Frequency of psychological distress in gynecologic cancer patients seen in a large urban medical center.

Psychological distress in cancer is a well-documented phenomenon, but additional information is needed about demographic and disease correlates in diverse populations with different forms of cancer. This study focused on gynecologic cancers. Using the Distress Thermometer and the Hospital Anxiety and Depression Scale, this study examined distress levels in 94 women with gynecologic cancer who were being treated as outpatients at a large urban medical center. The distress levels in this sample were lower than in comparable studies, raising questions about openness to reporting distress. Those who reported higher levels of distress were more likely to also report a mental health diagnosis or psychiatric medication. This suggests that an alternate form for distress screening may involve inquiring about mental health treatment. In this sample, younger women and those with higher educational achievement or private health insurance had higher levels of distress. Conversely, there were no relations between distress levels and disease characteristics, indicating that, for example, women with early stage disease have just as much risk of distress as those with later-stage disease.

An early modern human presence in Sumatra 73,000-63,000 years ago.

Genetic evidence for anatomically modern humans (AMH) out of Africa before 75 thousand years ago (ka) and in island southeast Asia (ISEA) before 60 ka (93-61 ka) predates accepted archaeological records of occupation in the region. Claims that AMH arrived in ISEA before 60 ka (ref. 4) have been supported only by equivocal or non-skeletal evidence. AMH evidence from this period is rare and lacks robust chronologies owing to a lack of direct dating applications, poor preservation and/or excavation strategies and questionable taxonomic identifications. Lida Ajer is a Sumatran Pleistocene cave with a rich rainforest fauna associated with fossil human teeth. The importance of the site is unclear owing to unsupported taxonomic identification of these fossils and uncertainties regarding the age of the deposit, therefore it is rarely considered in models of human dispersal. Here we reinvestigate Lida Ajer to identify the teeth confidently and establish a robust chronology using an integrated dating approach. Using enamel-dentine junction morphology, enamel thickness and comparative morphology, we show that the teeth are unequivocally AMH. Luminescence and uranium-series techniques applied to bone-bearing sediments and speleothems, and coupled uranium-series and electron spin resonance dating of mammalian teeth, place modern humans in Sumatra between 73 and 63 ka. This age is consistent with biostratigraphic estimations, palaeoclimate and sea-level reconstructions, and genetic evidence for a pre-60 ka arrival of AMH into ISEA. Lida Ajer represents, to our knowledge, the earliest evidence of rainforest occupation by AMH, and underscores the importance of reassessing the timing and environmental context of the dispersal of modern humans out of Africa.

Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder.

OBJECTIVE: To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder. METHOD: A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7. RESULTS: The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD. CONCLUSION: Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.

A Neanderthal lower molar from Stajnia Cave, Poland.

The primary aim of this study was to conduct a taxonomic assessment of the second of three isolated human teeth found in the Stajnia Cave (north of the Carpathians, Poland) in 2008. The specimen was located near a human tooth (S5000), which was identified by Urbanowski et al. (2010) as a Neanderthal permanent upper molar. Both of these teeth were excavated from the D2 layer, which belongs to the D stratigraphic complex comprising the archaeological assemblage associated with the Micoquian tradition. An Ursus spelaeus bone and Mammuthus primigenius tooth that were also excavated from the D2 layer were dated to >49,000 years BP (by AMS (14)C) and 52.9 ka BP (by U-Th), respectively. The sediment overlying stratigraphic complex D was dated to 45.9 ka BP by the OSL method. The S4300 tooth is a lower first or second permanent molar belonging to an individual other than that who once possessed the S5000 tooth. The S4300 tooth exhibits a combination of traits typical of Neanderthal lower molars, including a mid-trigonid crest, large anterior fovea, taurodontism and subvertical grooves on the interproximal face, indicating that this tooth belonged to a Neanderthal individual. The S4300 tooth from Stajnia Cave is one of the oldest human remains found in Poland.

New chronology for the Middle Palaeolithic of the southern Caucasus suggests early demise of Neanderthals in this region.

