Exercise: a path to wellness during adjuvant chemotherapy for breast cancer?

Background: Breast cancer treatment can represent a threat to a patient’s wellness. The role of exercise in perceived wellness in women with breast cancer merits further study. Objective: The objective of this study was to describe how exercise is perceived by women to influence their physical and psychosocial wellness at the time they were receiving chemotherapy. Methods: Five focus group interviews with a total of 27 women with early-stage breast cancer were conducted. Prior to the focus groups, the women had participated in an exercise intervention during chemotherapy treatment. Results: Three themes emerged from the analysis: exercise shapes feelings of psychological wellness; exercise stimulates feelings of physical wellness; and exercise influences social wellness. The women reported feeling stronger in a psychological sense after exercising, that the strength exercise improved their upper-limb functioning, and that engaging in exercise triggered social support and interactions. Conclusions: Exercise during breast cancer treatment is perceived to enhance the patients’ wellness on several dimensions and in particular psychological wellness. Exercise might support the patients’ efforts to restore their sense of wellness and enhance their level of daily life functioning. Implications for Practice: Cancer nurses should promote exercise as a wellness-fostering intervention during chemotherapy treatment. Focusing on how exercise can contribute to feelings of wellness may help women with breast cancer choose exercise as a health-promoting activity that contributes to their recovery

Tweeting the meeting. Quantitative and qualitative twitter activity during the 38th ESSO conference

Introduction: Social media is increasingly used to share information with the potential for fast and wide reach. Data on use during surgical oncology conferences is limited. We aimed to monitor twitter usage during a surgical oncology conference to audit impact of activity. Methods: A prospective, time-restricted, observational study of twitter activity using the #ESSO38 hashtag in the week before and during the 38th ESSO conference (10–12 October 2018; Budapest, Hungary). Data on individual tweets and retweets, including date and tweeter or retweeter were collected using NodeXL, FollowTheHashtag, Twitonomy and TAGS. Results: The study period (10–13 October) documented 328 tweets by 58 tweeters with 1167 retweets, with a soaring activity and mentions during the conference days, with a potential reach at over 7.5 million. The nodal network of tweets, the most active tweeters and retweeters are presented as well as the most frequently used hashtags. The top 3 hashtags used were #ESSO38, #SoMe4Surgery# and #EYSAC. A positive influence on the @ESSOweb twitter handle was noted, with the numbers of followers growing from 1.5 K to over 1.8 K representing a 20% growth in just over a week. Conclusions: Activity on tweeter during the conference was considerable, with a potential for a wide reach beyond those attending the conference. A more structured approach to the use of twitter for future conferences may enhance experience, activity and reach

Coherent Lidar Turbulence Measurement for Gust Load Alleviation

Atmospheric turbulence adversely affects operation of commercial and military aircraft and is a design constraint. The airplane structure must be designed to survive the loads imposed by turbulence. Reducing these loads allows the airplane structure to be lighter, a substantial advantage for a commercial airplane. Gust alleviation systems based on accelerometers mounted in the airplane can reduce the maximum gust loads by a small fraction. These systems still represent an economic advantage. The ability to reduce the gust load increases tremendously if the turbulent gust can be measured before the airplane encounters it. A lidar system can make measurements of turbulent gusts ahead of the airplane, and the NASA Airborne Coherent Lidar for Advanced In-Flight Measurements (ACLAIM) program is developing such a lidar. The ACLAIM program is intended to develop a prototype lidar system for use in feasibility testing of gust load alleviation systems and other airborne lidar applications, to define applications of lidar with the potential for improving airplane performance, and to determine the feasibility and benefits of these applications. This paper gives an overview of the ACLAIM program, describes the lidar architecture for a gust alleviation system, and describes the prototype ACLAIM lidar system

The Use of a Lidar Forward-Looking Turbulence Sensor for Mixed-Compression Inlet Unstart Avoidance and Gross Weight Reduction on a High Speed Civil Transport

Inlet unstart causes a disturbance akin to severe turbulence for a supersonic commercial airplane. Consequently, the current goal for the frequency of unstarts is a few times per fleet lifetime. For a mixed-compression inlet, there is a tradeoff between propulsion system efficiency and unstart margin. As the unstart margin decreases, propulsion system efficiency increases, but so does the unstart rate. This paper intends to first, quantify that tradeoff for the High Speed Civil Transport (HSCT) and second, to examine the benefits of using a sensor to detect turbulence ahead of the airplane. When the presence of turbulence is known with sufficient lead time to allow the propulsion system to adjust the unstart margin, then inlet un,starts can be minimized while overall efficiency is maximized. The NASA Airborne Coherent Lidar for Advanced In-Flight Measurements program is developing a lidar system to serve as a prototype of the forward-looking sensor. This paper reports on the progress of this development program and its application to the prevention of inlet unstart in a mixed-compression supersonic inlet. Quantified benefits include significantly reduced takeoff gross weight (TOGW), which could increase payload, reduce direct operating costs, or increase range for the HSCT

