A Progressive Postresection Walking Program Significantly Improves Fatigue and Health-Related Quality of Life in Pancreas and Periampullary Cancer Patients.


As patients with pancreas and periampullary cancer (PPC) experience improved survival rates and longevity, the focus shifts toward living life while surviving cancer. Fatigue is the most commonly reported symptom in all cancer patients. Exercise has been found to effectively decrease fatigue levels and improve physical functioning in cancer patients.
STUDY DESIGN: One hundred two patients with resected PPC consented to participate in this study and were randomized to either an intervention group (IG) or a usual care group (UCG). Subjects completed visual analog scales, the FACIT-Fatigue Scale and the Short Form-36v2 after surgery and again 3 to 6 months after hospital discharge.
RESULTS: Patients in the IG and UCG were comparable with regard to demographics, comorbidities, cancer type and staging, type of resection, preoperative fatigue and pain levels, adjuvant therapy, and baseline walking distance. Patients in the IG had significantly improved scores on the FACIT-Fatigue Scale at study completion, improved fatigue and pain scores, as well as overall physical functioning and mental health composite scores. At study completion, participants in the IG were walking twice as far and were significantly more likely to have continued walking or another form of exercise as compared with the UCG. Using hierarchical cluster analysis, 3 mutually exclusive symptom groupings were identified in the cohort. Kaplan-Meier survival analysis did not indicate an overall survival benefit for the IG.
CONCLUSIONS: This is the first prospective, randomized controlled trial to report that participation in a home walking program confers a significant benefit in resected PPC patients with regard to fatigue levels, physical functioning, and health-related quality of life.

Source: Journal Of American College of Surgeons.

 

Effectiveness of the LUCAS device for mechanical chest compression after cardiac arrest: systematic review of experimental, observational and animal studies.


The LUCAS mechanical chest compression device may be better than manual chest compression during resuscitation attempts after cardiac arrest.
OBJECTIVE: To summarise the evidence about the effectiveness of LUCAS.
DATA SOURCES: Searches of 4 electronic databases, reference lists of included studies, review articles, clinical guidelines, and the manufacturer`s web site. No language restrictions were applied. Date of last search: September 2011.
STUDY SELECTION: All studies, of any design, comparing mechanical chest compression using LUCAS with manual chest compression, with human or animal subjects. Studies published only as abstracts were included. Manikin studies, and case reports or case series, were excluded.
DATA EXTRACTION: Data were extracted on study methodology and outcomes, including return of spontaneous circulation, survival, injuries caused by resuscitation, and physiological parameters.
RESULTS: 22 papers reporting 16 separate studies were included. There was one randomised trial, nine cohort studies, 2 before/after studies and 4 animal studies. No meta-analyses were performed because of high risk of bias and heterogeneity in the study designs. Animal studies suggested an advantage to LUCAS in terms of physiological parameters, but human studies did not suggest an advantage in ROSC or survival. Existing evidence is low quality because most studies were small and many were poorly reported.
CONCLUSIONS: There is insufficient evidence to make any recommendations for clinical practice. Large scale, high quality randomised trials of LUCAS are needed.

Source: Heart

3-D, after-the-fact focus image sensors invented.


 At the heart of digital photography is a chip called an image sensor that captures a map of the intensity of the light as it comes through the lens and converts it to an electronic signal.

Using new computational methods and a tried-and-true chip-making process, Cornell scientists are taking this technology many steps further. Led by Alyosha Molnar, assistant professor of electrical and computer engineering, they are building image sensors that give detailed readouts of not only the intensity, but also the incident angle of light as it strikes the sensor.

The result could be the next generation of 3-D cameras, as well as the ability to focus photos after they’re taken.

“If I want to find something in 3-D space, if I just measure the amount of light hitting different locations, I know a little bit. I’ll get some sort of blurry blob,” Molnar said. “But if I know the incident angle of the light, I can triangulate back. So the question is how do you measure that?”

Molnar’s solution, which he invented with graduate student Albert Wang, is a uniquely designed pixel for a standard CMOS (complementary metal-oxide semiconductor) image sensor. Each 7-micron pixel, an array of which is fabricated on a CMOS chip, is made of a photodiode under a pair of stacked diffraction gratings.

Shine a light at the pixel, and the top grating allows some light through, creating a diffraction pattern. Changing the incident angle of light changes how this pattern interacts with the second grating, changing how much light gets through to the diode below. In other words, the first grating generates patterns, while the second analyzes the patterns. All this can be done in standard CMOS manufacturing process — at no added cost.

The innovative design lets the chip detect information about the incident angle of the light striking it with more detail than a normal CMOS imager. All the pixels, each of which record a slightly different angle, produce an image containing both angular and spatial information. This information can be analyzed through the use of a mathematical function called the Fourier Transform, extracting both the depth of objects in an image, as well as allowing for computational refocusing, or after-the-fact focusing, of the image taken.

