comparison of three adjuvant chemotherapy regimes using an extended log-logistic model in women with operable breast cancer

Objective: The main objective of the present study was to compare the effects of three common chemotherapy regimes in terms of disease-free survival (DFS) of breast cancer (BC) patients; the three explored regimes were taxane-based, anthracycline-based and CMF (cyclophosphamide methotrexate and 5-fluorouracil). Materials and methods: In this historical-cohort study, we obtained the information of 62 patients with confirmed BC in non-metastatic stage and followed them for 8 years. All the patients had undergone modified radical mastectomy surgery and had received adjuvant chemotherapy in three medical centers in Tehran, Iran. DFS was considered as the end-point. Afterwards, an extended log-logistic regression model was used to compare these regimes. Results: The mean (SD) age of patients was 49.0 (10.3) years. The median time of follow-up was 20.0 months and the probability of 5-years DFS was 0.48. Survival analysis indicated that the type of chemotherapy (OR(CMF vs. taxane) = 0.33, OR(anthracycline vs. taxane) = 0.74), grade (OR(III vs. I or II) = 0.35), tumor size (OR(>5cm vs. <5cm)= 0.179) and nodal involvements (OR(Yes vs. No)= 0.36) affected DFS. Conclusion: The current study revealed that the efficacy of taxane-based, in terms of DFS, was more than CMF (p = 0.05). Moreover, taxane-based chemotherapy prolonged DFS more than anthracycline-based one although the difference was not significant (p= 0.63). Finally, considering the importance of tumor size, histological grade and number of involved lymph nodes in lengthening DFS, it is crucial to highlight the role of public education and screening programs in order to detect tumor in its early stages

Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study.

BACKGROUND:Telehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD). However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices. OBJECTIVE:The objective of the study was to assess patient adoption and diminish barriers to use by initiating a user-centered design approach, which included usability testing to refine the telePR intervention prior to enrolling patients with COPD into a larger telePR study. METHODS:Usability testing was conducted in two phases to identify opportunities to streamline and improve the patient experience. The first phase included a prefield usability testing phase to evaluate technical, patient safety, and environmental factors comprising the system architecture. This was followed by an ergonomic evaluation of user interactions with the bicycle, telehealth tablets, and connected wearable devices to ensure optimal placement and practical support for all components of the intervention. The second phase of research included feasibility testing to observe and further optimize the system based on iterative rounds of telePR sessions. RESULTS:During usability and feasibility research, we identified and addressed multiple opportunities for system improvements. These included physical and environmental changes, modifications to accommodate individual patient factors, safety improvements, and technology upgrades. Each enrolled patient was subsequently identified and classified into one of the following 3 categories: (1) independent, (2) intermediate, or (3) dependent. This categorization was used to predict the level of training and support needed for successful participation in the telePR sessions. Feasibility results revealed that patients in the dependent category were unable to perform the rehab sessions without in-person support due to low technical acumen and difficulty with certain features of the system, even after modifications had been made. Intermediate and independent users, however, did exhibit increased independent utilization of telePR due to iterative improvements. CONCLUSIONS:Usability testing helped reduce barriers to use for two subsets of our population, the intermediate and independent users. In addition, it identified a third subset, dependent users, for whom the telePR solution was deemed unsuitable without in-person support. The study established the need for the development of standard operating procedures, and guides were created for both patients and remote respiratory therapists to facilitate the appropriate use of the telePR system intervention. Observational research also led to the development of standard protocols for the first and all subsequent telePR sessions. The primary goals in developing standardization protocols were to establish trust, ensure a positive experience, and encourage future patient engagement with telePR sessions

First report of Parophonus dia (Col.: Carabidae) for the Iranian fauna

During a faunistic study of the family Carabidae in Guilan province in summer 2011, beetle specimens were collected directly or by using pitfall traps and light traps. A species of ground beetles was identified and later confirmed by Dr. R. Felix (Berkel Enschot, The Netherlands) as Parophonus dia (Reitter). This species is recorded from Iran for the first time

First report of the white stem borer, Scirpophaga innotata (Lep.: Crambidae: Schoenobiinae), from Iran

We collected moth specimens from rice fields in the vicinity of the city of Lahijan in Caspian province of Guilan between 2011 and 2012. The light traps in the rice fields of the village of Pahmadan (37°16'12" N, 50°03'00" E) captured a number of specimens of Scirpophaga innotata (Walker), commonly known as white stem borer. The white stem borer is a major pest of rice in the south and southeast of Asia and Australia. This species is recorded from Iran for the first time

First report of Pterostichus (Phonias) strenuus (Col.: Carabidae), for the Iranian fauna

The carabid beetle Pterostichus (Phonias) strenuus (Panzer) is newly recorded from Iran. It was collected by hand from Ghaleroudkhan forests in the Caspian province of Guilan. This carabid beetle is widely distributed throughout the Palaearctic region including Europe, Uzbekistan, Kazakhstan and Russian Far East

Physical Therapy for Hospitalized COVID-19 Patients in Isolation: Feasibility and pilot implementation of telehealth for delivering individualized therapy.

