Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients-An analysis from the Brazilian Hodgkin Lymphoma Registry.

Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. The purpose of this study was to analyze the impact of the SES on the outcomes of Hodgkin lymphoma (HL) patients from the Brazilian Prospective HL Registry. SES stratification was done using an individual asset/education-based household index. A total of 624 classical HL patients with diagnosis from January/2009 to December/2014, and treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), were analyzed. The median follow-up was 35.6 months, and 33% were classified as lower SES. The 3-year progression- free survival (PFS) in higher and lower SES were 78 and 64% (p < 0.0001), respectively. The 3-year overall survival (OS) in higher and lower SES were 94 and 82% (p < 0.0001), respectively. Lower SES patients were more likely to be ≥ 60 years (16 vs. 8%, p = 0.003), and to present higher risk International Prognostic score (IPS) (44 vs. 31%, p = 0.004) and advanced disease (71 vs. 58%, p = 0.003). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR = 3.12 [1.86-5.22] for OS and HR = 1.66 [1.19-2.32] for PFS). The fatality ratio during treatment was 7.5 and 1.3% for lower and higher SES (p = 0.0001). Infections and treatment toxicity accounted for 81% of these deaths. SES is an independent factor associated with shorter survival in HL in Brazil. Potential underlying mechanisms associated with the impact of SES are delayed diagnosis and poorer education. Educational and socio-economic support interventions must be tested in this vulnerable population.

Treatment outcomes for Hodgkin lymphoma: First report from the Brazilian Prospective Registry.

Data about Hodgkin lymphoma (HL) in developing countries are scarce and suggest the existence of substantial disparities in healthcare and outcomes in large areas of the world. In 2009, a prospective registry of HL was implemented in Brazil. Web-based data were contributed by 20 institutions across the country participating in the Brazilian Prospective Hodgkin's Lymphoma Registry. The aim of this study was to present the clinical features and outcomes of newly diagnosed patients with HL aged 13 to 90 years. Multivariate Cox regression models were used to estimate progression-free (PFS) and overall survival (OS) by clinical factors. A total of 674 patients with classical HL were analysed, with a median follow-up of 37 months. Median age was 30 years (13-90). The median time from the onset of symptoms to diagnosis was 6 months (0-60). Only 6% of patients had early favourable disease, while 65% had advanced disease. Stage IVB was present in 26% and a high-risk International Prognostic Score in 38%. Doxorubicin, bleomycin, vinblastine, and dacarbazine was used in 93%. The median dose of radiotherapy was 36 Gy for localized disease and 32 Gy for advanced disease. The 3 year PFS in early favourable, early unfavourable, and advanced disease were 95%, 88%, and 66%, respectively. High-risk International Prognostic Score, advanced disease, and age greater than or equal to 60 were independently associated with poorer PFS and OS; performance status greater than or equal to 2 was also associated with a poorer OS. Poor-risk patients predominated. Radiation doses for localized disease appear higher than current recommendations. Outcomes appear inferior in developing countries than in developed countries. Delayed diagnosis is probably a major factor underlying these findings. Scattered reports from developing nations suggest that many aspects of standard care in developed countries remain unmet needs for populations living in developing countries. The present report contributes to this body of data, with a proper description of what is currently achieved in urban areas in Brazil.

Slow fluctuations in attentional control of sensory cortex.

Top-down control of visual sensory cortex has long been tied to the orienting of visual spatial attention on a rapid, moment-to-moment basis. Here, we examined whether sensory responses in visual cortex are also modulated by natural and comparatively slower fluctuations in whether or not one is paying attention to the task at hand. Participants performed a simple visual discrimination task at fixation as the ERPs to task-irrelevant probes in the upper visual periphery were recorded. At random intervals, participants were stopped and asked to report on their attentional state at the time of stoppage-either "on-task" or "off-task." ERPs to the probes immediately preceding these subjective reports were then examined as a function of whether attention was in an on-task versus off-task state. We found that sensory-evoked responses to the probes were significantly attenuated during off-task relative to on-task states, as measured by the visual P1 ERP component. In two additional experiments, we replicated this effect while (1) finding that off-task sensory attenuation extends to the auditory domain, as measured by the auditory N1 ERP component, and (2) eliminating state-dependent shifts in general arousal as a possible explanation for the effects. Collectively, our findings suggest that sensory gain control in cortex is yoked to the natural ebb and flow in how much attention we pay to the current task over time.

Effects of mountain beaver management and thinning on 15-year-old Douglas fir growth and survival.

We examined 4-year growth of 15-year-old damaged and undamaged Douglas fir (Pseudotsuga menzesii) after integrating temporary population reductions of mountain beaver (Aplodontia rufa) with thinning in a pre-commercial hand-planted plantation in western Washington. Five treatment combinations were considered: (1) trapping mountain beavers in an unthinned area, (2) trapping before thinning to 65 trees/ha (160 trees/ac), (3) no trapping and thinning to 65 trees/ha, (4) no trapping and thinning to 146 trees/ha (360 trees/ac), and (5) no trapping and no thinning. Removal of ≥ 90 % of mountain beavers temporarily reduced mountain beaver activity whether the stand was unthinned or thinned. Diameter growth at breast height (dbh) was greater for undamaged trees than for damaged trees in thinned areas. Tree height growth was greatest in trapped areas whether thinned or not. No differences were detected in 4-year survival between trees damaged aboveground and those without aboveground damage, which may be related to undetected root damage to trees without aboveground damage. Basal diameter growth and dbh growth were greatest for areas thinned to 65 trees/ha. Seventy-eight percent of stomachs from mountain beaver trapped in winter contained Douglas fir root or stem materials. Overall, short-term removal of mountain beavers integrated with pre-commercial thinning promoted growth of crop trees.

Mind wandering in sentence reading: decoupling the link between mind and eye.

When people read, their thoughts sometimes drift away from the task at hand: They are "mind wandering." Recent research suggests that this change in task focus is reflected in eye movements and this was tested in an experiment using controlled stimuli. Participants were presented with a series of sentences containing high- and low-frequency words, which they read while being eye-tracked, and they were sometimes probed to indicate whether they were on task or mind wandering. The results showed multiple differences between reading prior to a mind-wandering response and reading when on task: Mind wandering led to slower reading times, longer average fixation duration, and an absence of the word frequency effect on gaze duration. Collectively, these findings confirm that task focus could be inferred from eye movements, and they indicate that the link between word identification and eye scanning is decoupled when the mind wanders.

Everyday attention and lecture retention: the effects of time, fidgeting, and mind wandering.

We have all had our thoughts wander from the immediate task at hand. The emerging embodied cognition literature emphasizes the role that the body plays in human thought, and raises the possibility that changes in attentional focus may be associated with changes in body behavior. Recent research has found that when individuals view a lecture, mind wandering increases as a function of time. In the present study we asked whether this decline in attention during lecture viewing was associated with fidgeting. Participants were filmed while they watched a 40-min lecture video, and at regular 5-min intervals provided ratings of their attentiveness. Following the lecture, participant's memory for the material was assessed. Fidgeting behavior was coded from video recordings of each session. Results indicated that attention to, and retention of, lecture material declined as a function of time on task. Critically, and as predicted, fidgeting also increased with time on task. We also found that the relation between fidgeting and retention was significant even when the role of attention was factored into the equation, suggesting that fidgeting makes a unique contribution to retention of lecture material over and above that contributed by an individual's attention. We propose a novel non-attentional stress-based account of fidgeting and how this impacts retention for lecture material over and above changes in levels in mind wandering vis-a-vis changes in attention.