Proving this concept of image capture using angel-sensitive pixels has spawned many side projects in Molnar’s lab, including a lensless microcamera that spits out two-dimensional (albeit blurry) images.

So far, with the help of a standard Nikon camera lens, their chip can capture an image at 150,000 pixels — less than the 1 megapixel by today’s camera standards, but this can be improved by building larger chips.

Molnar’s technology has been making waves in the electronics, image processing and integrated circuits fields. He shared the most updated design of an angle-sensitive pixel for image capture at the IEEE International Electron Devices Meeting in Washington, D.C., late last year, and he detailed the math behind the device at an international optics and photonics (SPIE) conference in January in San Francisco.

Most recently, he and Wang won the Lewis Award for best paper from the International Solid-State Circuits Conference, Feb. 19-23, for their paper that details the new image-sensor technology.

The company Lytro is marketing a camera that employs similar light-field technology, but Molnar thinks Cornell’s technology may prove better in many applications. Molnar’s methods provide angular information in a pre-compressed format and allow for depth mapping with minimal computation. This could be especially good for video, which generates very large files, he said.

Source:  Cornell University

 

Can Bicycling Affect a Woman’s Sexual Health?


Spending time on a bicycle seat, which has been linked to erectile dysfunction in men, may also be a hazard to a woman’s sexual health, a new study shows.

Many women who cycle or take spin classes are familiar with the numbness that sometimes can occur from sitting on a traditional bike seat. Bike seats are designed in such a way that body weight typically rests on the nose of the seat, which can compress nerves and blood vessels in the genital area. In men, this raises the risk of erectile dysfunction, something that has beendocumented in studies of male police officers on bicycle patrol.

But female cyclists have not been studied as closely. A study by Yale researchers in 2006 found that female cyclists had less genital sensation compared with a control group of female runners. As a result, some scientists believe that female cyclists probably are at similar risk for sexual problems as male riders.

In the latest study, the Yale researchers tried to determine whether there are specific factors that influence soreness and numbness among female riders. Forty-eight women took part in the study, each a consistent rider who cycled a minimum of 10 miles a week, but typically much more.

The women took their personal bikes and saddles into the lab. The researchers mounted the bikes on a stationary machine, and had the riders position their seats and handlebars according to their preference. As the women pedaled, they reported whether they felt soreness, numbness or tingling as a result of sitting on the bike seat, and a device was used to measure sensation in the pelvic floor.

Notably, it was the position of the handlebars that seemed to have the most effect. Women on bikes with handlebars positioned lower than their seats experienced more pressure in an area of soft tissue called the perineum, and had decreased sensation in the pelvic floor.

The researchers found that the lower the handlebars in relation to the saddle, the more a woman has to lean forward, forcing her to put a greater percentage of her body weight on the perineum. This problem is particularly likely to occur when a rider leans forward, flattens her back and puts her hands on the “drop bars” of a road or track bicycle for a more aerodynamic position.

“We’re basically showing that there may be modifiable risk factors associated with female riders,” said Dr. Marsha K. Guess, an author of the study and an assistant professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine. “This better positions us to educate riders on safe riding practices that may actually be beneficial to reduction of pressure and lost sensation in the pelvic floor.”

The findings, published online in The Journal of Sexual Medicine, help shed further light on the problems faced by female riders, something that needs more long-term study, said Steven M. Schrader, a scientist at the National Institute for Occupational Safety and Health whose early research helped identify bike seat risks for male police officers on bicycle patrol.

Dr. Schrader said that over the years he has given speeches about his findings to groups of police officers who do bicycle patrol. Afterward, he said, women from the audience sometimes approach him and say, “It’s not just a men’s thing.”

“Women are having issues as well,” Dr. Schrader said.

Dr. Schrader’s research on officers showed that one of the best ways to eliminate or reduce pressure on the perineum is to use a bicycle saddle without a nose. The findings led the institute to recommend that police officers and other workers on bicycles use “no-nose” saddles, which put pressure on the sit bones, rather than the soft tissue of the perineum. Although he hasn’t studied use of the noseless saddles in women, he said he believes women would benefit as well.

“If you don’t put weight there,” he said, “there’s no pressure.”

 

Source: NY Times heath

 

 

 

Clostridium difficile — But from Where?


An investigation of Clostridium difficile transmission within hospital wards identified the transmission route in less than 25% of cases.

Clostridium difficile is a leading cause of both healthcare-associated diarrhea and hospital-acquired infection. With today’s more-virulent strains, such illness causes considerable morbidity and mortality. Although C. difficile infection (CDI) is almost universally preceded by antibiotic therapy, which may have ended weeks or months before symptom onset (JW Infect Dis Feb 29 2012), the source and transmission route of such infection often cannot be identified.

