Family physicians' perspectives on practice guidelines related to cancer control

BACKGROUND: Family physicians (FPs) play an important role in cancer control. While FPs' attitudes towards, and use of guidelines in general have been explored, no study has looked at the needs of FPs with respect to guidelines for the continuum of cancer control. The objective of this study was to understand which guideline topics FPs consider important. METHODS: Five group interviews were conducted by telephone with FPs from across Ontario, Canada. Transcripts were analyzed inductively. Content analysis identified emergent themes. Themes are illustrated by representative quotes taken from the transcripts. RESULTS: The main areas where FPs felt guidelines were needed most included screening – a traditional area of responsibility for FPs – and treatment and follow-up – areas where they felt they lacked the knowledge to best support patients. Confusion over best practice when faced with conflicting guidelines varied according to disease site. FPs defined good guideline formats; the most often cited forms of presentation were tear-off sheets to use interactively with patients, or a binder. Computer-based dissemination was acknowledged as the best way of widely distributing material that needs frequent updates. However, until computer use is a common aspect of practice, mail was considered the most viable method of dissemination. Guidelines designed for use by patients were supported by FPs. CONCLUSIONS: Preferred guideline topics, format, dissemination methods and role of patient guidelines identified by FPs in this study reflect the nature of their practice situations. Guideline developers and those supporting use of evidence-based guidelines (e.g., Canadian Strategy for Cancer Control) have a responsibility to ensure that FPs are provided with the resources they identify as important, and to provide them in a format that will best support their use

Altered Composition of the Oral Microbiota in Depression Among Cigarette Smokers: A Pilot Study

Alterations in the oral microbiota composition may influence mental health. However, linkages between compositional changes in the oral microbiota and their role in mental health among cigarette smokers remain largely unknown. In this study, we used shotgun metagenomics data for the oral microbiome of 105 participants. The data showed Bacteroidota, Fusobacteriota, Firmicutes, Proteobacteria, and Actinobacteria to be the most abundant phyla; Streptococcus, Haemophilus D, and Veillonella are the most abundant genera. Then, we clustered our subjects into avoidance and activation groups based on the behavioral activation for depression scale (BADS). Interestingly, the avoidance group exhibited a higher oral microbiome richness and diversity (alpha diversity). Differential abundance testing between BADS avoidance and activation groups showed the phyla Bacteroidota (effect size 0.5047, q = 0.0037), Campylobacterota (effect size 0.4012, q = 0.0276), Firmicutes A (effect size 0.3646, q = 0.0128), Firmicutes I (effect size 0.3581, q = 0.0268), and Fusobacteriota (effect size 0.6055, q = 0.0018) to be significantly increased in the avoidance group, but Verrucomicrobiota (effect size−0.6544, q = 0.0401), was found to be significantly decreased in the avoidance risk group. Network analysis of the 50 genera displaying the highest variation between both groups identified Campylobacter B, Centipeda, and Veillonella as hub nodes in the avoidance group. In contrast, Haemophilus and Streptococcus were identified as hub nodes in the activation group. Next, we investigated functional profiles of the oral microbiota based on BADS avoidance and activation groups and found Lysine degradations pathway was significantly enriched between both groups (ANCOM-BC, q = 0.0692). Altogether, we provide evidence for the presence of depression-related changes in the oral microbiota of smokers and possible functional contribution. The identified differences provide new information to enrich our understanding of oral microbiota-brain axis interplay and their potential impact on mental health

44. Copeptin as early marker of acute non-ST elevation myocardial infarction in patients suspected with acute coronary syndrome

Rapid diagnosis and management of AMI have great impact on morbidity and mortality. Diagnosis which is based on elevation of cardiac biomarkers has its limitations. Copeptin is the C-terminal part of the vasopressin prohormone. The pathophysiology mode of release should theoretically add diagnostic information of cardiac cell necrosis. One of the major limitations of cardiac biomarkers is the delayed release in circulation. So looking for a new marker with a short diagnostic time window is needed. Aim is to determine the role of copeptin as an early marker for acute non-ST elevation MI (NSTEMI). This study included 88 patients with chest pain. They were divided into 2 groups. Group (1); included 30 patients with diagnosis of NSTEMI. Diagnosis of AMI was established according to the universal definition of MI. Group (2); included 58 patients with diagnosis of unstable angina (UA). Full medical history, physical examination, 12 lead ECG, random blood glucose level, renal function, total cholesterol, triglyceride, cardiac troponin I and Copeptin were obtained on admission. Follow up cardiac troponin I was done. Inclusion criteria: Defined as chest pain of ⩽6h duration since onset, suggestive of myocardial ischemia, and lasting >20min. at rest. Exclusion criteria: Patients with positive First cardiac troponin were rolled out, patients with ST segment elevation were rolled out. Other exclusion criteria: Patients presenting after a cardiac arrest, Trauma or major surgery within the last 4 week; pregnancy; IV drug abuse; age less than 18 years; shock and sepsis. Patients who were included had second troponin I re- done and copeptin analysis done. In group 1 (NSTEMI) 28 patients had ECG changes and only 2 had NSTEMI without ECG changes. In group 2 (UA) 23 patients had ECG changes and 35 patients had normal ECG. Males and females were 49 and 39. Age in G1 and G2 was 60±4 and 53±5. Copeptin analysis was done 6h after Infarction or chest pain. All the patients with NSTEMI (30) had positive copeptin and positive troponin except one only who had+troponin only and another one who had + copeptin only. Of the 58 patients without MI none had the two tests positive, only one had+troponin and one had+copeptin. Using ROC curve: copeptin had sensitivity 100% and specificity 82.8% with using cut off point 13.2pmol/l. So copeptin can be used for early detection of myocardial infarction. Copeptin seems to be an ideal confirmatory marker for rapid rule out of AMI. If the two tests (with troponin) are positive, this is evident MI; if the two are negative it rules out MI

