Do patient‐reported measures of symptoms and health status predict mortality in hemodialysis? An assessment of POS‐S Renal and EQ‐5D

Introduction Experience with the use of patient‐reported outcome measures such as EQ‐5D and the symptom module of the Palliative care Outcome Scale—Renal Version (POS‐S Renal) as mortality prediction tools in hemodialysis is limited. Methods A prospective survival study of people receiving hemodialysis (N = 362). The EQ‐5D and the POS‐S Renal were used to assess symptom burden and self‐rated health (with a self‐rated component). Participants were followed from instrument completion to death or study end. Competing risks survival analysis was used to evaluate associations with time to death, with renal transplant as a competing risk. Findings 32% (N = 116) of participants died over a median (25th–75th centile) of 2.6 (1.41–3.38) years. Factors most notably associated with mortality adjusted hazard ratio (95%CI) included: lower EQ VAS score 2.7 (1.4, 5.2) P = 0.004 (lowest tertile), higher POS‐S Renal score 2.4 (1.3, 4.3) P = 0.004 (highest tertile), and lower EQ‐5D score 2.6 (1.3, 5.3) P = 0.01 (lowest tertile) as well as the presence of: “problems with mobility?” 2 (1.1, 3.3) P = 0.01, or “problems with usual activities?” 2.1 (1.4, 3.3), P < 0.001. After age adjustment area under the receiver operating curves (AUC) (95%CI) for mortality were: 0.71 (0.62, 0.79) for EQ VAS score, 0.71 (0.63, 0.80) for POS‐S Renal‐S Renal score, and 0.76 (0.68, 0.84) for EQ‐5D score. AUC 95%CI was highest for our fourth model at 0.79 (0.72, 0.86) comprised of individual elements from both instruments and established risk factors. Discussion EQ VAS scores and predictive models based on combinations of elements from the POS‐S Renal and EQ‐5D instruments may aid in mortality discrimination and possibly in the delivery of supportive care services.     

Depression and the long-term risk of pain, fatigue, and disability in patients with rheumatoid arthritis

OBJECTIVE: To determine whether a previous episode of major depression leaves a "scar" that places previously depressed patients with rheumatoid arthritis (RA) at risk for experiencing high levels of pain, fatigue, and disability. METHODS: A cohort of 203 patients with RA was randomly selected from a national panel and interviewed by phone about pain, fatigue, depressive symptoms, disability, and history of major depression. RESULTS: Excluding patients who met the criteria for current major depression, patients with both a history of depression and many depressive symptoms at the time of the interview (dysphoria) reported more pain than those without current dysphoria, irrespective of whether they had a history of depression. Dysphoria alone was not reliably related to pain reports. CONCLUSION: An episode of major depression, even if it occurs prior to the onset of RA, leaves patients at risk for higher levels of pain when depressive symptoms persist, even years after the depressive episode.     

Evidence that childhood acute lymphoblastic leukemia is associated with an infectious agent linked to hygiene conditions

OBJECTIVES: The incidence of acute lymphoblastic leukemia (ALL) in children has shown temporal and geographic variation during the 20th century, with higher rates in developed nations appearing in the first half of the century, but with persisting low rates in developing nations. We sought to assess the relation of childhood ALL with hygiene conditions, an aspect of socioeconomic development affecting rates of exposure to infectious agents. METHODS: Infection patterns for hepatitis A virus (HAV), an agent with a fecal-oral route of transmission, were used to indicate hygiene conditions in different populations, with emphasis on instructive United States and Japanese data. A catalytic model was fit to these data, estimating the HAV force of infection and age-specific seroprevalence rates over time. These analyses were used to assess the temporal relationship of changes in HAV infection rates to changes in childhood leukemia mortality and incidence rates. RESULTS: We observed an inverse relationship between HAV infection prevalence and rates of childhood leukemia. Further, decreases in the HAV force of infection in the United States and Japan appear to have preceded increases in childhood leukemia rates. We describe a model based on a putative leukemia-inducing agent with a change in infection rate over time correlated with that of HAV that describes well the temporal trends in childhood leukemia rates for White children in the US and for Japanese children. CONCLUSION: The data suggest that improved public hygiene conditions, as measured by decreased prevalence of HAV infection, are associated with higher childhood ALL incidence rates. The model that we present supports the plausibility of the hypothesis that decreased childhood exposure to a leukemia-inducing agent associated with hygiene conditions leads to higher rates of ALL in children by increasing the frequency of in utero transmission caused by primary infection during pregnancy (or by increasing the number of individuals infected in early infancy because of lack of protective maternal antibodies).     

A Review of the Development and Performance of the ARPANET Routing Algorithm

This paper presents a comprehensive review of the ARPANET routing algorithm, from its original implementation to our plans for future modifications. We hope that by collecting this information, and by providing considerable details, we can provide others with a useful reference document concerning some of the practical problems of network algorithm design. Much of the discussion below assumes a basic familiarity with the principles of packet switching, the ARPANET implementation, and some of the relevant terminology, information which can be found, for example, in [4]. Sections 1 and 2 give a brief summary of basic routing concepts and of the original routing algorithm, respectively. The following two sections describe in detail subsequent modifications and the actual implementation currently in use. Section 5 then discusses some problems that have developed over the past few years, as network usage has grown considerably. The final sections outline some explanations for these problems and some mechanisms for improving performance. We are in the process of implementing these and other changes to the routing algorithm.     

