Height and Mental Health and Health Utility Among Ethnic Chinese in a Polyclinic Sample in Singapore

Abstract Introduction: Whether fi nal height is associated with quality of life and mental health is a matter of epidemiological and medical concern. Both social and biological explanations have been previously proposed. This study aims to assess the associations in ethnic Chinese in Singapore. Materials and Methods: A cross-sectional study of 4414 respondents aged at least 21 years seen at a major polyclinic was performed. Socioeconomic and behavioural features of the sample and the Singapore population of similar ages were comparable. Height was measured by clinic nurses using an ultrasonic height senor. Participants were interviewed for socioeconomic, behavioural, health and quality of life information. Clinical morbidity data was collected from the participants' treating physicians. The SF-6D utility index and its Mental Health domain were the main endpoints. Linear and ordinal logistic regression models were used to analyse the utility index and the Mental Health scores, respectively. Results: Having adjusted for age and gender, the Mental Health domain (P <0.01) was associated with height but the utility index was not. Further adjustment for health, socioeconomic and behavioural covariates made little difference. Analyses based on height categories showed similar trends. Conclusion: Adult height has a positive association with mental health as measured by the SF-6D among ethnic Chinese in Singapore. Socioeconomic status and known physical health problems do not explain this association. Adult height had no association with SF-6D utility index scores

Breaking the diffusion limit with super-hydrophobic delivery of molecules to plasmonic nanofocusing SERS structures

n/

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Intrafraction Motion and Margin Assessment for Ethos Online Adaptive Radiotherapy Treatments of the Prostate and Seminal Vesicles

Purpose: Online adaptive radiation therapy (OART) uses daily imaging to identify changes in the patient's anatomy and generate a new treatment plan adapted to these changes for each fraction. The aim of this study was to determine the intrafraction motion and planning target volume (PTV) margins required for an OART workflow on the Varian Ethos system. Methods and Materials: Sixty-five fractions from 13 previously treated OART patients were analyzed for this retrospective study. The prostate and seminal vesicles were contoured by a radiation oncologist on 2 cone beam computed tomography scans (CBCT) for each fraction, the initial CBCT at the start of the treatment session, and the verification CBCT immediately before beam-on. In part 1 of the study, PTVs of different sizes were defined on the initial CBCT, and the geometric overlap with the clinical target volume (CTV) on the verification CBCT was used to determine the optimal OART margin. This was performed with and without a patient realignment shift by registering the verification CBCT to the initial CBCT. In part 2 of the study, the margins determined in part 1 were used for simulated Ethos OART treatments on all 65 fractions. The resultant coverage to the CTV on the verification CBCT, was compared with an image guided radiation therapy (IGRT) workflow with 7-mm margins. Results: Part 1 of the study found, if a verification CBCT and shift is performed, a 4-mm margin on the prostate and 5 mm on the seminal vesicles resulted in 95% of the CTV covered by the PTV in >90% of fractions, and 98% of the CTV covered by the PTV in >80% of fractions. Part 2 of the study found when these margins were used in an Ethos OART workflow, they resulted in CTV coverage that was superior to an IGRT workflow with 7-mm margins. Conclusions: A 4mm prostate margin and 5-mm seminal vesicles margin in an OART workflow with verification imaging are adequate to ensure coverage on the Varian Ethos system. Larger margins may be required if using an OART workflow without verification imaging

Finite Element Study of Correlation between Intracranial Pressure and External Vibration

In this paper, the correlation between intracranial pressure (ICP) and external vibration responses of the head was studied using finite element modeling. A two-dimensional finite element model of the head was constructed from magnetic resonance imaging (MRI) slice. The finite element model includes the skull, the cerebrospinal fluid (CSF) and the brain tissue. Material properties of the three components were obtained from the literature. A number of ICP values were selected from the normal ICP range. A series of finite element simulations were then conducted. In each of the simulations, one of the selected ICP values was applied to the finite element model. A harmless impact was exerted on one side of the head. External vibration responses were collected on the opposite side of the head. In all the simulations, the same impact was applied. The only factor that made a difference to vibrational responses was intracranial pressure. By comparing results obtained from all the simulations, it was found that all vibrational responses were related to intracranial pressure. However, some vibrational responses were more sensitive than the others to the change of intracranial pressure. The results from this study may be used as a base for developing a noninvasive procedure for evaluating intracranial pressure

Immunity duration of a recombinant adenovirus type-5 vector-based Ebola vaccine and a homologous prime-boost immunisation in healthy adults in China: final report of a randomised, double-blind, placebo-controlled, phase 1 trial

