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PubMed2005

Unconstrained cardiorespiratory and body movement monitoring system for home care.

An unconstrained respiratory rate (RR) and heart rate (HR) monitoring system to be used during sleeping is proposed. The system consisted of eight polyvinylidene fluoride cable sensors, charge amplifiers and measuring software, together with an analogue-to-digital converter unit. The cable sensors were horizontally embedded into a textile sheet on a bed surface covering the upper half of the body. The digital infinite impulse response filters were constructed to extract cardiorespiratory signals from displacement of the sensors. The system software automatically searched the optimum sensor(s) based on the power of the respective filter outputs. Then, the system obtained the 5 s average HR and 15 s average RR by measuring the intervals between the peaks of the respective autocorrelation functions of the filtered output. If the subject changed his posture, the system captured the image of the body position as a time stamp using a CCD camera. To show the validity of this method, the HR and RR obtained by this monitor were compared with those simultaneously measured using respiratory flow and an electrocardiogram. The results showed that the mean frame-by-frame difference ranged from -1.2 to 0.2 beats min(-1) for the HR and, for RR, ranged from -0.8 to 1.4 breath min(-1) during the short-term recordings. Similar differences were obtained during the first 2 h of overnight recordings. The proposed system is feasible for the combined long-term monitoring of a person's RR and HR with sleep posture changes and may be helpful for practical use in the home.

Adult↗

PubMed1989

Biofeedback gait training system for temporal and distance factors.

A biofeedback gait-training system has been developed which can deal with the gait problems of all subjects in any phase of rehabilitation: measurement, analysis, training and/or evaluation. The system is composed of a measuring walkway and a training walker. The walkway can measure all the temporal and distance factors of gait. The walker, with two parallel grasping bars and a CRT monitor, moves automatically with the aid of servo-motors. The system provides visual feedback for distance factors of gait and audio feedback for temporal factors. During the single-support phase the desired foot position for the next step and the supporting foot position are displayed on the CRT. The actual position of the foot placement is then overlaid for the double support duration that follows. A trainee learns to place the foot in such a way as to overlap the desired with the actual foot stamps on the CRT. The desired temporal factors are provided by buzzer tones. A trainee tries to shorten or elongate the duration of the respective phase of the gait cycle in accordance with the tone. Some experiments on normal subjects and on some with degenerative knee joints verified that the biofeedback signals were utilised effectively and that the walker was of value for improving pathological gait.

Adult↗

PubMed1994

Adverse reactions associated with simultaneous administration of multiple vaccines to travelers.

OBJECTIVE: To determine the frequency of local and systemic adverse reactions following the simultaneous administration of multiple vaccines. DESIGN: Prospective descriptive study using a self-administered questionnaire. All patients seen in a one-year period were given the questionnaire and a stamped, return-addressed envelope to be returned three days after their clinic visits. SETTING: Westchester County (New York) Department of Health Travelers' Clinic. PATIENTS: 984 patients made 1,205 visits. 64% returned the questionnaires. INTERVENTION: The patients reported the occurrence and duration of local and systemic reactions three days after the clinic visit. Demographic data, names of the vaccines, and a description of the injection site of each vaccine were collected separately by clinic staff for each patient at each visit. RESULTS: 58% of the patients reported local reactions and 39.5% at least one systemic complaint. The rate of local reactions increased from 45% with 1 injection in an arm to 78% with > or = 3 (OR = 99). The rate of systemic reactions increased from 25% following the administration of 1 vaccine to 70% with > or = 5 (OR = 7). Number of vaccines did not influence duration or severity of reaction. Age and gender were not associated with frequency of reactions. CONCLUSION: Side effects for vaccination of travelers are common. Increasing the number of vaccines is associated with increasing the rates of local and systemic reactions. These reactions are generally minor and should not be a reason to withhold multiple vaccinations to patients when needed.

Adult↗

PubMedDate not supplied

Large-scale oligonucleotide synthesizers. I. Basic principles and system design.