Neanderthal populations of the southern and northern Caucasus became locally extinct during the Late Pleistocene. The timing of their extinction is key to our understanding of the relationship between Neanderthals and anatomically modern humans (AMH) in Eurasia. Recent re-dating of the end of the Middle Palaeolithic (MP) at Mezmaiskaya Cave, northern Caucasus, and Ortvale Klde, southern Caucasus, suggests that Neanderthals did not survive after 39 ka cal BP (thousands of years ago, calibrated before present). Here we extend the analysis and present a revised regional chronology for MP occupational phases in western Georgia, based on a series of model-based Bayesian analyses of radiocarbon dated bone samples obtained from the caves of Sakajia, Ortvala and Bronze Cave. This allows the establishment of probability intervals for the onset and end of each of the dated levels and for the end of the MP occupation at the three sites. Our results for Sakajia indicate that the end of the late Middle Palaeolithic (LMP) and start of the Upper Palaeolithic (UP) occurred between 40,200 and 37,140 cal BP. The end of the MP in the neighboring site of Ortvala occurred earlier at 43,540-41,420 cal BP (at 68.2% probability). The dating of MP layers from Bronze Cave confirms that it does not contain LMP phases. These results imply that Neanderthals did not survive in the southern Caucasus after 37 ka cal BP, supporting a model of Neanderthal extinction around the same period as reported for the northern Caucasus and other regions of Europe. Taken together with previous reports of the earliest UP phases in the region and the lack of archaeological evidence for an in situ transition, these results indicate that AMH arrived in the Caucasus a few millennia after the Neanderthal demise and that the two species probably did not interact.

Human evolution out of Africa: the role of refugia and climate change.

Although an African origin of the modern human species is generally accepted, the evolutionary processes involved in the speciation, geographical spread, and eventual extinction of archaic humans outside of Africa are much debated. An additional complexity has been the recent evidence of limited interbreeding between modern humans and the Neandertals and Denisovans. Modern human migrations and interactions began during the buildup to the Last Glacial Maximum, starting about 100,000 years ago. By examining the history of other organisms through glacial cycles, valuable models for evolutionary biogeography can be formulated. According to one such model, the adoption of a new refugium by a subgroup of a species may lead to important evolutionary changes.

The effect of water height on stride frequency, stride length and heart rate during water treadmill exercise.

REASONS FOR PERFORMING STUDY: Water treadmill exercise is often incorporated into rehabilitation programmes for horses yet little is known about the biomechanical and physiological responses to water walking. OBJECTIVES: To establish whether stride frequency (SF) reached steady state as a result of 6 introductory water treadmill sessions and then to investigate the effect of increasing water height on SF, stride length (SL) and heart rate (HR). METHODS: Nine horses with no previous experience of water treadmills completed 6 sessions of walking for between 15 and 30 min. Each horse was fitted with a leg mounted accelerometer to measure SF. The effect of session on SF was tested using univariate ANOVA. Eight horses completed 3 further sessions at each of the following water heights; proximal interphalangeal joint (PIP), carpus and ulna. SF, SL and HR at each water height were compared to a control (hoof height) using univariate ANOVA. RESULTS: When SF during introductory sessions 4-6 were compared, there was no significant effect of session on SF (P > 0.05). In the second part of the experiment, SF was 0.57 ± 0.03 strides/s at control, 0.54 ± 0.03 strides/s at the PIP joint, 0.51 ± 0.02 strides/s at the carpus and 0.52 ± 0.03 strides/s at the ulna. Stride frequency at carpal and ulna height was significantly lower than at control (P < 0.05). Stride length was 1.53 ± 0.09 m for control, 1.63 ± 0.10 m at the PIP joint, 1.71 ± 0.08 m at the carpus and 1.68 ± 0.10 m at the ulna. Stride length at carpal and ulna height was significantly greater than control (P < 0.05). There was no significant difference between HR during control and any other water height (P > 0.05). CONCLUSION: Horses reached steady state gait within the first 6 sessions of water treadmill exercise. Walking in water at the level of the carpus or ulna resulted in a lower SF compared to walking in water at hoof height.

Two hominin incisor teeth from the middle Pleistocene site of Boxgrove, Sussex, England.

In 1995-1996 two isolated hominin lower incisors were found at the middle Pleistocene site of Boxgrove in England, with Lower Palaeolithic archaeology. Boxgrove 2 is a permanent lower right central incisor and Boxgrove 3 a permanent lower left lateral incisor. They were found separately, but close to one another and appear to belong to the same individual. The Boxgrove 1 tibia discovered in 1993 came from a different stratigraphic context and is thus believed to represent a different individual. This paper describes the morphology of the incisors, which is similar to other middle Pleistocene hominin specimens and, as with the tibia, suggests that they could be assigned to Homo heidelbergensis (recognising that the taxonomic status of this species is still a matter of debate). The incisors show substantial attrition associated with secondary dentine deposition in the pulp chamber and clearly represent an adult. They also show extensive patterns of non-masticatory scratches on the labial surfaces of both crown and root, including some marks which may have been made postmortem. The roots were exposed in life on their labial sides by a large dehiscence, extending almost to the root apex. This is demonstrated by deposits of calculus, polishing, and scratching on the exposed surfaces. The dehiscence may have been caused by repeated trauma to the gingivae or remodelling of the tooth-supporting tissues in response to large forces applied to the front of the dentition.

