Unmet supportive care needs in prostate cancer survivors with advanced disease: A mixed-methods exploration.

Purpose: Men with advanced prostate cancer experience a wide range of side effects from the cancer and its therapies, which have a negative effect on their quality of life (QOL). Few studies have evaluated supportive care needs in these individuals. The purpose of this study was to conduct a holistic supportive care needs assessment among these survivors guided by the Supportive Care Framework for Cancer Care. Methods: Using a convergent parallel mixed-methods approach, prostate cancer survivors with advanced disease (n = 188) completed a cross-sectional survey. A subset of these survivors (n = 20) participated in an interview to further explore their experience of unmet needs. Results: Survivors reported unmet supportive care needs in every domain of the framework. Up to 95.2% of the survivors had at least one unmet need, with a mean of 14.9 (range: 0-42). Several areas of convergence among the quantitative and qualitative data (fatigue, sexual dysfunction, practical, and emotional/psychological domains), as well as divergence (informational and spiritual domains, depression, urinary dysfunction) were found through the integration process. Conclusions: This study confirms that prostate cancer survivors with advanced disease experience high rates of unmet supportive care needs. The findings also highlight the diversity of those unmet needs. These results may assist with future development of patient-centered supportive care interventions that better meet the specific needs of this vulnerable group of cancer survivors.

The effect of implant position on bone strain following lateral unicompartmental knee arthroplasty: A Biomechanical Model Using Digital Image Correlation.

OBJECTIVES: Unicompartmental knee arthroplasty (UKA) is a demanding procedure, with tibial component subsidence or pain from high tibial strain being potential causes of revision. The optimal position in terms of load transfer has not been documented for lateral UKA. Our aim was to determine the effect of tibial component position on proximal tibial strain. METHODS: A total of 16 composite tibias were implanted with an Oxford Domed Lateral Partial Knee implant using cutting guides to define tibial slope and resection depth. Four implant positions were assessed: standard (5° posterior slope); 10° posterior slope; 5° reverse tibial slope; and 4 mm increased tibial resection. Using an electrodynamic axial-torsional materials testing machine (Instron 5565), a compressive load of 1.5 kN was applied at 60 N/s on a meniscal bearing via a matching femoral component. Tibial strain beneath the implant was measured using a calibrated Digital Image Correlation system. RESULTS: A 5° increase in tibial component posterior slope resulted in a 53% increase in mean major principal strain in the posterior tibial zone adjacent to the implant (p = 0.003). The highest strains for all implant positions were recorded in the anterior cortex 2 cm to 3 cm distal to the implant. Posteriorly, strain tended to decrease with increasing distance from the implant. Lateral cortical strain showed no significant relationship with implant position. CONCLUSION: Relatively small changes in implant position and orientation may significantly affect tibial cortical strain. Avoidance of excessive posterior tibial slope may be advisable during lateral UKA.Cite this article: A. M. Ali, S. D. S. Newman, P. A. Hooper, C. M. Davies, J. P. Cobb. The effect of implant position on bone strain following lateral unicompartmental knee arthroplasty: A Biomechanical Model Using Digital Image Correlation. Bone Joint Res 2017;6:522-529. DOI: 10.1302/2046-3758.68.BJR-2017-0067.R1.

Resting state functional magnetic resonance imaging reveals distinct brain activity in heavy cannabis users - a multi-voxel pattern analysis.

Chronic cannabis use can cause cognitive, perceptual and personality alterations, which are believed to be associated with regional brain changes and possible changes in connectivity between functional regions. This study aims to identify the changes from resting state functional magnetic resonance imaging scans. A two-level multi-voxel pattern analysis was proposed to classify male cannabis users from normal controls. The first level analysis works on a voxel basis and identifies clusters for the input of a second level analysis, which works on the functional connectivity between these regions. We found distinct clusters for male cannabis users in the middle frontal gyrus, precentral gyrus, superior frontal gyrus, posterior cingulate cortex, cerebellum and some other regions. Based on the functional connectivity of these clusters, a high overall accuracy rate of 84-88% in classification accuracy was achieved. High correlations were also found between the overall classification accuracy and Barrett Barrett Impulsiveness Scale factor scores of attention and motor. Our result suggests regional differences in the brains of male cannabis users that span from the cerebellum to the prefrontal cortex, which are associated with differences in functional connectivity.

