Use of wide-screen, high-definition monitors for improving adenoma detection: A prospective, randomized, controlled trial.

BACKGROUND AND AIM: Colonoscopy is sensitive at detecting large polyps; however, a significant polyp miss rate is still recognized. Indicators such as the adenoma detection rate (ADR) and, more recently, the adenoma per colonoscopy rate (APC) are increasingly used to ensure quality in colonoscopy. We carried out a prospective, randomized, controlled study evaluating improvement in adenoma detection between wide-screen, high-definition (WSHD) monitors compared to standard monitors (SD). METHODS: Patients undergoing screening or surveillance colonoscopy were randomized to a WSHD room or SD. Polyp size, location, shape, and histology were recorded. Right-sided polyps were considered to be those proximal to the splenic flexure. RESULTS: A total of 152 patients were enrolled in the study, with 78 (51.3%) and 74 (48.7%) enrolled in the WSHD and SD groups, respectively. A 10% absolute difference in favor of the WSHD group was noted for the ADR (41% vs 31% patients); however, the difference was statistically not significant. In the WSHD and SD groups, APC of 0.9 ± 1.4 versus 0.7 ± 1.4 (P = 0.49) were noted, respectively. For polyps <5 mm, an ADR of 0.3 ± 0.4 versus 0.2 ± 0.4 (P = 0.34) and APC of 0.5 ± 1.1 versus 0.2 ± 0.5 (P = 0.06) were seen in the WSHD and SD groups. CONCLUSION: This study shows a trend toward improvement in ADR, with an increase in APC for small adenomas that approaches statistical significance. WSHD monitors are a one-time, low-cost intervention for improving the quality of colonoscopy with potentially favorable outcomes.

Failure of college students to complete an online alcohol education course as a predictor of high-risk drinking that requires medical attention.

BACKGROUND: AlcoholEdu® for College and other computer-based education programs have been developed to reduce alcohol use and related problems among students. OBJECTIVES: This study investigated whether the failure of incoming first-year students to complete AlcoholEdu predicts future high-risk drinking that requires medical attention. METHODS: A review of clinical records kept by a single university's health service identified 684 undergraduates (classes of 2007-2011) who had presented for an alcohol event (September 2003 through June 2008). We used survival analysis to determine whether students who partially completed the course or failed to take it were disproportionately represented among student patients who presented with elevated blood alcohol concentration (BAC). RESULTS: Students who failed to take the online course were 4.64 times more likely than those who completed it to experience an alcohol event (p < .0001), while those students who had partially completed the course were 1.52 times more likely (p < .0001). Amount of online alcohol education and gender were not significantly related to students' measured BAC level. CONCLUSION: Students who had completed AlcoholEdu were less likely to present for an alcohol event than were students who partially completed or failed to take the course. Campus administrators should consider whether students who fail to complete an online alcohol course should be flagged for more focused interventions (e.g., brief motivational interview, mandatory education classes). SCIENTIFIC SIGNIFICANCE: This is the first study to show a relationship between first-year college students' non-completion of an online alcohol course and subsequent high-risk drinking that requires medical attention.

Electrochemical Noise Measurement to Assess Corrosion of Steel Reinforcement in Concrete.

The electrochemical noise method (ENM) has previously been employed to monitor the corrosion of steel reinforcement in concrete. The development of solid-state Ag/AgCl-based probes and dedicated monitoring technology (ProCoMeter) now offers a wider range of ENM configurations. The present study involves the laboratory investigation of three mortar samples containing steel bars and varying additions of chloride, with a view to future field application. ENM could be used to provide corrosion information on reinforcement without the need to provide direct electrical connections to the steel and without the risk or inducing or increasing corrosion. In addition to half-cell potentials, measurements were made using ENM in three different probe configurations over a total test period of 90 days. The samples were then broken open and the bars extracted and cleaned. A comparison was then made between the calculated metal thickness loss obtained from the Rn values and the actual metal thickness loss. The results showed that each configuration was able to order the results in the expected manner, with the simple single substrate (SSS) arrangement providing the best correlation with direct measurements. The study is ongoing with the intention of measurements being obtained in situ on existing reinforced concrete structures.

Receptor-Defined Breast Cancer in Five East African Countries and Its Implications for Treatment: Systematic Review and Meta-Analysis.

