Environmental and Infectious Causes of Malignancy

This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents a summary of the most relevant causative agents of cancer. Exposure to many environmental agents is associated with an increased incidence of certain malignancies, although causation is usually difficult to prove. Certain chemicals, infections (parasitic, viral, and bacterial) and ionizing radiation are known carcinogens. Variable genetic susceptibility to carcinogenesis is apparent. Up to 2/3 of human cancers are believed to have an environmental component.https://escholarship.umassmed.edu/cancer_concepts/1007/thumbnail.jp

Exploring the measure of potentially avoidable general practitioner-type presentations to the emergency department in regional Queensland using linked, patient-perspective data

Objective. To explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland. Methods. Linkage of an ED administrative dataset to a face-to-face patient survey of local residents (n = 1000); calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED; and exploration of these measures with patient-perspective linked data. Results. PAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49; AIHW 38, P , 0.001; ACEM 36, P , 0.001); with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38–0.77): P = 0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n = 227; ACEM: n = 67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of ,1 h at this hospital site (1-month survey period: 17.8%); and differences between the patient self-report and ED administrative record for 'self-referral to the ED' (Self-referred: Survey 71% vs EDIS 93%, P , 0.001). Conclusions. Identification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient 'self-referral to the ED', along with further consideration of hospital site variation for the length of medical consultation time

Staging of Cancer

The “stage” of a cancer is a short-hand way of describing the extent of cancer in a patient. Stage is based on macroscopic involvement of tissues by cancer. Staging of cancer occurs prior to the beginning of treatment, or at the first definitive surgery. Clinical staging, which includes radiography and exam findings, takes place initially. Pathologic staging, which is obtained from surgical specimens, can be acquired during the course of surgical treatment. Patients then carry either the clinical stage or the pathologic stage for the duration of their illness. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will describe principles of cancer staging.https://escholarship.umassmed.edu/cancer_concepts/1003/thumbnail.jp

Preventable hospitalisations in regional Queensland: potential for primary health?

Objective The aims of this study were to: (1) use local health data to examine potentially preventable hospitalisations (PPHs) as a proportion of total hospital separations and estimated costs to a large regional hospital in northern Queensland, including differences associated with Indigenous status; and (2) identify priority conditions and discuss issues related to strategic local primary health intervention. Methods A cross-sectional analysis was conducted using Queensland Hospital Admitted Patient Data Collection data (July 2012–June 2014) restricted to 51 087 separations generated by 29 485 local residents. PPHs were identified from the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM) and procedure codes using National Healthcare Agreement definitions. Age-standardised separation rates were calculated using Australian 2001 reference population and associated economic costs were estimated using Australian-refined diagnosis related groups. Results Eleven per cent (n = 5488) of all hospital separations were classified as PPH, and most were for common chronic (n = 2486; 45.3%) and acute (n = 2845; 51.8%) conditions. Because many acute presentations reflect chronic underlying disease, chronic conditions account for up to 76.5% of all PPHs. Age-standardised PPH rates were 3.4-fold higher for Indigenous than non-Indigenous people. Associated 2-year costs were AU$32.7 million, which was 10.7% of estimated total health care expenditure for hospital separations, and were higher for Indigenous (14.9%) than non-Indigenous (9.7%) people. Conclusions High hospitalisation rates and costs for common preventable chronic conditions represent opportunities for primary healthcare interventions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families

Health Communication in Neonatal Intensive Care: Results of Focus Groups or Interviews with Parents, Nurses and Physicians

Background and Purpose: Health communication interventions to successfully promote satisfaction with care among parents in the Neonatal Intensive Care Unit (NICU) are limited. This study investigated strategies for effective health communication in the NICU through focus groups with parents and nurses, and individual interviews with neonatologists. Methods: Eight parents, seventeen nurses, and three neonatologists from one NICU in Genesee County, Michigan participated. Results: Parents expressed a preference for daily, face-to-face communication with the physician. They recommended the use of visual aids to help with understanding infants� conditions. One such aid would be a baby diary to serve as the infant�s daily progress report for the parent to review during the visit. A communication strategy used by nurses was providing parents with the most up-to-date information in an approachable, reassuring manner. Physicians suggested interactive communication practice sessions as strategies to increase effective communication between physicians and parents. Physician-to-nurse strategies consisted of building trustworthy relationships by holding scientific forums, discussing health care disagreements, and accepting differing opinions. Conclusion: Future research may assess the influence of strategies recommended in this study on parental satisfaction with care and adherence to treatment recommendations as well as on health care provider self-efficacy