High Level Synthesis Using Vivado HLS for Optimizations of SHA-3

Hash functions represent a fundamental building block of many network security protocols. The SHA-3 hashing algorithm is the most recently developed hash function, and the most secure. Implementation of the SHA-3 hashing algorithm in Hardware Description Language (HDL) is time demanding and tedious to debug. On the other hand, High-Level Synthesis (HLS) tools offer potential solutions to the hardware design. HLS tools provide us with advanced capabilities for design evaluation and a wide variety of optimization techniques. In this paper, the SHA-3 hashing algorithm and its implementation onto a Xilinx® Zynq-7000 SoPC is explored. The SHA-3 hashing algorithm is initially coded in C programming language and then implemented with Xilinx Vivado HLS. The HLS tool enabled us to quickly analyze our design to make suitable optimizations which led to increased throughput of the SHA-3 hashing algorithm, up to 2000 Mbps. After pipelining the synthesized hardware design, it was capable of hashing a block of 1088 bits in 70 clock cycles

Visualising structural and functional characteristics distinguishing between newly diagnosed high-tension and low-tension glaucoma patients

Purpose: To determine whether there are quantifiable structural or functional differences that can distinguish between high-tension glaucoma (HTG; intraocular pressure [IOP] > 21 mm Hg) and low-tension glaucoma (LTG; IOP ≤ 21 mm Hg) at diagnosis. Method: This was a retrospective, cross-sectional study. Clinical results of one eye from 90 newly diagnosed HTG and 319 newly diagnosed LTG patients (117 with very-low-tension glaucoma [vLTG; ≤15 mm Hg] and 202 with middling LTG [mLTG; >15 mm Hg, ≤21 mm Hg]) were extracted, which included relevant demographic covariates of glaucoma, quantitative optical coherence tomography (including the optic nerve head, retinal nerve fibre layer and ganglion cell-inner plexiform layer) measurements and standard automated perimetry global metrics. We used binary logistic regression analysis to identify statistically significant clinical parameters distinguishing between phenotypic groups for inclusion in principal component (PC) (factor) analysis (PCA). The separability between each centroid for each cohort was calculated using the Euclidean distance (d(x,y)). Results: The binary logistic regression comparing HTG and all LTG identified eight statistically significant clinical parameters. Subsequent PCA results included three PCs with an eigenvalue >1. PCs 1 and 2 accounted for 21.2% and 20.2% of the model, respectively, with a d(x,y) = 0.468, indicating low separability between HTG and LTG. The analysis comparing vLTG, mLTG and HTG identified 15 significant clinical parameters, which were subsequently grouped into five PCs. PCs 1 and 2 accounted for 24.1% and 17.8%, respectively. The largest separation was observed between vLTG and HTG (d(x,y) = 0.581), followed by vLTG and mLTG (d(x,y) = 0.435) and lastly mLTG and HTG (d(x,y) = 0.210). Conclusion: Conventional quantitative structural or functional parameters could not distinguish between pressure-defined glaucoma phenotypes at the point of diagnosis and are therefore not contributory to separating cohorts. The overlap in findings highlights the heterogeneity of the primary open-angle glaucoma clinical presentations among pressure-defined groups at the cohort level

Optimization of a Quantum-Secure Sponge-Based Hash Message Authentication Protocol

Hash message authentication is a fundamental building block of many networking security protocols such as SSL, TLS, FTP, and even HTTPS. The sponge-based SHA-3 hashing algorithm is the most recently developed hashing function as a result of a NIST competition to find a new hashing standard after SHA-1 and SHA-2 were found to have collisions, and thus were considered broken. We used Xilinx High-Level Synthesis to develop an optimized and pipelined version of the post-quantumsecure SHA-3 hash message authentication code (HMAC) which is capable of computing a HMAC every 280 clock-cycles with an overall throughput of 604 Mbps. We cover the general security of sponge functions in both a classical and quantum computing standpoint for hash functions, and offer a general architecture for HMAC computation when sponge functions are used