The central problem in scaling up oligonucleotide synthesis is to expose each element of a large bed to the same conditions obtaining in very small ones, for the same intervals of time. Our analysis suggests that scale-up is chiefly limited by fluid path length through the bed. By using annular beds in zonal centrifuge rotors of unique design, with fluid flow controlled by combining centrifugal force with differences in physical density between reagents, reagent fronts may be kept exactly perpendicular to the direction of flow in each bed element. Under these conditions, bed volume may be increased by increasing rotor length and diameter. The rotor is lined with polypropylene or Teflon, and has a thick tempered glass end window. Transparent rotary valves of a unique design allow any of 47 reagents to be selected and the direction of flow through the rotor to be controlled. A photodiode spectrophotometer provides complete absorption spectra on fluid in the rotor inlet and outlet lines every 4 s, and a large balance weighs effluent from the synthesizer continuously. The entire operation is controlled by a work station, and steps may be programmed by time, absorbance, or reagent mass. Reagents are identified by spectra, and trityls are integrated on line. A detailed time-stamped log file provides a complete record of each synthesis.

Equipment Design↗

PubMed1998

Durable remission of locally advanced breast cancer with multimodality management.

We treated 20 women with locally advanced breast cancer between January 1991 and September 1996. The treatment regimen included 4 cycles of intensive doxorubicin (30 mg/m2/d on 3 consecutive days every 2 weeks with G-CSF support), followed by appropriate surgery, followed by high dose therapy with cyclophosphamide, carboplatin and thiotepa (STAMP V, CTCb). Of the 20 patients, seven presented with inflammatory breast cancer, three with Stage IIIB, seven with stage IIIA, one with multifocal Stage IIB and two with Stage IV M1 (ipsilateral supraclavicular lymph node involvement) (including one who had an inflammatory primary) disease. Six patients had not undergone mastectomy at the time of entering the protocol. These six received the doxorubicin in a neoadjuvant fashion and were thus evaluable for tumor response. The remaining 14 received doxorubicin as adjuvant therapy prior to intensification and transplantation. All patients underwent local-regional radiation therapy and were placed on oral tamoxifen. Doxorubicin was well tolerated in this schedule with all but three patients receiving all their cycles on schedule. Both BM and PBPC were easily collected after this regimen and, when reinfused, resulted in the prompt recovery of granulocytes (median 11 days to 500 absolute granulocyte count) and platelets (median 13 days to 20,000 platelets). The six patients who received doxorubicin prior to mastectomy all had major clinical responses, but were found to have microscopic focii of breast cancer in the mastectomy specimens. The overall treatment was well tolerated with the exception of one treatment-related death (5%). The overall and relapse free survival are 70% and 58% respectively with a median follow-up of 40 months (range 12-74 months). When the Stage IV patients are censored, the relapse-free survival rate is 69%. In the bone marrow transplant phase of treatment, the major non-hematologic toxicities were stomatitis (70%) and anorexia requiring parental nutrition (75%).

Adult↗

PubMed1997

[Value of various intra- and extraoral therapeutic procedures for treatment of obstructive sleep apnea and snoring].