A HISTORY OF THE THEORY OF PRENATAL ATTACHMENT.

John Bowlby's theory of human attachment has become widely applied across disciplines and across the stages of human development. This discussion explores the evolution of an application of Bowlby's theory to the experience of pregnancy, from both maternal and paternal perspectives. Although the theoretical construct of maternal fetal attachment (MFA) requires continued theoretically-driven research, existing studies have associated this proposed construct with health behaviors, marital relationship, depressive symptoms, and the postpartum mother-infant relationship, pointing toward its relevance for academicians and clinicians devoted to the service of women and infants.

Neanderthal exploitation of marine mammals in Gibraltar.

Two coastal sites in Gibraltar, Vanguard and Gorham's Caves, located at Governor's Beach on the eastern side of the Rock, are especially relevant to the study of Neanderthals. Vanguard Cave provides evidence of marine food supply (mollusks, seal, dolphin, and fish). Further evidence of marine mammal remains was also found in the occupation levels at Gorham's Cave associated with Upper Paleolithic and Mousterian technologies [Finlayson C, et al. (2006) Nature 443:850-853]. The stratigraphic sequence of Gibraltar sites allows us to compare behaviors and subsistence strategies of Neanderthals during the Middle Paleolithic observed at Vanguard and Gorham's Cave sites. This evidence suggests that such use of marine resources was not a rare behavior and represents focused visits to the coast and estuaries.

Prenatal depression in women hospitalized for obstetric risk.

OBJECTIVE: Little is known about depression during pregnancy in women with high maternal or fetal risk, as this population is often excluded from research samples. The aim of this study was to evaluate depressive symptoms and known risk factors for depression in a group of women hospitalized with severe obstetric risk. METHOD: In the antenatal unit, 129 inpatients completed the Edinburgh Postnatal Depression Scale (EPDS), the Dyadic Adjustment Scale (DAS), and the Maternal Antenatal Attachment Scale (MAAS) from October 2005 through December 2006. A subset of women were administered the Mood Disorders module of the Structured Clinical Interview for DSM-IV Axis I Disorders based on a score of > or = 11 on the EPDS. Obstetric complications were classified according to the Hobel Risk Assessment for Prematurity. RESULTS: Fifty-seven of the 129 women (44.2%) scored 11 or greater on the EPDS, and at least 25/129 (19.4%) met the DSM-IV criteria for major depressive disorder. Mothers reporting high attachment to the fetus on the MAAS reported lower severity of depressive symptoms (rho = -0.33, p < .0001); those reporting interpersonal relationship dissatisfaction on the DAS endorsed higher depressive severity (rho = -0.21, p = .02). Severity of obstetric risk was unrelated to depression, but one complication, incompetent cervix, was positively associated with level of depressive symptomatology. CONCLUSION: Findings indicate a higher prevalence rate of major depressive disorder in women with severe obstetric risk than that reported in low-risk pregnancy samples, suggesting the need for routine depression screening to identify those who need treatment. Fewer depressive symptoms were reported by mothers reporting strong maternal fetal attachment and greater relationship satisfaction.

Isotope evidence for the intensive use of marine foods by Late Upper Palaeolithic humans.

We report here on direct evidence for the intensive consumption of marine foods by anatomically modern humans at approximately 12,000 years ago. We undertook isotopic analysis of bone collagen from three humans, dating to the late Palaeolithic, from the site of Kendrick's Cave in North Wales, UK. The isotopic measurements of their bone collagen indicated that ca. 30% of their dietary protein was from marine sources, which we interpret as likely being high trophic level marine organisms such as marine mammals. This indicates that towards the end of the Pleistocene modern humans were pursuing a hunting strategy that incorporated both marine and terrestrial mammals. This is the first occurrence of the intensive use of marine resources, specifically marine mammals, that becomes even more pronounced in the subsequent Mesolithic period.

Phase I study of alternating doublets of topotecan/carboplatin and paclitaxel/carboplatin in patients with newly diagnosed, advanced ovarian cancer.

