Delay in diagnosis of patients with head-and-neck cancer in Canada: impact of patient and provider delay.

Background: Head-and-neck cancers (hncs) often present at an advanced stage, leading to poor outcomes. Late presentation might be attributable to patient delays (reluctance to seek treatment, for instance) or provider delays (misdiagnosis, prolonged wait time for consultation, for example). The objective of the present study was to examine the length and cause of such delays in a Canadian universal health care setting. Methods: Patients presenting for the first time to the hnc multidisciplinary team (mdt) with a biopsy-proven hnc were recruited to this study. Patients completed a survey querying initial symptom presentation, their previous medical appointments, and length of time between appointments. Clinical and demographic data were collected for all patients. Results: The average time for patients to have their first appointment at the mdt clinic was 15.1 months, consisting of 3.9 months for patients to see a health care provider (hcp) for the first time since symptom onset and 10.7 months from first hcp appointment to the mdt clinic. Patients saw an average of 3 hcps before the mdt clinic visit (range: 1-7). No significant differences in time to presentation were found based on stage at presentation or anatomic site. Conclusions: At our tertiary care cancer centre, a patient's clinical pathway to being seen at the mdt clinic shows significant delays, particularly in the time from the first hcp visit to mdt referral. Possible methods to mitigate delay include education about hnc for patients and providers alike, and a more streamlined referral system.

Shock Compression of Liquid Deuterium up to 1 TPa.

We present laser-driven shock compression experiments on cryogenic liquid deuterium to 550 GPa along the principal Hugoniot and reflected-shock data up to 1 TPa. High-precision interferometric Doppler velocimetry and impedance-matching analysis were used to determine the compression accurately enough to reveal a significant difference as compared to state-of-the-art ab initio calculations and thus, no single equation of state model fully matches the principal Hugoniot of deuterium over the observed pressure range. In the molecular-to-atomic transition pressure range, models based on density functional theory calculations predict the maximum compression accurately. However, beyond 250 GPa along the principal Hugoniot, first-principles models exhibit a stiffer response than the experimental data. Similarly, above 500 GPa the reflected shock data show 5%-7% higher compression than predicted by all current models.

Absolute Equation-of-State Measurement for Polystyrene from 25 to 60 Mbar Using a Spherically Converging Shock Wave.

We have developed an experimental platform for the National Ignition Facility that uses spherically converging shock waves for absolute equation-of-state (EOS) measurements along the principal Hugoniot. In this Letter, we present one indirect-drive implosion experiment with a polystyrene sample that employs radiographic compression measurements over a range of shock pressures reaching up to 60 Mbar (6 TPa). This significantly exceeds previously published results obtained on the Nova laser [R. Cauble et al., Phys. Rev. Lett. 80, 1248 (1998)PRLTAO0031-900710.1103/PhysRevLett.80.1248] at a strongly improved precision, allowing us to discriminate between different EOS models. We find excellent agreement with Kohn-Sham density-functional-theory-based molecular dynamics simulations.

Sea trout adapt their migratory behaviour in response to high salmon lice concentrations.

Sea trout face growth-mortality trade-offs when entering the sea to feed. Salmon lice epizootics resulting from aquaculture have shifted these trade-offs, as salmon lice might both increase mortality and reduce growth of sea trout. We studied mortality and behavioural adaptations of wild sea trout in a large-scale experiment with acoustic telemetry in an aquaculture intensive area that was fallowed (emptied of fish) synchronically biannually, creating large variations in salmon lice concentrations. We tagged 310 wild sea trout during 3 years, and gave half of the individuals a prophylaxis against further salmon lice infestation. There was no difference in survival among years or between treatments. In years of high infestation pressure, however, sea trout remained closer to the river outlet, used freshwater (FW) habitats for longer periods and returned earlier to the river than in the low infestation year. This indicates that sea trout adapt their migratory behaviour by actively choosing FW refuges from salmon lice to escape from immediate mortality risk. Nevertheless, simulations show that these adaptations can lead to lost growth opportunities. Reduced growth can increase long-term mortality of sea trout due to prolonged exposure to size-dependent predation risk, lead to lower fecundity and, ultimately, reduce the likelihood of sea migration.

