A multicentre review of the direct-access mammography programme in Ireland for women with breast pain.

AIM: To assess the current use of the direct access mammography pathway for breast pain and the rate of breast cancer detection in this patient cohort. MATERIALS AND METHODS: A retrospective review of general practitioner (GP)-referred mammograms performed during a 12-month period from January to December 2022 across four tertiary referral centres. With the use of medical records and GP referrals, patient demographics, presenting symptoms, family history, and clinical outcomes were recorded. RESULTS: The present study comprised 2,046 patients of which 21.6% did not report breast pain at the time of referral. Thirty-five per cent had a positive family history with 40% of these patients having no breast pain. Twelve per cent were recalled with 30% of these patients requiring biopsy. An overall cancer detection rate (CDR) of 7 per 1000 was determined for women with mastalgia. A CDR of 0 per 1,000 was determined for women <50 years with mastalgia alone and no additional risk factors for malignancy. Fisher's exact test showed no statistically significant association between breast pain and breast cancer. CONCLUSION: There was no statistically significant relationship found between breast pain and breast cancer. This review suggests a low cancer detection rate in women <50 years. In women <50 years with mastalgia without additional symptoms or family history, breast imaging is not required.

Benefits of mindful self-compassion for frontline nurses.

ABSTRACT: Nurses who regularly engage in self-compassion training may be more resilient to stressors and burnout, and thus able to provide more compassionate care to patients. The article explores the benefits and strategies of practicing mindful self-compassion (MSC) for nurses, reviews the effectiveness of an MSC curriculum, and discusses practical techniques for nurses to put MSC theory into practice.

The role of infiltrating lymphocytes in the neo-adjuvant treatment of women with HER2-positive breast cancer.

BACKGROUND: Pre-treatment tumour-associated lymphocytes (TILs) and stromal lymphocytes (SLs) are independent predictive markers of future pathological complete response (pCR) in HER2-positive breast cancer. Whilst studies have correlated baseline lymphocyte levels with subsequent pCR, few have studied the impact of neoadjuvant therapy on the immune environment. METHODS: We performed TIL analysis and T-cell analysis by IHC on the pretreatment and 'On-treatment' samples from patients recruited on the Phase-II TCHL (NCT01485926) clinical trial. Data were analysed using the Wilcoxon signed-rank test and the Spearman rank correlation. RESULTS: In our sample cohort (n = 66), patients who achieved a pCR at surgery, post-chemotherapy, had significantly higher counts of TILs (p = 0.05) but not SLs (p = 0.08) in their pre-treatment tumour samples. Patients who achieved a subsequent pCR after completing neo-adjuvant chemotherapy had significantly higher SLs (p = 9.09 × 10-3) but not TILs (p = 0.1) in their 'On-treatment' tumour biopsies. In a small cohort of samples (n = 16), infiltrating lymphocyte counts increased after 1 cycle of neo-adjuvant chemotherapy only in those tumours of patients who did not achieve a subsequent pCR. Finally, reduced CD3 + (p = 0.04, rho = 0.60) and CD4 + (p = 0.01, rho = 0.72) T-cell counts in 'On-treatment' biopsies were associated with decreased residual tumour content post-1 cycle of treatment; the latter being significantly associated with increased likelihood of subsequent pCR (p < 0.01). CONCLUSIONS: The immune system may be 'primed' prior to neoadjuvant treatment in those patients who subsequently achieve a pCR. In those patients who achieve a pCR, their immune response may return to baseline after only 1 cycle of treatment. However, in those who did not achieve a pCR, neo-adjuvant treatment may stimulate lymphocyte influx into the tumour.

Recurrent Obturator Hernia: A Rare Entity.

Obturator hernias are rare with an incidence of less than 1% of all hernias and are most common in frail, elderly females. They are difficult to diagnose and even more difficult to repair. They often present with a small bowel obstruction from the incarcerated bowel. We report a case of a recurrent obturator hernia after a laparoscopic repair using a patch of omentum. The recurrence was repaired laparoscopically with a trans-abdominal preperitoneal repair (TAPP) with mesh. Given the rarity of the disease, there is scarce literature on the ideal method of repair, especially in patients with recurrence. However, with recent trends toward minimally invasive preperitoneal mesh hernia repairs for inguinal and ventral hernias, this type of repair should be strongly considered for patients with obturator hernias as well.

