In 2007, Cancer Care Ontario introduced a provincial symptom screening program, which included pain, for cancer patients. Over this same time, opioid prescribing has been increasingly scrutinized ...among non-cancer patients. The study purpose was to see if opioid prescribing changed among older adults after 2007 in the context of changing opioid regulations, and whether effects were different among patients with a cancer history.
Ontario residents aged ≥65 years were identified from 2004 to 2013. Subjects were annually stratified into three groups: no cancer history, cancer diagnosis >5 years ago, and cancer diagnosis ≤5 years ago. We evaluated time trends by year for: 1) opioid prescription rate, comparing trends before and after 2007 and 2) mean daily opioid dose.
Between 2004 and 2013, opioid prescribing was relatively constant for cancer patients with no observed change in trends after 2007. For non-cancer patients, there was a 2% relative annual increase during this period. Significant changes were seen for opioid sub-classes (e.g., decreasing use of long-acting oxycodone). These were similar for those with or without a history of cancer. Among all groups, changes in the mean daily dose over time were similar in all drug classes.
Overall prescribing rates for cancer patients aged ≥65 years remain unchanged over time, in spite of the introduction of a provincial symptom screening program. Decreasing prescription rates in some drug sub-classes were observed. The potential impact of these changes on the quality of symptom control for cancer patients needs further investigation.
Objectives To determine if the length of interval between breast conserving surgery and start of radiotherapy affects local recurrence and to identify factors that might be associated with delay in ...older women with breast cancer.Design Retrospective cohort analysis with Cox proportional hazards models to study the association between time to radiotherapy and local recurrence, and propensity score and instrumental variable analyses to confirm findings. Logistic regression investigated factors associated with later start of radiotherapy.Setting Linked database (Surveillance, Epidemiology, and End Results Program-Medicare) in the United StatesParticipants 18 050 women aged over 65 with stage 0-II breast cancer diagnosed in 1991-2002 who received breast conserving surgery and radiotherapy but not chemotherapy.Main outcome measure Local recurrence.Results Median time from surgery to start of radiotherapy was 34 days, with 29.9% (n=5389) of women starting radiotherapy after six weeks. Just over 4% (n=734) of the cohort experienced a local recurrence. After adjustment for clinical and sociodemographic factors, intervals over six weeks were associated with increased likelihood of local recurrence (hazard ratio 1.19, 95% confidence interval 1.01 to 1.39, P=0.033). When the interval was modelled continuously (assessing accumulation of risk by day), the effect was statistically stronger (hazard ratio 1.005 per day, 1.002 to 1.008, P=0.004). Propensity score and instrumental variable analysis confirmed these findings. Instrumental variable analysis showed that intervals over six weeks were associated with a 0.96% increase in recurrence at five years (P=0.026). In multivariable analysis, starting radiotherapy after six weeks was significantly associated with positive nodes, comorbidity, history of low income, Hispanic ethnicity, non-white race, later year of diagnosis, and residence outside the southern states of the US.Conclusions There is a continuous relation between the interval from breast conserving surgery to radiotherapy and local recurrence in older women with breast cancer, suggesting that starting radiotherapy as soon as possible could minimise the risk of local recurrence. There are considerable disparities in time to starting radiotherapy after breast conserving surgery. Regions of the US known to have increased rates of breast conserving surgery had longer intervals before radiotherapy, suggesting limitations in capacity. Given the known negative impact of local recurrence on survival, mechanisms to ameliorate disparities and policies regarding waiting times for treatment might be warranted.
The performance of the dietary questionnaire used in a multiethnic cohort study in Hawaii and Los Angeles was assessed in a calibration substudy that compared diet reported from the questionnaire ...with three 24-hour dietary recalls. For the calibration substudy, subjects from each of eight subgroups defined by sex and ethnic group (African-American, Japanese-American, Latino, and White) were chosen randomly from among the cohort members, and each participant's previous day's diet was assessed by telephone recall on three occasions over approximately 2 months. After completing the three 24-hour recalls, each calibration subject was sent a second questionnaire; 1,606 persons completed three recalls and a second questionnaire (127 to 267 per ethnic-sex group). This report describes correlation coefficients and calibration slopes for the relation between the 24-hour recalls and second questionnaire values for a selected set of macro- and micronutrients, as absolute intakes, nutrient densities, and calorie-adjusted nutrients. In all subgroups, estimates of the correlation between the questionnaire and 24-hour recalls were greater after energy adjustment (average correlations ranged from 0.57–0.74 for nutrient densities and from 0.55–0.74 for calorie-adjusted nutrients) than when absolute nutrient values were used (average range 0.26–0.57). For absolute nutrient intakes, the correlations were greatest for Whites, somewhat lower for Japanese-Americans and Latinos, and lowest for African-Americans. After energy adjustment, the difference between subgroups were diminished, and the correlations were generally highly satisfactory. Am J Epidemiol 2000;151:358–70.
