Performance of administrative case definitions for comorbidity in multiple sclerosis in Manitoba and Nova Scotia

INTRODUCTION

As the population ages and the prevalence of comorbid conditions increases, the need for feasible, validated methods of comorbidity surveillance in chronic diseases such as multiple sclerosis (MS) increases.

METHODS

Using kappa (k) statistics, we evaluated the performance of administrative case definitions for comorbidities commonly observed in MS by comparing agreement between Manitoba (MB) administrative data and self-report (n = 606) and Nova Scotia (NS) administrative data and self-report (n = 1923).

RESULTS

Agreement between the administrative definitions and self-report was substantial for hypertension (k = 0.69 [NS], 0.76 [MB]) and diabetes (k = 0.70 [NS], 0.66 [MB]); moderate for hyperlipidemia (k = 0.53 [NS], 0.51 [MB]) and heart disease (k = 0.42 [NS], 0.51 [MB]) and fair for anxiety (k = 0.27 [NS], 0.26 [MB]). In NS, agreement was substantial for inflammatory bowel disease (k = 0.71) and moderate for epilepsy (k = 0.48).

CONCLUSION

Administrative definitions for commonly observed comorbidities in MS performed well in 2 distinct jurisdictions. This suggests that they could be used more broadly across Canada and in national studies.

A prospective study of early removal of the urethral catheter after colorectal surgery in patients having epidural analgesia as part of the Enhanced Recovery After Surgery programme

AIM

Early removal of the urethral catheters is part of the enhanced postoperative recovery programme (ERAS). The effect of epidural anaesthesia on urinary retention was investigated in patients after colorectal resection.

METHOD

A prospective cohort study of all patients having colorectal surgery within an ERAS programme that included insertion of an epidural catheter over the last 5 years.

RESULTS

Two-hundred and ten patients had an epidural and a urethral catheter postoperatively. The duration of catheterization was not recorded in one patient who was therefore excluded from the study. One-hundred and eighteen patients had a trial without catheter (TWOC) prior to stopping the epidural (early TWOC). Ninety-one patients had TWOC after the epidural was stopped (late TWOC). Sixteen (7.6%) patients went into urinary retention (14 early TWOC and two late TWOC). The rate of urinary retention in the early TWOC group was significantly higher than that in the late TWOC group (11.9% vs 2.2%; χ(2), P = 0.009). Those who underwent a laparoscopic resection were significantly more likely to have undergone an early TWOC (χ(2), P = 0.001); however, there was no difference in retention rates between open and laparoscopic surgery (χ(2), P = 0.402). Pelvic surgery was not significantly associated with an increased risk of postoperative urinary retention (χ(2), P = 0.627). Male sex was not significantly associated with urinary retention (χ(2), P = 0.087). In the early TWOC group 86% had the catheter removed within 24 hours of surgery.

CONCLUSION

Early TWOC with epidural analgesia running significantly increases the risk of urinary retention; however, it was still successful in 88% of patients.

Comparison of four target volume definitions for pancreatic cancer. Guidelines for treatment of the lymphatics and the primary tumor

BACKGROUND AND PURPOSE

Target volume definitions for radiotherapy in pancreatic ductal adenocarcinoma (PDAC) vary substantially. Some groups aim to treat the primary tumor only, whereas others include elective lymph nodes (eLNs). eLNs close to the primary tumor are often included unintentionally within the treatment volume, depending on the respective treatment philosophies. We aimed to measure the percentages of anatomical coverage of eLNs by comparing four different contouring guidelines.

PATIENTS AND METHODS

Planning target volumes (PTVs) were contoured using planning computed tomography (CT) scans of 11 patients with PDAC based on the Oxford, RTOG (Radiation Therapy Oncology Group), Michigan, and SCALOP (Selective Chemoradiation in Advanced Localised Pancreatic Cancer trial) guidelines. Clinical target volumes (CTVs) included the peripancreatic, para-aortic, paracaval, celiac trunk, superior mesenteric, and portal vein lymph node areas. Volumetric comparisons of the coverage of all eLN regions were conducted to illustrate the differences between the four contouring strategies.