BACKGROUND: Recently intra- and extraoral devices are increasingly used in order to treat obstructive sleep apnea (OSA) and snoring. We examined the value of some devices according to the literature and our own results. PATIENTS AND METHODS: The mandibular advancing devices aim at increasing upper airway diameter. The active part of the tongue extending device (SnorEx) is a stamp connected to a piston which exerts pressure at the base of the tongue causing its forward displacement; we studied 23 patients. The principle of an optically stimulating system ("eye-cover", Snore-Stop) consists of a microphone and light diods which are integrated in the eye-cover. After detecting acoustic signals (for example snoring) optical stimuli are generated in front of the eyes, which are thought to induce arousals causing a change of body position and the reduction of the snoring and apneas; we measured 24 patients. The principle of the tongue-retainer (Snore-Master) is the fixation of the tongue in a ventral position, which is thought to enlarge the mesopharyngeal area; we studied 14 patients. The nose plaster (Breathe-Right) contains an elastic spine that pulls the alae nasi cranial. This manipulation is thought to increase the diameter of the nostril and reduce the airway resistance. We measured 30 patients with obstructive sleep apnea and 20 snoring subjects without obstructive sleep apnea. RESULTS: Regarding the mandibular advancing due to different appliance designs and study protocols variable success rates have been documented. In patients with mild to moderate obstructive sleep apnea a reduction of the sleep related breathing disorder could be shown. Non compliance (NC) to the tongue extending device was 75% (17/23). Non-compliance-patients were characterized by unacceptable local-side-effects of the prosthesis, lacking improvement of symptoms and of the respiratory disturbance index. Both tongue-retainer and -extensor are characterized by a high incidence of local side effects. Neither the eye-cover nor the nose plaster could improve the severity of obstructive sleep apnoe or snoring. In contrast to another study we could not show a significant effect of the tongue-retainer. CONCLUSIONS: Neither the nose plaster nor the optical stimulating device influenced the degree of obstructive sleep apnea and snoring. There are conflicting data regarding the tongue retainer. The high rate of non-compliant subjects and the low efficacy of the tongue extending prosthesis precludes large-scale use of this treatment modality in patients with obstructive sleep apnoe and snoring. In selected individuals suffering from a mild to moderate degree of obstructive sleep apnea with CPAP-inefficiency and -incompliance the mandibular advancing principle may be an therapeutic alternative to CPAP.

Equipment Design↗

PubMed2001

Automated examination notification of emergency department images in a picture archiving and communication system.

This study compares the timeliness of radiology interpretation of Emergency Department (ED) imaging examinations in a picture archiving and communication system (PACS) before and after implementation of an automated paging system for notification of image availability. An alphanumeric pager for each radiology subspecialty (chest, pediatrics, bone, neuroradiology, and body) was used to alert the responsible radiologist that an ED imaging examination is available to be viewed on the PACS. The paging system was programmed to trigger off of the PACS database when an image is received on the appropriate radiology display station. The pager message includes the radiology accession number and examination description (such as chest, two-view, or c-spine, etc). The PACS paging tool performance was assessed by calculating the time elapsed, for each ED imaging examination, from the Time Imaged to the Time of Interpretation, where the Time Imaged is the actual image completion time measured at the imaging modality, and the Time Interpreted is the time a radiology interpretation is rendered to the ED, and is measured from the Radiology-to-ED fax time stamp. These measures were analyzed pre- and post-paging system implementation to determine any impact of the automated notification tool on radiology service turnaround time. Results show an improved radiology response time from image completion to interpretation rendered to ED clinicians, down from hour(s) to minutes, with the automated paging examination notification system. Examinations are read by the appropriate radiology specialty section in a more timely fashion, and fewer cases go unread by radiology.

Emergency Service, Hospital↗

PubMed1998

[Karl E. Hammerschmidt. Humanist, natural scientist and pioneer in anesthesia].

Karl Eduard Hammerschmidt was born in Vienna in 1801. There are indications that after studying law he passed on to studies in medicine and surgery in Vienna, though it has to be said there is no trace of his attaining any qualification. After this he worked in various scientific sectors and in recognition of his achievements he was accepted as a member of the Kaiser Leopold Academy of Researchers in Natural Sciences in Bonn. From February 1847 to March 1848 he induced numerous general anaesthetics with ether, working with Dr. J. Weiger, a dentist in Vienna. On 11 July 1847 he published preliminary statistics based on 1560 dental operations performed under ether anaesthesia and also on numerous experiments performed on himself and investigations conducted with ether in animals and in healthy subjects. From the viewpoint of scientific research into and widening of the applications of ether anaesthesia, his most meritorious achievements include the early publication of a staging classification for ether anaesthesia, the introduction of an anaesthetic protocol for patients that also lent itself to data recording for statistical purposes and the early realization that the ability to hear is retained for a very long time during anaesthesia. In 1848 Hammerschmidt was obliged to flee to Istanbul by way of Hungary because of his involvement in the October Revolution. Once there, he continued to work as a doctor and later became Professor of Medicine at the University of Istanbul. He converted to Islam, taking the name of Abdullah Bey, and also became a colonel in the Turkish army. He was one of the founders of the Red Crescent, the humanitarian sister organization of the Red Cross, and the Turkish Post commemorated this with the issue of a stamp honouring him when the organization celebrated the centenary of its formation in 1968. In 1869 the Hapsburg dynasty also honoured him with orders and distinctions. He died in Istanbul in 1874 as a highly esteemed personage.

