The management of menopausal symptoms in women following treatment for cancer at a specialist menopause service.

OBJECTIVE: The aim of this study was to identify prescribing patterns at a specialist menopause service in a central London teaching hospital for women following treatment for a malignancy. STUDY DESIGN: This was a prospective cohort study with data collected over a seven-month period from December 2019 to June 2020. All women reviewed at the specialist menopause services following treatment of a malignancy, BRCA carriers and Lynch syndrome were included in the study, with management options divided into three categories: hormonal, non-hormonal and no treatment. MAIN OUTCOME MEASURES: The primary outcome of this study was to identify prescribing patterns for all women reviewed following a diagnosis of a malignancy, as well as those with genetic mutations necessitating risk-reducing prophylactic bilateral salpingo-oopherectomy (BSO). RESULTS: Altogether 71 women were included in this study, with the majority of women post management of a non-gynaecological malignancy (51/71, 72%), of which breast cancer was the most common (37/71, 52%). While non-hormonal treatment was the most popular among those treated for breast cancer, for all other malignancies, hormonal treatment was more widespread. Fourteen women also had genetic mutations, with all of these women commencing hormonal treatment post risk reducing surgery. CONCLUSION: With the exception of those with a history of hormone-sensitive breast cancer, the use of hormonal treatment for menopausal symptoms remained widespread. While this was a relatively small study, the need for long-term follow-up across specialist menopause services, to assess the risk of recurrence is vital

Signatures of natural selection in a foundation tree along Mediterranean climatic gradients

Temperature and precipitation regimes are rapidly changing, resulting in forest dieback and extinction events, particularly in Mediterranean-type climates (MTC). Forest management that enhance forests’ resilience is urgently required, however adaptation to climates in heterogeneous landscapes with multiple selection pressures is complex. For widespread trees in MTC we hypothesized that: patterns of local adaptation are associated with climate; precipitation is a stronger factor of adaptation than temperature; functionally related genes show similar signatures of adaptation; and adaptive variants are independently sorting across the landscape. We sampled 28 populations across the geographic distribution of Eucalyptus marginata (jarrah), in South-west Western Australia, and obtained 13,534 independent single nucleotide polymorphic (SNP) markers across the genome. Three genotype-association analyses that employ different ways of correcting population structure were used to identify putatively adapted SNPs associated with independent climate variables. While overall levels of population differentiation were low (FST = 0.04), environmental association analyses found a total of 2336 unique SNPs associated with temperature and precipitation variables, with 1440 SNPs annotated to genic regions. Considerable allelic turnover was identified for SNPs associated with temperature seasonality and mean precipitation of the warmest quarter, suggesting that both temperature and precipitation are important factors in adaptation. SNPs with similar gene functions had analogous allelic turnover along climate gradients, while SNPs among temperature and precipitation variables had uncorrelated patterns of adaptation. These contrasting patterns provide evidence that there may be standing genomic variation adapted to current climate gradients, providing the basis for adaptive management strategies to bolster forest resilience in the future

Relationships among seismic velocity, metamorphism, and seismic and aseismic fault slip in the Salton Sea Geothermal Field region