A pilot evaluation of the Food as Medicine program for patients with type 2 diabetes.

The objective of this study was to determine the effectiveness of the Food as Medicine Program (modified and adapted based on supporting research of the Fresh Food Farmacy™ program) that was implemented at a southeast regional hospital with voluntary participants with diabetes. It was hypothesized that participants would experience a decline in type 2 diabetes symptoms following the 12-month program of bi-monthly healthy groceries, nutritional guidance, educational sessions, and group health coaching. For this initial pilot study, four cohorts of patients were admitted consisting of 20 participants. The 12-month program included bi-monthly food pick-ups, nutritional recipes, and bi-monthly group educational and health coaching sessions for participants. They also completed pre- and post-program assessments, including a medical history questionnaire, biometric screening (HbA1c, weight, BMI, and blood pressure), and health behavior questionnaires. While there were not statistically significant differences from pre- to post-program, mean HbA1c slightly decreased from the time of the initial test (i.e., month 1) to follow-up testing (i.e., month 12). The pre- to post-program trends for diabetes self-care activities indicated improvements for general and specific diet maintenance, days of exercise per week, blood glucose testing per week, foot care, and smoking habits. Participants also exhibited a decrease in diabetes distress for emotional, physical, regimen, and interpersonal distress from pre- to post-program. This is very important as self-regulation of behaviors is necessary to successful management of diabetes. The results are discussed in relation to the limitations created by COVID-19, along with future implementation suggestions.

A RE-AIM analysis of the sources of strength program in a United States high school.

The purpose of this study was to analyze the Sources of Strength program implemented at a high school in the southeastern United States using the RE-AIM framework. Students (n = 1,250) were recruited from one high school in the southeastern United States that was implementing Sources of Strength. College undergraduate students mentored high school peer leaders to implement Sources of Strength to promote opioid and suicide protective factors for the high school. This was a cross-sectional design in which a post-implementation survey assessed program effectiveness, satisfaction, and feedback for maintenance. Analysis used the RE-AIM framework of reach, effectiveness, adoption, implementation, and maintenance. Reach: 100 % of students participated in at least one campaign. Effectiveness: Mean protective factor scores were 3.83 for happiness; 3.93 for knowledge of coping skills, and 3.38 for practice of coping skills. Adoption: One high school and 100 % of classrooms participated in at least one campaign. Implementation: 18 high school peer leader meetings were facilitated by the undergraduate mentors. Maintenance: High school students qualitatively provided input on future campaign needs, and the program was continued following this RE-AIM analysis. The Sources of Strength program promoted suicide and opioid protective factors in high school students during COVID-19. Future research should compare the efficacy of Sources of Strength at baseline and follow-up with multiple high school sites.

An Analysis of an Exercise is Medicine on Campus ® Program: A Case Report.

BACKGROUND: The objective of this study was to assess the efficacy of an Exercise is Medicine on Campus® program on university student biometrics and muscular endurance. It was hypothesized that participants in the 12-week program would experience significant improvements in body mass index, blood pressure, body fat percentage, waist circumference, and muscular endurance. METHODS: To be eligible for the program, participants must have met two of the three criteria: (1) blood pressure over 140 and/or 90 (3 consecutive measurements over 2 weeks), (2) BMI over 30, and/or (3) diagnosed chronic condition or currently taking medication for chronic condition. Participants engaged in six bi-weekly exercise instructional meetings that lasted approximately 30 minutes in length. Participants completed measures of resting heart rate, waist-to-hip ratio, body composition percentage via bioelectrical impedance, and muscular endurance before and after the program. RESULTS: Although not statistically significant, there was a decrease in BMI, blood pressure, body fat percentage, and waist circumference from pre- to post-program. Two-tailed t-tests revealed significant improvements in squats (P = .04), pushups (P = .05), and curl-ups (P = .03) from pre- to post-program. CONCLUSION: The results are discussed in terms of current research and future university campus application.

Minimally Invasive Surgery for Median Arcuate Ligament Syndrome and Celiac Artery Stenosis.

