Over-the-Counter Analgesic-Related Exposure and Toxicity in Pediatrics.

BACKGROUND: Analgesics are one of the most commonly purchased and used OTC medication classes from pharmacies in the United States. Drug toxicity is a leading cause of injury death in the United States. Limited studies, if any, have examined the impact of specific OTC medication toxicities in the pediatric population. OBJECTIVE: To examine the toxicity arising from the use of over-the-counter (OTC) analgesic medications in pediatric patients in Ohio. METHODS: Data from National Poison Data System for Ohio was obtained for the past 5 years. This data was processed to focus on target populations; pediatrics defined as ages 0-17 years experiencing toxicities related to OTC analgesic medications. The data was categorized into three groups: 0-6 years old, 7-12 years old, and 13-17 years old and reported toxicity was studied based on medications used/given, reasoning for toxicity, and medical outcomes. RESULTS: Patients aged 0-6 years mainly experienced toxicities from acetaminophen (35%) and ibuprofen (52.7%), due to unintentional exposure (general misuse and therapeutic error; 74.2% and 25.4%, respectively), causing primarily minimal clinical effect (48.4%). Ages 7-12 experienced toxicities from acetaminophen (38.5%) and ibuprofen (44.9%) due to unintentional exposure therapeutic error (44.8%) and intentional suspected suicides (30.1%), causing mainly minimal clinical effects (35.5%) and no effect (23.4%). Pediatric ages 13-17 experienced toxicities due to ibuprofen (36.3%) and acetaminophen (38.9%), with primary reasoning of intentional suspected suicide (81.3%), causing medical outcomes of minor effect and no effect (38.2% and 31.2%, respectively). A chi-square test was performed to analyze correlation between case intention (unintentional or intentional) and age group. Proportion of intentional exposures differ by age [X2 (2, N = 18,766) = 14672, p < .0001]. CONCLUSION: Observations from this study underscore the importance of raising awareness about OTC analgesic toxicities which remain prominent in Ohio.

Anticancer Effects of the Novel Pyrazolyl-Urea GeGe-3.

In a screen of over 200 novel pyrazole compounds, ethyl 1-(2-hydroxypentyl)-5-(3-(3-(trifluoromethyl) phenyl)ureido)-1H-pyrazole-4-carboxylate (named GeGe-3) has emerged as a potential anticancer compound. GeGe-3 displays potent anti-angiogenic properties through the presumptive targeting of the protein kinase DMPK1 and the Ca2+-binding protein calreticulin. We further explored the anticancer potential of GeGe-3 on a range of established cancer cell lines, including PC3 (prostate adenocarcinoma), SKMEL-28 (cutaneous melanoma), SKOV-3 (ovarian adenocarcinoma), Hep-G2 (hepatocellular carcinoma), MDA-MB231, SKBR3, MCF7 (breast adenocarcinoma), A549 (lung carcinoma), and HeLa (cervix epithelioid carcinoma). At concentrations in the range of 10 µM, GeGe-3 significantly restricted cell proliferation and metabolism. GeGe-3 also reduced PC3 cell migration in a standard wound closure and trans-well assay. Together, these results confirm the anticancer potential of GeGe-3 and underline the need for more detailed pre-clinical investigations into its molecular targets and mechanisms of action.

Emotional distress predicts palliative cancer care attitudes: The unique role of anger.

OBJECTIVE: Although palliative care can mitigate emotional distress, distressed patients may be less likely to engage in timely palliative care. This study aims to investigate the role of emotional distress in palliative care avoidance by examining the associations of anger, anxiety, and depression with palliative care attitudes. METHODS: Patients (N = 454) with heterogeneous cancer diagnoses completed an online survey on emotional distress and palliative care attitudes. Emotional distress was measured using the Patient-Reported Outcomes Measurement Information System anger, anxiety, and depression scales. The Palliative Care Attitudes Scale was used to measure palliative care attitudes. Regression models tested the impact of a composite emotional distress score calculated from all three symptom measures, as well as individual anger, anxiety, and depression scores, on palliative care attitudes. All models controlled for relevant demographic and clinical covariates. RESULTS: Regression results revealed that patients who were more emotionally distressed had less favorable attitudes toward palliative care (p < 0.001). In particular, patients who were angrier had less favorable attitudes toward palliative care (p = 0.013) while accounting for depression, anxiety, and covariates. Across analyses, women had more favorable attitudes toward palliative care than men, especially with regard to beliefs about palliative care effectiveness. CONCLUSIONS: Anger is a key element of emotional distress and may lead patients to be more reluctant toward timely utilization of palliative care. Although psycho-oncology studies routinely assess depression or anxiety, more attention to anger is warranted. More research is needed on how best to address anger and increase timely utilization of palliative cancer care.

