The two-stage clonal expansion model in occupational cancer epidemiology: Results from three cohort studies

Copyright © 2010 by the BMJ Publishing Group Ltd. All rights reserved.Objectives: The objective of this work was to apply the two-stage clonal expansion model, with the intention to expand the literature on epidemiological applications of the model and demonstrate the feasibility of incorporating biologically based modelling methods into the widely used retrospective cohort study. Methods: The authors fitted the two-stage clonal expansion model model to three occupational cohort studies: (1) a cohort of textile workers exposed to asbestos and followed for lung cancer mortality; (2) a cohort of diatomaceous earth workers exposed to silica and also followed for lung cancer mortality; and (3) a cohort of automotive manufacturing workers exposed to straight metalworking fluid (MWF) and followed for larynx cancer incidence. The model allowed the authors to estimate exposure effects in three stages: cancer initiation (early effects), promotion or malignant transformation (late effects). Results: In the first cohort, the authors found strong evidence for an early effect of asbestos on lung cancer risk. Findings from analyses of the second cohort suggested early and less evidently late effects of silica on lung cancer risk. In the MWF (third) cohort, there was only weak evidence of straight MWF exposure effects on both early and late stages. The authors also observed a late birth cohort effect on larynx cancer risk. Conclusions: The findings for asbestos and silica were essentially confirmatory, supporting evidence for their early effects on lung cancer from a large body of literature. The effect of straight MWF on larynx cancer was less clear.This work was supported by a grant from the US National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention,R01-OH03575, and a grant from the Centers for Disease Control and Prevention/ Association of Teachers of Preventive Medicine number TS 0699

Hepatitis B testing and treatment in HIV patients in The Gambia - compliance with international guidelines and clinical outcomes

Background Compliance with WHO guidelines on HBV screening and treatment in HIV-coinfected patients is often challenging in resource limited countries and has been poorly assessed in sub-Saharan Africa. Methods Between 2015 and 2016, we assessed physician’s compliance with WHO guidelines on HIV-HBV coinfection in the largest HIV clinic in The Gambia, and the hepatic outcomes in HIV-HBV coinfected patients as compared to randomly selected HIV-monoinfected controls. Results 870 HIV-infected patients regularly seen in this clinic agreed to participate in our study. Only 187 (21.5%, 95% CI 18.8–24.3) had previously been screened for HBsAg, 23 (12.3%, 95% CI 8.0–17.9) were positive of whom none had liver assessment and only 6 (26.1%) had received Tenofovir. Our HBV testing intervention was accepted by all participants and found 94/870 (10.8%, 95% CI 8.8–13.1) positive, 78 of whom underwent full liver assessment along with 40 HBsAg-negative controls. At the time of liver assessment, 61/78 (78.2%) HIV-HBV coinfected patients received ART with 7 (11.5%) on Tenofovir and 54 (88.5%) on Lamivudine alone. HIV-HBV coinfected patients had higher APRI score compared to controls (0.58 vs 0.42, p = 0.002). HBV DNA was detectable in 52/53 (98.1%) coinfected patients with 14/53 (26.4%) having HBV DNA >20,000 IU/L. 10/12 (83.3%) had at least one detectable 3TC-associated HBV resistance, which tended to be associated with increase in liver fibrosis after adjusting for age and sex (p = 0.05). Conclusions Compliance with HBV testing and treatment guidelines is poor in this Gambian HIV programme putting coinfected patients at risk of liver complications. However, the excellent uptake of HBV screening and linkage to care in our study suggests feasible improvements

Controlling Light Through Optical Disordered Media : Transmission Matrix Approach

We experimentally measure the monochromatic transmission matrix (TM) of an optical multiple scattering medium using a spatial light modulator together with a phase-shifting interferometry measurement method. The TM contains all information needed to shape the scattered output field at will or to detect an image through the medium. We confront theory and experiment for these applications and we study the effect of noise on the reconstruction method. We also extracted from the TM informations about the statistical properties of the medium and the light transport whitin it. In particular, we are able to isolate the contributions of the Memory Effect (ME) and measure its attenuation length

Reproducibility of measurements of oestrogen-receptor concentration in breast cancer.