Extraction of effective solid-liquid interfacial free energies for full 3D solid crystallites from equilibrium MD simulations.

Molecular dynamics simulations of an embedded atom copper system in the isobaric-isenthalpic ensemble are used to study the effective solid-liquid interfacial free energy of quasi-spherical solid crystals within a liquid. This is within the larger context of molecular dynamics simulations of this system undergoing solidification, where single individually prepared crystallites of different sizes grow until they reach a thermodynamically stable final state. The resulting equilibrium shapes possess the full structural details expected for solids with weakly anisotropic surface free energies (in these cases, ∼5% radial flattening and rounded [111] octahedral faces). The simplifying assumption of sphericity and perfect isotropy leads to an effective interfacial free energy as appearing in the Gibbs-Thomson equation, which we determine to be ∼177 erg/cm2, roughly independent of crystal size for radii in the 50-250 Šrange. This quantity may be used in atomistically informed models of solidification kinetics for this system.

When relative allocation depends on total resource acquisition: implication for the analysis of trade-offs.

A central tenet of evolutionary biology states that life-history traits are linked via trade-offs, as classically exemplified by the van Noordwijk and de Jong model. This model, however, assumes that the relative resource allocation to a biological function varies independently of the total resource acquisition. Based on current empirical evidence, we first explored the dependency between the total resource acquisition and the relative resource allocation to reproduction and showed that such dependency is the rule rather than the exception. We then derived the expression of the covariance between traits when the assumption of independence is relaxed and used simulations to quantify the importance of such dependency on the detection of trade-offs between current reproduction and future survival. We found that the dependency between the total energy acquisition and the relative allocation to reproduction can influence the probability to detect trade-offs between survival and reproduction. As a general rule, a negative dependency between the total energy acquisition and the relative allocation to reproduction should lead to a higher probability of detecting a trade-off in species with a fast pace of life, whereas a positive dependency should lead to a higher probability of detecting a trade-off in species with a slow pace of life. In addition to confirming the importance of resource variation to reveal trade-offs, our finding demonstrates that the covariance between resource allocation and resource acquisition is generally not null and also plays a fundamental role in the detection of trade-offs.

Integral equation model for warm and hot dense mixtures.

In a previous work [C. E. Starrett and D. Saumon, Phys. Rev. E 87, 013104 (2013)] a model for the calculation of electronic and ionic structures of warm and hot dense matter was described and validated. In that model the electronic structure of one atom in a plasma is determined using a density-functional-theory-based average-atom (AA) model and the ionic structure is determined by coupling the AA model to integral equations governing the fluid structure. That model was for plasmas with one nuclear species only. Here we extend it to treat plasmas with many nuclear species, i.e., mixtures, and apply it to a carbon-hydrogen mixture relevant to inertial confinement fusion experiments. Comparison of the predicted electronic and ionic structures with orbital-free and Kohn-Sham molecular dynamics simulations reveals excellent agreement wherever chemical bonding is not significant.

Contrast-enhanced computed tomographic evaluation of the deep digital flexor tendon in the equine foot compared to macroscopic and histological findings in 23 limbs.