Despite popular intuition, positive world beliefs poorly reflect several objective indicators of privilege, including wealth, health, sex, and neighborhood safety.

OBJECTIVES: We tested whether generalized beliefs that the world is safe, abundant, pleasurable, and progressing (termed "primal world beliefs") are associated with several objective measures of privilege. METHODS: Three studies (N = 16,547) tested multiple relationships between indicators of privilege-including socioeconomic status, health, sex, and neighborhood safety-and relevant world beliefs, as well as researchers and laypeople's expectations of these relationships. Samples were mostly from the USA and included general population samples (Study 2) as well as focused samples of academic researchers (Study 1) and people who had experienced serious illness or trauma (Study 3). RESULTS: Studies 1-2 found mostly negligible relationships between world beliefs and indicators of privilege, which were invariably lower than researcher predictions (e.g., instead of the expected r = 0.33, neighborhood affluence correlated with Abundant world belief at r = 0.01). Study 3 found that people who had experienced serious illness (cancer, cystic fibrosis) only showed modest differences in beliefs from controls. CONCLUSIONS: While results do not preclude that some individuals' beliefs were meaningfully affected by life events, they imply that such changes are smaller or less uniform than widely believed and that knowing a person's demographic background may tell us relatively little about their beliefs (and vice versa).

Application of Terror Management Theory to End-Of-Life Care Decision-Making: A Narrative Literature Review.

Patients with serious illnesses often do not engage in discussions about end-of-life care decision-making, or do so reluctantly. These discussions can be useful in facilitating advance care planning and connecting patients to services such as palliative care that improve quality of life. Terror Management Theory, a social psychology theory stating that humans are motivated to resolve the discomfort surrounding their inevitable death, has been discussed in the psychology literature as an underlying basis of human decision-making and behavior. This paper explores how Terror Management Theory could be extended to seriously ill populations and applied to their healthcare decision-making processes and quality of care received.

Anxiety, depression, and end-of-life care utilization in adults with metastatic cancer.

OBJECTIVE: End-of-life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end-of-life care in metastatic cancer. METHODS: This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011-12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. RESULTS: Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter. CONCLUSIONS: Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end-of-life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end-of-life care.

Changes in taste and smell of food during prostate cancer treatment.

PURPOSE: The present study examined the prevalence of changes in the taste and smell of food among men with advanced prostate cancer who were receiving hormone therapy and/or chemotherapy. METHOD: Participants were 75 men with advanced prostate cancer treated at an academic medical center. They completed a prospective survey about nausea while eating, taste and smell of food, and appetite periodically during a mean of 1.3 years of follow-up. Demographics, treatments, and weight data were extracted from electronic health records. Logistic regression analyses were used to examine the associations between the presence of the symptoms surveyed, treatments, and weight loss of ≥10%. RESULTS: Participants experienced poor taste of food (17%) and poor smell of food (8%) during the study. Nausea was associated with an increased likelihood of experiencing poor taste (50.0% v 12.3%, OR=7.13, P=.008) and smell (30.0% v 4.6%, OR=8.86, P=.016) of food. Poor taste of food was associated with an increased likelihood of experiencing poor appetite (35.0% v 10.9%, OR=12.43, P<.001). Participants were more likely to experience poor taste of food at any point in the study if they were being treated with denosumab (35.0% v 10.9%, OR=4.40, P=.020) or docetaxel (41.7% v 12.7%, OR=4.91, P=.022). Participants were more likely to experience ≥10% weight loss if experiencing poor taste of food (38.4% v 8.6%, OR=6.63, P=.010) or poor appetite (60.0% v 6.6%, OR=21.38, P<.001). CONCLUSION: Clinicians should query patients for changes in taste and smell of food, especially if they are experiencing weight loss.

