Background
Depression and anxiety are common in patients with breast cancer and associated with worse quality of life and treatment outcomes. Yet, these symptoms are often underrecognized and ...undermanaged in oncology practice. The objective of this study was to describe depression and anxiety severity and associated patient factors during adjuvant or neoadjuvant chemotherapy in women with early breast cancer using repeated single‐item reports.
Materials and Methods
Depression and anxiety were measured from consecutive patients and their clinicians during chemotherapy infusion visits. Associations between psychiatric symptoms and patient characteristics were assessed using Fisher's exact tests for categorical variables and t tests for continuous variables. The joint relationship of covariates significant in unadjusted analyses was evaluated using log‐binomial regression. Cohen's kappa was used to assess agreement between patient‐ and clinician‐reported symptoms.
Results
In a sample of 256 patients, 26% reported at least moderately severe depression, and 41% reported at least moderately severe anxiety during chemotherapy, representing a near doubling in the prevalence of these symptoms compared with before chemotherapy. Patient‐provider agreement was fair (depression: κ = 0.31; anxiety: κ = 0.28). More severe psychiatric symptoms were associated with being unmarried, having worse function, endorsing social activity limitations, using psychotropic medications, and having a mental health provider. In multivariable analysis, social activity limitations were associated with more severe depression (relative risk RR, 2.17; 95% confidence interval CI, 1.36–3.45) and anxiety (RR, 1.48; 95% CI, 1.05–2.09).
Conclusion
Oncologists frequently underestimate patients’ depression and anxiety and should consider incorporating patient‐reported outcomes to enhance monitoring of mental health symptoms.
Implications for Practice
In this sample of 256 patients with breast cancer, depression and anxiety, measured using single‐item toxicity reports completed by patients and providers, were very common during adjuvant or neoadjuvant chemotherapy. Patient‐reported depression and anxiety of at least moderate severity were associated with multiple objective indicators of psychiatric need. Unfortunately, providers underrecognized the severity of their patients’ mental health symptoms. The use of patient‐reported, single‐item toxicity reports can be incorporated into routine oncology practice and provide clinically meaningful information regarding patients’ psychological health.
Depression and anxiety are underrecognized and undermanaged in oncology practice. This article describes the severity of depression and anxiety and associated factors in women with early breast cancer undergoing chemotherapy.
The effects of climate events on the feeding ecology and trophic dynamics of Pacific salmon (Oncorhynchus spp.) in offshore waters of the central Gulf of Alaska were investigated during early summers ...(1994–2000), based on analyses of stomach contents, and carbon and nitrogen stable isotopes (δ13C and δ15N). Gonatid squids (mainly Berryteuthis anonychus) were the dominant prey of all salmon species except for chum salmon (O. keta). During the 1997 El Niño event and the 1999 La Niña event, squids decreased sharply in the diets of all Pacific salmon except coho salmon (O. kisutch) in the Subarctic Current, and chum salmon diets changed from gelatinous zooplankton (1995–97) to a more diverse array of zooplankton species. A δ13C and δ15N analysis indicated that all salmon species occupied the same branch of the food web in 1999–2000. We hypothesize that high‐seas salmon adapt to climate‐induced changes in their prey resources by switching their diets either within or between trophic levels. To understand the effects of climate change on Pacific salmon in the Gulf of Alaska, biological oceanographic research on B. anonychus and other important prey resources is needed.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
We have studied the magnetic island coalescence process in an open system with two‐fluid simulations including electron inertial effects. We have found that the two X‐lines at the lateral‐edges of a ...perturbed current sheet possess the intrinsic advantage to dominate and to create an inflating magnetic island between them. While this state will eventually be taken over by the well‐known single X‐line structure, the double X‐line state can be extended in time and is expected commonly in maturing stages of reconnection regions.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
•The overall plant system related to the water-cooling system has been developed for JA DEMO.•Management of tritium concentration in the primary cooling system is clarified for JA DEMO.•Tritium ...permeation from the primary to the secondary cooling system was found to be less than the Japanese PWR restriction value.•A pressure suppression pool is effective to suppress the tritium release to the environment at the ex-vessel LOCA.•The system diagram of water coolant and tritium was also delineated for JA DEMO.
