected from a CRC screening intervention. Models were cross-validated by randomly splitting the data into training and validation samples. The predicted probabilities of screening completion from the final model were trichotomized into framework groups and cross-validated by defining cut-points in the training sample, applying them to the validation sample, and comparing across samples for homogeneity. The final model included demographic and simple psychosocial measures and predicted screening behavior adequately (AUROC=0.63). The framework groups (cut-points 0.62 (low), 0.74 (medium), and 1.0 (high)) were homogeneous across the two samples. The model and framework may be useful for designing and delivering targeted interventions to promote CRC screening. Future research should validate the framework groups

The sensitivity of harassment to orbit: Mass loss from early-type dwarfs in galaxy clusters

We conduct a comprehensive numerical study of the orbital dependence of harassment on early-type dwarfs consisting of 168 different orbits within a realistic, Virgo-like cluster, varying in eccentricity and pericentre distance. We find harassment is only effective at stripping stars or truncating their stellar discs for orbits that enter deep into the cluster core. Comparing to the orbital distribution in cosmological simulations, we find that the majority of the orbits (more than three quarters) result in no stellar mass loss. We also study the effects on the radial profiles of the globular cluster systems of early-type dwarfs. We find these are significantly altered only if harassment is very strong. This suggests that perhaps most early-type dwarfs in clusters such as Virgo have not suffered any tidal stripping of stars or globular clusters due to harassment, as these components are safely embedded deep within their dark matter halo. We demonstrate that this result is actually consistent with an earlier study of harassment of dwarf galaxies, despite the apparent contradiction. Those few dwarf models that do suffer stellar stripping are found out to the virial radius of the cluster at redshift = 0, which mixes them in with less strongly harassed galaxies. However when placed on phase-space diagrams, strongly harassed galaxies are found offset to lower velocities compared to weakly harassed galaxies. This remains true in a cosmological simulation, even when haloes have a wide range of masses and concentrations. Thus phase-space diagrams may be a useful tool for determining the relative likelihood that galaxies have been strongly or weakly harassed

Infection Prevention and the Protective Effects of Unidirectional Displacement Flow Ventilation in the Turbulent Spaces of the Operating Room

Background: Unidirectional displacement flow (UDF) ventilation systems in operating rooms are characterized by a uniformity of velocity 80% and protect patients and operating room personnel against exposure to hazardous substances. However, the air below the surgical lights and in the surrounding zone is turbulent, which impairs the ventilation system’s effect. Aim: We first used the recovery time (RT) as specified in International Organization for Standardization 14644 to determine the particle reduction capacity in the turbulent spaces of an operating room with a UDF system. Methods: The uniformity of velocity was analyzed by comfort-level probe grid measurements in the protected area below a hemispherical closed-shaped and a semi-open column-shaped surgical light (tilt angles: 0/15/30) and in the surrounding zone of a research operating room. Thereafter, RTs were calculated. Results: At a supply air volume of 10,500 m3/h, the velocity, reported as average uniformity+standard deviation, was uniform in the protected area without lights (95.8% + 1.7%), but locally turbulent below the hemispherical closedshaped (69.3% + 14.6%), the semi-open column-shaped light (66.9% + 10.9%), and in the surrounding zone (51.5%+17.6%). The RTs ranged between 1.1 and 1.7 min below the lights and 3.5+0.28 min in the surrounding zone and depended exponentially on the volume flow rate. Conclusions: Compared to an RT of 20 min as required for operating rooms with mixed dilution flow, particles here were eliminated 12–18 times more quickly from below the surgical lights and 5.7 times from the surrounding zone. Thus, the effect of the lights was negligible and the UDF’s retained its strong protective effect

Progression of Symptoms and Functioning Among Female Cardiac Patients With and Without Diabetes

Objective: To determine if older women with both heart disease and diabetes experience worse physical and psychosocial functioning and higher symptom burden over an 18-month period compared with those with heart disease alone. Methods: Data from older women with heart disease (>=60 years, n = 1008, 18% with diabetes) were used to assess the impact of diabetes on physical functioning (Sickness Impact Profile [SIP]-Physical and Six-Minute Walk test [6MWT]), psychosocial functioning (SIP-Psychosocial and depressive symptoms), and physical symptom burden (cardiac and general) at baseline and 4, 12, and 18 months later. Generalized estimating equation models compared trends in outcomes over time between groups with and without diabetes. Results: Across all four time points, women with heart disease and diabetes had greater functional impairment, as indicated by higher SIP scores, than those without diabetes (43%-71% higher SIP-Physical scores and 32%-65% higher SIP-Pyschosocial scores; all p<=-0.002). 6MWT distance was 17%-30% less in the diabetes group across time points (all p<=-0.002). Depressive symptoms were 27%-39% higher in the diabetes group (all p-<-0.03) except at month 4. Women with diabetes scored 15%-29% higher on a physical symptom index across time points (all p-<-0.05) than those without diabetes; no significant differences were observed in cardiac symptoms until month 18 (diabetes group 29% higher, p = 0.02). Subgroups with and without diabetes in this sample experienced significantly different trends over time in SIP-Physical scores (p = 0.02) and 6MWT distance (p = 0.05), such that the disadvantage of the diabetes group at baseline was greater 18 months later. Conclusions: Women with comorbid diabetes and heart disease are vulnerable to poor health-related quality of life, particularly in terms of physical functioning and symptoms, and require special efforts from clinical care providers to ameliorate a potential downward trend in these outcomes over time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90452/1/jwh-2E2010-2E2123.pd