Summary: Background: The 2013–15 Ebola virus disease epidemic in west Africa greatly accelerated the development of Ebola vaccine. We aimed to analyse the immune persistence induced by one shot of an adenovirus type-5 vector-based Ebola virus vaccine up to 6 months and the effect of boosting with a homologous vector in healthy adults in China. Methods: In a randomised, double-blind, placebo-controlled, phase 1 clinical trial in one site in Jiangsu Province, China, 120 healthy adults aged 18–60 years received an initial dose of intramuscular adenovirus type-5 Ebola virus vaccine of 4·0 × 1010 viral particles, 1·6 × 1011 viral particles, or placebo, and were followed up to day 168. Participants were subsequently re-recruited to receive a booster dose of the same vaccine or placebo, in the same dose, at month 6. Women who were pregnant, breastfeeding, or planned to become pregnant during the next month were excluded. Randomisation was conducted by computer-generated block randomisation. Randomisation data were unmasked for interim analysis of the data obtained between days 0–28 but not disclosed to participants or site staff. Safety and immunogenicity analysis were done on the intention-to-treat population. We aimed to assess the safety profile of the experimental vaccine and the immunity responses to a single-dose immunisation or a homologous prime-boost regimen. Primary outcomes were Ebola glycoprotein-specific ELISA antibody responses 28 days post-boost and the occurrences of adverse reactions post-boost. The original trial and the extended booster study were registered with ClinicalTrials.gov, numbers NCT02326194 and NCT02533791, respectively. Findings: Between Dec 28, 2014, and Jan 9, 2015, we enrolled 210 volunteers. 90 participants were not randomised due to not meeting inclusion criteria (61), meeting exclusion criteria (4), or withdrawal of consent (25). 120 people were randomly assigned to receive intramuscular Ebola vaccine at 4·0 × 1010 viral particles (low dose, n=40), Ebola vaccine at 1·6 × 1011 viral particles (high dose, n=40), or placebo (n=40, in two groups of 20). After prime vaccination, the geometric mean titer (GMT) of ELISA EC90 peaked at 682·7 (95% CI 424·3–1098·5) in the low-dose vaccine group and 1305·7 (970·1–1757·2) in the high-dose vaccine group at day 28, and then fell gradually through the next a few months to 575·5 (394·8–838·8) in the high-dose vaccine group and 197·9 (107·9–362·7) in the low-dose vaccine group at day 168. No specific response was recorded in the placebo group with a GMT of 5·0. Of the 120 participants involved in the initial trial, ten participants declined to participate, and 110 were included in the boost immunisation: 38 received the low dose, 35 received the high dose, and 37 received the placebo. At day 28 after boost vaccination, the ELISA EC90 titres rapidly rose to 6110 (95% CI 4705–7935) in the low-dose group and to 11825 (8904–15705) in the high dose group. 78 of 110 participants reported at least one solicited adverse reaction within the first 7 days after booster administration. Both of the groups who received vaccine showed significantly higher incidence of mild or moderate solicited adverse reactions than did the placebo group. Interpretation: The adenovirus 5-vectored Ebola vaccine of 1·6 × 1011 viral particles was highly immunogenic and safe. The lower dose of 4·0 × 1010 viral particles was also safe, but immunogenicity seemed to be more vulnerable to the pre-existing immunity of adenovirus 5. A homologous priming-boosting regimen with adenovirus type-5 Ebola vaccine at 6 months interval was able to elicit greater antibody responses with longer duration. These results support an immunisation strategy to implement a booster injection for a more durable protection against Ebola virus disease. Funding: Chinese Ministry of Science and Technology and The National Health and Family Planning Commission, Beijing Institute of Biotechnology, and Tianjin CanSino Biotechnology

Developing a Strategy for the Improvement in Patient Experience in a Canadian Academic Department of Surgery

Patient experience (PE) is recognized as a key component in the quality of health-care delivery. Public reporting of hospital, division, and physician-specific PE results has added to the momentum of adopting strategies to augment this metric of care. The Ottawa Hospital embarked on a journey to improve PE as a pillar of its quality improvement plan. This article demonstrates the efforts of a single surgery department from one large urban center to improve in-hospital PE in the rapidly changing environment of medicine and surgery. A multidisciplinary group within the department and a focus group of previous surgical inpatients were organized to address immediate challenges related to inpatient PE issues. We identified concrete strategies to optimize pain control, perceptions of patient respect and dignity, perceptions of surgeon availability, discharge medication understanding, and overall experience. Also, we identified a need in our department for timely patient feedback, improved communication styles in our staff and trainees, and an internal curriculum offering additional training for our staff and residents. We anticipate that the current results would be of significant interest to other departments wishing to optimize their PE profile as part of the ongoing quality improvement process at hospitals across North America