What are the costs of queuing for hip fracture surgery in Canada?

This paper investigates the effect of wait time for hip fracture surgery in Canada on post-surgery length of stay in hospital and inpatient mortality. After controlling for observed and unobserved patient and hospital characteristics, pre-surgery delay has little effect on either of the two outcome variables. Patients from higher income postal-codes experience only slightly shorter delays, and income has no substantial effect on post-surgery outcomes. For hip fracture patients surgery delay may lead to greater pre-surgery inpatient costs and more patient discomfort, but we find no evidence of a detrimental impact on post-surgery outcomes.     

The ratio between carcinoma antigen-125 levels in the seminal plasma and serum may be a marker for fertilization in intracytoplasmic sperm injection

Objective: To assess the relationship between tumor marker carcinoma antigen-125 levels in seminal plasma and serum and fertilization rates in an IVF program, using intracytoplasmic sperm injection (ICSI).

Design: A prospective study.

Setting: IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Patient(s): Twenty-five infertile patients with severe oligo-terato-asthenospermia syndrome and 25 fertile male donors.

Intervention(s): None.

Main Outcome Measure(s): Serum and seminal plasma carcinoma antigen-125 concentrations and fertilization rate per cycle.

Result(s): In the infertile group, the seminal plasma carcinoma antigen-125 levels ranged from 22.0 to 1,284.0 U/mL (mean level ± SD, 229.9 ± 274.2 U/mL). In the normospermic fertile male donors, the seminal plasma carcinoma antigen-125 concentrations ranged from 12.2 to 336.7 U/mL (mean level ± SD, 110.1 ± 91.6 U/mL). This difference was statistically significant. The mean ± SD ratio between the seminal plasma/serum carcinoma antigen−125 levels differed significantly between the infertile group (47.9 ± 61.3) and the fertile male donors (5.7 ± 3.5). In the infertile group, the ratio between the seminal plasma/serum carcinoma antigen-125 levels was found to be negatively correlated with the oocyte fertilization rate.

Conclusion(s): The ratio between carcinoma antigen−125 levels in the seminal plasma and serum may be an indirect marker for male infertility and fertilization rate in IVF treatment using ICSI.     

The relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants

This study examines the relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants in the state of California. Data were obtained from the 2009 California Health Interview Survey and included Asian (n?=?1264) and Hispanic (n?=?571) adults aged 60 and older who were born outside of the US. Outcome variables included presence of past year alcohol consumption, past year binge drinking, and number of binge drinking days. Acculturation was measured with items pertaining to English use and proficiency. Hierarchical multiple or logistic regression analyses were conducted separately for each racial/ethnic group and each dependent variable. Alcohol consumption was found in less than half of the sample for both Asians (43.2%) and Hispanics (39.2%). Binge drinking was found in 3.1% of Asians and 8.4% of Hispanics. Acculturation was significantly related to past year alcohol consumption for Hispanics, past year binge drinking for Asians, and binge drinking days for Asians, such that higher level of acculturation predicted a greater likelihood of alcohol consumption but decreased likelihood of binge drinking and fewer binge drinking days. The results indicate that acculturation may be related to alcohol consumption patterns for older immigrants. This suggests future needs to develop an in-depth understanding of the health behaviors of these immigrant elderly groups.     

Does Scalp Cooling Have the Same Efficacy in Black Patients Receiving Chemotherapy for Breast Cancer?

Lessons Learned

• Despite U.S. Food and Drug Administration approval to reduce alopecia, data on efficacy of scalp cooling in Black patients with cancer are limited by lack of minority representation in prior clinical trials.
• Scalp cooling devices may have less efficacy in Black patients; additional studies are required to explore the possible causes for this, including hair texture and cap design.

BackgroundThe Paxman scalp cooling (SC) device is U.S. Food and Drug Administration (FDA)‐approved for prevention of chemotherapy‐induced alopecia. Studies report 50%–80% success rates and high patient satisfaction, yet there have been no studies of SC in Black patients. We conducted a phase II feasibility study of Paxman SC with a planned enrollment of 30 Black patients receiving chemotherapy for stage I–III breast cancer.MethodsBlack patients who planned to receive at least four cycles of chemotherapy with non‐anthracycline (NAC) or anthracycline (AC) regimens were eligible. Alopecia was assessed by trained oncology providers using the modified Dean scale (MDS) prior to each chemotherapy session. Distress related to alopecia was measured by the Chemotherapy Alopecia Distress Scale (CADS).ResultsFifteen patients enrolled in the intervention before the study was closed early because of lack of efficacy. Median MDS and CADS increased after SC, suggesting increased hair loss (p < .001) and alopecia distress (p = .04). Only one participant was successful in preventing significant hair loss; the majority stopped SC before chemotherapy completion because of grade 3 alopecia (>50% hair loss).ConclusionSC may not be efficacious in preventing alopecia in Black women. Differences in hair thickness, hair volume, and limitations of cooling cap design are possible contributing factors.     

Biogeography of Burkholderia pseudomallei in the Torres Strait Islands of Northern Australia

It has been hypothesized that biogeographical boundaries are a feature of Burkholderia pseudomallei ecology, and they impact the epidemiology of melioidosis on a global scale. This study examined the relatedness of B. pseudomallei sourced from islands in the Torres Strait of Northern Australia to determine if the geography of isolated island communities is a determinant of the organisms'' dispersal. Environmental sampling on Badu Island in the Near Western Island cluster recovered a single clone. An additional 32 clinical isolates from the region were sourced. Isolates were characterized using multilocus sequence typing and a multiplex PCR targeting the flagellum gene cluster. Gene cluster analysis determined that 69% of the isolates from the region encoded the ancestral Burkholderia thailandensis-like flagellum and chemotaxis gene cluster, a proportion significantly lower than that reported from mainland Australia and consistent with observations of isolates from southern Papua New Guinea. A goodness-of-fit test indicated that there was geographic localization of sequence types throughout the archipelago, with the exception of Thursday Island, the economic and cultural hub of the region. Sequence types common to mainland Australia and Papua New Guinea were identified. These findings demonstrate for the first time an environmental reservoir for B. pseudomallei in the Torres Strait, and multilocus sequence typing suggests that the organism is not randomly distributed throughout this region and that seawater may provide a barrier to dispersal of the organism. Moreover, these findings support an anthropogenic dispersal hypothesis for the spread of B. pseudomallei throughout this region.     

Occupational Therapy in the Intensive Care Unit: A Systematic Review

This paper is a synthesis of the available literature on occupational therapy interventions performed in the adult intensive care unit (ICU). The databases of Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and CINAHL databases were systematically searched from inception through August 2016 for studies of adults who received occupational therapy interventions in the ICU. Of 1,938 citations reviewed, 10 studies met inclusion criteria. Only one study explicitly discussed occupational therapy interventions performed and only one study specifically tested the efficacy of occupational therapy. Future research is needed to clarify the specific interventions and role of occupational therapy in the ICU and the efficacy of these interventions.