Anesthesiology↗

PubMed2005

Socioeconomic influences on bone health in postmenopausal women: findings from NHANES III, 1988-1994.

Our objectives were (1) to examine the associations of education and income with bone health in non-Hispanic White, non-Hispanic Black and Mexican-American postmenopausal women, (2) to determine if any observed associations can be explained by behavioral factors such as calcium intake and physical activity and (3) to determine if government food assistance and education are associated with increased calcium intake among low-income women. Cross-sectional data were gathered by the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III) using a stratified multistage probability design. Bone health was indicated by total hip bone mineral density (BMD, g/cm2). Multiple linear regression was used to evaluate the associations of education, income and behavioral factors with BMD. There were 2,905 postmenopausal women with acceptable DXA scans and complete relevant data selected from a nationally representative sample of the civilian non-institutionalized population aged 2 months and older. Education and income were positively associated with BMD in Black and White women, respectively, but not in Mexican-American women. When behavioral factors were included in the analyses, associations with education and income were eliminated. Instead, positive associations with estrogen use, calcium intake and physical activity, and a negative association with smoking, were noted in White women. Among low-income women, education was associated with increased calcium intake, while participation in the Food Stamp Program was associated with increased calcium intake in Black women. We conclude that education and/or income are positively associated with BMD among Black and White postmenopausal women, and that efforts to promote bone health among low-income women are warranted.

Black or African American↗

PubMed2006

The debate over dopamine's role in reward: the case for incentive salience.

INTRODUCTION: Debate continues over the precise causal contribution made by mesolimbic dopamine systems to reward. There are three competing explanatory categories: 'liking', learning, and 'wanting'. Does dopamine mostly mediate the hedonic impact of reward ('liking')? Does it instead mediate learned predictions of future reward, prediction error teaching signals and stamp in associative links (learning)? Or does dopamine motivate the pursuit of rewards by attributing incentive salience to reward-related stimuli ('wanting')? Each hypothesis is evaluated here, and it is suggested that the incentive salience or 'wanting' hypothesis of dopamine function may be consistent with more evidence than either learning or 'liking'. In brief, recent evidence indicates that dopamine is neither necessary nor sufficient to mediate changes in hedonic 'liking' for sensory pleasures. Other recent evidence indicates that dopamine is not needed for new learning, and not sufficient to directly mediate learning by causing teaching or prediction signals. By contrast, growing evidence indicates that dopamine does contribute causally to incentive salience. Dopamine appears necessary for normal 'wanting', and dopamine activation can be sufficient to enhance cue-triggered incentive salience. Drugs of abuse that promote dopamine signals short circuit and sensitize dynamic mesolimbic mechanisms that evolved to attribute incentive salience to rewards. Such drugs interact with incentive salience integrations of Pavlovian associative information with physiological state signals. That interaction sets the stage to cause compulsive 'wanting' in addiction, but also provides opportunities for experiments to disentangle 'wanting', 'liking', and learning hypotheses. Results from studies that exploited those opportunities are described here. CONCLUSION: In short, dopamine's contribution appears to be chiefly to cause 'wanting' for hedonic rewards, more than 'liking' or learning for those rewards.

Animals↗

PubMed2006

Development of a murre (Uria spp.) egg control material.

