Understanding the Lexicon of Fatigue in Parkinson's Disease

Background:

Fatigue in Parkinson’s disease (PD) is multifaceted and associated with reduced quality of life. In turn, the language used by people with PD to describe fatigue is variable and poorly understood. We sought to elucidate the lexicon of fatigue using a qualitative grounded theory approach.

Objective:

The objective of this study was to understand how patients with PD describe fatigue.

Methods:

A pre-study phase of online journaling (Phase 1) provided information regarding topics of importance to patients. Following this, two independent samples of fatigued subjects were studied. Individuals with PD participated in a telephone interview (Phase 2); interview transcripts were analyzed to develop a detailed codebook. To ensure trustworthiness of the findings, an online survey (Phase 3) was administered to individuals with self-reported PD participating in the online study Fox Insight. The survey included the following question: “How do you define fatigue? Please provide your definition in the space below.” The codebook developed from Phase 2 was applied to the Phase 3 responses.

Results:

Fifteen individuals participated in Phase 2 and 413 individuals completed Phase 3. Fatigue was subdivided into three domains: cognitive, emotional, and physical. Nearly all individuals experienced more than one domain of fatigue. The most common themes included tiredness, lack of energy, and negative motivation.

Conclusion:

Fatigue in PD is multidimensional. Questionnaires that only assess the physical impact of fatigue may not be adequate to capture the broad range of experiences of fatigue among people with PD.

MOVE UP STUDY RESULTS: WEIGHT LOSS POSITIVELY AFFECTS HEALTH-RELATED QUALITY OF LIFE BUT NOT DEPRESSIVE SYMPTOMS

Obesity is prevalent among older adults as are increases in depressive symptoms and declines in health-related quality of life (HRQOL). Healthy weight loss and mitigating mild depressive symptoms (MDS) and HRQOL could have critical public health significance. The Mobility and Vitality Lifestyle Program (MOVE UP) led by Community Health Workers delivered 32 healthy aging/weight management group sessions over 13 months. Data from 240 participants were evaluated to assess program impact on CES-D (20-item) depressive symptom and SF-36 HRQOL scores. Participants were 88% female, 28% black/other race, 42% ≥ college-educated. Mean (SD) age was 67.6 (4.1) and BMI was 34.7 (4.7). At baseline, average CES-D score was 7.9 (7.2) and 27.9 % (N = 67) had MDS, scoring 17.1 (6.2). Results show significant mean (SD) weight change of -12.7 (13.3) lb from baseline (p<0.0001). Overall, CES-D mean (SD) score change was -0.4 (6.7) (p=0.33); participants with MDS had an average CES-D decrease of -4.4 (7.8) points (p<0.0001). Further, HRQOL improved significantly in all realms, particularly the physical component score (p<0.0001). SF-36 (SD) total score improved +1.1 (7.6), mental + 2.1 (11.7), and physical + 5.0 (16.7). Regression analyses (age/sex adjusted) demonstrate that for each 5 lb of weight loss there was an average (SEM) 3.35 (1.49) point increase in SF-36 total score (p=0.03). The mitigation of depressive symptoms in the MDS subgroup was not significantly associated with weight loss but may reflect other positive effects of the intervention experience. Conversely, positive HRQOL changes appear to be driven strongly by weight loss.

Assessment of swallowing function after circumferential pharyngolaryngectomy. A multicenter study by the GETTEC group

OBJECTIVE

Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction.

MATERIAL AND METHOD

A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases.

RESULTS

Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P=0.04).

CONCLUSION

Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.

Improving supersonic flights with femtosecond laser filamentation

When a flying object becomes supersonic, a concomitant increase in drag leads to a considerable rise in fuel consumption. We show experimentally that an embarked terawatt femtosecond laser can significantly decrease this drag. We measured a 50% transient reduction of drag on a test model placed in a supersonic wind tunnel at Mach 3. This effect was initiated by the thin hot air column created in front of the supersonic object by filamentation of the laser pulse. We also show that this technique offers possibilities for steering.