Author Posting. © American Geophysical Union, 2015. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Solid Earth 120 (2015): 2600–2615, doi:10.1002/2014JB011579.The Salton Sea Geothermal Field is one of the most geothermally and seismically active areas in California and presents an opportunity to study the effect of high-temperature metamorphism on the properties of seismogenic faults. The area includes numerous active tectonic faults that have recently been imaged with active source seismic reflection and refraction. We utilize the active source surveys, along with the abundant microseismicity data from a dense borehole seismic network, to image the 3-D variations in seismic velocity in the upper 5 km of the crust. There are strong velocity variations, up to ~30%, that correlate spatially with the distribution of shallow heat flow patterns. The combination of hydrothermal circulation and high-temperature contact metamorphism has significantly altered the shallow sandstone sedimentary layers within the geothermal field to denser, more feldspathic, rock with higher P wave velocity, as is seen in the numerous exploration wells within the field. This alteration appears to have a first-order effect on the frictional stability of shallow faults. In 2005, a large earthquake swarm and deformation event occurred. Analysis of interferometric synthetic aperture radar data and earthquake relocations indicates that the shallow aseismic fault creep that occurred in 2005 was localized on the Kalin fault system that lies just outside the region of high-temperature metamorphism. In contrast, the earthquake swarm, which includes all of the M > 4 earthquakes to have occurred within the Salton Sea Geothermal Field in the last 15 years, ruptured the Main Central Fault (MCF) system that is localized in the heart of the geothermal anomaly. The background microseismicity induced by the geothermal operations is also concentrated in the high-temperature regions in the vicinity of operational wells. However, while this microseismicity occurs over a few kilometer scale region, much of it is clustered in earthquake swarms that last from hours to a few days and are localized near the MCF system.This work was funded by USGS NEHRP proposal G10AP00101 and NSF proposal 0943906.2015-10-2

Autonomous metrology for robot mounted 3D vision systems

Using a metrology system simulation approach, an algorithm is presented to determine the best position for a robot mounted 3D vision system. Point cloud data is simulated, taking into account sensor performance, to create a ranked list of the best camera positions. These can be used by a robot to autonomously determine the most advantageous camera position for locating a target object. The algorithm is applied to an Ensenso active stereo 3D camera. Results show that when used in combination with a RANSAC object recognition algorithm, it increased positional precision by two orders of magnitude, from worst to best case

Comparison of walking performance over the first 2 minutes and the full 6 minutes of the Six-Minute Walk Test

BackgroundAlthough the Six-Minute Walk Test (6MWT), as recommended by the American Thoracic Society, is widely used as a measure of functional endurance, it may not be applicable in some settings and populations. We sought to examine, therefore, performance over the first 2 minutes and the full 6 minutes of the 6MWT. Specifically, we investigated completion rates, distances walked, test-retest reliability, and the relationship between distances walked over the first 2 and the full 6 minutes of the 6MWT.MethodsCommunity-dwelling children and adults age 3-85 years (n = 337) were asked to walk back and forth on a 15.24 meter (50 ft) course as far as possible without running over a 6 minute period. Test completion and the distance covered by the participants at 2 and 6 minutes were documented. The reliability of distances covered at 2 and 6 minutes was determined by retesting a subsample of 54 participants 6 to 10 days later. The relationship between distances covered at 2 and 6 minutes was determined for the 330 participants completing the 6MWT.ResultsAll 337 participants completed at least 2 minutes of walking, but 7 children less than 5 years of age ceased walking before 6 minutes had elapsed. For the remaining 330 participants the mean distance walked was 186 meters at 2 minutes and 543 meters at 6 minutes. The distances covered at 2 and 6 minutes were reliable between sessions (intraclass correlation coefficients = 0.888 and 0.917, respectively). The distances covered over 2 and 6 minutes were highly correlated (r = 0.968).ConclusionsThe completion rate, values obtained, test-retest reliability, and relationship of the distances walked in 2 and 6 minutes support documentation of 2 minute distance during the 6MWT. The findings also provide support for use of a Two-Minute Walk Test as the endurance component in the Motor Battery of the NIH Toolbox