Median arcuate ligament syndrome (MALS) is a pathology commonly reported in educational literature, although in reality it is scarcely seen. Herein, we present the case of a 48-year-old female patient who presented with nausea, vomiting, and unintentional weight loss. After thorough work up of her symptoms through a variety of different modalities, MALS was confirmed and she underwent surgical release via a minimally invasive approach. The authors of this article feel that this case is important to present due to paucity of reported cases in the literature. In addition, this patient was exceptionally unique to report as we selected to perform a slight adaptation of a minimally invasive approach, while there are multiple different treatment techniques and management plans that have previously been described in a variety of different literatures and require further discussion.

Fatal Sequelae of Reperfusion Injury in Postoperative Gastric Bypass.

BACKGROUND Obesity is a pandemic that is currently uncontrolled. In the surgical population, bariatric surgery is a sustainable and attractive option. However, both obesity and surgery can independently increase the risk for venous thromboembolism and subsequent significant and even fatal adverse effects. CASE REPORT We present the unique case of a 63-year-old woman who developed substantial venous thrombosis in the postoperative period following a laparoscopic hiatal hernia repair and Roux-en-Y gastric bypass. Venous thrombosis following surgery is a known possible complication, but we felt that this case required reporting due to the extreme extent of thrombosis and the significant course of events that occurred following her readmission. Due to the increased thrombus burden, the patient developed phlegmasia cerulea dolens and required operative thrombectomy. With restoration of blood flow following the procedure, the patient's clinical status rapidly declined, likely due to reperfusion injury. Ultimately, she developed multisystem organ failure, which included the constellation of shock, hypoxic respiratory failure, acute renal failure, shock liver, and, finally, cardiopulmonary arrest. CONCLUSIONS As the authors of this paper, we were especially inclined to report this particular case as the patient's clinical course was exceedingly complex due to her presenting phlegmasia cerulea dolens. The course was further complicated postoperatively by the detrimental sequelae of massive reperfusion injury, which likely eventually led to her death. We felt this pertinent to present because, after an extensive PubMed literature review, this sequence of events following gastric bypass surgery has yet to be reported in the literature.

The impact of COVID-19 on college anxiety, optimism, gratitude, and course satisfaction.

ObjectiveTo examine the relationship between college student anxiety, optimism, gratitude, and perception of the Physical Activity and Lifestyle program (PAL) instructional response/effectiveness following COVID-19. Participants: Data were collected from a southeastern, midsize university (n = 1640) during April 2020. Methods: Participants responded to a Web-based survey that included mental health factors (optimism, gratitude, anxiety) and perceptions of COVID-19 academic response. Results: The results of this study revealed a significant, negative relationship between anxiety and optimism (r = .36), gratitude (r = -.12), and perceived instruction following COVID-19 (r = -.11). There were statistically significant differences in perceived PAL instructional response/effectiveness following COVID-19 between anxiety classification, with severely anxious students expressing lower instructional response to COVID-19 when compared to moderately or mildly anxious students, [F(2,1516) = 10.60, p < .001]. Conclusions: The results inform educators on the importance of effective education and coping strategies following online transition during a pandemic.

Self-compassion training within a workplace physical activity program: A pilot study.

BACKGROUND: Desire2Move (D2M) is an 8-week team-based, workplace program that incorporates competition and self-monitoring to encourage physical activity (PA). OBJECTIVE: The purpose of this pilot study was to evaluate the effectiveness of a self-compassion (SC) intervention within the existing workplace PA program. METHODS: University employees (n = 20) were assigned to a SC treatment group or an attention control group. Participants logged their PA minutes using MapMyRun. Treatment group. participants received a 7-week, SC podcast intervention. Participants self-reported PA, SC, and demographic information at pre- and post-intervention. Separate ANOVAs were used to determine group differences. RESULTS: There was not a statistically significant group x time interaction for SC, F(1, 18) = 0.02, p = 0.90, or main effects for time, F(1, 18) = 0.28, p = 0.61, or group, F(1, 18) = 1.70, p = 0.21, g = -0.42 [95%CI = -3.13, 2.29]. There were not significant differences between groups for total PA minutes during D2M, F(1, 18) = 2.15, p = 0.16, g = -0.63 [-1.53,0.27]. Overall, participants engaged in more than the recommended levels of PA each week. CONCLUSIONS: This pilot study provided feedback and guidance for future online SC training within a workplace PA intervention.

Characterization of the Mercury pulsed power x-ray source spectrum using multichannel density aerogel Cherenkov detectors.