The reproducibility of measurements of oestrogen-receptor activity has been examined in multiple specimens from a rabbit uterus, a rat mammary tumour and human breast tumours. The relationship between receptor concentration and tumour histology has also been investigated in 11 large primary tumours. In the animal tissues, receptor measurements were relatively reproducible (coefficient of variance: wet wt. basis 16-17%, protein basis 16-21%) but in human breast tumours receptor activity varied considerably (c.v.: wet wt. basis, 22-125%; protein basis, 28-72%). In addition to these variations in receptor activity within tumours, there was a difference between tumours, as demonstrated by an analysis of variance (P less than 0.01). In the 11 primary breast cancers selected for study, the level of receptor activity was related to menopausal status and the tumour content of the specimen. We conclude that the receptor activity detected varies within a tumour and depends upon the tumour content of the biopsy specimen. Predictions based on precise quantitation of receptor concentrations may therefore necessitate replicate tumour sampling and correction for the fraction of non-tumour tissue in each sample

Pre-Altitude Serum Ferritin Levels and Daily Oral Iron Supplement Dose Mediate Iron Parameter and Hemoglobin Mass Responses to Altitude Exposure

Purpose : To investigate the influence of daily oral iron supplementation on changes in hemoglobin mass (Hbmass) and iron parameters after 2–4 weeks of moderate altitude exposure.Methods :Hematological data collected from 178 athletes (98 males, 80 females) exposed to moderate altitude (1,350–3,000 m) were analysed using linear regression to determine how altitude exposure combined with oral iron supplementation influenced Hbmass, total iron incorporation (TII) and blood iron parameters [ferritin and transferrin saturation (TSAT)]. Results :Altitude exposure (mean ± s: 21 ± 3 days) increased Hbmass by 1.1% [-0.4, 2.6], 3.3% [1.7, 4.8], and 4.0% [2.0, 6.1] from pre-altitude levels in athletes who ingested nil, 105 mg and 210 mg respectively, of oral iron supplement daily. Serum ferritin levels decreased by -33.2% [-46.9, -15.9] and 13.8% [-32.2, 9.7] from pre-altitude levels in athletes who supplemented with nil and 105 mg of oral iron supplement daily, but increased by 36.8% [1.3, 84.8] in athletes supplemented with 210 mg of oral iron daily. Finally, athletes who ingested either 105 mg or 210 mg of oral iron supplement daily had a greater TII compared with non-supplemented athletes (0 versus 105 mg: effect size (d) = -1.88 [-2.56, -1.17]; 0 versus 210 mg: effect size (d) = -2.87 [-3.88, -1.66]). Conclusion :Oral iron supplementation during 2–4 weeks of moderate altitude exposure may enhance Hbmass production and assist the maintenance of iron balance in some athletes with low pre-altitude iron stores