International consensus (ICON) on functional and aesthetic rhinoplasty

During the 2017 IFOS international congress in Paris, a roundtable discussion on the topic of functional and aesthetic rhinoplasty was organised. Five experts, from the five continents and renown in the field of rhinoplasty, were brought together to discuss the issue from an international perspective and to put forward a consensus or on the contrary practical differences. Five questions were put to the experts beforehand to guarantee independent answers, which were then discussed during the roundtable. The questions were the following: - What are the age limits for achieving a rhinoplasty? - Do you use objective measurements before, during and after surgery? (facial landmarks, airflow, peroperative measurements) - How do you manage the preoperative general information and computer imaging of the patient? - What are the indications in your practice to perform a CT-scan or endoscopic examination before doing a rhinoplasty? - What kind of graft or prosthesis do you use for an augmentation rhinoplasty? This paper offers a synthesis of the roundtable based on the experts' answers to the different questions.

Unifying different interpretations of the nonlinear response in glass-forming liquids

This work aims at reconsidering several interpretations coexisting in the recent literature concerning nonlinear susceptibilities in supercooled liquids. We present experimental results on glycerol and propylene carbonate, showing that the three independent cubic susceptibilities have very similar frequency and temperature dependences, for both their amplitudes and phases. This strongly suggests a unique physical mechanism responsible for the growth of these nonlinear susceptibilities. We show that the framework proposed by two of us [J.-P. Bouchaud and G. Biroli, Phys. Rev. B 72, 064204 (2005)PRBMDO1098-012110.1103/PhysRevB.72.064204], where the growth of nonlinear susceptibilities is intimately related to the growth of glassy domains, accounts for all the salient experimental features. We then review several complementary and/or alternative models and show that the notion of cooperatively rearranging glassy domains is a key (implicit or explicit) ingredient to all of them. This paves the way for future experiments, which should deepen our understanding of glasses.

Selective area growth of AlN/GaN nanocolumns on (0001) and (11-22) GaN/sapphire for semi-polar and non-polar AlN pseudo-templates

Despite the strong interest in optoelectronic devices working in the deep ultraviolet range, no suitable low cost, large-area, high-quality AlN substrates have been available up to now. The aim of this work is the selective area growth of AlN nanocolumns by plasma assisted molecular beam epitaxy on polar (0001) and semi-polar (11-22) GaN/sapphire templates. The resulting AlN nanocolumns are vertically oriented with semi-polar {1-103} top facets when grown on (0001) GaN/sapphire, or oriented at 58° from the template normal and exposing {1-100} non-polar top facets when growing on (11-22) GaN/sapphire, in both cases reaching filling factors ≥80%. In these kinds of arrays each nanostructure could function as a building block for an individual nano-device or, due to the large filling factor values, the overall array top surfaces could be seen as a quasi (semi-polar or non-polar) AlN pseudo-template.

High-resolution FTIR spectroscopy of trisulfane HSSSH: a candidate for detecting parity violation in chiral molecules

We present the first analysis of high resolution infrared spectra for trisulfane, a candidate to measure molecular parity violation.

Housing Relocation Policy and Violence: A Literature Review

This article summarizes and reviews the cross-discipline literature on violent crime in destination neighborhoods postrelocation in order to build a more comprehensive picture of risk factors for violence, as well as how and why housing policies influence risk of violence. High rates of violent crime continue to be a persistent problem in areas of concentrated poverty and public housing. Modern housing programs such as Moving to Opportunity and Housing Opportunities for People Everywhere are popular interventions for reducing the density of low-income people receiving public housing assistance by relocating residents of distressed housing projects. However, evidence suggests that relocated residents may not experience less violence or improved safety in their new communities.

Partnership Building and Implementation of an Integrated Healthy-Aging Program

BACKGROUND

Evidence-based interventions exist for prevention of chronic disease in older adults. Partnering with community organizations may provide a mechanism for disseminating these interventions.

OBJECTIVE

To describe the partnership and program implementation by the Arthritis Foundation (AF) and the University of Pittsburgh.