Targeting the ERG oncogene with splice-switching oligonucleotides as a novel therapeutic strategy in prostate cancer.

BACKGROUND: The ERG oncogene, a member of the ETS family of transcription factor encoding genes, is a genetic driver of prostate cancer. It is activated through a fusion with the androgen-responsive TMPRSS2 promoter in 50% of cases. There is therefore significant interest in developing novel therapeutic agents that target ERG. We have taken an antisense approach and designed morpholino-based oligonucleotides that target ERG by inducing skipping of its constitutive exon 4. METHODS: We designed antisense morpholino oligonucleotides (splice-switching oligonucleotides, SSOs) that target both the 5' and 3' splice sites of ERG's exon 4. We tested their efficacy in terms of inducing exon 4 skipping in two ERG-positive cell lines, VCaP prostate cancer cells and MG63 osteosarcoma cells. We measured their effect on cell proliferation, migration and apoptosis. We also tested their effect on xenograft tumour growth in mice and on ERG protein expression in a human prostate cancer radical prostatectomy sample ex vivo. RESULTS: In VCaP cells, both SSOs were effective at inducing exon 4 skipping, which resulted in a reduction of overall ERG protein levels up to 96 h following a single transfection. SSO-induced ERG reduction decreased cell proliferation, cell migration and significantly increased apoptosis. We observed a concomitant reduction in protein levels for cyclin D1, c-Myc and the Wnt signalling pathway member ß-catenin as well as a marker of activated Wnt signalling, p-LRP6. We tested the 3' splice site SSO in MG63 xenografts in mice and observed a reduction in tumour growth. We also demonstrated that the 3' splice site SSO caused a reduction in ERG expression in a patient-derived prostate tumour tissue cultured ex vivo. CONCLUSIONS: We have successfully designed and tested morpholino-based SSOs that cause a marked reduction in ERG expression, resulting in decreased cell proliferation, a reduced migratory phenotype and increased apoptosis. Our initial tests on mouse xenografts and a human prostate cancer radical prostatectomy specimen indicate that SSOs can be effective for oncogene targeting in vivo. As such, this study encourages further in vivo therapeutic studies using SSOs targeting the ERG oncogene.

Cytokinin activity during early kernel development corresponds positively with yield potential and later stage ABA accumulation in field-grown wheat (Triticum aestivum L.).

MAIN CONCLUSION: Early cytokinin activity and late abscisic acid dynamics during wheat kernel development correspond to cultivars with higher yield potential. Cytokinins represent prime targets for marker development for wheat breeding programs. Two major phytohormone groups, abscisic acid (ABA) and cytokinins (CKs), are of crucial importance for seed development. Wheat (Triticum aestivum L.) yield is, to a high degree, determined during the milk and dough stages of kernel development. Therefore, understanding the hormonal regulation of these early growth stages is fundamental for crop-improvement programs of this important cereal. Here, we profiled ABA and 25 CK metabolites (including active forms, precursors and inactive conjugates) during kernel development in five field-grown wheat cultivars. The levels of ABA and profiles of CK forms varied greatly among the tested cultivars and kernel stages suggesting that several types of CK metabolites are involved in spatiotemporal regulation of kernel development. The seed yield potential was associated with the elevated levels of active CK levels (tZ, cZ). Interestingly, the increased kernel cZ levels were followed by higher ABA production, suggesting there is an interaction between these two phytohormones. Furthermore, we analyzed the expression patterns of representatives of the four main CK metabolic gene families. The unique transcriptional patterns of the IPT (biosynthesis) and ZOG (reversible inactivation) gene family members (GFMs) in the high and low yield cultivars additionally indicate that there is a significant association between CK metabolism and yield potential in wheat. Based on these results, we suggest that both CK metabolites and their associated genes, can serve as important, early markers of yield performance in modern wheat breeding programs.

Projected warming disrupts the synchrony of riparian seed release and snowmelt streamflow.