The Seabird Tissue Archival and Monitoring Project (STAMP) is a collaborative Alaska-wide effort by the US Fish and Wildlife Service's Alaska Maritime National Wildlife Refuge (USFWS/AMNWR), the US Geological Survey's Biological Resources Division (USGS/BRD), the Bureau of Indian Affairs Alaska Region Subsistence Branch (BIA/ARSB), and the National Institute of Standards and Technology (NIST) to monitor long-term (decadal) trends in environmental contaminants using seabird eggs. To support this effort, a matrix- (seabird egg) and concentration-specific control material was needed to ensure quality during analytical work. Although a herring gull egg quality assurance (HGQA) material is available from Environment Canada (EC), contaminant concentrations in this material tended to be higher than those observed in Alaskan murre (Uria spp.) eggs. Therefore, to prepare a more appropriate control material, a total of 12 common murre (U. aalge) and thick-billed murre (U. lomvia) eggs from four Bering Sea and Gulf of Alaska nesting locations were cryohomogenized to create 190 aliquots each containing approximately 6 g. This new control material was analyzed by different methods at NIST and EC facilities for the determination of concentrations and value assignment of 63 polychlorinated biphenyl (PCB) congeners, 20 organochlorine pesticides, and 11 polybrominated diphenyl ether (PBDE) congeners. The total PCB concentration is approximately 58 ng g(-1) wet mass. Results obtained for analytes not listed on the certificates of analysis of the previously used control materials, HGQA and NIST's Standard Reference Material (SRM) 1946 Lake Superior Fish Tissue, are also presented.

Alaska↗

PubMed2000

Changes in motor representation related to facial nerve damage and regeneration in adult rats.

The present study examined how facial nerve regeneration shapes movement representation patterns in previously disconnected motor cortices. Electrical microstimulation was used to bilaterally map the motor cortices of adult rats subjected to unilateral facial nerve lesion and reanastomosis stamps at the stylomastoid foramen level. The motor cortex output patterns of two groups of experimental hemispheres (contralateral to lesioned side) were compared before and after facial nerve reinnervation. The motor cortex output patterns in the control hemispheres (ipsilateral to the lesioned side) were used as reference. Before facial nerve reinnervation, the motor cortex forelimb and eye output area extended into the vibrissa area; such enlargement did not occupy the medial part of the former vibrissa area where ipsilateral vibrissa or neck movements were represented. After facial nerve reinnervation, the contralateral vibrissa movement reorganized into a shrunken cortical area corresponding to the medial portion of the former vibrissa representation, i.e., where the ipsilateral vibrissa and neck movements were mainly represented prior to facial nerve reinnervation. The enlargement of the forelimb and eye representation remained unchanged, even after the vibrissa motor innervation was reactivated. Before facial nerve reinnervation into expanded forelimb and eye representations, a minimal current was required to evoke these movements, which did not vary from the normal range. A higher current was necessary to evoke the ipsilateral vibrissa and neck movements in the medial part of the vibrissa representation than the threshold needed to elicit the vibrissa movement normally represented in this cortical region. After facial nerve reinnervation, the overall current required to evoke movement remained the same as that which evoked movement before the vibrissa motor innervation was reactivated.

Action Potentials↗

PubMed2003

Photolithographically defined deposition of attachment factors as a versatile method for patterning the growth of different cell types in culture.

Spatially defined growth of cells in culture is a useful model for studies ranging from the characterization of cellular motility to the analysis of network behaviour in structurally defined ensembles of excitable cells. Current methodological approaches for obtaining patterned growth include sophisticated modifications of surface chemistry, stamping techniques and microfluidics. The implementation of most of these techniques requires the availability of highly specialized apparatus and some of the methods are specific for certain cell types and/or substrate materials. The goal of the present study was to develop a cell-patterning technique that can be implemented by any laboratory working with cell culture and that is highly adaptable in terms of cell types and substrate materials. The method is based on a photolithographic process that permits the patterned deposition of attachment factors of choice on surfaces previously coated with agar with a spatial resolution (maximal deviation from a straight line) of +/-3 micro m. Because agar efficiently prevents cell adhesion, patterned growth obtained with this technique displays virtually no off-pattern cell attachment. The method permitted the patterning of cardiomyocytes, fibroblasts and HeLa cells on either glass substrates or polymer-coated materials with a spatial resolution of a few micrometers.

