Association of Insulin Resistance and Higher Oncotype DX™ Recurrence Score

Annals of Surgical Oncology - Black women with breast cancer have a worse overall survival compared with White women; however, no difference in Oncotype DX? (ODX) recurrence scores has been...     

Glucocorticoid-Binding Proteins in Human Acute Lymphoblastic Leukemic Blast Cells

The first known step in steroid hormone action is the association of the steroid with specific cytoplasmic steroid-binding proteins (SBP). Using a competitive binding assay, we detected, quantified, and partially characterized such a SBP in cytosol from glucocorticoid-sensitive human lymphoblastic leukemic blasts. The affinity of steroids for the SBP was directly related to their known killing potency. For example, steroids without glucocorticoid effect such as androstenedione, etiocholanolone, and tetrahydrocortisol were unable to displace radiolabeled dexamethasone from the SBP in the binding reaction. The dose-response curve for in vitro inhibition of [(3)H]thymidine uptake in leukemic blasts correlated closely with the binding affinity of glucocorticoids to the SBP, providing additional support for an essential physiologic role for SBP in steroid action. SBP activity was either greatly diminished or absent in glucocorticoid-resistant cells. Six patients who intially had SBP in their blasts and were responsive to combinations of drugs including glucocorticoids no longer had SBP activity detectable at a time when they no longer responded to combinations of drugs including glucocorticoids. In vitro [(3)H]thymidine uptake was not inhibited by steroids in leukemic blast cells lacking SBP activity. Other patients who had received some antileukemic therapy including glucocorticoids and who still had SBP in their leukemic blasts, were still responsive to drug combinations that included glucocorticoids. This appears to be the first study demonstrating glucocorticoid receptors in a human tissue.     

The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate

OBJECTIVES: To describe the development of the Amputee Mobility Predictor (AMP) instrument designed to measure ambulatory potential of lower-limb amputees with (AMPPRO) and without (AMPnoPRO) the use of a prosthesis, and to test its reliability and validity. DESIGN: Measurement study using known groups method and concurrence with existing measures. SETTING: Academic medical center. PARTICIPANTS: A convenience sample of 191 lower-limb amputee subjects who had completed prosthetic training, 24 in the reliability study (mean age +/- standard deviation, 68.3+/-17.9y, range, 28-99y) and 167 in the validity study (mean age, 54.8+/-18.6y; range, 18-100y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Intra- and interrater reliability; construct validity by known groups method; concurrent validity by comparisons with 6-minute walk test, Comorbidity Index, age, and time since amputation; predictive validity by comparison with 6-minute walk test after controlling for other factors. RESULTS: Interrater reliability was.99 for subjects tested with and without their prosthesis; intrarater reliability was.96 and.97. Both the AMPnoPRO (P<.0001) and the AMPPRO scores (P<.0001) distinguished among the 4 Medicare functional classification levels. The AMP correlated strongly with 6-minute walk scores (AMPnoPRO r=.69, P<.0001; AMPPRO r=.82, P<.0001) and the amputee activity survey (AMPnoPRO r=.67, P<.0001; AMPPRO r=.77, P<.0001), and negatively correlated with age (AMPnoPRO r=-.69, P<.0001; AMPPRO r=.56, P<.0001) and comorbidity (AMPnoPRO r=-.43, P<.0001; AMPPRO r=.38, P<.0001). CONCLUSION: The AMP with and without a prosthesis are reliable and valid measures for the assessment of functional ambulation in lower-limb amputee subjects.     

Examining the vulnerability of ambivalent young adults to e-cigarette messages

Abstract

This study used a randomized online experiment to understand the interrelationships between e-cigarette benefit and harm perceptions, e-cigarette use ambivalence, and e-cigarette message exposure and perceived effectiveness. A high prevalence of ambivalent attitudes toward e-cigarettes at baseline was reported. Ambivalent individuals reported significantly higher benefits and lower harm perceptions compared to univalent individuals. Contrary to past findings, ambivalence was not responsive to persuasive messages in this study. This study situates e-cigarette use perceptions in a realistic setting. High baseline ambivalence in this study calls for more unequivocal messages from the FDA about the risks of e-cigarette use.     