Globally, spring phenology and abiotic processes are shifting earlier with warming. Differences in the magnitudes of these shifts may decouple the timing of plant resource requirements from resource availability. In riparian forests across the northern hemisphere, warming could decouple seed release from snowmelt peak streamflow, thus reducing moisture and safe sites for dominant tree recruitment. We combined field observations with climate, hydrology, and phenology models to simulate future change in synchrony of seed release and snowmelt peaks in the South Platte River Basin, Colorado, for three Salicaceae species that dominate western USA riparian forests. Chilling requirements for overcoming winter endodormancy were strongest in Salix exigua, moderately supported for Populus deltoides, and indiscernible in Salix amygdaloides. Ensemble mean projected warming of 3.5°C shifted snowmelt peaks 10-19 d earlier relative to S. exigua and P. deltoides seed release, because decreased winter chilling combined with increased spring forcing limited change in their phenology. By contrast, warming shifted both snowmelt peaks and S. amygdaloides seed release 21 d earlier, maintaining their synchrony. Decoupling of snowmelt from seed release for Salicaceae with strong chilling requirements is likely to reduce resources critical for recruitment of these foundational riparian forests, although the magnitude of future decoupling remains uncertain.

The role of psychology in determining human-predator conflict across southern Kenya.

Conflict between people and carnivores can lead to the widespread killing of predators in retaliation for livestock loss and is a major threat to predator populations. In Kenya, a large, rural, pastoralist population comes into regular conflict with predators, which persist across southern Kenya. We explored the social and psychological backdrop to livestock management practices in this area in a process designed to be easy to use and suitable for use across large areas for the study of conflict and transboundary implementation of wildlife conflict reduction measures, focusing on community involvement and needs. We carried out fully structured interviews of livestock managers with a survey tool that examined how social and psychological factors may influence livestock management behavior. We compared survey responses on 3 sites across the study area, resulting in 723 usable responses. Efficacy of individuals' livestock management varied between and within communities. This variation was partially explained by normative and control beliefs regarding livestock management. Individual livestock managers' self-reported management issues were often an accurate reflection of their practical management difficulties. Psychological norms, control beliefs, and attitudes differed among sites, and these differences partially explained patterns associated with conflict (i.e., variation in livestock management behavior). Thus, we conclude that a one-size-fits-all approach to improving livestock management and reducing human-predator conflict is not suitable.

El Papel de la Psicología en la Determinación del Conflicto Humano - Depredador en el sur de Kenia Resumen El conflicto entre las personas y los carnívoros puede derivar en la cacería extendida de los depredadores como consecuencia de la pérdida del ganado, además de ser una amenaza importante para las poblaciones de depredadores. En Kenia, una gran población rural y pastora entra en conflicto regularmente con los depredadores, que son muy comunes en el sur del país. Exploramos el trasfondo social y psicológico de las prácticas de manejo de ganado en esta área en un proceso diseñado para ser fácil de usar y adecuado para grandes áreas para el estudio del conflicto y la implementación transfronteriza de medidas de reducción del conflicto con la fauna. Nos enfocamos particularmente en las necesidades y en la participación de la comunidad. Realizamos entrevistas estructuradas a los manejadores del ganado con una herramienta de censo que examinó cómo los factores psicológicos y sociales pueden influir sobre el comportamiento del manejador del ganado. Comparamos las respuestas del censo en tres sitios del área de estudio, lo que resultó en 723 respuestas útiles. La efectividad del manejo de ganado realizado por los individuos varió entre y dentro de las comunidades. Esta variación estuvo explicada parcialmente por las creencias normativas y de control en relación al manejo del ganado. Los temas de manejo reportados por los mismos manejadores individuales de ganado casi siempre fueron un reflejo acertado de sus complicaciones prácticas en el manejo. Las normas psicológicas, las creencias de control y las actitudes difirieron entre sitios, y estas diferencias explicaron parcialmente los patrones asociados con el conflicto (es decir, la variación en el comportamiento del manejador del ganado). Por lo tanto, concluimos que una estrategia igual-para-todos para mejorar el manejo del ganado y reducir el conflicto humano - depredador no es la adecuada.

Perceived importance of affective forecasting in cancer treatment decision making.