The Aerogel Cherenkov Detector for Cygnus (ACD/C) is a time-dependent, x-ray spectral detector that uses SiO2 aerogels spanning an index of refraction (n = 1.02-1.07) corresponding to a 1.1-2.3 MeV x-ray energy threshold. The ACD/C was developed for pulsed power x-ray sources like Cygnus located at the Nevada National Site and Mercury located at the Naval Research Laboratory (NRL). Aerogels sit between the measurement capabilities of gas (>2 MeV) and solids such as fused silica (>0.3 MeV). The detector uses an aluminum converter to Compton scatter incoming x-rays and create relativistic electrons, which produce Cherenkov light in an aerogel or a fused silica medium. The ACD/C was fielded at the NRL when Mercury was tuned to produce up to 4.8 MeV endpoint bremsstrahlung. Despite a high radiation and electromagnetic interference background, the ACD/C was able to achieve high signal over noise across five aerogel densities and fused silica, including a signal to noise for a 1.1 MeV aerogel threshold. Previous experiments at Cygnus observed a signal that was comparable to the noise (1×) at the same threshold. The ACD/C observed time-resolved rise and fall times for different energy thresholds of the photon spectrum. Monte Carlo simulations of the ACD/C's aerogel response curves were folded with a simulation of Mercury's photon energy spectrum and agree within the error to the observed result.

Bertolotti's syndrome. A cause of back pain in young people.

Bertolotti's syndrome is characterised by anomalous enlargement of the transverse process(es) of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium and cause isolated L4/5 disc disease. We analysed the elective MR scans of the lumbosacral spine of 769 consecutive patients with low back pain taken between July 2003 and November 2004. Of these 568 showed disc degeneration. Bertolotti's syndrome was present in 35 patients with a mean age of 32.7 years (15 to 60). This was a younger age than that of patients with multiple disc degeneration, single-level disease and isolated disc degeneration at the L4/5 level (p

Cost-effectiveness of captopril therapy after myocardial infarction.

OBJECTIVES: This study sought to assess the cost-effectiveness of captopril therapy for survivors of myocardial infarction. BACKGROUND: The recent randomized, controlled Survival and Ventricular Enlargement (SAVE) trial showed that captopril therapy improves survival in survivors of myocardial infarction with an ejection fraction < or = 40%. The present ancillary study was designed to determine how the costs required to achieve this increase in survival compared with those of other medical interventions. METHODS: We developed a decision-analytic model to assess the cost-effectiveness of captopril therapy in 50- to 80-year old survivors of myocardial infarction with an ejection fraction < or = 40%. Data on costs, utilities (health-related quality of life weights) and 4-year survival were obtained directly from the SAVE trial, and long-term survival was estimated using a Markov model. In one set of analyses, we assumed that the survival benefit associated with captopril therapy would persist beyond 4 years (persistent-benefit analyses), whereas in another set we assumed that captopril therapy incurred costs but no survival benefit beyond 4 years (limited-benefit analyses). RESULTS: In the limited-benefit analyses, the incremental cost-effectiveness of captopril therapy ranged from $3,600/quality-adjusted life-year for 80-year old patients to $60,800/quality-adjusted life-year for 50-year old patients. In the persistent-benefit analyses, incremental cost-effectiveness ratios ranged from $3,700 to $10,400/quality-adjusted life-year, depending on age. The outcome was generally not sensitive to changes in estimates of variables when they were varied individually over wide ranges. In a "worst-case" analysis, incremental cost-effectiveness ratios for captopril therapy remained favorable ($8,700 to $29,200/quality-adjusted life-year) for 60- to 80-year old patients but were higher ($217,600/quality-adjusted life-year) for 50-year old patients. CONCLUSIONS: We conclude that the cost-effectiveness of captopril therapy for 50- to 80-year old survivors of myocardial infarction with a low ejection fraction compares favorably with other interventions for survivors of myocardial infarction.

Fetal islet allotransplantation in rabbits.

Haploidentical fetal rabbit islets were transplanted into the renal subcapsular space of outbred maternal hosts. Islets were prepared by a mild collagenase digestion and were cultured in air and a high oxygen environment for 10 days prior to implantation. Grafts were examined at 14 days and later. No grafts survived in the absence of host immunosuppression, even when treatment of the donor tissue included both culture and ultraviolet-B irradiation (groups 1 and 3). With a high dose of oral cyclosporine, 30 mg/kg/day on days 0-3, viable but disrupted islets were present in 1/7 recipients of islets treated by culture alone. Only with high-dose peritransplant cyclosporine or chronic low-dose immunosuppression, and islet treatment with UVB and culture, was regular graft survival achieved (groups 4A and 5). These results demonstrate that haploidentical outbred hosts can be made to accept fetal islet allografts pretreated by UVB irradiation and culture in a high oxygen environment only if the recipient is given a high peritransplant dose of oral cyclosporine (30 mg/kg/day) or chronic low-dose cyclosporine, (10 mg/kg/day).

