One-Year Morbidity Following Videoscopic Inguinal Lymphadenectomy for Stage III Melanoma

Simple Summary Inguinal lymphadenectomy (the removal of lymph nodes in the groin) is currently part of the treatment options for stage III melanoma patients. Surgery can be performed using one large inguinal incision (open approach) or a few smaller incisions (videoscopic approach). Previous research has already shown less severe complications and comparable oncologic outcomes after the videoscopic approach. Postoperative lymphedema following inguinal lymphadenectomy is a well-known problem which can potentially decrease quality of life. With the arrival of adjuvant systemic treatment options, less invalidating surgery is highly desirable. However, lymphedema and quality of life have only been investigated after the open approach. Therefore, we evaluated lymphedema and quality of life following videoscopic inguinal lymphadenectomy for stage III melanoma. The videoscopic inguinal lymphadenectomy is a feasible approach due to the comparable lymphedema incidence and normalization of quality of life during follow-up. Purpose: We aimed to elucidate morbidity following videoscopic inguinal lymphadenectomy for stage III melanoma. Methods: Melanoma patients who underwent a videoscopic inguinal lymphadenectomy between November 2015 and May 2019 were included. The measured outcomes were lymphedema and quality of life. Patients were reviewed one day prior to surgery and postoperatively every 3 months for one year. Results: A total number of 34 patients were included for participation; 19 (55.9%) patients underwent a concomitant iliac lymphadenectomy. Lymphedema incidence was 40% at 3 months and 50% at 12 months after surgery. Mean interlimb volume difference increased steadily from 1.8% at baseline to 6.9% at 12 months (p = 0.041). Median Lymph-ICF-LL total score increased from 0.0 at baseline to 12.0 at 3 months, and declined to 8.5 at 12 months (p = 0.007). Twelve months after surgery, Lymph-ICF-LL scores were higher for females (p = 0.021) and patients that received adjuvant radiotherapy (p = 0.013). The Median Distress Thermometer and EORTC QLQ-C30 summary score recovered to baseline at 12 months postoperatively (p = 0.747 and p = 0.203, respectively). Conclusions: The onset of lymphedema is rapid and continues to increase up to one year after videoscopic inguinal lymphadenectomy. Quality of life recovers to the baseline value

The development and validation of sexual health indicators of Canadians aged 16-24 years

Objectives: We developed and validated a set of self-administered, multidimensional indicators of sexual health among Canadians aged 16–24 years. Methods: This study used a mixed-method qualitative and quantitative approach to develop and validate indicators of sexual health. We used the four-stage Dillman method to identify, focus-test, pilot-test, and validate key metrics to measure sexual health. We collected quantitative data to validate the measures through a computer-assisted self-interviewing program among a purposive sample of 1,158 people aged 16–24 years recruited from four Canadian provinces. Results: The survey contained 75 items measuring five dimensions of sexual health: (1) physical, mental, emotional, and social well-being in relation to sexuality; (2) approach to sexuality; (3) sexual relationships; (4) sexual experiences; and (5) discrimination, coercion, and violence. Principal components analysis for composite measures found seven components with eigenvalues ≥ 1. The factor structure was stable across gender, age, size of area of residence, and language in which the survey was completed. Cronbach’s alpha coefficients ranged from 0.79 to 0.90. Indicators of condom use at last vaginal sex, protection self-efficacy, sexually transmitted infection/HIV testing self-efficacy, and sexual orientation also showed good construct validity. Conclusions: The indicators constituted a conceptually grounded survey that is easy for young adults to complete and contains valid, reliable, and psychometrically robust measures. The survey instrument provides a tool for future research to collect population-level data to measure and monitor trends in the sexual health of young people in Canada

Estimation of capture probabilities using generalized estimating equations and mixed effects approaches

Modeling individual heterogeneity in capture probabilities has been one of the most challenging tasks in capture-recapture studies. Heterogeneity in capture probabilities can be modeled as a function of individual covariates, but correlation structure among capture occasions should be taking into account. A proposed generalized estimating equations (GEE) and generalized linear mixed modeling (GLMM) approaches can be used to estimate capture probabilities and population size for capture-recapture closed population models. An example is used for an illustrative application and for comparison with currently used methodology. A simulation study is also conducted to show the performance of the estimation procedures. Our simulation results show that the proposed quasi-likelihood based on GEE approach provides lower SE than partial likelihood based on either generalized linear models (GLM) or GLMM approaches for estimating population size in a closed capture-recapture experiment. Estimator performance is good if a large proportion of individuals are captured. For cases where only a small proportion of individuals are captured, the estimates become unstable, but the GEE approach outperforms the other methods

Depression and unplanned secondary healthcare use in patients with multimorbidity: a systematic review

