Predicting 5- and 10-year survival in older women with early-stage breast cancer: self-rated health and walking ability.

OBJECTIVES To determine life expectancy for older women with breast cancer. DESIGN Prospective longitudinal study with 10 years of follow-up data. SETTING Hospitals or collaborating tumor registries in four geographic regions (Los Angeles, California; Minnesota; North Carolina; Rhode Island). PARTICIPANTS Women aged 65 and older at time of breast cancer diagnosis with Stage I to IIIA disease with measures of self-rated health (SRH) and walking ability at baseline (N = 615; 17% aged ≥80, 52% Stage I, 58% with ≥2 comorbidities). MEASUREMENTS Baseline SRH, baseline self-reported walking ability, all-cause and breast cancer-specific estimated probability of 5- and 10-year survival. RESULTS At the time of breast cancer diagnosis, 39% of women reported poor SRH, and 28% reported limited ability to walk several blocks. The all-cause survival curves appear to separate after approximately 3 years, and the difference in survival probability between those with low SRH and limited walking ability and those with high SRH and no walking ability limitation was significant (0.708 vs 0.855 at 5 years, P ≤ .001; 0.300 vs 0.648 at 10 years, P < .001). There were no differences between the groups in breast cancer-specific survival at 5 and 10 years (P = .66 at 5 years, P = .16 at 10 years). CONCLUSION The combination of low SRH and limited ability to walk several blocks at diagnosis is an important predictor of worse all-cause survival at 5 and 10 years. These self-report measures easily assessed in clinical practice may be an effective strategy to improve treatment decision-making in older adults with cancer.

Effects of exercise with oxygen prebreathe for decompression risk reduction

Astronauts performing extravehicular activities (EVA) are at risk for occupational hazards due to a hypobaric environment, in particular Decompression Sickness (DCS). DCS results from nitrogen gas bubble formation in body tissues and venous blood. Denitrogenation achieved through lengthy staged decompression protocols has been the mainstay of prevention of DCS in space. Due to the greater number and duration of EVAs scheduled for construction and maintenance of the International Space Station, more efficient alternatives to accomplish missions without compromising astronaut safety are desirable. ^ This multi-center, multi-phase study (NASA-Prebreathe Reduction Protocol study, or PRP) was designed to identify a shorter denitrogenation protocol that can be implemented before an EVA, based on the combination of adynamia and exercise enhanced oxygen prebreathe. Human volunteers recruited at three sites (Texas, North Carolina and Canada) underwent three different combinations (“PRP phases”) of intense and light exercise prior to decompression in an altitude chamber. The outcome variables were detection of venous gas embolism (VGE) by precordial Doppler ultrasound, and clinical manifestations of DCS. Independent variables included age, gender, body mass index, oxygen consumption peak, peak heart rate, and PRP phase. Data analysis was performed both by pooling results from all study sites, and by examining each site separately. ^ Ten percent of the subjects developed DCS and 20% showed evidence of high grade VGE. No cases of DCS occurred in one particular PRP phase with use of the combination of dual-cycle ergometry (10 minutes at 75% of VO2 peak) plus 24 minutes of light EVA exercise (p = 0.04). No significant effects were found for the remaining independent variables on the occurrence of DCS. High grade VGE showed a strong correlation with subsequent development of DCS (sensitivity, 88.2%; specificity, 87.2%). In the presence of high grade VGE, the relative risk for DCS ranged from 7.52 to 35.0. ^ In summary, a good safety level can be achieved with exercise-enhanced oxygen denitrogenation that can be generalized to the astronaut population. Exercise is beneficial in preventing DCS if a specific schedule is followed, with an individualized VO2 prescription that provides a safety level that can then be applied to space operations. Furthermore, VGE Doppler detection is a useful clinical tool for prediction of altitude DCS. Because of the small number of high grade VGE episodes, the identification of a high probability DCS situation based on the presence of high grade VGE seems justified in astronauts. ^