Now, investigators have published the results of an extensive investigation of C. difficile transmission dynamics in Oxfordshire, U.K. From September 2007 through March 2010, 29,299 unformed stool samples from 14,858 individuals (inpatients and outpatients) were tested by enzyme immunoassay for C. difficile toxins; samples that tested positive were cultured. A total of 1276 C. difficile isolates were subjected to multilocus sequence typing, which revealed 69 distinct strains.

Analysis of hospital admissions and ward-movement data for each patient with CDI, assuming an 8-week maximum infection period and a 12-week maximum incubation period, showed that 66% of cases were not linked to known cases, and only 23% had a credible ward-based source. When the analysis was adjusted for chance meetings of patients within the hospital, only 16% of cases were linked by probable transmission events.

Comment: The results of this sophisticated epidemiologic study contrast with the current view of hospitals as C. difficile transmission “hotspots.” Editorialists note that the authors did not consider several potential sources and routes of C. difficile transmission in hospitals, such as intervention suites, other wards, and asymptomatic carriers. Nonetheless, there appear to be additional, as-yet-unidentified reservoirs of infectivity and routes of C. difficile transmission in the community.

Source: Journal Watch Infectious Diseases

 

Pessary Can Prevent Preterm Birth in Women with a Short Cervix.


A cervical pessary can lower the risk for preterm delivery among women diagnosed with a short cervix during the second trimester of pregnancy, according to a Lancet study.

Some 400 women with a cervix measuring 25 mm or less on transvaginal ultrasound at 18–22 weeks’ gestation were randomized either to insertion of a cervical pessary or to expectant management. The primary outcome — delivery before 34 weeks’ gestation — occurred significantly less often in the pessary group (6% vs. 27% with expectant management). In addition, pessary recipients were less likely to have infants with low birth weights or respiratory distress syndrome.

The authors point out that the “precise mechanism by which a pessary confers a benefit is not known,” and they call for further research to confirm their findings. Nonetheless, they conclude: “The cervical pessary is an affordable, safe, and reliable alternative for prevention of preterm birth in a population of appropriately selected at-risk pregnant women.”

Source: Lancet

Invasive Breast Cancer Overdiagnosed at Least 15% of Time .


Between 15% and 25% of screen-detected invasive breast cancers in Norway represent overdiagnoses that would not have otherwise been made in the course of a woman’s lifetime, an Annals of Internal Medicine study finds. Editorialists say such overdiagnoses likely occur more often in the U.S.

Researchers used a national registry to follow invasive breast cancer diagnoses as screening was gradually introduced in Norway over a decade. Using two analytic approaches, they estimated rates of overdiagnosis between 15% and 25%, translating to 6 to 10 overdiagnoses for every 2500 women screened.

The study authors and Annals‘ editorialists urge that women be informed about the overdiagnosis risk in the face of uncertainty over which tumors will progress to clinical symptoms. The editorialists point to the “ethical responsibility to alert women to this phenomenon.” They conclude: “Just because communicating with patients will be difficult does not mean that we should not tackle this problem.”

Source: Annals of Internal Medicine.

Should We Terraform Mars?


As we continue to explore farther out into our solar system and beyond, the question of habitation or colonization inevitably comes up. Manned bases on the Moon or Mars for example, have long been a dream of many. There is a natural desire to explore as far as we can go, and also to extend humanity’s presence on a permanent or at least semi-permanent basis. In order to do this, however, it is necessary to adapt to different extreme environments. On the Moon for example, a colony must be self-sustaining and protect its inhabitants from the airless, harsh environment outside.

Mars, though, is different. While future bases could adapt to the Martian environment as well, there is also the possibility of modifying the surrounding environment instead of just co-existing with it. This is the process of terraforming – essentially trying to tinker with Mars’ atmosphere and environment to make it more Earth-like. Although still a long ways off technologically, terraforming the Red Planet is seen as a future possibility. Perhaps the bigger question is, should we?

One of the main issues is whether Mars has any indigenous life or not – how does this affect the question of colonization or terraforming?

If Mars does have any kind of biosphere, it should be preserved as much as possible. We still don’t know yet if any such biosphere exists, but the possibility, which has only increased based on recent discoveries, must be taken into account. Such a precious discovery, which could teach us immensely about how life arose on both worlds, should be completely off-limits. Small colonies might be fine, but living on Mars should not be at the expense of any native habitats, if they exist. The most likely place to find life on Mars is underground. If the surface is truly as sterile and barren as it seems to be, then colonies there shouldn’t be too much of a problem. It has also been suggested that Martian caves would make ideal human habitats, serving as natural protection from the harsh conditions on the surface. True, but if it turned out that something else was already taking up residence in them, then we should leave them alone. If Mars is home to  any indigenous life, then terraforming should be a non-issue.