Standardized isolation of protoplasts.

Isolation of leaf mesophyll protoplasts from tobacco (Nicotiana tabacum) is facilitated using a specially designed digestion chamber. The chamber's airtight seals and various ports reduce the complexity, time and contamination risks which may be associated with standard isolations. The polished glass viewing window allows continuous monitoring of protoplast release, thus facilitating more precise determinations of the optimal digestion time. In concert with a simplified centrifugation step, the protoplast isolation procedure is greatly standardized.

No effect of cigarette smoking on electroencephalographic nonlinearity.

The Gaussian surrogate-date procedure was applied to the measurement of the effect of cigarette smoking on the dimensional complexity of normal, resting EEG. Evidence of significant nonlinearity in the EEG was obtained, replicating previous results. However, unlike EEG dimensional complexity, EEG nonlinearity (difference between original and surrogate data) was not affected by smoking. This indicates that, under resting conditions, smoking/nicotine may have a modulating effect on input from the reticular activating system, with such input having a global, linearizing effect on cortical dynamics. Nonlinear dynamics resulting from intracortical processes appear not to be affected.

Flexible effects of quantified cigarette-smoke delivery on EEG dimensional complexity.

A quantified smoke delivery system (QSDS) was used to experimentally control the administration of inhaled cigarette smoke to 28 male smokers. One puff (2 s, 35 cc) was taken every 30 s on a cigarette (nicotine yield 1.0 mg) until the char line reached 3 mm from the filter wrap. The smoke was inhaled for 5 s. Resting eyes-closed and eyes-open EEG was recorded from F3, F4, P3, and P4 before and after quantified smoke delivery (QSD). EEG dimensional complexity (DCx, a measure derived from chaos theory) was computed using the Takens-Ellner method. QSD appeared to have a 'flexible' effect on EEG DCx, primarily lowering it in subjects whose pre-smoking level was high, not affecting it in subjects whose pre-smoking level was intermediate, and tending to raise it in subjects whose pre-smoking level was low. This replicates previous results obtained with ad libitum smoking, suggesting the hypothesis that smoking may have an "optimizing" effect on the complexity of brain dynamics.

HIV and the brain: evidence of early involvement and progressive damage.

AIDS is often accompanied by progressive encephalopathy and 'subcortical' dementia, but there is uncertainty regarding how early the brain involvement may begin in the course of HIV infection. This study used a cognitive auditory 'oddball' paradigm to elicit sensory and cognitive event related potential (ERP) components from healthy controls and from patients at different stages of HIV infection. Sensory component latencies did not differ between groups, but cognitive components showed progressive delays corresponding to increasingly severe clinical stages of HIV infection. The earliest changes were found among asymptomatic HIV + patients, suggesting that this test is a sensitive indicator of early subclinical CNS damage. In contrast, neither frequency analysis nor nonlinear dynamical analysis of the EEG showed differences between healthy controls and patients.

Uterine rupture during pregnancy in a patient with a history of hysteroscopic metroplasty.

BACKGROUND: Uterine septa may be responsible for spontaneous abortion. Hysteroscopic metroplasty may improve pregnancy outcome. CASE: A patient with a history of hysteroscopic resection of a uterine septum presented in preterm labor. This was her second pregnancy following the procedure; the first resulted in a term vaginal delivery. This second pregnancy ended with a preterm cesarean delivery. A 3.5 x 3.5-cm fundal rupture was discovered during the cesarean. The metroplasty had been performed with the KTP laser under direct laparoscopic visualization. No surgical complications had occurred. CONCLUSIONS: Uterine rupture during a pregnancy may occur following hysteroscopic metroplasty, even when no complications occur at surgery and even if a normal pregnancy outcome follows the procedure. Physicians providing care for patients who have had hysteroscopic metroplasty should be aware of the potential for uterine rupture during pregnancy.