Birth prevalence of isolated congenital limb reduction defects in Texas 1999--2001

Objective. Congenital limb defects are common birth defects occurring in approximately 2-7/10,000 live births. Because congenital limb defects are pervasive throughout all populations, and the conditions profoundly affect quality of life, they represent a significant public health concern. Currently there is a paucity of etiologic information in the literature regarding congenital limb reduction defects which represents a major limitation in developing treatment strategies as well as identifying high risk pregnancies. ^ Additionally, despite the fact that the majority of congenital limb reduction defects are isolated, most previous studies have not separated them from those occurring as part of a known syndrome or with multiple additional congenital anomalies of unknown etiology. It stands to reason that factors responsible for multiple congenital anomalies that happen to include congenital limb reduction defects may be quite different from those factors leading to an isolated congenital limb reduction defect. ^ As a first step toward gaining etiologic understanding, this cross-sectional study was undertaken to determine the birth prevalence and obtain demographic information about non-syndromic (isolated) congenital limb reduction defects that occurred in Texas from 1999-2001. ^ Methods. The study population included all infants/fetuses with isolated congenital limb reduction defects born in Texas during 1999-2001; the comparison population was all infants who were born to mothers who were residents of Texas during the same period of time. The overall birth prevalence of limb reduction defects was determined and adjusted for ethnicity, gender, site of defect (upper limb versus lower limb), county of residence, maternal age and maternal education. ^ Results. In Texas, the overall birth prevalence of isolated CLRDs was 2.1/10,000 live births (1.5 and 0.6/10,000 live births for upper limb and lower limb, respectively). ^ The risk of isolated lower limb CLRDs in Texas was significantly lower in females when gender was examined individually (crude prevalence odds ratio of 0.57, 95% CI of 0.36-0.91) as well as in relation to all other variables used in the analysis (adjusted prevalence odds ratio of 0.58, 95% CI of 0.36-0.93). ^ Harris County (which includes the Houston metropolitan area) had significantly lower risks of all (upper limb and lower limb combined) isolated CLRDs when examined in relation to other counties in Texas, with a crude prevalence odds ratio of 0.4 (95% CI: 0.29-0.72) and an adjusted prevalence odds ratio of 0.50 (95% CI: 0.31-0.80). The risk of isolated upper limb CLRDs was significantly lower in Harris County (crude prevalence odds ratio of 0.45, CI of 0.26-0.76 and adjusted prevalence odds ratio of 0.49, CI of 0.28-0.84). This trend toward decreased risk in Harris County was not observed for isolated lower limb reduction defects (adjusted prevalence odds ratio of 0.50, 95% confidence interval: 0.22-1.12). ^ Conclusions. The birth prevalence of isolated congenital limb reduction defects in Texas is in the lower limits of the range of rates that have been reported by other authors for other states (Alabama, Arkansas, California, Georgia, Hawaii, Iowa, Maryland, Massachusetts, North Carolina, Oklahoma, Utah, Washington) and other countries (Argentina, Australia, Austria, Bolivia, Brazil, Canada, Chile, China, Colombia, Costa Rica, Croatia, Denmark, Ecuador, England, Finland, France, Germany, Hungary, Ireland, Israel, Italy, Lithuania, Mexico, Norway, Paraguay, Peru, Spain, Scotland, Sweden, Switzerland, Uruguay, and Venezuela). In Texas, the birth prevalence of isolated congenital lower limb reduction defects was greater for males than females, while the birth prevalence of isolated congenital upper limb reduction defects was not significantly different between males and females. The reduced rates of limb reduction defects in Harris County warrant further investigation. This study has provided an important first step toward gaining etiologic understanding in the study of isolated congenital limb reduction defects. ^

Automated soldier medical readiness: Prevalence of " medically not ready" using data from the electronic soldier readiness processing system (ESRP)