Abstract Purpose Metabolic syndrome (MetS), the clustering of several risk factors for cardiovascular disease, is highly prevalent in Hispanics/Latinos. We tested whether all components significantly ...loaded on the syndrome in Hispanics/Latinos and whether their contribution differed by sex and Hispanic ancestry. We also examined associations of MetS with prevalent diabetes and coronary heart disease in Hispanics/Latinos. Methods Data were obtained from a population-based cohort of n = 15,823 participants in the HCHS/SOL study who self-identified as being of Central American, Cuban, Dominican, Mexican American, Puerto Rican, or South American ancestry and were aged 18 to 74 years at screening. Results A latent variable model of waist circumference, systolic and diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting glucose fit the data in men and women, but the contribution of HDL-C was weak. No difference in the latent model of MetS was detected across Hispanic/Latino ancestry groups. MetS was significantly associated with diabetes and coronary heart disease. Conclusions Our results indicate that similar criteria for MetS may be applied across Hispanic/Latino ancestry groups but call into question the role of HDL-C in classifying the MetS in Hispanics/Latinos.
Collards (
Brassica oleracea var.
acephala) are an important vegetable crucifer produced worldwide for human consumption, and one subject to severe injury by Lepidoptera. We have produced
Bacillus ...thuringiensis (Bt)-transgenic collard lines that have the potential to be used either for direct control or as a “dead end” trap crop for Lepidoptera. To produce collard lines expressing Bt genes, a
cry1Ac Bt gene, in association with the
nptII gene for kanamycin-resistance, and a
cry1C Bt gene, in association with the
hpt gene for hygromycin-resistance, were introduced into seedling explants by
Agrobacterium tumefaciens-mediated transformation. A total of 30 kanamycin-resistant and 28 hygromycin-resistant plants were regenerated from two collard cultivars (“McCormack's Green Glaze” glossy leaves and “Champion” non-glossy leaves). PCR assays of the kanamycin- and hygromycin-resistant plants and Southern analyses of the hygromycin-resistant Champion plants confirmed the presence and integration of the associated Bt genes. ELISA analyses of leaf tissue from the antibiotic-resistant plants showed that production of the Cry1Ac and Cry1C Bt proteins varied greatly among independent transformants, ranging from undetectable to over 2000
ng of Bt protein/mg of total soluble protein. All
cry1Ac and
cry1C collard plants in which Bt protein was detected caused complete mortality of larvae from susceptible diamondback moth,
Plutella xylostella. Cry1Ac-transgenic plants also controlled
P. xylostella populations resistant to Cry1C protein, while
cry1C-transgenic plants controlled Cry1Ac-resistant
P. xylostella. Sexual crosses have produced lines with both Bt genes. “McCormack's Green Glaze” plants were more attractive for
P. xylostella oviposition than cabbage plants and hence are suitable for use as “dead end” trap crops. If approved for human consumption in the future, Bt collards could serve not only as a trap crop but also as a cash crop, thereby expanding the traditional role of a trap crop. This example of Bt collards illustrates the potential for using biotechnology in multiple ways for insect control.
Camelina sativa, a wild relative of Brassica crops, is virtually immune to blackspot disease caused by Alternaria brassicicola. Intertribal somatic hybrids were produced between C. sativa and ...rapid-cycling Brassica oleracea as a step toward the transfer of resistance to this disease into Brassica vegetable crops. The plants recovered were confirmed as somatic hybrids by flow cytometry and RAPD analysis. All hybrids showed a morphology intermediate between the two parents. Rooted plants grew in soil up to 4-5 weeks, and some produced sterile flowers. Two of three hybrids tested showed a high level of resistance to A. brassicicola. Resistance was correlated with the induction of high levels of the phytoalexin camalexin 48 h after inoculation, as in the resistant Camelina fusion partner. In contrast, susceptible somatic hybrids produced much lower levels of camalexin.