The conceptual design of Japan’s fusion demonstration plant (JA DEMO) is now being developed. In this paper, an overall plant system concept related to tritium handling in the water-cooling system is developed to give a concrete shape to the present JA DEMO concept as an electric power plant. The basic condition of tritium permeation from the in-vessel components to the primary cooling system is evaluated to be 5.7 g-T/day. The tritium concentration of the primary coolant is assumed to be 1 TBq/kg similar to the heavy water reactor condition. The capacity of the water detritiation system (WDS) is assessed, and the bypass feed water from the primary cooling loop is evaluated to be 94 kg/h under the tritium extraction efficiency of 0.96. Based on those specific parameters, the existing WDS in the heavy water reactor is found to be applicable to that of JA DEMO. Configuration of the primary heat transfer system (PHTS) is also discussed. Based on the heavy water reactor experience, tritium permeation through a steam generator (SG) to the secondary cooling system in PHTS is evaluated at 11.77TBq/year/loop (318 Ci/year/loop), which is found to be less than the restricted amount of tritium disposal for a pressurized water reactor in Japan. The key effect of the heavy water reactor experience is reduction of tritium permeation by oxide layer formed on SG pipes. Finally, a confinement concept of tritium release from PHTS is discussed under the condition of ex-vessel loss of coolant accident (LOCA). A pressure suppression system is installed to prevent the upper tokamak hall from pressurizing at the ex-vessel LOCA, and the tritium leakage from the upper tokamak hall is consequently restrained. The resultant early public dose at the plant site boundary can be reduced to 1.8 mSv, which is negligibly smaller than 100 mSv of the no-evacuation limit recommended by IAEA.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Most automatic spike detection systems in the scalp electroencephalogram (EEG) focused on the characteristics of "spike." However, the characteristics of "false positives" (FPs) have not been fully ...studied. In this paper, we proposed a system that contains a series of algorithms to eliminate FPs and a template method to confirm spikes. The system used large area context available on 49 channels from two common montages. The impact of slow-waves after spikes was taken into consideration, as well as the information from single channel, multichannel, and whole recording. Two types of FPs were identified in this paper. The ones from typical artifacts were identified by analysis of background EEG activities, and the ones from other EEG activities were declared by spatial and temporal characteristics of spike activities. Finally, a multichannel template method was used to assess the performance of the proposed system. The system was evaluated using 17 routine EEG recordings. Spike activities were observed in six of them. Effective multichannel templates were extracted from four recordings containing frequent spikes. The least selectivity was 92.6% and the most false positive rate was 0.26 min -1 . Proposed algorithms for elimination of FPs are also suitable for other algorithms to enhance performance since most FPs can be identified while few true spikes are eliminated.
IMPORTANCE: Health care systems, payers, and hospitals use hospital readmission rates as a measure of quality. Although hospitals can track readmissions back to themselves (hospital A to hospital A), ...they lack information when their patients are readmitted to different hospitals (hospital A to hospital B). Because hospitals lack different-hospital readmission (DHR) data, they may underestimate all-hospital readmission (AHR) rates (hospital A to hospital A or B). OBJECTIVES: To determine the prevalence of 30-day pediatric DHRs; to assess the effect of DHR on readmission performance; and to identify patient and hospital characteristics associated with DHR. DESIGN, SETTING, AND PARTICIPANTS: We analyzed all-payer inpatient claims for 701 263 pediatric discharges (patients aged 0-17 years) from 177 acute care hospitals in New York State from January 1, 2005, through November 30, 2009, to identify 30-day same-hospital readmissions (SHRs), DHRs, and AHRs. Data analysis was performed from March 12, 2013, through April 6, 2015. We compared excess readmission ratios (calculated per the Medicare formula) using SHRs and AHRs to determine what might happen if the federal formula were applied to a specific state and to evaluate how often hospitals might accurately anticipate—using data available to them—whether they would incur penalties (excess readmission ratio >1) for readmissions. Using multivariate logistic regression, we identified patient- and hospital-level predictors of DHR vs SHR. MAIN OUTCOMES AND MEASURES: The proportion of DHRs vs SHRs, AHR and SHR rates, and excess readmissions. RESULTS: Different-hospital readmissions constituted 13.9% of 31 325 AHRs. At the individual hospital level, the median (interquartile range) percentage of DHRs was 21.6% (12.8%-39.1%). The median (interquartile range) adjusted AHR rate was 3.4% (3.0%-4.1%), 38.9% higher than the median adjusted SHR rate of 2.5% (2.0%-3.4%) (P < .001). Excess readmission ratios using SHRs inaccurately anticipated penalties (changed from >1 to ≤1 or vice versa) for 20 of the 177 hospitals (11.3%); all were nonchildren’s hospitals and 18 of 20 (90.0%) were nonteaching hospitals. Characteristics associated with higher odds ratios (ORs) (reported with 95% CIs) of DHR in multivariate analyses included being younger (compared with age <1 year, ORs 95% CIs for the other age categories ranged from 0.76 0.66-0.88 to 0.85 0.73-0.99); being white (ORs 95% CIs for nonwhite race/ethnicity ranged from 0.74 0.65-0.84 to 0.88 0.79-0.99); having private insurance (1.14 1.04-1.24); having a chronic condition indicator for a mental disorder (1.33 1.13-1.56) or a disease of the nervous system (1.37 1.20-1.57) or circulatory system (1.20 1.00-1.43); and admission to a nonchildren’s (1.62 1.01-2.60), urban (ORs for nonurban hospitals ranged from 0.35 0.24-0.52 to 0.36 0.21-0.64), or lower-volume (0.73 0.64-0.84) hospital (P < .05 for each). CONCLUSIONS AND RELEVANCE: Different-hospital readmissions differentially affect hospitals’ pediatric readmission rates and anticipated performance, making SHRs an incomplete surrogate for AHRs—particularly for certain hospital types. Failing to incorporate DHRs into readmission measurement may impede quality assessment, anticipation of penalties, and quality improvement.
