Maximum Output and Low-Frequency Limitations of B71 and B81 Clinical Bone Vibrators: Implications for Vestibular Evoked Potentials.

OBJECTIVES: Bone-conducted vestibular evoked myogenic potentials (VEMPs) are tuned to have their maximum amplitude in response to tone bursts at or below 250 Hz. The low-frequency limitations of clinical bone vibrators have not been established for transient, tone burst stimuli at frequencies that are optimal for eliciting VEMPs. DESIGN: Tone bursts with frequencies of 250 to 2000 Hz were delivered to B71 and B81 bone vibrators and their output was examined using an artificial mastoid. The lower-frequency limit of the transducers was evaluated by examining the spectral output of the bone vibrators. Maximum output levels were evaluated by measuring input-output functions across a range of stimulus levels. RESULTS: Both the B71 and B81 could produce transient tone bursts with frequency as low as 400 Hz. However, tone bursts with frequencies of 250 and 315 Hz resulted in output with peak spectral energy at approximately 400 Hz. From 500 to 2000 Hz, maximum output levels within the linear range were between 120 and 128 dB peak force level. The newer B81 bone vibrator had a maximum output approximately 5 dB higher than the B71 at several frequencies. CONCLUSIONS: These findings demonstrate that both transducers can reach levels appropriate to elicit bone-conducted VEMPs, but the low-frequency limitations of these clinical bone vibrators limit tone burst frequency to approximately 400 Hz when attempting to stimulate the otolith organs via tone bursts.

Rural vs urban residence affects risk-appropriate colorectal cancer screening.

BACKGROUND & AIMS: Little is known about the effects of geographic factors, such as rural vs urban residence and travel time to colonoscopy providers, on risk-appropriate use of colorectal cancer (CRC) screening in the general population. We evaluated the effects of geographic factors on adherence to CRC screening and differences in screening use among familial risk groups. METHODS: We analyzed data from the 2010 Utah Behavior Risk Factor Surveillance System, which included state-added questions on familial CRC. By using multiple logistic regression models, we assessed the effects of rural vs urban residence, travel time to the nearest colonoscopy provider, and spatial accessibility of providers on adherence to risk-appropriate screening guidelines. Study participants (n = 4260) were respondents aged 50 to 75 years. RESULTS: Sixty-six percent of the sample adhered to risk-appropriate CRC screening guidelines, with significant differences between urban and rural residents (68% vs 57%, respectively; P < .001) across all familial risk groups. Rural residents were less likely than urban dwellers to be up-to-date with screening guidelines (multivariate odds ratio, 0.65; 95% confidence interval, 0.53-0.79). In the unadjusted analysis, rural vs urban residence (P < .001), travel time to the nearest colonoscopy provider (P = .003), and spatial accessibility of providers (P = .012) were associated significantly with adherence to screening guidelines. However, rural vs urban residence (P < .001) was the only geographic variable independently associated with screening adherence in the adjusted analyses. CONCLUSIONS: There are marked disparities in use of risk-appropriate CRC screening between rural and urban residents in Utah. Differences in travel time to the nearest colonoscopy provider and spatial accessibility of providers did not account for the geographic variations observed in screening adherence.

Unstaged cancer in the United States: a population-based study.

BACKGROUND: The current study examines unstaged disease for 18 cancer sites in the United States according to the influence of age, sex, race, marital status, incidence, and lethality. METHODS: Analyses are based on 1,040,381 male and 1,011,355 female incident cancer cases diagnosed during 2000 through 2007. Data were collected by population-based cancer registries in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. RESULTS: The level of unstaged disease was greater in more lethal cancers (e.g., liver, esophagus, and pancreas) compared with less deadly cancers (i.e., colon, urinary bladder, and female breast). Unstaged disease increased with age and is greater among non-married patients. Blacks compared with whites experienced significantly higher levels of unstaged cancers of the stomach, rectum, colon, skin (melanoma), urinary bladder, thyroid, breast, corpus, cervix, and ovaries, but lower levels of unstaged liver, lung and bronchial cancers. Males compared with females experienced significantly lower levels of unstaged cancers of the liver, pancreas, esophagus, and stomach, but significantly higher levels of unstaged lung and bronchial cancer and thyroid cancer. The percent of unstaged cancer significantly decreased over the study period for 15 of the 18 cancer sites. CONCLUSION: Tumor staging directly affects treatment options and survival, so it is recommended that further research focus on why a decrease in unstaged disease did not occur for all of the cancer sites considered from 2000 to 2007, and why there are differential levels of staging between whites and blacks, males and females for several of the cancer sites.