PURPOSE: To examine whether adults with cancer view affective forecasting as important for treatment decisions, and to examine these perceptions among key subgroups. DESIGN: Adults with cancer (N = 376) completed a cross-sectional survey that included demographic and clinical characteristics, the IPIP five-factor personality measure, and a rating of the perceived importance of affective forecasting for cancer treatment decisions. Descriptive statistics characterized the importance of affective forecasting. Multivariate analyses examined whether health and personality variables were associated with affective forecasting importance. FINDINGS: Most participants (89.6%) identified affective forecasting as important for treatment decisions. Affective forecasting was more likely to be rated as important among patients with prostate cancer (p < .001), patients lower in neuroticism (p = .02), and patients higher in agreeableness (p = .004). Conclusions/Implications: Patients believe it is important to understand how treatments will impact their emotional well-being. Oncology clinicians should discuss with patients these consequences during healthcare decision-making.

Distress among African American and White adults with cancer in Louisiana.

Purpose/Objectives: Screening for distress is a key priority in cancer care, and African American patients may experience increased distress compared to White patients. However, this question has not yet been addressed in Louisiana. The purpose of the present study was to examine the relationship between African American race and distress at a cancer center in Louisiana.Design/Methods: This was a retrospective study of 1,544 patients who were treated at an academic cancer center in 2015. Extracted data included patient self-reports of distress using the single-item Distress Thermometer (DT) and demographic and clinical characteristics. Hypotheses were tested using logistic regression.Findings: Distress was present in 19.7% of the sample. In univariate analyses, African American patients were more likely than White patients to experience distress (OR = 1.38, p = .013). However, race was no longer associated with distress in a multivariate analysis that adjusted for the covariates of age, gender, cancer site, presence of metastases, and number of distress screenings (OR = 1.07, p = .670). Distress was more common in patients who were younger (OR = 2.26, p < .001), diagnosed with lung/bronchus cancer (OR = 5.28, p < .001), or screened more often (OR = 5.20, p < .001). Distress was less common among patients with female breast cancer (OR = 0.39, p = .015).Conclusions/Implications: This study suggests that African American individuals with cancer in Louisiana are at increased risk for distress, but that this can be attributed to African American patients being younger, more likely to have lung cancer, and screened more frequently. Implications include careful consideration of patient race, age, and cancer site during distress management in cancer care.

A Validation Study of the Mini-IPIP Five-Factor Personality Scale in Adults With Cancer.

The Mini International Personality Item Pool (Mini-IPIP) is a brief measure of the Five-Factor Model of personality with documented validity in healthy samples of adults and could be useful for assessing personality in patient populations such as individuals with cancer. The purpose of this study was to examine the psychometric properties of the Mini-IPIP in 2 samples of adults with cancer. A sample of 369 (Sample 1) and a sample of 459 (Sample 2) adults with cancer completed an online survey including the Mini-IPIP. To assess criterion validity, Sample 2 completed measures of emotional distress. Analyses included internal consistency (Samples 1 and 2), confirmatory factor analyses (CFAs; Samples 1 and 2), and correlations and a structural regression model to examine the associations between the 5 personality factors and emotional distress (Sample 2 only). Results showed that the Mini-IPIP demonstrated levels of internal consistency and CFA model fit that were similar to previous validation studies conducted in the general population. Consistent with prior research and theory, this study also found that personality factors measured by the Mini-IPIP were associated with measures of emotional distress in Sample 2. These findings suggest the potential utility of the Mini-IPIP in both research and clinical settings involving individuals with cancer.

Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: In advanced cancer, patients want to know how their care options may affect survival and quality of life, but the impact of outpatient specialty palliative care on these outcomes in cancer is uncertain. PURPOSE: To estimate the impact of outpatient specialty palliative care programs on survival and quality of life in adults with advanced cancer. METHODS: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing outpatient specialty palliative care with usual care in adults with advanced cancer. Primary outcomes were 1 year survival and quality of life. Analyses were stratified to compare preliminary studies against higher-quality studies. Secondary outcomes were survival at other endpoints and physical and psychological quality-of-life measures. RESULTS: From 2,307 records, we identified nine studies for review, including five high-quality studies. In the three high-quality studies with long-term survival data (n = 646), patients randomized to outpatient specialty palliative care had a 14% absolute increase in 1 year survival relative to controls (56% vs. 42%, p < .001). The survival advantage was also observed at 6, 9, 15, and 18 months, and median survival was 4.56 months longer (14.55 vs. 9.99 months). In the five high-quality studies with quality-of-life data (n = 1,398), outpatient specialty palliative care improved quality-of-life relative to controls (g = .18, p < .001), including for physical and psychological measures. CONCLUSIONS: Patients with advanced cancer randomized to receive outpatient specialty palliative care lived longer and had better quality of life. Findings have implications for improving care in advanced cancer.

Reducing the Hypertensive Effects of the Prolonged Surgical Tourniquet Using a Dual-Cuff Strategy: A Prospective Randomized Controlled Trial.

We evaluated whether moving the "line of crush" from thigh to the calf before onset of tourniquet-mediated hypertension would prevent or diminish it. We also evaluated any change in pain or functional outcome. Twenty adult patients were recruited and randomly assigned to either control or intervention groups. Inclusion criteria: any willing participant >18 years old with foot and/or ankle pathology requiring an operation lasting >90 minutes. Exclusion criteria included contraindication to general anesthesia, peripheral neuropathy affecting lower limbs of any etiology, or chronic pain requiring regular opiate analgesia. The intervention group received a thigh tourniquet for 60 minutes, after which a calf tourniquet was inflated and the thigh tourniquet was deflated. The control group received only a thigh tourniquet throughout surgery. At 90 minutes, the control group had mean arterial pressure of 86.8 mmHg, compared with the intervention group at 76.3 mmHg (p ≤ .014). At end of surgery, the difference had increased further (control 98.1 mmHg, intervention 78.3 mmHg (p ≤ .001). Moving the line of crush during limb tourniquet application prevents development of the hypertensive response. For cases in which a prolonged tourniquet application is required, a dual-tourniquet technique will prevent intraoperative hypertension and may influence long-term pain and function.

Understanding the distressed prostate cancer patient: Role of personality.

OBJECTIVE: To evaluate the relationship between personality and emotional distress in prostate cancer. Neuroticism and introversion were hypothesized to be associated with clinically significant symptoms of emotional distress, including depression, anxiety, and suicidal ideation. METHODS: Men with a history of prostate cancer (n = 212) completed an NIH-funded cross-sectional study using well-validated measures of personality, depression, anxiety, and suicidal ideation. Covariates were age, education, time since diagnosis, comorbidity, and presence of metastases. RESULTS: Emotional distress was reported by 37% of participants, including depression (23%), anxiety (15%), and suicidal ideation (10%). As hypothesized, men who were more neurotic were more likely to report emotional distress (44.5% vs 26.9%; OR = 2.78, P = .004), depression (31.9% vs 11.8%; OR = 4.23, P = .001), and suicidal ideation (29.4% vs 9.7%; OR = 4.15, P = .001). Introverts were more likely to report emotional distress (45.2% vs 28.7%; OR = 2.32, P = .012) and depression (30.8% vs 15.7%; OR = 2.57, P = .014). Men with metastases were more likely to report emotional distress (51.7% vs 31.2%; OR = 4.56, P < .001). CONCLUSIONS: Neuroticism and introversion were associated with clinically significant emotional distress in men with prostate cancer. Findings suggest that, in the context of treatment for prostate cancer, patient distress reflects disease characteristics (eg, metastases presence) as well as stable personality traits. Implications for clinical care are discussed.

Measurement of glomerular filtration rate in patients undergoing obesity surgery.