Agar↗

PubMed2003

Productivity and cost assessment of computed radiography, digital radiography, and screen-film for outpatient chest examinations.

An objective assessment and comparison of computed radiography (CR) versus digital radiography (DR) and screen-film for performing upright chest examinations on outpatients is presented in terms of workflow, productivity, speed of service, and potential cost justification. Perceived ease of use and workflow of each device is collected via a technologist opinion survey. Productivity is measured as the rate of patient throughput from normalized timing studies. The overall speed of service is calculated from the time of examination ordering as stamped in the radiology information system (RIS), to the time of image availability on the picture archiving and communication system (PACS), to the time of interpretation rendered (from the RIS). A cost comparison is discussed in terms of potential productivity gains and device expenditures. Comparative results of a screen-film (analog) dedicated chest unit versus a CR reader and a DR dedicated chest unit show a higher patient throughput for the digital systems. A mean of 8.2 patients were moved through the analog chest room per hour, versus 9.2 patients per hour using the CR system and 10.7 patients per hour with the DR system. This represents a 12% increase in patient throughput for CR over screen-film; a 30% increase in patient throughput for DR over screen-film, which is statistically significant; and a 16% increase in patient throughput for DR over CR, which is not statistically significant. Measured time to image availability for interpretation is much faster for both CR and DR versus screen-film, with the mean minutes to image availability calculated as 29.2 +/- 14.3 min for screen-film, 6.7 +/- 1.5 min for CR, and 5.7 +/- 2.5 min for DR. This represents an improved time to image availability of 77% for CR over screen-film, 80% for DR over screen-film, and 15% for DR over CR. These results are statistically significant (P <.0001) for both CR over screen-film and DR over screen-film but not statistically significant for DR over CR. A comparison of the digital technology costs illustrates that the high cost of DR may not be justifiable unless a facility has a steady high patient volume to run the device at or near 100% productivity. Both CR and DR can improve workflow and productivity over analog screen-film in a PACS for delivery of projection radiography services in an outpatient environment. Cost justification for DR over CR appears to be tied predominantly to high patient volume and continuous rather than sporadic use patterns.

Ambulatory Care Facilities↗

PubMed2002

Workflow assessment of digital versus computed radiography and screen-film in the outpatient environment.

An objective assessment and comparison of computed radiography (CR) versus digital radiography (DR) and screen-film in terms of workflow, productivity, speed-of-service, and potential cost justification for imaging ambulatory patients is presented. Perceived ease-of-use and workflow of each device is collected via a technologist opinion survey. Productivity is measured as the rate of patient throughput from normalized timing studies. The overall speed-of-service is calculated from the time of examination ordering as stamped in the radiology information system (RIS), to the time of image availability on the picture archiving and communication system (PACS), to the time of interpretation rendered (from the RIS). Comparative results of screen-film (analog) versus a CR reader and a DR dedicated chest unit show a higher patient throughput for the digital systems. A mean of 10.7 patients were moved through the DR chest room per hour, and 9.2 patients per hour using CR, versus 8.2 patients per hour for the analog device. Measured time to image availability for interpretation is much faster for both DR and CR versus screen-film, with the mean minutes to image availability calculated as 5.7 +/- 2.5 minutes for DR, 6.7 +/- 1.5 minutes for CR, and 29.2 +/- 14.3 minutes for screen film. DR and CR can improve workflow and productivity over analog screen-film in a PACS for delivery of projection radiography services in an outpatient environment, but DR requires high volume to be cost effective over CR.

Efficiency, Organizational↗

PubMed2004

Nobel Lecture. Aquaporin water channels.