METHODS

The AF Exercise Program (AFEP; an existing evidence-based program) was enhanced with the "10 Keys"™ to Healthy Aging (a prevention-focused program bundling the most common risk factors for chronic disease and disability in older adults and applies behavior change strategies to enhance prevention). The program was delivered in 20 sessions over 10 weeks by community health workers in a cluster-randomized trial.

LESSONS LEARNED

Partnering with an organization having an existing infrastructure supports program delivery at the community level. This partnership provided programming in 54 sites across Pittsburgh and surrounding communities.

CONCLUSIONS

This collaborative partnership created a productive synergy maximizing strengths in both research and program delivery.

[Diverging detection limits of immunochemical tests for occult blood underline the necessity of standardization and quality assurance]

BACKGROUND

Immunological fecal occult blood tests (FIT) are superior in detecting colorectal cancer and its precursors compared to conventional Guajac-based tests. Besides quantitative, laboratory-based FITs qualitative, office-based FITs are increasingly employed. Studies have shown major variation of these tests with respect to sensitivity and specificity, which is most probably caused by different detection limits. In the present study we therefore determined and compared the detection limits and other criteria of commercial FITs.

METHODS

We determined the detection limits for 21 qualitative and one quantitative FIT using commercial control solutions with defined hemoglobin (Hb) concentrations. These detection limits were compared with the manufacturers' data.

RESULTS

The detection limits of the tests showed a wide range of 2 to over 60 µg Hb per gram stool. In many cases the detection limits we determined were not in accordance with the manufacturers' data. Two tests didn't show a positive reaction even with the highest hemoglobin concentration of 440 ng/mL. On the other hand one test showed a positive reaction even at the lowest hemoglobin concentration of 25 ng/mL.

CONCLUSION

The large differences in the detection limits found in this study are consistent with observations of large variation of sensitivity and specificity of qualitative FITs in screening practice. Proper clinical validation of each FIT is to be required before admission for colorectal cancer screening. An additional regular quality control, i. e. by means of external quality control measures and documentation of results of colonoscopies following positive tests results, should be mandatory.

Titanium induced polarity inversion in ordered (In,Ga)N/GaN nanocolumns

We report on the formation of polarity inversion in ordered (In,Ga)N/GaN nanocolumns grown on a Ti-masked GaN-buffered sapphire substrate by plasma assisted molecular beam epitaxy. High-resolution transmission electron microscopy and electron energy-loss spectroscopy reveal a stacking fault-like planar defect at the homoepitaxial GaN interface due to Ti incorporation, triggering the generation of N-polar domains in Ga-polar nanocolumns. Density functional theory calculations are applied to clarify the atomic configurations of a Ti monolayer occupation on the GaN (0002) plane and to prove the inversion effect. The polarity inversion leads to an enhanced indium incorporation in the subsequent (In,Ga)N segment of the nanocolumn. This study provides a deeper understanding of the effects of Ti mask in the well-controlled selective area growth of (In,Ga)N/GaN nanocolumns.

Merkel cell carcinoma: value of sentinel lymph-node status and adjuvant radiation therapy

BACKGROUND

Sentinel lymph-node (LN) biopsy (SLNB) is a valuable tool to assess the regional LN status in Merkel cell carcinoma (MCC). However, its prognostic value is still debated. This study was undertaken to assess SLNB usefulness for MCC management and to determine the impact of SLNB status on disease-free survival (DFS) and overall survival (OS) by comparing SLNB-positive versus -negative patients according to demographic, clinical and treatment characteristics.

PATIENTS AND METHODS

In this retrospective, multicenter observational study, SLNB was proposed to all patients referred for clinically N0 MCC. Treatment schedule consisted of wide-margin surgical resection of primary MCC followed by adjuvant radiation therapy (aRT) to the primary site and, for SLNB-positive patients, radical LN dissection followed by regional aRT. Univariate and multivariate analyses determined factors associated with DFS and OS.