Collecting core data in severely injured patients using a consensus trauma template: an international multicentre study

Introduction: No worldwide, standardised definitions exist for documenting, reporting and comparing data from severely injured trauma patients. This study evaluated the feasibility of collecting the data variables of the international consensus-derived Utstein Trauma Template. Methods: Trauma centres from three different continents were invited to submit Utstein Trauma Template core data during a defined period, for up to 50 consecutive trauma patients. Directly admitted patients with a New Injury Severity Score (NISS) equal to or above 16 were included. Main outcome variables were data completeness, data differences and data collection difficulty. Results: Centres from Europe (n = 20), North America (n = 3) and Australia (n = 1) submitted data on 965 patients, of whom 783 were included. Median age was 41 years (interquartile range (IQR) 24 to 60), and 73.1% were male. Median NISS was 27 (IQR 20 to 38), and blunt trauma predominated (91.1%). Of the 36 Utstein variables, 13 (36%) were collected by all participating centres. Eleven (46%) centres applied definitions of the survival outcome variable that were different from those of the template. Seventeen (71%) centres used the recommended version of the Abbreviated Injury Scale (AIS). Three variables (age, gender and AIS) were documented in all patients. Completeness > 80% was achieved for 28 variables, and 20 variables were > 90% complete. Conclusions: The Utstein Template was feasible across international trauma centres for the majority of its data variables, with the exception of certain physiological and time variables. Major differences were found in the definition of survival and in AIS coding. The current results give a clear indication of the attainability of information and may serve as a stepping-stone towards creation of a European trauma registry

The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic and macrophage infiltration, microvessel density and survival in patients with primary operable breast cancer

The significance of the inter-relationship between tumour and host local/systemic inflammatory responses in primary operable invasive breast cancer is limited. The inter-relationship between the systemic inflammatory response (pre-operative white cell count, C-reactive protein and albumin concentrations), standard clinicopathological factors, tumour T-lymphocytic (CD4+ and CD8+) and macrophage (CD68+) infiltration, proliferative (Ki-67) index and microvessel density (CD34+) was examined using immunohistochemistry and slide-counting techniques, and their prognostic values were examined in 168 patients with potentially curative resection of early-stage invasive breast cancer. Increased tumour grade and proliferative activity were associated with greater tumour T-lymphocyte (P<0.05) and macrophage (P<0.05) infiltration and microvessel density (P<0.01). The median follow-up of survivors was 72 months. During this period, 31 patients died; 18 died of their cancer. On univariate analysis, increased lymph-node involvement (P<0.01), negative hormonal receptor (P<0.10), lower albumin concentrations (P<0.01), increased tumour proliferation (P<0.05), increased tumour microvessel density (P<0.05), the extent of locoregional control (P<0.0001) and limited systemic treatment (Pless than or equal to0.01) were associated with cancer-specific survival. On multivariate analysis of these significant covariates, albumin (HR 4.77, 95% CI 1.35–16.85, P=0.015), locoregional treatment (HR 3.64, 95% CI 1.04–12.72, P=0.043) and systemic treatment (HR 2.29, 95% CI 1.23–4.27, P=0.009) were significant independent predictors of cancer-specific survival. Among tumour-based inflammatory factors, only tumour microvessel density (P<0.05) was independently associated with poorer cancer-specific survival. The host inflammatory responses are closely associated with poor tumour differentiation, proliferation and malignant disease progression in breast cancer

Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest: an analysis of the TTH48 trial

BackgroundThe aim of this study was to explore the performance and outcomes for intravascular (IC) versus surface cooling devices (SFC) for targeted temperature management (TTM) after out-of-hospital cardiac arrest.MethodsA retrospective analysis of data from the Time-differentiated Therapeutic Hypothermia (TTH48) trial (NCT01689077), which compared whether TTM at 33 degrees C for 48h results in better neurologic outcomes compared with standard 24-h duration. Devices were assessed for the speed of cooling and rewarming rates. Precision was assessed by measuring temperature variability (TV), i.e., the standard deviation (SD) of all temperature measurements in the cooling phase. Main outcomes were overall mortality and poor neurological outcome, including death, severe disability, or vegetative status.ResultsA total of 352 patients had available data and were included in the analysis; of those, 218 (62%) were managed with IC. A total of 114/218 (53%) patients with IC and 61/134 (43%) with SFC were cooled for 48h (p=0.22). Time to target temperature (34 degrees C) was significantly shorter for patients treated with endovascular devices (2.2 [1.1-4.0] vs. 4.2 [2.7-6.0] h, p<0.001), but temperature was also lower on admission (35.0 [34.2-35.6] vs. 35.3 [34.5-35.8]degrees C; p=0.02) and cooling rate was similar (0.4 [0.2-0.8] vs. 0.4 [0.2-0.6]degrees C/h; p=0.14) when compared to SFC. Temperature variability was significantly lower in the endovascular device group when compared with SFC methods (0.6 [0.4-0.9] vs. 0.7 [0.5-1.0]degrees C; p=0.007), as was rewarming rate (0.31 [0.22-0.44] vs. 0.37 [0.29-0.49]degrees C/hour; p=0.02). There was no statistically significant difference in mortality (endovascular 65/218, 29% vs. others 43/134, 32%; p=0.72) or poor neurological outcome (endovascular 69/218, 32% vs. others 51/134, 38%; p=0.24) between type of devices.ConclusionsEndovascular cooling devices were more precise than SFC methods in patients cooled at 33 degrees C after out-of-hospital cardiac arrest. Main outcomes were similar with regard to the cooling methods

Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group

BackgroundTo determine shortâ and longâ term oncologic outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for the treatment of pancreatic neuroendocrine tumor (pNET).MethodsThe data of the patients who underwent curative MIDP or ODP for pNET between 2000 and 2016 were collected from a multiâ institutional database. Propensity score matching (PSM) was used to generate 1:1 matched patients with MIDP and ODP.ResultsA total of 576 patients undergoing curative DP for pNET were included. Two hundred and fourteen (37.2%) patients underwent MIDP, whereas 362 (62.8%) underwent ODP. MIDP was increasingly performed over time (2000â 2004: 9.3% vs 2013â 2016: 54.8%; Pâ <â 0.01). In the matched cohort (nâ =â 141 in each group), patients who underwent MIDP had less blood loss (median, 100 vs 200â mL, Pâ <â 0.001), lower incidence of Clavienâ Dindoâ â ¥â III complications (12.1% vs 24.8%, Pâ =â 0.026), and a shorter hospital stay versus ODP (median, 4 versus 7 days, Pâ =â 0.026). Patients who underwent MIDP had a lower incidence of recurrence (5â year cumulative recurrence, 10.1% vs 31.1%, Pâ <â 0.001), yet equivalent overall survival (OS) rate (5â year OS, 92.1% vs 90.9%, Pâ =â 0.550) compared with patients who underwent OPD.ConclusionPatients undergoing MIDP over ODP in the treatment of pNET had comparable oncologic surgical metrics, as well as similar longâ term OS.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150595/1/jso25481_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150595/2/jso25481.pd

Impact Factor: outdated artefact or stepping-stone to journal certification?

A review of Garfield's journal impact factor and its specific implementation as the Thomson Reuters Impact Factor reveals several weaknesses in this commonly-used indicator of journal standing. Key limitations include the mismatch between citing and cited documents, the deceptive display of three decimals that belies the real precision, and the absence of confidence intervals. These are minor issues that are easily amended and should be corrected, but more substantive improvements are needed. There are indications that the scientific community seeks and needs better certification of journal procedures to improve the quality of published science. Comprehensive certification of editorial and review procedures could help ensure adequate procedures to detect duplicate and fraudulent submissions.Comment: 25 pages, 12 figures, 6 table

Immediate thoracotomy for penetrating injuries: Ten years' experience at a Dutch level I trauma center

Background: An emergency department thoracotomy (EDT) or an emergency thoracotomy (ET) in the operating theater are both beneficial in selected patients following thoracic penetrating injuries. Since outcome-descriptive European studies are lacking, the aim of this retrospective study was to evaluate ten years of experience at a Dutch level I trauma center. Method: Data on patients who underwent an immediate thoracotomy after sustaining a penetrating thoracic injury between October 2000 and January 2011 were collected from the trauma registry and hospital files. Descriptive and univariate analyses were performed. Results: Among 56 patients, 12 underwent an EDT and 44 an ET. Forty-six patients sustained one or multiple stab wounds, versus ten with one or multiple gunshot wounds. Patients who had undergone an EDT had a lower GCS (p < 0. 001), lower pre-hospital RTS and hospital triage RTS (p < 0. 001 and p = 0. 009, respectively), and a lower SBP (p = 0. 038). A witnessed loss of signs of life generally occurred in EDT patients and was accompanied by 100 % mortality. Survival following EDT was 25 %, which was significantly lower than in the ET group (75 %; p = 0. 002). Survivors had lower ISS (p = 0. 011), lower rates of pre-hospital (p = 0. 031) and hospital (p = 0. 003) hemodynamic instability, and a lower prevalence of concomitant abdominal injury (p = 0. 002). Conclusion: The overall survival rate in our study was 64 %. The outcome of immediate thoracotomy performed in this level I trauma center was similar to those obtained in high-incidence regions like the US and South Africa. This suggests that trauma units where immediate thoracotomies are not part of the daily routine can achieve similar results, if properly trained