Planning and Patching Proof

Polynomial interpretations are a useful technique for proving termination of term rewrite systems. We show how polynomial interpretations with negative coefficients, like x–1 for a unary function symbol or x–y for a binary function symbol, can be used to extend the class of rewrite systems that can be automatically proved terminating.Proceedings of the 7th International Conference, AISC 2004, Linz, Austria, September 22-24, 2004

DBS-implanted Parkinson\u27s Disease Patients Show Better Olfaction Than Those Treated Medically

Dysosmia in PD (Parkinson’s Disease) may result from changes in the olfactory apparatus or in structures involved in olfactory perception. Previous work1,2 has suggested that deep brain stimulation (DBS) pa-tients have improved odor discrimination in stimulation-on/medication-off state in comparison to their own scores in a stimulation-off/medication-off state. What remains unclear is whether it is the ON state itself or an effect of stimulation that leads to improved olfaction. In this study we evaluate dysosmia in two PD cohorts in the ON state, those treated with medication alone and those treated with medication and DBS. A prospective study geared at improving predictive value of olfactory testing with a battery of psychological tests enrolled 45 PD patients and 44 controls. Of the PD patients, 9 had bilateral STN (subthalamic nucleus) DBS and 36 were medically treated. Subset analysis of PD patients with and without DBS placement revealed no difference in apathy or depression. DBS patients had better olfaction on UPSIT (Univ of Pennsylvania Smell Identification Test) (p This study provides further data that DBS patients have improved ol-faction. It also provides preliminary evidence that DBS with medica-tion improves dysosmia to a greater extent than medication alone. This may result from indirect stimulation of olfactory processing cen-ters or changes in olfactory circuitry metabolism

Assessment of Olfactory Processing in Parkinson’s Disease Patients

Background: Hyposmia is an early symptom of Parkinson’s Disease (PD) that often predates motor symptoms by years. Hyposmia has been shown to have a more consistent link to idiopathic PD than to other movement disorders. Olfaction has the potential to be used as a biomarker for PD, either through clinical evaluation or imaging. Objectives: This study uses functional magnetic resonance imaging (fMRI) to assess differences in olfaction pathways between anosmic early PD patients and age and gender-matched controls. Methods: 12 PD patients and 12 age- and gender-matched control subjects were recruited from the subject panel of a previous UMMS study on olfaction and PD. All PD patients were determined to be anosmic, and all controls were determined to have normal olfaction for their age and gender. All subjects underwent fMRI including periods with and without odorant exposure. Statistical analysis was performed using SPM8, using a general linear model to calculate BOLD signal changes for each scent relative to room air. A random effect model was used to infer general population effects. Results: Control subjects showed significant activation in the piriform cortex, anterior olfactory nucleus, insula, hippocampus and temporal lobe, all regions associated with olfactory processing. Relative to control subjects, PD patients showed no significant BOLD activation in the olfactory pathways of the brain. In response to a citrus scent, PD patients showed activation in the superior and middle frontal lobe, as well as the cingulate gyrus. In response to a cinnamon scent, PD patients showed significant activation in the precuneus and paracentral lobule as well as lower levels of activation in the frontal lobe. PD patients showed no significant areas of activation in response to a mint scent. Conclusion: Our results suggest that anosmic PD patients do not show activation of the olfactory pathways in the brain on exposure to these odorants. Taken together with previous studies, this suggests that BOLD activation in these regions of the brain can reflect clinical olfactory capability. In addition, PD patients show areas of increased activation, particularly in the frontal lobe. These distinct patterns of BOLD activation allow us to consider the feasibility of fMRI as a biomarker for diagnosis and evaluation of PD

Evaluation of Tsunami Loads on Wood Frame Walls at Full Scale

The performance of full-scale light-frame wood walls subjected to wave loading was examined using the Large Wave Flume of the Network for Earthquake Engineering (NEES) Tsunami Facility at Oregon State University. The hydrodynamic conditions (water level and bore speed) and structural response (horizontal force, pressure, and deflection) were observed for a range of incident tsunami heights and for several wood wall framing configurations. The walls were tested at the same cross-shore location with a dry bed condition. For each tsunami wave height tested, the force and pressure profiles showed a transient peak force followed by a period of sustained quasi-static force. The ratio of the transient force to quasi-static force was 2.2. These experimental values were compared to the predicted values using the linear momentum equation, and it was found that the equation predicted the measured forces on the vertical wall within an accuracy of approximately 20% without using a momentum correction coefficient. The experiments also showed that the more flexible 2x4 wall resulted in lower peak forces when compared to the 2x6 walls subjected to similar tsunami heights. However, the 2x6 walls were able to withstand larger waves before failure.Keywords: light-frame wood walls, impact, tsunami mitigation, tsunami forces, tsunami damageKeywords: light-frame wood walls, impact, tsunami mitigation, tsunami forces, tsunami damag