REASONS FOR PERFORMING THE STUDY: Distal deep digital flexor tendinopathy is an important cause of foot lameness in horses that is difficult to diagnose with radiography and ultrasonography. Magnetic resonance imaging is a well-accepted and validated technique for the identification of deep digital flexor tendon (DDFT) lesions, but has some practical and financial drawbacks. Contrast-enhanced computed tomography (CECT) has been proposed as a suitable alternative, but validation studies are currently lacking. OBJECTIVE: To assess the accuracy of CECT for the identification and characterisation of deep digital flexor tendinopathy. STUDY DESIGN: Descriptive study of CT, macroscopic and histological findings of the DDFT. METHODS: Plain and CECT scans were acquired of 23 limbs of 16 horses with clinical lameness localised to the foot. All horses had lesions of the DDFT that were identified and characterised with CT and CECT with respect to their anatomic location and extent. All horses underwent post mortem examination and gross abnormalities were described. Samples of the DDFT were taken at specific sites (lesion and nonlesion) for histological evaluation. Macroscopic and histological outcomes were compared with CECT findings. RESULTS: Of 67 sites in 23 DDFTs that were evaluated, 42 sites in 18 tendons had lesions on CECT images. These 42 sites also had lesions on macroscopic evaluation. There were 3 false negative and 3 false positive results identified on CECT. The sensitivity of CECT for diagnosing lesions of the DDFT in the equine foot was 93%. CONCLUSION: CECT is an effective adjunct to the more commonly used diagnostic techniques in equine foot pain.

Solid iron compressed up to 560 GPa.

Dynamic compression by multiple shocks is used to compress iron up to 560 GPa (5.6 Mbar), the highest solid-state pressure yet attained for iron in the laboratory. Extended x-ray absorption fine structure (EXAFS) spectroscopy offers simultaneous density, temperature, and local-structure measurements for the compressed iron. The data show that the close-packed structure of iron is stable up to 560 GPa, the temperature at peak compression is significantly higher than expected from pure compressive work, and the dynamic strength of iron is many times greater than the static strength based on lower pressure data. The results provide the first constraint on the melting line of iron above 400 GPa.

Structural and optical properties of liquid CO2 for pressures up to 1 TPa.

We report on the use of first-principles molecular dynamics calculations to examine properties of liquid carbon dioxide in the pressure-temperature range of 0-1 TPa and 200-100 000 K. The computed equations of state points are used to predict a series of shock Hugoniots with initial starting conditions that are relevant to existing and ongoing shock-wave experiments. A comparison with published measurements up to 70 GPa shows excellent agreement. We find that the liquid undergoes a gradual phase transition along the Hugoniot and have characterized this transition based on changes in bonding and structural properties as well as the conductivity and reflectivity of the fluid.

[Psychosocial resources, transitory events and quality of life of aging people.]. / Ressources psychosociales, événements transitoires et qualité de vie des personnes vieillissantes.

Based on data of the Québec longitudinal study on aging, this article examines crosswise the relation between psychosocial resources of elderly people and their quality of life. The sample of 781 subjects includes three groups of elderly people selected according to their age and their experience or not of a major transitory event: retirement (60-65), widowed (70-75) and functional incapacity (80-85). The results confirm that respondents with a high level of psychosocial resources obtain better performances in the various indexes of quality of life. However, in regards to events, the protective effect of psychosocial resources on quality of life is only shown with those people in retirement. We notice that with people with functional incapacity, social support seem to slightly contribute in maintaining quality of life. Finally, the authors propose certain explanations.

Structural integrity of the female condom after a single use, washing, and disinfection.

The Reality(R) female condom is approved for use during a single act of intercourse, but is expensive relative to other barrier methods. Re-use is a potential strategy to reduce its per-use cost. We tested the structural integrity of female condoms (n = 318) after a single act of vaginal intercourse. We also measured the impact of laboratory washing (1, 5, or 10 times) with and without disinfection on the structural integrity of unused condoms. Structural integrity was measured via 5 tests: seam tensile strength, water leakage, air-burst, tear propagation, and device dimensions. No degradation in device structural integrity occurred after a single use when compared to control for seam tensile (16.0 vs.15.7 mPa; p = 0.558); water leakage (1.9% vs. 0.9%; p = 0.618); air burst (3.9 vs. 3.6 kPa; p <0.001); or tear propagation (344.6 vs. 336.8 psi; p = 0.313). Mean length was slightly increased [single use vs. control (177.9 vs. 172.5 mm; p <0.001)]. No consistent pattern of structural degradation emerged across all wash/disinfection groups. Our data suggest the structural integrity of the female condom remains intact after a single use and cleaning.