The Sensitivity of Harassment to Orbit: Mass Loss from Early-Type Dwarfs in Galaxy Clusters

We conduct a comprehensive numerical study of the orbital dependence of harassment on early-type dwarfs consisting of 168 different orbits within a realistic, Virgo-like cluster, varying in eccentricity and pericentre distance. We find harassment is only effective at stripping stars or truncating their stellar disks for orbits that enter deep into the cluster core. Comparing to the orbital distribution in cosmological simulations, we find that the majority of the orbits (more than three quarters) result in no stellar mass loss. We also study the effects on the radial profiles of the globular cluster systems of early-type dwarfs. We find these are significantly altered only if harassment is very strong. This suggests that perhaps most early-type dwarfs in clusters such as Virgo have not suffered any tidal stripping of stars or globular clusters due to harassment, as these components are safely embedded deep within their dark matter halo. We demonstrate that this result is actually consistent with an earlier study of harassment of dwarf galaxies, despite the apparent contradiction. Those few dwarf models that do suffer stellar stripping are found out to the virial radius of the cluster at redshift=0, which mixes them in with less strongly harassed galaxies. However when placed on phase-space diagrams, strongly harassed galaxies are found offset to lower velocities compared to weakly harassed galaxies. This remains true in a cosmological simulation, even when halos have a wide range of masses and concentrations. Thus phase-space diagrams may be a useful tool for determining the relative likelihood that galaxies have been strongly or weakly harassed.Comment: 17 pages, 13 figures, Accepted to MNRAS 8th September 201

Canonical NF-κB signaling is uniquely required for the long-term persistence of functional mature B cells

Although canonical NF-κB signaling is crucial to generate a normal mature B-cell compartment, its role in the persistence of resting mature B cells is controversial. To resolve this conflict, we ablated NF-κB essential modulator (NEMO) and I{kappa}B kinase 2 (IKK2), two essential mediators of the canonical pathway, either early on in B-cell development or specifically in mature B cells. Early ablation severely inhibited the generation of all mature B-cell subsets, but follicular B-cell numbers could be largely rescued by ectopic expression of B-cell lymphoma 2 (Bcl2), despite a persisting block at the transitional stage. Marginal zone (MZ) B and B1 cells were not rescued, indicating a possible role of canonical NF-κB signals beyond the control of cell survival in these subsets. When canonical NF-κB signaling was ablated specifically in mature B cells, the differentiation and/or persistence of MZ B cells was still abrogated, but follicular B-cell numbers were only mildly affected. However, the mutant cells exhibited increased turnover as well as functional deficiencies upon activation, suggesting that canonical NF-κB signals contribute to their long-term persistence and functional fitness

Meaning‐based coping, chronic conditions and quality of life in advanced cancer & caregiving

ObjectiveThis study examined the relationship between the number of co‐existing health problems (patient comorbidities and caregiver chronic conditions) and quality of life (QOL) among patients with advanced cancer and their caregivers and assessed the mediating and moderating role of meaning‐based coping on that relationship.MethodsData came from patients with advanced cancers (breast, colorectal, lung, and prostate) and their family caregivers (N = 484 dyads). Study hypotheses were examined with structural equation modeling using the actor‐partner interdependence mediation model. Bootstrapping and model constraints were used to test indirect effects suggested by the mediation models. An interaction term was added to the standard actor‐partner interdependence model to test for moderation effects.ResultsMore patient comorbidities were associated with lower patient QOL. More caregiver chronic conditions were associated with lower patient and caregiver QOL. Patient comorbidities and caregiver chronic conditions had a negative influence on caregiver meaning‐based coping but no significant influence on patient meaning based coping. Caregiver meaning‐based coping mediated relationships between patient comorbidities and caregiver health conditions and patient and caregiver QOL. No significant moderating effects were observed.ConclusionsDespite the severity of advanced cancer for patients and caregivers, the co‐existing health problems of one member of the dyad have the potential to directly or indirectly affect the wellbeing of the other. Future research should consider how the number of patient comorbidities and caregiver chronic conditions, as well as the ability of patients and caregivers to manage those conditions, influences their meaning‐based coping and wellbeing. Copyright © 2016 John Wiley & Sons, Ltd.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138410/1/pon4146_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138410/2/pon4146.pd