RESULTS

The PTV sizes of the RTOG and Oxford guidelines were comparable. The SCALOP and Michigan PTV sizes were similar to each other and significantly smaller than the RTOG and Oxford PTVs. A large variability of eLN coverage was found for the various subregions according to the respective contouring strategies.

CONCLUSION

This is the first study to directly compare the percentage of anatomical coverage of eLNs according to four PTVs in the same patient cohort. Potential practical consequences are discussed in detail.

A WBAN System for Ambulatory Monitoring of Physical Activity and Health Status: Applications and Challenges

Recent technological advances in sensors, low-power integrated circuits, and wireless communications have enabled the design of low-cost, miniature, lightweight, intelligent physiological sensor platforms that can be seamlessly integrated into a body area network for health monitoring. Wireless body area networks (WBANs) promise unobtrusive ambulatory health monitoring for extended periods of time and near real-time updates of patients' medical records through the Internet. A number of innovative systems for health monitoring have recently been proposed. However, they typically rely on custom communication protocols and hardware designs, lacking generality and flexibility. The lack of standard platforms, system software support, and standards makes these systems expensive. Bulky sensors, high price, and frequent battery changes are all likely to limit user compliance. To address some of these challenges, we prototyped a WBAN utilizing a common off-the-shelf wireless sensor platform with a ZigBee-compliant radio interface and an ultra low-power microcontroller. The standard platform interfaces to custom sensor boards that are equipped with accelerometers for motion monitoring and a bioamplifier for electrocardiogram or electromyogram monitoring. Software modules for on-board processing, communication, and network synchronization have been developed using the TinyOS operating system. Although the initial WBAN prototype targets ambulatory monitoring of user activity, the developed sensors can easily be adapted to monitor other physiological parameters. In this paper, we discuss initial results, implementation challenges, and the need for standardization in this dynamic and promising research field.

Magnetic linear dichroism in the angular dependence of core-level photoemission from (Ga,Mn)As using hard x rays

We report a study of the electronic properties of the ferromagnetic semiconductor (Ga,Mn)As using magnetic linear dichroism in the angular dependence of Mn 2p photoemission under hard x-ray excitation. Bulk plasmon loss satellites demonstrate that the probed Mn ions are incorporated deep within the GaAs lattice, while the observed large dichroism indicates that the spectra originate from ferromagnetic substitutional Mn. Simulations of the spectra using an Anderson impurity model show that the ferromagnetic Mn 3d electrons of substitutional Mn in (Ga,Mn)As are intermediate between localized and delocalized.

A STUDY OF THE MECHANISM OF NUCLEINATE-INDUCED LEUCOPENIC AND LEUCOCYTIC STATES, WITH SPECIAL REFERENCE TO THE RELATIVE ROLES OF LIVER, SPLEEN, AND BONE MARROW

The leucopenia induced by sodium nucleinate has been followed by repeated counts made simultaneously from the blood of a peripheral vein and from the internal organs, combined with a study of histological sections of the same organs taken with the counts. Measurements with the oncometer of changes in volume of the spleen have been correlated with the leucopenia and the leucocytosis following sodium nucleinate. It has thus been determined that the leucopenia is not the result of a vasomotor phenomenon, or of a change in blood volume, nor is it secondary to a retention of the white cells in the capillaries of lung or liver; it is due to the accumulation of neutrophilic leucocytes in the parenchyma of the spleen. That the spleen is solely responsible for the temporary depression of white cells in the general circulation under these conditions has been shown by splenectomy. In splenectomized rabbits no leucopenia developed, but instead a leucocytosis due to a direct action on the bone marrow. A profound change occurs in the distribution of the cells in the circulation at the moment of death. The liver, within a minute of the cessation of the circulation, shows a three- to fourfold increase in the number of white cells per c.mm., the differential count remaining unchanged. Thus estimations of the physiological distribution and redistribution of cells in the living state may be made only with the circulation unimpaired. The injection into normal rabbits of adenine and guanine nucleotides, split products of nucleic acid, gave immediate leucocytosis of bone marrow origin similar to that observed with the more complex molecule when the spleen was eliminated. The response of the bone marrow to chemotactic stimuli, such as those have used, may be reflected in the general circulation, through an absolute increase of young neutrophilic leucocytes, within a period of less than 1 hour. Within this brief period there takes place maturation from Myelocyte C and metamyelocyte into the early motile leucocyte, and the delivery of these just matured cells into the circulation. The response to one injection of nucleinate or nucleotide may persist into the 3rd and 4th days with a gradual depletion of the normal reserve of Myelocytes C in the bone marrow.