Identifying accurate numbers of soldiers determined to be medically not ready after completing soldier readiness processing may help inform Army leadership about ongoing pressures on the military involved in long conflict with regular deployment. In Army soldiers screened using the SRP checklist for deployment, what is the prevalence of soldiers determined to be medically not ready? Study group. 15,289 soldiers screened at all 25 Army deployment platform sites with the eSRP checklist over a 4-month period (June 20, 2009 to October 20, 2009). The data included for analysis included age, rank, component, gender and final deployment medical readiness status from MEDPROS database. Methods.^ This information was compiled and univariate analysis using chi-square was conducted for each of the key variables by medical readiness status. Results. Descriptive epidemiology Of the total sample 1548 (9.7%) were female and 14319 (90.2%) were male. Enlisted soldiers made up 13,543 (88.6%) of the sample and officers 1,746 (11.4%). In the sample, 1533 (10.0%) were soldiers over the age of 40 and 13756 (90.0%) were age 18-40. Reserve, National Guard and Active Duty made up 1,931 (12.6%), 2,942 (19.2%) and 10,416 (68.1%) respectively. Univariate analysis. Overall 1226 (8.0%) of the soldiers screened were determined to be medically not ready for deployment. Biggest predictive factor was female gender OR (2.8; 2.57-3.28) p<0.001. Followed by enlisted rank OR (2.01; 1.60-2.53) p<0.001. Reserve component OR (1.33; 1.16-1.53) p<0.001 and Guard OR (0.37; 0.30-0.46) p<0.001. For age > 40 demonstrated OR (1.2; 1.09-1.50) p<0.003. Overall the results underscore there may be key demographic groups relating to medical readiness that can be targeted with programs and funding to improve overall military medical readiness.^

A case-comparison study of weight fluctuations during young adulthood and coronary artery disease during middle age

The hypothesis that large fluctuations in weight during young adulthood are associated with the degree of coronary artery disease was investigated by comparing patterns of weight change of patients with angiographically defined diseased or normal arteries. Participants (n = 823) were selected from men and women aged 40-74 years who had undergone angiography at North Carolina Baptist Hospital during 1987-88. Weight history from age 20 to 40 was assessed with a mailed questionnaire. Per cent prevalence of "yo-yo dieting" adjusted for age, race, and coronary disease risk factors in patients who had 0, 1, 2, 3, or more than 3 diseased arteries was 8.6, 8.8, 3.7, 5.6 and 7.1 per cent respectively (p = 0.313). These results do not support the research hypothesis. However, since the results may have been confound by neuroticism, they should not be interpreted as strong evidence against this hypothesis. ^

Association between sugar-sweetened beverages and both gestational weight gain and gestational diabetes

This cross-sectional study aimed at evaluating the association between sugar sweetened beverage (SSB) consumption and both excessive gestational weight gain (EGWG) and gestational diabetes mellitus (GDM). The study was conducted in the postpartum units of Memorial Hermann Hospital, Lyndon Baines Johnson General Hospital, the University of Texas Medical Branch at Galveston General Hospital, and the University of Texas at Brownsville Hospital. Between June 2009 and September 2010, women between the ages of 18 and 49 years with singleton pregnancies who delivered an infant born at 37 weeks of gestation or later were approached. Descriptive, univariate and multivariate analysis were employed in our study using the Statistical Analysis System (SAS) software version 9.1 (SAS Institute Inc. Cary, North Carolina). Our investigation did not find statistically significant associations between SSBs and EGWG. Our study reported no evidence of an association between SSBs and GDM except for sports drinks. However, the estimate of this association was deemed very imprecise. In conclusion, our study did not find strong provide strong support for the hypothesis that high consumption of SSBs increases the risk of EGWG or GDM. ^