[Incidence of the onset of disability and recovery of functional autonomy among the very old after one year]. / Incidence à un an de l'entrée en incapacité et de la récupération de l'autonomie fonctionnelle chez les octogénaires.

BACKGROUND: This article measures the survival rate and explores the changes in functional autonomy among both men and women over a one-year period in a sample of 272 subjects aged 80-85. METHODS: Data were taken from the Quebec Longitudinal Study on Aging, a multi-cohort prospective study focusing on health and quality of life. The sample comprises two sub-groups, namely disabled and autonomous subjects. Eligible participants were selected from the Quebec Health Insurance Plan (QHIP) file. However, to obtain the required number of participants, the sample was completed from eligible subjects who volunteered in response to TV, billboard and newspaper advertising about the project. The Functional Autonomy Measurement System (SMAF) was used to assess disability. The SMAF assesses functional disability in 5 domains: activities of daily living (ADL), mobility, instrumental activities (IADL), communication, and mental functioning. RESULTS: After one year, nearly 5% of the subjects had died and 72.5% were still autonomous, i.e., they had a score under 4.5 on the SMAF. The annual incidence of the onset of disability (including death, lengthy hospitalization, functional incapacities and cognitive deficits) was 20%. However, no difference was found between the sexes in regard to the risk of losing autonomy. The main areas where disability occurred among the previously autonomous subjects were, in order of importance, domestic tasks, mobility and communication. The study confirmed that it is possible to recover autonomy, even at this advanced age, particularly for women (11.2%), but less so for men (3.6%). CONCLUSION: This phenomenon of recovering functional autonomy suggests that octogenarians have a residual potential and confirms the effectiveness of preventive and curative measures and the benefits of interventions by community and family networks.

Stressful life events and psychological distress of the very old: does social support have a moderating effect?

The purpose of this paper was to examine whether social support has a moderating effect on the relationship between exposure to stressful life events and psychological distress. To test this, 224 men and women aged 81-86 were sampled from two municipal regional counties: Sherbrooke (and vicinity) and Trois-Rivières, in the Province of Quebec, Canada. The French version of the Geriatric Scale of Recent Life Events, the Psychiatric Symptom Index, and the Social Provision Scale were used. Multiple regression analyses revealed that social support did not cancel out the deleterious effect of life events on the outcome measure. The negative aspect of social interaction may explain why social support did not have a protective effect. Also, social isolation resulting from psychological distress could reduce the opportunity for instrumental help and emotional support.

Growth of infants prenatally exposed to cocaine/crack: comparison of a prenatal care and a no prenatal care sample.

OBJECTIVE: It has not been possible to draw firm conclusions about the effects of prenatal cocaine exposure because of methodologic problems involved in the conduct of this research. This study, designed to overcome some of these methodologic problems, is a prospective, longitudinal investigation of the effects of prenatal cocaine/crack exposure on neonatal growth in two samples, one with and one without prenatal care (PC). METHODS: Women in the PC sample (n = 295) were interviewed at the end of each trimester about their use of cocaine, crack, alcohol, tobacco, marijuana, and other drugs. Women in the no prenatal care (NPC) sample (n = 98) were interviewed at delivery about their drug use during each trimester of pregnancy. In both samples, information was also obtained about sociodemographic, lifestyle, psychologic, and social support characteristics. Both samples consisted of women who were predominantly low income, single, and high school educated. Of the women, 48% in the PC sample were black; 81% in the NPC sample were black. Infants were examined during the postpartum hospital stay by project nurses who were blind to maternal substance use status. RESULTS: Women in both samples who used cocaine/crack during pregnancy were older, had lower family incomes, and used more alcohol than did women who did not use cocaine/crack during pregnancy. In addition, women in the NPC sample were more likely to be black, less educated, gained less weight during pregnancy, and used more alcohol than did women in the PC sample, regardless of cocaine use. In both samples, cocaine/crack use during early pregnancy predicted reduced gestational age, birth weight, length, and head circumference, after controlling for the significant covariates of cocaine use. In a comparison of the samples, the offspring of the NPC/cocaine group were significantly smaller than were the offspring of the PC/no cocaine group, whereas the offspring of the PC/cocaine and NPC/cocaine groups did not differ. CONCLUSIONS: These results indicate that exposure to cocaine/crack during early pregnancy decreases the intrauterine growth of exposed offspring in women with and without PC. Each of the growth parameters was affected indicating symmetric growth retardation. The adequacy of PC was not a significant factor in determining the difference between cocaine-exposed and nonexposed infants. These samples are being followed throughout childhood to determine whether there are long-term effects of prenatal cocaine/crack exposure on growth.