PURPOSE: Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) are determinants of treatment and mortality for patients with breast cancer (BC). In East Africa, the estimated 5-year survival (37.7%) is far lower than the US average (90%). This meta-analysis investigates BC receptor subtypes within five East African countries to ascertain cross-country patterns and prioritize treatment needs. METHODS: From a PubMed search, January 1, 1998-June 30, 2019, for all English-only BC articles for Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, eligible studies had receptor distributions for female BC samples ≥ 30 patients. Outcomes were proportions of ER+, PR+, and HER2-positive (HER2+), and/or molecular subtypes. Data included study characteristics and mean or median patient age. Using metaprop, Stata 16, we estimated pooled proportions (ES) with 95% CIs and assessed heterogeneity. RESULTS: Among 36 BC studies with receptor data, 21 met criteria. Weighted mean age was 47.5 years and median, 48. Overall ES were as follows: 55% for ER-positive (ER+) (95% CI, 47 to 62), 23% for HER2+ (95% CI, 20 to 26), and 27% for triple-negative BC (TNBC) (95% CI, 23 to 32). CONCLUSION: We found differences between countries, for example, lower distribution of TNBC in Ethiopia (21%) compared with Uganda (35%). ER+, the dominant BC subtype overall at 55%, emphasizes the need to prioritize endocrine therapy. Overall proportions of HER2+ BC (with or without ER+ or PR+), 23%, approached proportions of TNBC, 27%, yet HER2 testing and treatment were infrequent. Testing and reporting of receptor subtypes would promote delivery of more effective treatment reducing the mortality disparity.

Impact of psoriasis on patients' work and productivity: a retrospective, matched case-control analysis.

BACKGROUND: Psoriasis negatively impacts patient quality of life; however, the impact on work and productivity is not well known. OBJECTIVE: To determine the impact of psoriasis on work and productivity using data from the National Health and Wellness Survey (NHWS). METHODS: Data collected from 40 730 adults who completed the NHWS between 1 May and 30 June 2004, of whom 1127 had psoriasis, were analyzed. Psoriasis patients and a matched cohort of non-psoriasis patients were identified to assess the impact of psoriasis on work and productivity. RESULTS: Psoriasis patients were more likely to have missed work for health-related reasons (p < 0.05), had significantly more health-related work productivity impairment (p < 0.001), more overall work impairment (p < 0.001), and more impairment in activity other than work (p < 0.001) than non-psoriasis patients. CONCLUSIONS: The results of this large-scale national survey suggest that psoriasis has a significant negative impact on overall work productivity.

Diversity and habitat relationships of hypogeous fungi. III. Factors influencing the occurrence of fire-adapted species.

Among the huge array of hypogeous ectomycorrhizal fungi so far documented from Australia, six genera and more than 30 species occur within the family Mesophelliaceae, all of which show various adaptations for surviving in fire-prone landscapes. These mostly endemic fungi are critical to postfire reestablishment of regenerating vegetation, and their fruit-bodies provide essential food resources for diverse ground-dwelling fauna. We developed habitat models for five common representatives of the Mesophelliaceae based on repeat collections of their fruit-bodies from 136 study plots situated along a series of environmental gradients across the south-eastern mainland of Australia. At a meso- or landscape scale, temperature influenced the occurrence of Castoreum radicatum, Mesophellia clelandii and Nothocastoreum cretaceum, with the type of response varying. Below a threshold, C. radicatum preferred sites with cooler mean annual temperatures. In contrast, M. clelandii and N. cretaceum had optimal ranges of temperature, above and below which the probability of detecting them dropped. Also at a landscape scale, C. radicatum was more likely to be detected at sites with lower levels of precipitation during the driest quarter of the year. At a micro-site scale, M. clelandii and N. cretaceum were more likely to occur in stands with an intermediate number of host eucalypt stems, likely relating to successional age of the stand. Sites with a higher number of large fallen trees were more likely to have N. cretaceum, while sites with intermediate litter depths were more likely to have C. radicatum and M. clelandii. Mesophellia glauca and M. trabalis showed no consistent patterns. They are apparently the most broadly adaptable in terms of the independent variables tested. Although fire has been previously suggested to be heavily implicated in the life cycle of several members of the Mesophelliaceae, we found no relationship between time since disturbance by fire and other factors and likelihood of occurrence. Instead, other habitat attributes appeared to be more important in explaining their distribution. The complex and differing responses of the species of Mesophelliaceae studied here, to features of their environment, reinforce the need to manage multiple-use forest landscapes across the region for a diversity of attributes.