The association between neck disability and jaw disability

The association between cervical spine disorders (CSD) and temporomandibular disorders (TMD) has been extensively investigated. However, no studies investigating the relationship between the level of jaw disability and neck disability have been published. Therefore, the objective of this study was to determine whether there was a relationship between neck disability measured using the neck disability index (NDI) and jaw disability measured through the jaw function scale (JFS). A sample of 154 subjects who attended the TMD/Orofacial Pain clinic and students and staff at the University of Alberta participated in this study. All subjects were asked to complete the NDI, the JFS, the jaw disability checklist (JDC), and the level of chronic disability of TMD (chronic pain grade disability questionnaire used in the RDC/TMD). Spearman rho test was used to analyse the relationship between neck disability and jaw disability. Multiple regression analysis was used to determine the association between the level of chronic disability of TMD and neck disability. A strong relationship between neck disability and jaw disability was found (r = 0.82). A subject with a high level of TMD disability (grade IV) increased by about 19 points on the NDI when compared with a person without TMD disability. These results have implications for clinical practice. If patients with TMD have neck disability in addition to jaw disability, treatment needs to focus on both areas because the improvement of one could have an influence on the other.

Maternal and neonatal sepsis caused by Haemophilus influenzae type d

A 29-year-old pregnant woman was admitted to hospital with signs of sepsis and threatened pre-term labour. The premature neonate also showed signs of sepsis. Haemophilus influenzae biotype III was cultured from a midstream urine sample taken from the mother, maternal placental swabs and neonatal blood cultures. The placental and neonatal isolates were both found to be serotype d by PCR, and were indistinguishable by PFGE.

Evaluation of dicloran's contribution to the mutagenic activity of Cristais River, Brazil, water samples

2,6-Dichloro-4-nitroaniline (dicloran) is a mutagenic aromatic amine used as an agricultural fungicide and in the synthesis of disperse dyes. It is a known mutagen (Salmonella/microsome assay) in strains TA98 and TA100. Dicloran was initially detected, but not quantified, in the Cristais River, Brazil. The objective of the present study was to estimate the contribution of dicloran to mutagenic activity in samples from this river. Dicloran was found in the raw water at 0.14 microg/L but not in the treated water. Comparison of mutagenic potencies in Salmonella strain YG1041 for dicloran and the river water sample indicated that dicloran contributed less than 0.1% of total mutagenic activity.

Survey of excited state neutron spectroscopic factors for Z=8-28 nuclei

We have extracted 565 neutron spectroscopic factors of sd and fp shell nuclei by systematically analyzing more than 2000 measured (d, p) angular distributions. We are able to compare 125 of the extracted spectroscopic factors to values predicted by large-basis shell-model calculations and evaluate the accuracies of spectroscopic factors predicted by different shell-model interactions in these regions. We find that the spectroscopic factors predicted for most excited states of sd-shell nuclei using the latest USDA or USDB interactions agree with the experimental values. For fp shell nuclei, the inability of the current models to account for the core excitation and fragmentation of the states leads to considerable discrepancies. In particular, the agreement between data and shell-model predictions for Ni isotopes is not better than a factor of 2 using either the GXPF1A or the XT interaction.