Stearoyl-CoA desaturase (SCD) catalyses the synthesis of oleic acid (18:1, n -9), which is mostly esterified into triacylglycerols (TAGs) as an energy reserve. Delta-6 Desaturase (D6D) and Delta-5 ...desaturase (D5D) are the key enzymes for the synthesis of highly unsaturated fatty acids (HUFAs), such as arachidonic acid (20:4, n -6) and docosahexaenoic acid (22:6, n -3), that are incorporated in phospholipids (PLs) and perform essential physiological functions. Despite these different physiological roles of SCD and D6D/D5D, these desaturases share common regulatory features, including dependence of expression on insulin, suppression by HUFAs, and induction by peroxisome proliferators (PPs). A key regulator of desaturase gene expression is sterol-regulatory element binding protein-1c (SREBP-1c), which mediates transcriptional activation of the SCD and D6D genes by insulin and inhibition by HUFAs. Because HUFAs are poorly incorporated into TAGs, the primary role of SREBP-1c in liver may be monitoring and regulating fatty acid composition in PLs rather than the regulation of TAG synthesis. The induction of desaturases by PPs is enigmatic because the major effect of PPs is induction of fatty acid oxidation enzymes by activating PP-activated receptor-alpha (PPARa). To our knowledge, no other gene that is induced by both SREBP-1 and PP has been identified. It is yet to be determined whether PPARa mediates the process directly. Available data suggest that the induction of desaturases by PPs may be a compensatory response to an increased demand for unsaturated fatty acids because PPs increase fatty acid degradation and induce proliferation of peroxisomes.
To identify subgroups likely to benefit from monoclonal antibody and antiviral therapy by evaluating the relationship between comorbidities and hospitalization among US adolescents with symptomatic ...coronavirus disease 2019 (COVID-19).
We analyzed the relationship between presence of comorbidities and need for hospitalization within 28 days of COVID-19 diagnosis for adolescents aged 12-17 years listed in the Pediatric COVID-19 US registry, a multicenter retrospective cohort of US pediatric patients with COVID-19. Comorbidities assessed included obesity, chronic kidney disease (CKD), diabetes, immunosuppressive disease or treatment, sickle cell disease (SCD), heart disease, neurologic disease/neurodevelopmental disorders, and pulmonary disease (excluding patients with mild asthma). We used multivariable logistic regression to determine race/ethnicity-adjusted associations between comorbidities and hospitalization.
A total of 1877 patients met our inclusion criteria, of whom 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. In a race/ethnicity-adjusted model, the following comorbidities were independently associated with increased odds of hospitalization: SCD (aOR, 6.9; 95% CI, 3.0-15.9), immunocompromising condition (aOR, 6.4; 95% CI, 3.8-10.8), obesity (aOR, 3.2; 95% CI, 2.1-4.9), diabetes (aOR, 3.0; 95% CI, 1.4-6.2), neurologic disease (aOR, 2.8; 95% CI, 1.8-4.3), and pulmonary disease (excluding mild asthma) (aOR, 1.9; 95% CI, 1.2-3.1). Heart disease and CKD were not independently associated with hospitalization.
SCD, immunocompromising conditions, obesity, diabetes, neurologic disease, and pulmonary disease (excluding mild asthma) were associated with hospitalization for symptomatic COVID-19. Adolescents with acute COVID-19 and these comorbidities should be prioritized for consideration of therapy to avert hospitalization.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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