Risk-adjusted colon and rectal cancer incidence rates in the United States.

BACKGROUND: Population-based cancer incidence rates that adjust for multiple cancer primaries and for prevalent cases of the disease provide a better approximation of risk. DESIGN: This study is based on a retrospective cohort. SETTING/PATIENTS: Included in the study were 9 original Surveillance, Epidemiology and End Results registries focusing on white and black males and females from 2000 through 2007. MAIN OUTCOME MEASURE: The main outcome measured was malignant colorectal cancer. RESULTS: Conventional colorectal cancer incidence rates overestimate population risk by 3.6% for white males, 4.0% for black males, 3.4% for white females, and 3.3% for black females. The level of overestimation bias remained similar across the age span for white and black males. However, for white females, rates were overestimated by 2.1% for ages 30 to 39 and increased to 3.8% for ages 80 years and older. Corresponding values for black females were 1.5% and 3.8%. The trends in conventional rates were generally similar to the trends in risk-adjusted incidence rates, increasing or stable before age 50, but decreasing thereafter. The number of colorectal cancer cases in the United States is estimated from conventional incidence rates. In 2007, the number of colorectal cases was 59,599 for white males, 7,670 for black males, 58,972 for white females, and 8,786 for black females. The number of colorectal cancer cases based on prevalence-corrected incidence rates increased by 2.2% for white males, 1.5% for black males, 2.1% for white females, and 1.5% for black females. CONCLUSION: Colorectal cancer incidence rates that include second and later colorectal cancer primaries and adjust for prevalence better reflect cancer burden, whereas colorectal cancer incidence rates that only include the first diagnosed case and adjust for prevalence better reflect cancer risk.

Mood disturbance fails to resolve across 31 days of cigarette abstinence in women.

Smoking abstinence responses were characterized in 96 female smokers. Participants completed subjective state measures twice per week for 5 weeks and were then randomly assigned to a group required to abstain for 31 days or a control group that continued to smoke. Financial incentives for biochemically verified abstinence resulted in an 81% completion rate. Abstinence-related increases in depression, tension, anger, irritability, and appetite showed little tendency to return to prequit levels and remained significantly elevated above smoke-group levels. In contrast to psychological components of anxiety, physical components decreased to smoke group levels by the 2nd week of abstinence. Trait depression and neuroticism predicted larger increased abstinence-associated negative affect. The Big Five personality dimensions predicted variance not associated with depressive traits.

Quality of life indicators according to voice disorders and voice-related conditions.

OBJECTIVES/HYPOTHESIS: To evaluate the association between a history of voice disorders and voice-related conditions and the short form-36 eight-scale measure of functional health and well-being as well as psychometrically based physical and mental health summary measures within a senior population. STUDY DESIGN: Cross-sectional survey completed by 461 individuals aged 50 years and older, October 2010. METHODS: The questionnaire included items on demographics, medical history, health, and voice use and disorders. Quality of life indicators were based on questions from the SF-36. RESULTS: The prevalence of ever having had a voice disorder was 17%. Hoarseness, esophageal reflux, frequent throat clearing, respiratory allergies, pneumonia, difficulty projecting the voice, chronic dryness of the throat, bitter or acid taste, effort required to talk, stomach or duodenal ulcers, wobbly or shaky voice, voice discomfort, chronic throat soreness, and emphysema were significantly associated with participants indicating they had experienced a voice disorder. The history of anxiety and depression was also significantly associated with a history of voice-related conditions. Those with a history of voice disorders had significantly poorer health with respect to physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to emotional problems, emotional well-being and social functioning, energy or fatigue, and general health perception. CONCLUSIONS: Voice disorders stem from a variety of risk factors and biological mechanisms. Such disorders may lead to poor physical and psychosocial functioning.