COMPARISON OF TWO ELLIPTICAL MOTION RUNNING MACHINES AND TREADMILL RUNNING

INTRODUCTION: One of the major problems associated with rehabilitation from impact- associated running injuries is maintaining cardiovascular fitness. Recently, elliptical motion exercise machines have been developed in an attempt to simulate running while minimizing impact forces. These machines have been shown to maintain cardiovascular fitness. However, they have not yet been shown to truly simulate the running motion. The purpose of this study was to provide a quantitative comparison of two elliptical motion exercise machines (C1 and C2) and treadmill running (C3). METHODS: Both of the elliptical motion machines fixed stride length, although one allowed a greater stride length (C1). Eight subjects were tested in each of three submaximal exercise conditions during a 15 minute bout. Subjects performed at a stride frequency that resulted in a heart rate of 65% of their age-predicted maximum heart rate. Five 60 Hz digital cameras were used to collect lower extremity kinematic data. Pre-amplified surface electrodes measured the muscle activity of seven lower extremity muscles. Impact forces were assessed using a 1.7g PCB accelerometer placed on the distal medial aspect of the tibia. Both the accelerometer and EMG data were collected concurrently on a microcomputer sampling at 600 Hz. Lower extremity joint and segment parameters, onset and offset of muscles during stride, peak impact force and time to peak impact force were calculated. An analysis of variance was used to compare the measured parameters between each machine condition and to identify whether the duration of the exercise bout had an effect. RESULTS: There were no significant differences in stride duration with controlled stride frequency. The results of the analysis of the kinematic data showed that the majority of the differences between the machines and treadmill running occurred at the ankle and knee joints. At the ankle and knee joints, the touchdown angle was greater for the two machines (C1 and C2) than for treadmill running (ankle: 11.97 o and 22.14 o versus 2.23o; knee: 34.94 o and 33.89 o versus 12.05 o). At the ankle joint, the maximum plantar flexion angle was greatest in treadmill running, while there were no significant differences in any knee angles subsequent to touchdown. There were no differences in any of the hip angles at any time in the stride. Impact values on the two machines were 30% of those measured during treadmill running, and the time of occurrence of the impact was substantially longer into the stride. The results of the EMG data showed that the duration of muscle activity throughout the stride was different in the triceps surae, rectus femoris and vastus lateralis. In each case, the duration of the stride in which these muscles were active was least in treadmill running. CONCLUSIONS: In conclusion, while there are a few differences between the elliptical machines and running, it appears that the machines could be considered representative of running with distinctly less impact. Thus, these machines could be used as rehabilitation tools for runners recovering from impact-related injuries

Parental Views on Sexual Education in Public Schools in a Rural Kentucky County Eastern Kentucky University

Despite Kentucky having almost twice the national birth rate with 50 births per 1,000 female population ages 15-19 (County Health Rankings, 2015), the implementation of comprehensive sexual education in Kentucky public schools remains a controversial topic. This study examined parental attitudes regarding comprehensive sex education curriculum in a rural Kentucky middle school. A survey was distributed to a convenience sample population of parents (N=100) whose children were enrolled in a rural Appalachian middle school in grades 6th thru 8th. Data were analyzed using Chi square and multi-variate techniques. Of the 63 participants, 58.7% believed that sex education should begin in middle school. Of the 73% (n=46) of respondents who believed abstinence-plus should be taught, 58.7% (n=27) were between the ages of 26 and 35, and 28.3% (n=13) were between the ages of 36 and 45. Differences in attitudes towards sex education was strongly influenced by both age and education level

Safety and efficacy of topical tranexamic acid over intravenous tranexamic acid in reducing blood loss and transfusion rates in hip and knee arthroplasty

Background: Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss. Hence the present study was undertaken to compare the efficacy of topical TXA and intravenous (IV) TXA in reducing blood loss and transfusion rate in primary total hip and total knee arthroplasty.Methods: Total of 31 cases undergoing either primary THA (23 cases) or TKA (8 cases) during a study period from June were enrolled. Outcome measures were drained output, transfusion rate, drop in haemoglobin (Hb) and blood loss measured by Nadler et al formula.Results: In THR group, 12 (52.17%) cases and in TKA group, 3 (37.5%) cases were managed using IV TXA whereas 11 (47.82%) and 5 (62.5%) cases were managed using topical TXA in THR and TKR group respectively. The mean drain output was greater among IV TKR group (261.66±129.60 ml) as compared to topical TKR group (210±129.49 ml). In THR drain output in IV group was 216±104.08 ml. In both the groups, mean blood loss was lower in cases where IV TXA was administered as compared to topical TXA, (p>0.05). The mean drop in Hb was greater after topical administration of TXA in both the groups as compared to IV administered TXA. In THR group, 9 (39.13%) patients required blood transfusion. In sickle cell disease patients, we found more blood loss and drain output as compared to non-sickle cell disease (SCD) patients.Conclusions: Both IV and topical TXA are clinically effective and safe in decreasing calculated blood loss, Hb drop after THA and TKA.