What if Mars is lifeless? Even if no life otherwise exists there, that pristine and unique alien environment, so far barely scratched by humans, needs to be preserved as is as much as possible. We’ve already done too much damage here on our own planet. By studying Mars and other planets and moons in their current natural state, we can learn so much about their history and also learn more about our own world in that context. We should appreciate the differences in and variety of worlds instead of just transforming them to suit our own ambitions.

There is also the more current but related problem of contamination. There has been a long-standing protocol, via the 1967 Outer Space Treaty, to have all spacecraft going to the Moon or Mars sterilized as much as possible. If bacteria from Earth made it to the Martian surface and survived, it would complicate the search for life there; if a lander or rover was to later identify living organisms in the soil, it might be difficult to determine whether they were just contamination or true native life forms. From both a scientific and ethical perspective, it would seem prudent to try to protect Mars as much as we can from earthly intruders. This applies equally to whether Mars is already inhabited or not. Fortunately, for almost any kind of bacteria or other microrganisms from Earth, it would be very difficult if not impossible to survive on the Martian surface, nevermind flourish. The risk of planet-wide contamination is very negligible, but it is still better to take strict preventive measures than to play with chance.

See also this excellent paper by astrobiologist Chris McKay. Some different views from this article on whether Mars should be protected and preserved at all costs or altered to help life to flourish there, but is a good presentation of the current ideas being put on the table. From the summary:

“Planetary ecosynthesis on Mars is being seriously discussed within the field of planetary science. It appears that restoring a thick atmosphere on Mars and the recreation of an environment habitable to many forms of life is possible. It is important now to consider if it “should” be done. To do this takes us into new and interesting territory in environmental ethics but both utilitarian and intrinsic worth arguments support the notion of planetary ecosynthesis. Strict preservationism arguments do not. It is important to have the long-term view of life on Mars and the possibilities of planetary ecosynthesis. This affects how we explore Mars now. Mars may well be our first step out into the biological universe, it is a step we should take carefully.”

Source: Research Gate.

 

 

Bisphosphonate Use Associated with Inflammatory Eye Diseases .


First-time use of oral bisphosphonates is associated with greater risk for uveitis and scleritis, according to a retrospective cohort study in the CMAJ.

Researchers assessed the health records of all patients who visited an ophthalmologist over 7 years. Nearly 11,000 filled their first prescription for oral bisphosphonates, while 920,000 did not have any recorded bisphosphonate use.

Bisphosphonate users had increased risks for uveitis (adjusted relative risk, 1.45) and scleritis (adjusted RR, 1.51), relative to nonusers. The authors estimate numbers needed to harm of 1100 for uveitis and 370 for scleritis.

They propose that patients may experience a surge of inflammatory mediators when they begin taking bisphosphonates, which may put them at greater risk for inflammatory eye diseases. They conclude that clinicians should “inform their patients about the signs and symptoms of scleritis and uveitis, so that prompt treatment may be sought and further complications averted.”

Source: CMAJ

 

 

Quad-core Snapdragon S4 is firing up for laptop wars.


In pacing this PC market push, Qualcomm already started shipping prototype Snapdragon-based Windows 8 machines to developers. The program combines a pre-release version of Windows on ARM with Snapdragon S4 test PCs. Qualcomm has become part of Microsoft’s Windows on ARM developer seeding program. The two companies are working on putting test PCs, SoC-loaded computers, in the hands of select developers, in an invitation-only program. The developers can test and optimize applications for Snapdragon-powered Windows on ARM PCs.

Qualcomm’s Windows move will serve its intention to bite into Intel market share in the PC and tablet category. The Qualcomm selling point is that the Snapdragon S4 chip, with its 28nm architecture, will pave the way for vendors to issue skinny, light, powerful, yet power-efficient, laptops, head to head with Intel “ultrabooks.”

 

Chandhok is also playing on the advantages of Snapdragon-based Windows 8 machines as very light. He seemed to be suggesting they will be surprisingly light. “We think much lighter than what Intel calls an ultrabook,” Chandhok said in the report. He noted that having a powerful Snapdragon chip with four CPU cores and multiple graphics cores will really enhance Windows 8 devices for applications such as games.

Those outside Qualcomm are prepared to wait and see to what extent Snapdragon on Windows 8 will boost the company’s standing in ultrabook PCs, especially as to if and how Snapdragon S4 chips for Windows 8 laptops will outperform competing products with Intel on board.

 

Until now, Qualcomm has been known as a manufacturer of chips for smartphones and tablets. They will be going up against competition not only from Intel but also from Nvidia and Texas Instruments. As several observers note, consumers can expect to have interesting choices in ultra-thin laptops as a result.

Source:PhysOrg.com