Quantification of antimicrobial use in Fijian livestock farms

Antimicrobial resistance (AMR) is a major threat to humans and animals globally. Antimicrobial stewardship has been acknowledged as a primary strategy to tackle AMR. An important first step for antimicrobial stewardship is to quantify antimicrobial use (AMU). In Fiji, there are currently no data on AMU in livestock farms. This study aimed to quantify AMU in different livestock enterprises (beef, dairy, broiler, and layer) and farming systems (backyard, semi-commercial and commercial) in Central and Western divisions of Viti Levu, Fiji. A survey with 210 livestock farmers and 26 managers representing 276 enterprises was conducted between May and September 2019. The difference in AMU between different livestock enterprises and farming systems was investigated using ANOVA. In Fiji, the estimated annual antibiotic use in livestock was lower than the global average (44 compared with 118 mg/PCU). However, this use was concentrated in 56% of participant farms (the remaining 44% did not use antimicrobials). Total estimated quarterly anthelmintic use (20797mg) was not affected by farming systems but was highest (P<0.001) in dairy enterprises (24120 mg) and lowest in broiler enterprises (4 mg). Quarterly antibiotic use was different between the enterprises regardless of the metrics used to quantify the use (P<0.05). Total estimated quarterly mg/PCU of antibiotic use was highest (P<0.001) in broiler enterprises (12.4 mg/PCU) and lowest in beef enterprises (0.2 mg/PCU). For all other ESVAC metrics, total estimated antibiotic use was higher in poultry and lower in cattle enterprises. Backyard systems used less antibiotics (total mg) than commercial systems, but for other metrics, the trend was reverse. The use of both antibiotics and anthelmintics (rather than antibiotics or anthelmintics alone, or no AMU) was associated with dairy enterprises (Χ2=123, P<0.001). Further studies should be conducted to quantify and evaluate the drivers of AMU in Fijian livestock farms. In addition, differences in AMU between different enterprises and farming systems suggest that strategies to reduce AMU should be tailored to specific settings

Analytical and clinical evaluation of an electrochemiluminescence immunoassay for the determination of CA 125

The CA 125 II assay on the Elecsys(R) 2010 analyzer was evaluated in an international multicenter trial. Imprecision studies yielded within-run CVs of 0.8-3.3% and between-day CVs of 2.4-10.9%; CVs for total imprecision in the manufacturer's laboratory were 2.4-7.8%. The linear range of the assay extended to at least 4500 kilounits/L (three decades). Interference from triglycerides (10.3 mmol/L), bilirubin (850 micromol/L), hemoglobin (1.1 mmol/L), anticoagulants (plasma), and several widely used drugs was undetectable. Method comparisons with five other CA 125 II assays showed good correlation but differences in standardization. A 95th percentile cutoff value of 35 kilounits/L was calculated from values measured in 593 apparently healthy (pre- and postmenopausal) women. In 95% of patients with benign gynecological diseases CA 125 was </=190 kilounits/L; 63% of patients with newly diagnosed ovarian carcinoma had values >190 kilounits/L. A comparison of CA 125 values obtained with the Elecsys test and with other common CA 125 tests in monitored patients being treated for ovarian cancer showed identical patterns. In conclusion, the Elecsys CA 125 II assay is linear over a broad range, yields precise and accurate results, is free from interferences, and compares well with other assays

An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England

Objective Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist in the planning of regional stroke services we examined the volume, characteristics and prognosis of patients according to the mode of presentation to local services. Study design and setting A prospective regional database of consecutive acute stroke admissions was conducted in North East, England between 01/09/10-30/09/11. Case ascertainment and transport mode were checked against hospital coding and ambulance dispatch databases. Results Twelve acute stroke units contributed data for a mean of 10.7 months. 2792/3131 (89%) patients received a diagnosis of stroke within 24 hours of admission: 2002 arrivals by emergency ambulance; 538 by private transport or non-emergency ambulance; 252 unknown mode. Emergency ambulance patients were older (76 vs 69 years), more likely to be from institutional care (10% vs 1%) and experiencing total anterior circulation symptoms (27% vs 6%). Thrombolysis treatment was commoner following emergency admission (11% vs 4%). However patients attending without emergency ambulance had lower inpatient mortality (2% vs 18%), a lower rate of institutionalisation (1% vs 6%) and less need for daily carers (7% vs 16%). 149/155 (96%) of highly dependent patients were admitted by emergency ambulance, but none received thrombolysis. Conclusion Presentations of new stroke without emergency ambulance involvement were not unusual but were associated with a better outcome due to younger age, milder neurological impairment and lower levels of pre-stroke dependency. Most patients with a high level of pre-stroke dependency arrived by emergency ambulance but did not receive thrombolysis. It is important to be aware of easily identifiable demographic groups that differ in their potential to gain from different service configurations