Thank you very much. I am humbled, I am delighted; I am honored. This is every scientist's dream: to give the Nobel Lecture in Stockholm. But I would not be honest if I did not tell you that I am having a little anxiety being on this platform. I have lectured a number of times in Sweden, and I thought I would share with you some events preceding a special lecture that I gave here a few years ago. Arriving at Arlanda Airport, I waited in line at the Pass Control behind a group of businessmen in suits with briefcases. I heard the first in line asked by the control officer to state the purpose of his visit to Sweden. When the man replied "business," the officer approved and stamped his passport. One at a time, each stepped forward and was asked the same thing; each answered "business" and was approved. Eventually it was my turn, and I was dressed in rumpled clothes after spending the night in the Economy Minus section of an SAS jetliner. The officer asked me the purpose of my visit, and I said "I am here to give the von Euler Lecture at Karolinska Institute." The officer immediately looked up, stared at me, and asked, "Are you nervous?" At that point I became intensely nervous and said "Yes, I am a little nervous." The officer looked up again and stated "Well, you should be!" So if the lecturers look a little nervous, the problem is at Arlanda.

Animals↗

PubMed2005

A multicenter randomized clinical trial evaluating interleukin-2 activated hematopoietic stem cell transplantation and post-transplant IL-2 for high risk breast cancer patients.

PURPOSE: This Phase III randomized multicenter trial compared progression-free (PFS) and overall survival (OS) for autologous peripheral blood stem cell (aPBSC) transplantation with or without immunotherapy in high-risk breast cancer patients. METHODS: Eligible patients had American Joint Committee on Cancer (AJCC) 5th Edition Stage II/IIIA with > or = 4 axillary nodes, Stage IIIB, or chemotherapy-sensitive or stable Stage IV disease. Following treatment with cyclophosphamide, thiotepa and carboplatin (STAMP V), patients were randomized to aPBSC transplant with or without immunotherapy. Patients on immunotherapy received cells that were incubated in interleukin-2 (IL-2) for 24 h followed by parenteral IL-2 for 5 days then 2 days of rest for 4 weeks. RESULTS: Fifty-nine patients were treated (35 Stage II/IIIA; 13 Stage IIIB; 11 Stage IV), 30 patients were randomized to immunotherapy and 29 patients to no immunotherapy. Neutrophils engrafted a median of 10 days post-transplant in both groups. The median times to platelet engraftment were 9 and 10 days after transplant in the no-immunotherapy and immunotherapy groups, respectively (p = 0.03). There was no statistical evidence (p = 0.61) of a difference in progression-free and surviving (PFS) at 3 years for patients receiving immunotherapy (53%) compared with no immunotherapy (48%). There was some evidence of superiority in overall survival (OS) at 3 years for patients receiving immunotherapy (83%) compared with no immunotherapy (69%), but the difference between survival curves was not statistically significant (p = 0.08). Also, there was some evidence that patients developing acute graft versus host disease (aGVHD) had superior PFS (p = 0.02) but not OS (p = 0.19) than patients not developing aGVHD. Toxicities were transient and similar between groups, with no treatment-related deaths. CONCLUSIONS: This phase III study of high-risk breast cancer patients randomized to immunotherapy or no immunotherapy demonstrated that a well-tolerated immunotherapy regimen added to aPBSC transplant did not improve PFS, but there was some improvement in OS, but not by an amount that was statistically significant (p = 0.08).

Adolescent↗

PubMed2006

Food security and child hunger among recently resettled Liberian refugees and asylum seekers: a pilot study.

Little is known about the food insecurity situation among families resettled into the United States as part of the refugee resettlement program. This paper reports on a pilot study examining food insecurity among recently arrived refugee families (n=33). Objectives were to evaluate the usefulness and feasibility of methods to assess the prevalence of food insecurity and child hunger, and to examine associations between child hunger and measures of socio-economic status and measures of acculturation. Results indicated that 85% of households were food insecure, and 42% experienced child hunger. Hunger was more likely to be indicated in households using foods stamps, with lower income, and lower education. Hunger was also more likely to be indicated in households where the primary shopper experienced difficulty shopping and with language. Results are in broad agreement with those reported in other studies and highlight economic and information barriers to achieving food security. These data suggest that further study of food insecurity is warranted among recently resettled refugee communities resettled in the United States.

Acculturation↗