Background: Growing numbers of people with multimorbidity have a co-occurring mental health condition such as depression. Co-occurring depression is associated with poor patient outcomes and increased healthcare costs including unplanned use of secondary healthcare which may be avoidable. Aim: To summarise the current evidence on the association between depression and unplanned secondary healthcare use among patients with multimorbidity. Methods: We conducted a systematic review by searching MEDLINE, EMBASE, PsychINFO, Web of Science, CINAHL, and Cochrane Library from January 2000 to March 2021. We included studies on adults with depression and at least one other physical long-term condition that examined risk of emergency hospital admissions as a primary outcome, alongside emergency department visits or emergency readmissions. Studies were assessed for risk of bias using The National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool. Relevant data were extracted from studies and a narrative synthesis of findings produced. Results: Twenty observational studies were included in the review. Depression was significantly associated with different outcomes of unplanned secondary healthcare use, across various comorbidities. Among the studies examining these outcomes, depression predicted emergency department visits in 7 out of 9 studies; emergency hospital admissions in 19 out of 20 studies; and emergency readmissions in 4 out of 4 studies. This effect increased with greater severity of depression. Other predictors of unplanned secondary care reported include increased age, being female, and presence of greater numbers of comorbidities. Conclusion: Depression predicted increased risk of unplanned secondary healthcare use in individuals with multimorbidity. The literature indicates a research gap in identifying and understanding the impact of complex multimorbidity combinations, and other patient characteristics on unplanned care in patients with depression. Findings indicate the need to improve planned care for patients with moderate-to-severe depression. We suggest regular reviews of care plans, depression severity monitoring and assessment of hospital admission risk in primary care settings

Solar neutrino with Borexino: results and perspectives

Borexino is a unique detector able to perform measurement of solar neutrinos fluxes in the energy region around 1 MeV or below due to its low level of radioactive background. It was constructed at the LNGS underground laboratory with a goal of solar $^{7}$Be neutrino flux measurement with 5\% precision. The goal has been successfully achieved marking the end of the first stage of the experiment. A number of other important measurements of solar neutrino fluxes have been performed during the first stage. Recently the collaboration conducted successful liquid scintillator repurification campaign aiming to reduce main contaminants in the sub-MeV energy range. With the new levels of radiopurity Borexino can improve existing and challenge a number of new measurements including: improvement of the results on the Solar and terrestrial neutrino fluxes measurements; measurement of pp and CNO solar neutrino fluxes; search for non-standard interactions of neutrino; study of the neutrino oscillations on the short baseline with an artificial neutrino source (search for sterile neutrino) in context of SOX project.Comment: 15 pages, 4 figure

Recent Borexino results and prospects for the near future

The Borexino experiment, located in the Gran Sasso National Laboratory, is an organic liquid scintillator detector conceived for the real time spectroscopy of low energy solar neutrinos. The data taking campaign phase I (2007 - 2010) has allowed the first independent measurements of 7Be, 8B and pep fluxes as well as the first measurement of anti-neutrinos from the earth. After a purification of the scintillator, Borexino is now in phase II since 2011. We review here the recent results achieved during 2013, concerning the seasonal modulation in the 7Be signal, the study of cosmogenic backgrounds and the updated measurement of geo-neutrinos. We also review the upcoming measurements from phase II data (pp, pep, CNO) and the project SOX devoted to the study of sterile neutrinos via the use of a 51Cr neutrino source and a 144Ce-144Pr antineutrino source placed in close proximity of the active material.Comment: 8 pages, 11 figures. To be published as proceedings of Rencontres de Moriond EW 201

Search for Solar Axions Produced in p(d,3He)Ap(d,\rm{^3He})A Reaction with Borexino Detector

A search for 5.5-MeV solar axions produced in the $p+d\rightarrow\rm{^3He}+A (5.5 \rm{MeV})$ reaction was performed using the Borexino detector. The Compton conversion of axions to photons, ${\rm A}+e\rightarrow e+\gamma$; the axio-electric effect, ${\rm A}+e+Z\rightarrow e+Z$; the decay of axions into two photons, ${\rm A}\rightarrow2\gamma$; and inverse Primakoff conversion on nuclei, ${\rm A}+Z\rightarrow\gamma+Z$, are considered. Model independent limits on axion-electron ($g_{Ae}$), axion-photon ($g_{A\gamma}$), and isovector axion-nucleon ($g_{3AN}$) couplings are obtained: $|g_{Ae}\times g_{3AN}| \leq 5.5\times 10^{-13}$ and $|g_{A\gamma}\times g_{3AN}| \leq 4.6\times 10^{-11} \rm{GeV}^{-1}$ at $m_A <$ 1 MeV (90% c.l.). These limits are 2-4 orders of magnitude stronger than those obtained in previous laboratory-based experiments using nuclear reactors and accelerators.Comment: 11 pages, 7 figures, submitted to Phys.Rev.