The Sudbury Neutrino Observatory (SNO) used an array of {sup 3}He proportional counters to measure the rate of neutral-current interactions in heavy water and precisely determined the total active ...({nu}{sub x}) {sup 8}B solar neutrino flux. This technique is independent of previous methods employed by SNO. The total flux is found to be 5.54{sub -0.31}{sup +0.33}(stat){sub -0.34}{sup +0.36}(syst)x10{sup 6} cm{sup -2} s{sup -1}, in agreement with previous measurements and standard solar models. A global analysis of solar and reactor neutrino results yields {delta}m{sup 2}=7.59{sub -0.21}{sup +0.19}x10{sup -5} eV{sup 2} and {theta}=34.4{sub -1.2}{sup +1.3} degrees. The uncertainty on the mixing angle has been reduced from SNO's previous results.
: PT‐141, a synthetic peptide analogue of α‐MSH, is an agonist at melanocortin receptors including the MC3R and MC4R, which are expressed primarily in the central nervous system. Administration of ...PT‐141 to rats and nonhuman primates results in penile erections. Systemic administration of PT‐141 to rats activates neurons in the hypothalamus as shown by an increase in c‐Fos immunoreactivity. Neurons in the same region of the central nervous system take up pseudorabies virus injected into the corpus cavernosum of the rat penis. Administration of PT‐141 to normal men and to patients with erectile dysfunction resulted in a rapid dose‐dependent increase in erectile activity. The results suggest that PT‐141 holds promise as a new treatment for sexual dysfunction.
Whether an angiotensin receptor blocker is of benefit when added to a full dose of angiotensin-converting enzyme (ACE) inhibitor in heart failure (HF) is uncertain.
The effect of candesartan, ...compared with placebo, in 2548 patients randomized in the CHARM-Added trial was analyzed according to (i) ACE inhibitor dose at baseline, (ii) ACE inhibitor dose during follow-up, and (iii) combination treatment with ACE inhibitor and β-blocker at baseline. The main outcome was the composite of cardiovascular death or HF hospitalization.
The benefit of candesartan was not modified by the dose of ACE inhibitor. In all patients (n = 2548), the candesartan/placebo hazard ratio (HR) for the primary outcome was 0.85 (95% CI 0.75-0.96). In patients taking a guideline recommended dose of ACE inhibitor at baseline (n = 1291), this HR was 0.79 (95% CI 0.67-0.95; interaction
P value .26). In patients taking a Food and Drug Administration–designated maximum dose of ACE inhibitor (n = 529), this HR was 0.75 (95% CI 0.57-0.98; interaction
P value .29). The benefit of candesartan was preserved in patients taking β-blockers in addition to a higher dose of ACE inhibitor and in patients maintaining a high dose of ACE inhibitor throughout follow-up.
These clinical findings support the pharmacologic evidence that ACE inhibitors and angiotensin receptor blockers have distinct mechanisms of action and show that their combined use improves outcomes in patients with HF more than an evidence-based dose of ACE inhibitor alone.
Range spreading is frequently evident in midlatitude topside ionograms from the ISS‐B satellite. These ionograms provide a geographically unbiased perspective for the first global investigation of ...nighttime spread echo events that focuses solely on the midlatitude domain. The topside echo occurrence probability data show significant longitudinal variations, along with very large winter/equinox asymmetries in several geographic regions. The spread echoes are divided into two types and found to have different geophysical dependences. Small‐scale events that appear as spreading in one or two consecutive ionograms have a marked seasonal dependence on magnetic declination and no obvious correlation with auroral indices. Larger‐scale events in which the spreading is observed over spatial domains of 1000 km or more have less dependence on magnetic declination but are anticorrelated with the AE index in periods 6–8 hours prior to their appearance. The declination dependence for the small‐scale events suggests that the irregularities are most prevalent when the E region conductivity is low at both ends of the flux tube. This in turn suggests that electric fields mapping from the E region up to F region altitudes are likely involved in their generation. The correlation of the larger‐scale events with depressed AE signatures suggests that traveling ionospheric disturbances caused by auroral heating are not the most likely cause of these large features at midlatitudes.
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