N-hydroxyurea and hydroxamic acid inhibitors of cyclooxygenase and 5-lipoxygenase.

Two series of compounds (1 and 2) having structural features of the dual COX/5-LO inhibitor tepoxalin and the 5-LO inhibitor ABT-761 were prepared. Many of these hybrid compounds are potent COX and 5-LO inhibitors; two compounds (1a and 2t) inhibit eicosanoid biosynthesis in an ex vivo assay.

[Epithelial-myoepithelial carcinoma of the salivary glands: report of a case]. / Carcinome épithélial-myoépithélial des glandes salivaries. Etude à propos d'un cas.

Epithelial-myoepithelial carcinoma (E.M.C.) is a rare lowgrade salivary gland neoplasm that occurs in both major and minor salivary glands. It is characterized by tubular and solid growth pattern with a dual cell population including an inner layer of epithelial cells which are peripherically bounded by a layer of clear myoepithelial cells. This differentiation is confirmed by electron microscopic and immunohistochemical studies. The differential diagnosis included clear cell tumor of the salivary gland and metastatic renal carcinoma. The majority of these tumours arise in the parotid in women with a peak incidence from the 6th to the 8th decade. We report a case of parotidic E.M.C. in a 33 year old man.

The estimation of the bioaccessibility of heavy metals in soils using artificial biofluids by two novel methods: mass-balance and soil recapture.

The possible human health effects resulting from the ingestion of soil bound heavy metals can be poorly estimated if concentration of total metals in soil, rather than bioavailable fraction of metals, are incorporated into dose calculations. Information regarding bioavailability often is obtained from animal studies, which are not easily conducted and still may not represent human conditions. A rapid simulation of the bioaccessible fraction of contaminant in a soil, in which that fraction is mass soluble in gastrointestinal tract fluids, has been employed in an in vitro sequential extraction technique. Using a mass-balance analytical approach to measure bioaccessibility in four soils, the results indicated that each metal had a bioaccessible fraction less than its total metal content. Lead (Pb) in Standard Reference Material, Montana SRM 2710, was found to be 62 +/- 1% bioaccessible; Pb in contaminated soil collected from Bunker Hill, ID, USA was 70 +/- 11%. Lead in Jersey City, NJ, USA slag material was only 39 +/- 14% bioaccessible while Pb in a residential soil was 69%. Arsenic (As) and chromium (Cr) data from select soils also have bioaccessibility less than the corresponding total metal in soil, with 41 +/- 2% As in a residential soil, 66 +/- 8% As in SRM 2710, and 34 +/- 14% Cr in Jersey City slag material. Recovering the soil at the end of the in vitro extraction allowed for the determination of the insoluble fraction of total metal in soil. This recaptured soil metal mass was a valuable measurement since it greatly reduced analysis and therefore labor and time, yet also provided a reasonable estimate of bioaccessibility. It also allowed for calculation of a bioaccessibility value in a soil containing very low metal mass, which would otherwise have resulted in a non-detectable concentration at the dilutions required in the synthetic human biofluid system.