Campaigns and Cliques: Variations in Effectiveness of an Antismoking Campaign as a Function of Adolescent Peer Group Identity

Identity-based strategies have been suggested as a way to promote healthy behaviors when traditional approaches fall short. The truth® campaign, designed to reduce smoking in adolescents, is an example of a campaign that uses such a strategy to reach youth described as being outside the mainstream. This article examines the effectiveness of this strategy in promoting antitobacco company beliefs among youth. Survey data from 224 adolescents between 14 and 15 years of age were used to examine whether the truth® campaign was more or less effective at reaching and promoting antitobacco company beliefs among youth who identify with nonmainstream crowds (deviants and counterculture) versus those who identify with mainstream crowds (elites and academics). Analyses revealed that adolescents who identified as deviants and counterculture were more likely to have been persuaded by the truth® campaign. Social identity theory is used as a theoretical framework to understand these effects and to make recommendations for future health campaigns.     

Red blood cell use outside the operating theater: a prospective observational study with modeling of potential blood conservation during severe blood shortages

BACKGROUND: National guidance recommends planning for future blood shortages, but few studies have evaluated how reduced demand could be achieved acutely.
STUDY DESIGN AND METHODS: A trained observer collected data concerning red blood cell (RBC) transfusion events outside the operating theater during 68 hours of blood bank monitoring over 7 weeks. Data were gathered at the patients' bedside from clinical staff and charts. Transfusions were classified according to the presence of bleeding and medical specialty (medical, surgical, other). Hemoglobin (Hb) transfusion triggers, RBCs transfused, and posttransfusion Hb values were collected. Evidence-based scenarios were used to model the potential RBC savings that could be achieved if acute shortages occurred, incorporating ischemic heart disease as a potential decision modifier.
RESULTS: A total of 83 patients received 100 transfusion events, comprising 207 RBC units, during the sampling periods. The relative use of RBC units across specialties was as follows: medical, 74%; surgical, 22%; and other, 4%. For medical and surgical patients, respectively, 31 and 10% of all RBC units were transfused for anemia without evidence of bleeding, and 38 and 12% were transfused for non–life-threatening bleeding. Eight-five percent of all patients who received transfusions had stable vital signs before transfusion. Our model suggested that only 11% of RBCs would be conserved by cancellation of major surgery, whereas 23% to 47% of all RBCs could be conserved by controlling transfusions to medical patients.
CONCLUSION: In institutions with patterns of blood use similar to ours, control of transfusions to medical patients is the most effective response to acute blood shortages.     

Changing Attitudes Toward Smoking and Smoking Susceptibility Through Peer Crowd Targeting: More Evidence From a Controlled Study

Peer crowd identification consistently predicts an adolescent’s smoking behavior. As such, several interventions have targeted adolescents and young adults based on their identification with a specific crowd (e.g., Hipsters). This study uses a controlled experimental design to isolate and test the effect of peer crowd targeting in an antismoking ad on antismoking attitudes and smoking susceptibility. Two hundred and thirty-nine adolescents, age 13–15 years, completed a baseline survey and then viewed an antismoking ad targeting one of eight crowds; 1 week later they completed a posttest. Participants were assessed on antismoking attitudes and smoking susceptibility. Adolescents who strongly identified with the crowd targeted by the ad reported stronger antismoking attitudes and lower levels of smoking susceptibility. Those who disidentified with the crowd targeted in the ad exhibited not statistically significant increases in smoking susceptibility and weaker antismoking attitudes at posttest. These findings indicate that targeting youths based on their peer crowd is a useful strategy for antismoking interventions. Additional research should further examine whether youths who disidentify with the targeted crowd in an ad exhibit reactance against the message.     

Improving the access of young urban children to speech, language and hearing screening via telehealth

We studied the feasibility of low-cost videoconferencing (using Skype) in urban community health clinics for speech, language and hearing screening of children up to six years of age. During a two-year study, screening services were provided via videoconferencing at two community clinics in an inner city area of Cleveland, Ohio. In total, 411 screenings were completed. Of these, 358 children (87%) received hearing screenings, 377 (92%) received tympanometry screening and 263 (64%) received speech and language screening only. A total of 151 children were aged three years or under (37%). The reliability of pure tone hearing screening (n = 7), DPOAE screening (n = 51) and speech-language screening (n = 10) was 100%. Typanometry screenings (n = 55) were 84% reliable. Families reported a high level of satisfaction with both the technology and with the videoconferencing. The results indicate that low-cost videoconferencing for screening of speech, language and hearing development in very young children in urban community health clinics is feasible, reliable and strongly supported by the community.