Olecranon fractures.

Several options exist for the management olecranon fractures. These include tension band, plate and intramedullary fixation techniques as well as fragment excision with triceps advancement and non-operative management. No one technique is suitable for the management of all olecranon fractures. In deciding how to treat this common trauma presentation, the surgeon needs a good understanding of the anatomy, different fracture morphologies, surgical options and potential complications. With appropriate management and early mobilisation good functional results can be expected in the majority of patients.

Baseline conditions and subtractive logic in neuroimaging.

Discrepancies in the patterns of cortical activation across studies may be attributable, in part, to differences in baseline tasks, and hence, reflect the limits of the subtractive logic underlying much of neuroimaging. To assess the extent of these effects, three of the most commonly used baseline conditions (rest, tone monitoring, and passive listening) were compared using phoneme discrimination as the experimental task. Eight participants were studied in a fMRI study with a 4.1 T system. The three baseline conditions systematically affected the amount of activation observed in the identical phoneme task with major affects in Broca's area, the left posterior superior temporal gyrus, and the left and right inferior parietal regions. Two central findings were: 1) a differential effect of baseline within each region, with the rest baseline condition producing the greatest amount of activation and the passive listening condition producing the least, and 2) systematic baseline task activation in the inferior parietal regions. These results emphasize the relativity of activation patterns observed in functional neuroimaging, and the necessity to specify the baseline processes in context to the experimental task processes.

Differences in auditory processing of words and pseudowords: an fMRI study.

Although there has been great interest in the neuroanatomical basis of reading, little attention has been focused on auditory language processing. The purpose of this study was to examine the differential neuroanatomical response to the auditory processing of real words and pseudowords. Eight healthy right-handed participants performed two phoneme monitoring tasks (one with real word stimuli and one with pseudowords) during a functional magnetic resonance imaging (fMRI) scan with a 4.1 T system. Both tasks activated the inferior frontal gyrus (IFG), the posterior superior temporal gyrus (pSTG) and the inferior parietal lobe (IPL). Pseudoword processing elicited significantly more activation within the posterior cortical regions compared with real word processing. Previous reading studies have suggested that this increase is due to an increased demand on the lexical access system. The left inferior frontal gyrus, on the other hand, did not reveal a significant difference in the amount of activation as a function of stimulus type. The lack of a differential response in IFG for auditory processing supports its hypothesized involvement in grapheme to phoneme conversion processes. These results are consistent with those from previous neuroimaging reading studies and emphasize the utility of examining both input modalities (e.g., visual or auditory) to compose a more complete picture of the language network.

Tolerance to spherical aberration induced by rigid contact lenses.

We have investigated the effects of spherical aberration (SA) on visual performance by fitting subjects with rigid lenses of varying front surface asphericity. Three pairs of lenses were worn by each subject with front surface asphericities of Q = 0 (conventional spherical surface), Q = -0.26 (similar to the average corneal asphericity) and Q = -0.51. The calculated average change in spherical aberration induced by each pair of contact lenses in photopic conditions was +0.02 D (Q = 0), -0.49 D (Q = -0.26) and -0.94 D (Q = -0.51). In mesopic conditions these same lenses induced an average change in spherical aberration of +0.01 D (Q = 0), -1.18 D (Q = -0.26) and -2.16 D (Q = -0.51). In this double-blind study, 12 adapted, low to moderate myopic rigid lens wearers wore each pair of lenses for one week and noted visual performance. With each pair of lenses we also measured the subject's visual acuity with high and low contrast logMAR charts. All measurements were conducted using the right eye at distance in photopic and mesopic conditions. When forced to select the lenses they would accept as compensation for participation in the study, most subjects (9 out of 12) chose the Q = 0 lenses, 3 subjects those the Q = -0.26 lenses and none of the subjects chose the Q = -0.51 lenses. Visual performance measures showed little difference between the Q = 0 and Q = -0.26 lenses. However, the Q = -0.51 lenses significantly reduced visual acuity in mesopic conditions with the low contrast acuity chart.