Objective To optimize the ability of hospitalized patients isolated due to COVID-19 to participate in physical therapy. Design This was a prospective, quality improvement trial of the feasibility and acceptability of a hybrid in-person and telerehabilitation platform to deliver physical therapy to hospitalized adults. Setting Inpatient wards of a tertiary care, multi-specialty academic medical center in the greater New York City metropolitan area. Participants A convenience sample of 39 COVID-19+ adults, mean age 57.3 years, 69% male, all previously community dwelling agreed to participate in a combination of in-person and telerehabilitation sessions (TR). Intervention Initial in-person evaluation by physical therapist followed by twice daily PT sessions, one in-person and one via a telehealth platform meeting Health Insurance Portability and Accountability Act (HIPAA) confidentiality requirements. The communication platform was downloaded to each participant\u27s personal smart device to establish audiovisual contact with the Physical Therapist. Measures The 6-clicks Activity Measure for Post-Acute Care (AM-PAC) was used to score self-reported functional status pre-morbidly by, and by the therapist at baseline and discharge. Results Functional status measured by AM-PAC 6-clicks demonstrated improvement from admission to discharge. Barriers to participation were identified and strategies are planned to facilitate use of the platform in future. Conclusions A consistent and structured protocol for engaging patient participation in PT delivered via a telehealth platform was successfully developed. A process was put in place to allow for further development, recruitment and testing in a randomized trial

Evaluation of COI and ITS2 sequences ability to distinguish Lysiphlebus fabarum and Lysiphlebus confusus (Hymenoptera: Aphidiidae)

All wasp species in the genus Lysiphlebus Förster are solitary endoparasitoids of aphids andconsidered a taxonomically difficult group. In this study a part of COI and ITS2 was used to distinguishtwo closely related species L. fabarum (Marshall) and L. confusus Tremblay & Eady in Iran. Thesequencing with a similarity about 99.5% showed COI's inability to separate the species L. fabarum andL. confusus. The ITS2 region of the rDNA partly separated the species with the similarity of 96.5-98.5%.The result is indicative of DNA barcoding deficiency in the identification of the species, as the two generegions fail to efficiently separate the species

Investigating the effect of light color temperature on selective attention, error and human reaction time