Psoriasis: cardiovascular risk factors and other disease comorbidities.

The risk factors of cardiovascular disease and other disease comorbidities appear to be more common in patients with psoriasis compared with the general population. To support this concept, the association between psoriasis and cardiovascular disease and other comorbidities was analyzed using data collected from 40 730 patients in the National Health and Wellness Survey (NHWS) during May and June 2004. A case-control study was conducted with data from 1127 patients with psoriasis and a matched cohort of nonpsoriasis patients. Psoriasis patients were significantly more likely to have cardiovascular comorbidities, including hypertension, hypercholesterolemia, and diabetes, compared with nonpsoriasis patients. Other comorbidities significantly associated with psoriasis were arthritis, depression, sleep disorder/insomnia, chronic obstructive pulmonary disease, and gastroesophageal reflux disease. Responses to this large survey confirm that patients with psoriasis have a higher rate of cardiovascular risk factors and other comorbidities compared with patients without psoriasis.

Factors Associated with Foliar Disease of Staked Fresh Market Tomatoes Grown Under Differing Bed Strategies.

The use of mulch or compost to reduce foliar disease in fresh market tomato could reduce fungicide use. Between 1997 and 1999, foliar disease was monitored in tomatoes grown in beds with bare soil, black polyethylene, composted dairy manure, or hairy vetch. Early blight was reduced in plots with vetch compared with bare soil or compost in all years and compared with polyethylene cover in 1 year. Early blight was reduced in plots with polyethylene versus compost and bare soil in 1 and 2 years, respectively. Septoria leaf spot was reduced in plots with vetch versus other bed strategies in 1998 and bare soil or compost in 1999. This disease was reduced in plots with polyethylene versus bare soil or compost in 1998 and 1999. Soil coverage of tomato leaflets and soil particle dispersal were reduced in plots with polyethylene or vetch versus bare soil or compost in both years that these variables were assessed. Sensor wetness duration was reduced in plots with polyethylene or vetch versus bare soil or compost in one of two years. These findings suggest that foliar disease reduction in mulch was associated with reduced splash dispersal and, in one year, reduced leaf wetness.

Foliar Disease in Fresh-Market Tomato Grown in Differing Bed Strategies and Fungicide Spray Programs.

A 3-year field study in central Maryland evaluated foliar disease in fresh-market tomato grown using combinations of four bed strategies and three fungicide programs. Bed strategies included uncovered beds with or without a composted dairy manure amendment or beds covered with black polyethylene or hairy vetch mulch. Fungicide programs included no fungicide, weekly fungicide, or fungicide applications scheduled according to the TOMCAST disease predictor. In plots with hairy vetch-covered beds, early blight caused by Alternaria solani, Septoria leaf spot caused by Septoria lycopersici, and defoliation were lower versus uncovered beds each year. Early blight and defoliation were lower in beds covered with vetch versus polyethylene mulch in 2 of 3 years. Disease severity, defoliation, and marketable yield were similar for the weekly and TOMCAST fungicide programs, with 40 to 50% fewer sprays using TOMCAST. Marketable yield was similar among bed strategies except for higher yields in covered versus uncovered and unamended beds in a relatively wet year and lower yields in vetch versus polyethylene beds in a dry year.

An alternative agriculture system is defined by a distinct expression profile of select gene transcripts and proteins.

Conventional agriculture has relied heavily on chemical inputs that have negatively impacted the environment and increased production costs. Transition to agricultural sustainability is a major challenge and requires that alternative agricultural practices are scientifically analyzed to provide a sufficiently informative knowledge base in favor of alternative farming practices. We show a molecular basis for delayed leaf senescence and tolerance to diseases in tomato plants cultivated in a legume (hairy vetch) mulch-based alternative agricultural system. In the hairy vetch-cultivated plants, expression of specific and select classes of genes is up-regulated compared to those grown on black polyethylene mulch. These include N-responsive genes such as NiR, GS1, rbcL, rbcS, and G6PD; chaperone genes such as hsp70 and BiP; defense genes such as chitinase and osmotin; a cytokinin-responsive gene CKR; and gibberellic acid 20 oxidase. We present a model of how their protein products likely complement one another in a field scenario to effect efficient utilization and mobilization of C and N, promote defense against disease, and enhance longevity.