The growth of crystals of erbium hydride

Crystals of the rare-earth hydride ErH₂ have been produced with face areas greater than a square millimetre and corresponding volumes exceeding those of earlier crystals by orders of magnitude. The hydride, which was produced in bulk polycrystalline form by hydriding erbium metal at 950° C, has been examined by optical and X-ray techniques. For material of composition ErH₂ and ErH_1.8 the size of the grains and their degree of strain appears to depend more on oxygen contamination during formation and on the subsequent cooling procedure, than on the size of erbium metal crystals in the starting material.     

Sensory acceptability of white bread with added Australian sweet lupin (Lupinus angustifolius) kernel fibre and its glycaemic and insulinaemic responses when eaten as a breakfast

The aim of this study was to determine whether lupin kernel fibre (LKF) could lower the glycaemic and insulinaemic responses of bread without reducing palatability. Healthy adults (n = 21) consumed control (white) bread (2.7% total dietary fibre (TDF)) once and LKF bread (8.5% TDF) once, as 50 g available carbohydrate breakfasts, in random order on different occasions. Venous blood samples were taken fasting, then post‐prandially over 2 h and analysed for plasma glucose and insulin. Incremental areas under curves (IAUC) for glucose and insulin, glycaemic index (GI) and insulinaemic index (II) were calculated. Sensory acceptability of a control (white) bread (3.5% TDF) and two LKF breads (6.6 and 8.3% TDF) was determined (n = 54). A reduction of 18.8% (P < 0.05) was seen in IAUC for insulin of LKF bread compared with the control (white) bread breakfast. No significant differences were seen in the other glucose or insulin measures. Mean sensory ratings for all breads were ‘acceptable’, with no significant differences between the ratings of the breads. In conclusion, LKF can be formulated into palatable bread and beneficially influenced the IAUC for insulin. Further studies are required to determine unequivocally whether LKF has beneficial effects on blood glucose and insulin measures. Copyright © 2003 Society of Chemical Industry     

Investigation of the mouse cerebellum using STIM and μ-PIXE spectrometric and FTIR spectroscopic mapping and imaging

The cerebral biochemistry associated with the development of many neurological diseases remains poorly understood. In particular, incomplete understanding of the mechanisms through which vascular inflammation manifests in tissue damage and altered brain function is a significant hindrance to the development of improved patient therapies. To this extent, a combination of spectrometric/spectroscopic mapping/imaging methods with an inherent ability to provide a wealth of biochemical and physical information have been investigated to understand further the pathogenesis of brain disease.In this study, proton-induced X-ray emission (PIXE) mapping was combined with scanning transmission ion microscopy (STIM) mapping and Fourier-transform infrared (FTIR) imaging of the same tissue sample to study directly the composition of the murine (mouse) cerebellum. The combination of the elemental, density and molecular information provided by these techniques enabled differentiation between four specific tissue types within the murine cerebellum (grey matter, white matter, molecular layer and micro blood vessels). The results presented are complementary, multi-technique measurements of the same tissue sample. They show elemental, density and molecular differences among the different tissue types.     

Facilitating the care of terminally Ill children

Life-threatening illness is fortunately rare in children. Some children, however, will need palliative care for symptom control; psychological support may be needed by the child and the child's family; and families may require help with decisions about life-prolonging treatment. Providing consistent high-quality care for a relatively uncommon problem is difficult. Adult palliative care services, liaison with pediatricians can help provide this care.     

Fast VLSI algorithms for division and square root

Real time digital signal processing demands high performance implementations of division and square root. This can only be achieved by the design of fast and efficient arithmetic algorithms which address practical VLSI architectural design issues. In this paper, new algorithms for division and square root are described. The new schemes are based on pre-scaling the operands and modifying the classical SRT method such that the result digits and the remainders are computed concurrently and the computations in adjacent rows are overlapped. Consequently, their performance exceeds that of the SRT methods. The hardware cost for higher radices is considerably more than that of the SRT methods but for many applications, this is not prohibitive. A system of equations is presented which enables both an analysis of the method for any radix and the parameters of implementations to be easily determined. This is illustrated for the case of radix 2 and radix 4. In addition, a highly regular array architecture combining the division and square root method is described.     

Incidence of hepatitis B virus infection in the United States, 1976-1994: estimates from the National Health and Nutrition Examination Surveys

Recurrence is a common sequela of Clostridium difficile-associated diarrhea (CDD) and may increase morbidity, costs, and treatment-related antimicrobial resistance. Because recurrent CDD (RCDD) frequently occurs very soon after an initial episode, our goal was to determine the risk factors for early RCDD (occurring < or = 45 days after the initial episode). We conducted a case-control study, comparing 13 patients with early RCDD (case patients) with 46 patients who had only one CDD episode (control patients) at Centre Hospitalier Angrignon (Québec) during January 1993 through November 1994. Risk factors for early RCDD included a history of chronic renal insufficiency, a white blood cell count of > or = 15 x 10(3)/mm3, and community-acquired diarrhea with the first CDD episode. For seven of eight case patients, C. difficile strains from the first and second CDD episodes were identical, suggesting that relapse is more common than reinfection. These results suggest that treatments should be directed at preventing relapses in patients at high risk for early RCDD.