RESULTS

Among 87 patients with successful SLNB, 21 (24.1%) were SLNB-positive. Median follow-up for the entire series was 39 months; respective 3-year DFS and OS rates were 73% and 81.4%, respectively. Univariate analysis (all patients) identified SLNB-negativity as being associated with prolonged OS (P = 0.013) and aRT (all sites considered) was associated with longer DFS (P = 0.004) and OS (P = 0.018). Multivariate analysis (all patients) retained SLNB status and aRT (all sites considered) as being associated with improved DFS (P = 0.014 and 0.0008) and OS (P = 0.0020 and 0.0019). Moreover, for SLNB-negative patients, tumor-bed irradiation was also significantly associated with prolonged DFS (P = 0.006) and OS (P = 0.014).

CONCLUSIONS

The present study demonstrates that SLNB-negativity is a strong predictor of longer DFS and OS in stage I and II MCC patients. The similar benefit for aRT on tumor bed observed in this study has to be confirmed by a prospective study. The results advocate for SLNB being considered to all MCC patients.

High resolution GHz and THz (FTIR) spectroscopy and theory of parity violation and tunneling for 1,2-dithiine (C4H4S2) as a candidate for measuring the parity violating energy difference between enantiomers of chiral molecules

Our results show that this molecule is a suitable candidate for a possible first determination of the parity violating energy difference Δ_pvE between enantiomers.

Distinguishing cubic and hexagonal phases within InGaN/GaN microstructures using electron energy loss spectroscopy

3D InGaN/GaN microstructures grown by metal organic vapor phase epitaxy (MOVPE) and molecular beam epitaxy (MBE) have been extensively studied using a range of electron microscopy techniques. The growth of material by MBE has led to the growth of cubic GaN material. The changes in these crystal phases has been investigated by Electron Energy Loss Spectroscopy, where the variations in the fine structure of the N K‐edge shows a clear difference allowing the mapping of the phases to take place. GaN layers grown for light emitting devices sometimes have cubic inclusions in the normally hexagonal wurtzite structures, which can influence the device electronic properties. Differences in the fine structure of the N K‐edge between cubic and hexagonal material in electron energy loss spectra are used to map cubic and hexagonal regions in a GaN/InGaN microcolumnar device. The method of mapping is explained, and the factors limiting spatial resolution are discussed.

Generation and optimization of the self-administered bleeding assessment tool and its validation as a screening test for von Willebrand disease

INTRODUCTION/AIM

Our aim was to generate, optimize and validate a self-administered bleeding assessment tool (self-BAT) for von Willebrand disease (VWD).

METHODS

In Phase 1, medical terminology in the expert-administered International Society on Thrombosis and Haemostasis (ISTH)-BAT was converted into a Grade 4 reading level to produce the first version of the Self-BAT which was then optimized to ensure agreement with the ISTH-BAT. In Phase 2, the normal range of bleeding scores (BSs) was determined and test-retest reliability analysed. In Phase 3, the optimized Self-BAT was tested as a screening tool for first time referrals to the Haematology clinic.

RESULTS

Bleeding score from the final optimized version of the Self-BAT showed an excellent intra-class correlation coefficient (ICC) of 0.87 with ISTH-BAT BS in Phase 1. In Phase 2, the normal range of BSs for the optimized Self-BAT was determined to be 0 to +5 for females and 0 to +3 for males and excellent test-retest reliability was shown (ICC = 0.95). In Phase 3, we showed that a positive Self-BAT BS (≥6 for females, ≥4 for males) has a sensitivity of 78%, specificity of 23%, positive predictive value (PPV) of 0.15 and negative predictive value (NPV) of 0.86 for VWD; these figures improved when just the females were analysed; sensitivity of 100%, specificity of 21%, PPV = 0.17 and NPV = 1.0.

CONCLUSION

We show an optimized Self-BAT can generate comparable BS to the expert-administered ISTH-BAT and is a reliable, effective screening tool to incorporate into the assessment of individuals, particularly women, referred for a possible bleeding disorder.