OBJECTIVE: The aim of this study was to evaluate topotecan with carboplatin in an alternating doublet with carboplatin and paclitaxel in first-line ovarian cancer. METHODS: Patients with newly diagnosed stage III/IV ovarian cancer were studied. The maximum tolerated dose (MTD) of topotecan (cycles 1, 3, 5, 7) in an alternating doublet regimen was determined through standard dose escalation in cohorts of three; doses of carboplatin (area under the curve [AUC] 4 to 5) and paclitaxel (175 mg/m(2), cycles 2, 4, 6, 8) were fixed. Dose-limiting toxicity (DLT) was defined only for cycle 1 as febrile neutropenia, prolonged grade 4 granulocytopenia, grade 4 thrombocytopenia, > or =grade 3 nonhematologic toxicity, or failure to recover in < or =7 days. The use of granulocyte colony-stimulating factor (G-CSF) to permit further dose escalation was also studied. RESULTS: Thirty-seven patients received 142 cycles of topotecan/carboplatin. Hematologic DLTs included grade 4 neutropenia (59 events, 42% of cycles) and thrombocytopenia (32 events, 23% of cycles). Granulocytopenia was generally short-lived, and only 2 cases of febrile neutropenia occurred. The MTD was 1.0 mg/m(2)/day topotecan and carboplatin AUC 4, alternating with 175 mg/m(2) paclitaxel and carboplatin AUC 4. Although G-CSF effectively managed myelosuppression, thrombocytopenia developed in later cycles, limiting further topotecan dose escalation. The median progression-free survival was 20.5 months, and elevated pretreatment CA-125 levels normalized in 29 of 34 (85%) patients. CONCLUSION: The establishment of a reasonably well-tolerated alternating doublet regimen, coupled with evidence of antitumor activity, provides the basis for further investigation of topotecan in first-line therapy of ovarian cancer. Topotecan (1.0 mg/m(2) daily for 3 days) was chosen for further evaluation in a phase II study.

Comparison of partial sequence of the cap binding protein (eIF4E) isolated from Agaricus bisporus and its pathogen Verticillium fungicola.

The 3' regions of the gene encoding the cap binding protein eIF4E were successfully isolated from Agaricus bisporus and Verticillium fungicola using a degenerate primer within the eIF4E gene and an anchored oligo d(T) primer. The deduced amino acid sequences contained 173 residues for A. bisporus and 171 residues V. fungicola. Analysis of these sequences shows that despite conserved regions of homology, centering around tryptophan residues, A. bisporus and V. fungicola are very diverse at the amino acid and DNA level. Percentage homology between the two fungi is low at the nucleotide, 35%, and amino acid level, 29%. The highest degree of similarity between the A. bisporus sequence and other published sequences is with the Homo sapiens eIF4E sequence (32%). V. fungicola exhibited highest homology with the eIF4E sequence from Caenorhabditis elegans (34%). Southern analysis of genomic DNA indicated a single copy of the gene within the A. bisporus genome.

Growth processes in teeth distinguish modern humans from Homo erectus and earlier hominins.

A modern human-like sequence of dental development, as a proxy for the pace of life history, is regarded as one of the diagnostic hallmarks of our own genus Homo. Brain size, age at first reproduction, lifespan and other life-history traits correlate tightly with dental development. Here we report differences in enamel growth that show the earliest fossils attributed to Homo do not resemble modern humans in their development. We used daily incremental markings in enamel to calculate rates of enamel formation in 13 fossil hominins and identified differences in this key determinant of tooth formation time. Neither australopiths nor fossils currently attributed to early Homo shared the slow trajectory of enamel growth typical of modern humans; rather, both resembled modern and fossil African apes. We then reconstructed tooth formation times in australopiths, in the approximately 1.5-Myr-old Homo erectus skeleton from Nariokotome, Kenya, and in another Homo erectus specimen, Sangiran S7-37 from Java. These times were shorter than those in modern humans. It therefore seems likely that truly modern dental development emerged relatively late in human evolution.

Does the menopause influence the risk of bacteriuria?

The objective of this study was to test the hypothesis that the risk of bacteriuria is increased as a result of estrogen deprivation following the menopause. All midstream urine samples (MSU) sent to the King's College Hospital department of microbiology by general practitioners in 1997 were assessed. Bacteriuria was diagnosed when the bacterial count was >10(5) organisms/ml. Logistic regression analysis was performed to investigate the effects of age and sex on the likelihood of having a positive result. Non-linear effects of age were investigated, with interest focusing in particlar on the time around the menopause. There were 15,392 MSU samples analyzed; 11,811 (77%) were from women and 3581 (23%) from men. In both sexes the proportion of positive results increased with increasing age (P<0.0001). The specimens taken from women were significantly more likely to be positive than those taken from a man of the same age (P<0.0001). In women there was no evidence of any non-linear relationship between age and the log odds of a positive result. A plot of the proportion of positive results versus age did not suggest any departure from a linear relationship at or following the menopause. In conclusion, the increased risk of bacteriuria which occurs as women get older appears to happen gradually as a result of the aging process, rather than as the result of pathophysiological changes in the urogenital tract that take place at or following the menopause.