Nd-Sr isotopes in fossil fish debris from IODP Exp302

Strontium and neodymium radiogenic isotope ratios in early to middle Eocene fossil fish debris (ichthyoliths) from Lomonosov Ridge (Integrated Ocean Drilling Program Expedition 302) help constrain water mass compositions in the Eocene Arctic Ocean between 55 and 45 Ma. The inferred paleodepositional setting was a shallow, offshore marine to marginal marine environment with limited connections to surrounding ocean basins. The new data demonstrate that sources of Nd and Sr in fish debris were distinct from each other, consistent with a salinity-stratified water column above Lomonosov Ridge in the Eocene. The 87Sr/86Sr values of ichthyoliths (0.7079 - 0.7087) are more radiogenic than Eocene seawater, requiring brackish to fresh water conditions in the environment where fish metabolized Sr. The 87Sr/86Sr variations probably record changes in the overall balance of river Sr flux to the Eocene Arctic Ocean between 55 and 45 Ma and are used here to reconstruct surface water salinity values. The eNd values of ichthyoliths vary between -5.7 and -7.8, compatible with periodic (or intermittent) supply of Nd to Eocene Arctic intermediate water (AIW) from adjacent seas. Although the Norwegian-Greenland Sea and North Atlantic Ocean were the most likely sources of Eocene AIW Nd, input from the Tethys Sea (via the Turgay Strait in early Eocene time) and the North Pacific Ocean (via a proto-Bering Strait) also contributed.

El catálogo de próxima generación o NextGen : una herramienta de descubrimiento para el catálogo en línea

La herramienta de descubrimiento que ha dado lugar al llamado catálogo de próxima generación o NextGen es una interfaz ensamblada a la base de datos del catálogo en línea, que proporciona opciones similares a las de los motores de búsqueda de la World Wide Web. Entre las características más importantes se pueden mencionar: búsqueda por palabras claves del usuario, corrección de ortografía, asociación de palabras por prefijos y sufijos, gradación por relevancia, búsqueda booleana guiada, navegación facetada, ofrecimiento de ítems relacionados, servicios personalizados como MiCuenta o MiBiblioteca, opciones de diseño, características de la Web social como etiquetado o folksonomía, inclusión de reseñas, anotaciones o calificaciones por parte de los usuarios, aportes de la producción propia, creación de grupos de interés, etc. El desafío que se presenta es repensar el catálogo de modo que contribuya a descubrir la información del modo más eficiente posible, con inclusión de resúmenes, notas de contenido o vínculo al texto completo de los documentos. Existen experiencias basadas en programas comerciales como el catálogo de las bibliotecas de la North Carolina State University (Sirsi/Dynyx + interfaz Endeca) y otras con recursos open source como la de BRAC University de Bangladesh (Koha + Vufind). Se considera que esta última experiencia puede ser de interés para las bibliotecas de nuestro medio.

"Es preciso, pues, regimentar" : La organización de la Guardia Nacional de campaña. Buenos Aires, 1852-1862

En este trabajo estudiamos la organización de la Guardia Nacional en la campaña y la frontera bonaerense, durante los diez años que siguieron a su creación (1852-1862). En ese proceso se destacan dos períodos bien definidos. El primero, 1852-1857, se caracterizó por el predominio de los jueces de paz en el manejo de la institución. El segundo, 1857-1862, se definió por una mayor presencia de los jefes de los regimientos. Nos centraremos en el rol que tuvieron las autoridades civiles y militares que protagonizaron el "arreglo" de la Guardia Nacional de campaña. Procuraremos complejizar la percepción que existe sobre las relaciones de poder que se establecieron entre las jurisdicciones civil y militar, al mismo tiempo entre esta última.

El coronel Don Benito Machado. Un comandante de Guardias Nacionales en la frontera sur bonaerense (1852-1880)

En el presente trabajo, analizamos los regimientos de Guardias Nacionales y las funciones que desempeñaron sus comandantes durante el proceso de organización nacional en la frontera sur bonaerense, desde el estudio de caso del coronel don José Benito Machado. En primer lugar, repasamos las características específicas que adoptaron las Guardias Nacionales en las sociedades de la frontera sur de la provincia de Buenos Aires; mientras que, en segundo lugar, analizamos los diversos mecanismos desarrollados por Benito Machado para construir las bases de poder en la región que posibilitaron el afianzamiento de su liderazgo