BACKGROUND: Most studies on obesity surgery have measured renal function using the estimated GFR. However, due to the reduction of muscle mass, and therefore creatinine that accompanies weight loss, such measures can falsely suggest an improvement in renal function. To balance the risks of surgery versus any potential benefits on renal function, we need to be able to determine renal function using valid and reliable methodologies. In this pilot study we aimed to measure renal function in patients with CKD undergoing obesity surgery using the gold standard 51Cr-EDTA GFR clearance methodology which is independent of measures of muscle mass. METHODS: Nine consecutive obese patients with CKD underwent obesity surgery. Their renal function was assessed using 51Cr-EDTA GFR, cystatin C and serum creatinine as well as using eGFR equations including MDRD CKD Epi, Cockcroft Gault and CKD Epi cystatin before and 12 months after surgery. RESULTS: Renal function using the 51Cr-EDTA measured GFR did not change significantly after surgery. Similar results were obtained when Cystatin C, CKD Epi cystatin, CKD Epi cystatin creatinine and adjusted Cockcroft Gault Creatinine clearance methods were used. In contrast there were either trends or significant improvements in renal function measured using the MDRD and CKD Epi equations. CONCLUSIONS: In this pilot study using the gold standard 51Cr-EDTA method we found stabilisation in renal function after obesity surgery. Until further definitive data emerge it is critical to balance the risk and benefits of surgery, especially if renal function may not improve as often as previously suggested. TRIAL REGISTRATION: ClinicalTrials.gov NCT01507350 . Registered June 2011.

Epidemiological study of dogs with otitis externa in Cape Breton, Nova Scotia.

From May 2008 to December 2013, 320 cases of otitis externa were diagnosed among 2012 dogs undergoing routine physical examinations at Celtic Creatures Veterinary Clinic, Sydney River, Nova Scotia for a diagnosis frequency of 15.9% [95% confidence interval (CI): 14.3% to 17.6%]. Twenty-four percent of these dogs exhibited 1 or multiple recurrences despite initial treatment with topical antimicrobial/anti-inflammatory solutions. The frequency of diagnosis was significantly higher in breeds with pendulous ears, but was not affected by ear hairiness. There were no seasonal patterns in the frequency of diagnosis. In clinical examination of 60 dogs with otitis externa, bacteria were evident in 47% of infections. Of 10 genera cultured, Staphylococcus spp. and diptheroids were most common. In this study, analysis of clinical records provided insights into the local prevalence of otitis externa and the efficacy of treatment in routine clinical situations.

Étude épidémiologique des chiens atteints d'une otite externe au cap Breton, en Nouvelle-Écosse. De mai 2008 à décembre 2013, 320 cas d'otite externe ont été diagnostiqués parmi 2012 chiens subissant des examens de routine à la Celtic Creatures Veterinary Clinic, pour une fréquence de diagnostic de 15,9 % (IC de 95 % : de 14,3 % à 17,6 %). Vingt-quatre pour cent des chiens ont manifesté une ou plusieurs récurrences malgré le traitement initial avec des solutions topiques antimicrobiennes/anti-inflammatoires. La fréquence du diagnostic était significativement supérieure chez les races avec des oreilles pendantes, mais elle n'était pas affectée par la présence de poils dans l'oreille. Il n'y avait aucun profil saisonnier dans la fréquence du diagnostic. Dans un examen clinique de 60 chiens avec une otite externe, les bactéries étaient évidentes dans 47 % des infections. Parmi les 10 genres pour lesquels une culture a été réalisée, Staphylococcus spp. et les dipthéroïdes étaient les plus fréquents. Dans cette étude, l'analyse des dossiers cliniques a fourni des renseignements sur la prévalence locale de l'otite externe et l'efficacité du traitement des situations cliniques de routine.(Traduit par Isabelle Vallières).

Social Media Awareness and Implications in Nursing Leadership.

Many nursing professionals-may be reluctant to engage in or are confused about appropriate use of social media in a clinical, research, or policy context. To address this issue, we developed a study to enhance nurse leaders' facility with social media in the context of a national professional meeting. This study examined a social media campaign at the 2015 American Academy of Nursing conference. The campaign was intended to bridge the gap between active social media users and nonusers attending the conference. Following a targeted social media campaign at the American Academy of Nursing 2015 Transforming Health, Driving Policy Conference, responses to the conference evaluation questions about social media were reviewed and analyzed. Overall, evaluations were positive about the campaign; however, some conference attendees were not aware of its various components. Despite perceived barriers to its use, there is significant curiosity about social media use among nurse leaders. With the engagement of these leaders, there may be opportunities to enhance social media use at professional meetings and to make broader use of this valuable tool throughout the nursing profession.