Background and aims: The reaction time of humans that affected by several factors includes the time that takes to stimulate the sensory organs and the stimulus effect is transmitted to the brain, then is perceived and the decision is made; consequently, the command resulting from the decision of the brain is sent from the brain to the functional organs. Failure to respond at the right time may result in human error and accidents. There are important factors that affect the reaction time. Attention is one of the important factors affecting the speed of the reaction. Selective attention and correct perception of several stimuli among the other stimuli is one of the effective factors in promoting performance and safety. Additionally, various environmental factors may be effective in determining selective attention, increasing the number of errors and the human response time in detecting triggers. Lighting is one of the factors affecting the processing mechanisms of the brain. In the design of indoor and outdoor lighting systems, the quality parameters of the lighting system are usually less considered. Color temperature is one of the most important qualitative parameters of light, which is measured by the Kelvin unit and is an indicator for the brightness and color of the light. The aim of this study was to investigate the effect of light color temperature on selective attention, error rate and reaction time. Methods: This research is an interventional and laboratory study in order to determine the effect of the light color temperature on human error, selective attention, and reaction time of students in Tarbiat Modares University (TMU) of Tehran during the fall of 2018. All students were in the same age range. The inclusion criteria for this study were; not having any eye-related diseases, such as diminished vision and subtlety, and mental-psychiatric disorders. On the day before performing the test, participants were informed to: have enough sleep and rest, adhere to a regular diet, and avoid taking medicines, coffee and caffeinated drinks. In this interventional study, 92 students (36 female and 56 male) from Tarbiat Modarres University of Tehran with an average age of 28.33 years were recruited as subjects. The measurements and tests related to selective attention and reaction time of individuals were performed in 4 locations with an equal lighting system and different color temperatures (3500, 4000, 5000, or 6500 degrees Kelvin). In the first step of the study, in order to determine the effect of light color temperature on the studied parameters, the participants were randomly divided into four groups with 24 subjects in each group. Before the main test was being performed, the participants were kept in rooms adjusted to a brightness of 3500° K to rest for at least 5 minutes in order to be adapted to the situation, and then, in the same conditions, to become familiar with the test method they were studied with the Stroop software. In the second step, each group was placed in a separate room where the levels of brightness had been designed with one of the lighting systems to yield a color temperature of 3500, 4000, 5000, and 6500° K. Cognitive performance tests including reaction time, accuracy and selective attention were measured using Stroop tests. Measurement of score interference and time interference, which are indicators for selective attention, were calculated by measuring the difference in the error rate and the reaction time in detecting incongruent and consonant words. Stroop test was used to determine the reaction time, error and other parameters. This test consists of two parts; the practice and the main test, each of them has two stages. The first step is to name the color of circular shapes that appears on the laptop monitor screen. The participant, upon viewing the image, applies pressure on keyboard buttons which are labeled with colors corresponding to the ones on the screen. The second step is to name the word which appears in a white box. The names of the colors appear, and as soon as the correct word is recognized, the participant should press the color word associated to the word on the keyboard. The third step, which is the main stage of the test, is a non-consistent word (red-green-blue) that shown randomly and sequentially on the monitor's screen. The subject must only press the keyboard button with the same color, only emphasizing the color and regardless of its connotation. In this test, 48 consistent colored words (the color of the word is identical with the meaning of the word; red, yellow, green and blue) and 48 non-consistent colored words (the color of the word is not the same as the word meaning; for example, the blue word shown in red). The time lap between the stimulants was 800 milliseconds and the duration of each of them was 2000 milliseconds. The subject's task was to select the correct color only. Finally, the data were analyzed using SPSS software. Results: Based on the results of this study, the highest mean of correct selection (474.49 ± 10.65) and the lowest mean of the correct ones (654.49 ± 11.77) were assigned to the color temperature of 6500 and 3500 ° K, respectively. Also, the highest mean of error rate (15.65 ± 9.77) and the lowest mean of error rate (10.94 ± 9.4) were reported at a color temperature of 3500 and 6500 ° K, respectively. According to the results of this study, with increase in color temperature from 3500 to 5000° Kelvin, the number of questions that were not responded decreased. Likewise, the number of unanswered questions for the color temperature of 6500 °K slightly increased compared to the color temperature of 5000 and 4000 °K. The results also indicated that, with an increase in color temperature from 3500 to 6500 °K, the reaction time to visual stimuli also decreased. The highest interference score was in the light color temperature of 3500 °K which indicates that the number of faults in naming inconsistent words relative to consonant words was higher in color temperature of 3500° K compared to other color temperatures. Also, according to Fig. 3, the maximum interference time was at 6500 ° K. This indicates that the performance time of the subjects in naming inconsistent words was higher relative to consonants in color temperature of 6,500° K compared to other color temperatures. Although the average response time under lighting condition with color temperature of 6500° K (718.95 ± 65.33) was less than the color temperature of 3500° K (728.58 ± 43.48), according to the results of the study, with a decrease in color temperature, the increase in mean response time was observed, but this difference was not significant (p p). Also, based on independent t-test (Table 2), there was a significant relationship between subjects' gender and variables such as interference score, interference time and number of unanswered questions. For all of these three variables (interference score, interference time and number of unanswered questions) mean in men was significantly lower than women (p <0.05). Based on subjects' gender, the average response time under different color temperatures showed that the response time (or reaction time) of female under lighting conditions with 3000 and 5,000 ° K was higher than male, while under lighting conditions with 4000 and 6500° K the response time of male was higher than female students. Although the average response time under different color temperatures was different between male and female subjects, based on the results of independent t-test, such difference was not significant. Conclusion: In general, the results of this study showed that when subjects are exposed to light color temperature of 6,500 ° K, the number of correct responses by them is higher than those exposed to other color temperatures, and with increasing the color temperature, the number of correct answers increases. Also, according to the results of this study, the error rate decrease by increasing color temperature of light source. Based on the results of this study, it is suggested to make use of light sources with a color temperature of 6,500 ° K in designing the lighting system of the places where human reaction time and error are high importance. Accordingly, it is recommended to repeat this study in other demographic groups, as well as taking into account the qualitative parameters of the lighting system in addition to its quantitative parameters. © 2020 Iran University of Medical Sciences. All rights reserved