El servicio de armas de los habitantes de la campaña durante el Sitio de Buenos Aires. La Guardia de Luján, 1852-1853

El siguiente artículo analiza cómo operó el reclutamiento de hombres para el servicio de armas durante el levantamiento de Hilario Lagos y el sitio de la ciudad de Buenos Aires, de diciembre de 1852 a julio de 1853, en el partido de la Guardia de Luján (hoy Mercedes). Para ello, presta especial atención al rol de los jueces de paz y de las autoridades militares de la campaña, los instrumentos utilizados para hacer efectivo el control y organización de las milicias, así como los principios de resistencia existentes

"Es preciso, pues, regimentar" : La organización de la Guardia Nacional de campaña. Buenos Aires, 1852-1862

En este trabajo estudiamos la organización de la Guardia Nacional en la campaña y la frontera bonaerense, durante los diez años que siguieron a su creación (1852-1862). En ese proceso se destacan dos períodos bien definidos. El primero, 1852-1857, se caracterizó por el predominio de los jueces de paz en el manejo de la institución. El segundo, 1857-1862, se definió por una mayor presencia de los jefes de los regimientos. Nos centraremos en el rol que tuvieron las autoridades civiles y militares que protagonizaron el "arreglo" de la Guardia Nacional de campaña. Procuraremos complejizar la percepción que existe sobre las relaciones de poder que se establecieron entre las jurisdicciones civil y militar, al mismo tiempo entre esta última.

Isotopic record across the Aptian/Albian boundary of ODP Hole 171-1049C

Geochemical analyses of extraordinarily well preserved late Aptian-early Albian foraminifera from Blake Nose (Ocean Drilling Program Site 1049) reveal rapid shifts of d18O, d13C, and 87Sr/88Sr in the subtropical North Atlantic that may be linked to a major planktic foraminifer extinction event across the Aptian/Albian boundary. The abruptness of the observed geochemical shifts and their coincidence with a sharp lithologic contact is explained as an artifact of a previously undetected hiatus of 0.8-1.4 million years at the boundary contact, but the values before and after the hiatus indicate that major oceanographic changes occurred at this time. 87Sr/88Sr increase by ~0.000200, d13C values decrease by 1.5 per mil to 2.2 per mil, and d18O values decrease by ~1.0 per mil (planktics) to 0.5 per mil (benthics) across the hiatus. Further, both 87Sr/88Sr ratios and d18O values during the Albian are anomalously high. The 87Sr/88Sr values deviate from known patterns to such a degree that an explanation requires either the presence of inter-basin differences in seawater 87Sr/88Sr during the Albian or revision of the seawater curve. For d18O, planktic values in some Aptian samples likely reflect a diagenetic overprint, but preservation is excellent in the rest of the section. In well preserved material, benthic foraminiferal values are largely between 0.5 and 0.0 per mil and planktic samples are largely between 0.0 per mil to -1.0 per mil, with a brief excursion to -2.0 per mil during OAE 1b. Using standard assumptions for Cretaceous isotopic paleotemperature calculations, the d18O values suggest bottom water temperatures (at ~1000 -1500 m) of 8-10°C and surface temperatures of 10-14°C, which are 4-6°C and 10-16°C cooler, respectively, than present-day conditions at the same latitude. The cool subtropical sea surface temperature estimates are especially problematic because other paleoclimate proxy data for the mid-Cretaceous and climate model predictions suggest that subtropical sea surface temperatures should have been the same as or warmer than at present. Because of their exquisite preservation, whole scale alteration of the analyzed foraminifera is an untenable explanation. Our proposed solution is a high evaporative fractionation factor in the early Albian North Atlantic that resulted in surface waters with higher d18O values at elevated salinities than commonly cited in Cretaceous studies. A high fractionation factor is consistent with high rates of vapor export and a vigorous hydrological cycle and, like the Sr isotopes, implies limited connectivity among the individual basins of the Early Cretaceous proto-Atlantic ocean.