Nutritional status and quality of life among breast Cancer patients undergoing treatment in Addis Ababa, Ethiopia.

BACKGROUND: The prevalence of malnutrition in cancer patients ranges from 30 to 60%. While it is known that malnutrition is prevalent among cancer patients, the relationship between undernutrition and quality of life among breast cancer patients has not been adequately explored. Therefore, the present study was aimed at assessing the association between undernutrition and quality of life among Breast Cancer patients under treatment in Addis Ababa, Ethiopia. METHODS: A cross-sectional study on breast cancer patients under treatment at the outpatient and in-patient departments of oncology centers of two tertiary hospitals in Addis Ababa - Tikur Anbessa Specialized Hospital (TASH) and St. Paul Millennium Medical College (SPHMMC) oncology was conducted from May 12 to August 26,2020. Nutritional status was assessed using Subjective Global Assessment (SGA) screening tool. Quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cancer 30 (EORTC QLQ C30) a standard quality of life measurement scale for cancer patients. To determine the relationship between quality of life scores and nutritional status multivariable linear regression was fitted. RESULTS: A total of 411 breast cancer patients with mean age of 44.4 (± 11.47) years. And 393 (95.6%) of them female were included in the study. A high prevalence of moderate 127 (30.9%) and severe 106 (25.8%) malnutrition was observed. Moderate (ß = -9.21 CI (- 14.59, - 4.67)) and severe (ß = -17.81 CI (- 16.6, 2 - 2.91)) malnutrition were negatively associated with the overall quality of life. Malnutrition also showed negative associations with all domains of functional status (P < 0.05) and strong positive associations with symptom scores covered in the EORTC QLQ C-30 (P < 0.05). CONCLUSION: This study indicated that malnutrition is a major problem among breast cancer patients and the nutritional status breast cancer patients was related to their quality of life….

Socio-demographic and economic inequity in the use of insecticide-treated bed nets during pregnancy: a survey-based case study of four sub-Saharan African countries with a high burden of malaria.

Despite global investments in malaria eradication and mitigation efforts, including the dissemination of ITNs to vulnerable communities, the goal of widespread malaria control among pregnant women has yet to be realized in many African countries. One of the explanations forwarded for this is related to the adoption and regular use of ITNs by pregnant women. Based on the available DHS and MIS data from four malaria high burden African countries- according to WHO malaria report 2020- inequality was measured by applying both relative and absolute summary measures for the four dimensions of inequality: economic status, education, place of residence and region. By considering the number of subgroups in each variable, simple and complex summary measures were used.ITN utilization by pregnant women showed an increasing trend over time in all the four countries. There was also significant inequality (variability) in the ITN utilization among population groups. DRC, Mozambique and Uganda showed noticeable inequality that favors the richest population, whereas in Nigeria the inequality was observed among both the rich and the poor during different survey yearsIn conclusion, in all the four countries, there were significant regional variations or differences in ITN use among pregnant mothers across all dimensions of inequality in the survey years. Tailored cost-effective interventions could be considered to improve ITN utilization among pregnant women.

Regional and socio-economic disparity in use of insecticide-treated nets to prevent malaria among pregnant women in Kenya.

BACKGROUND: Insecticide-treated net (ITN) use is among the most recommended strategies to prevent malaria in pregnancy. We analysed the regional and socio-economic patterns of ITN use among pregnant women in Kenya using data from the 2003, 2008 and 2014 Kenyan Demographic and Health Surveys (KDHSs). METHODS: Inequality was assessed using four dimensions: economic status, education, place of residence and region. Both relative and absolute summary measures were applied. In addition, simple and complex summary measures, i.e. difference, population attributable fraction, population attributable risk and ratio were considered based on the number of subgroups in each variable. RESULTS: There was overt inequality in the use of ITNs among pregnant women, with greater use among the better-off group in 2003 and 2014. Greater ITN use was also observed among pregnant women with a higher level of education. Pregnant women from urban settings tended to use ITNs (slept under a net the night before the survey) more than their rural counterparts in the 2003 KDHS. There were significant regional variations across the three surveys in all inequality summary measures, except ratio in the 2014 survey. CONCLUSIONS: Significant inequality in ITN use among pregnant women was observed at a macro scale.

Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative.

BACKGROUND: The COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time. LOCAL PROBLEM: The Royal National Orthopaedic Hospital (RNOH) sees on average 11 200 face-to-face consultations a month. On average 7% of these are delivered virtually via telephone. In response to the COVID-19 crisis, the RNOH set a target of reducing face-to-face consultations to 20% of all outpatient attendances. This report outlines a quality improvement initiative to rapidly implement virtual consultations at the RNOH. METHODS: The COVID-19 Action Team, a multidisciplinary group of healthcare professionals, was assembled to support the implementation of virtual clinics. The Institute for Healthcare Improvement approach to quality improvement was followed using the Plan-Do-Study-Act (PDSA) cycle. A process of enablement, process redesign, delivery support and evaluation were carried out, underpinned by Improvement principles. RESULTS: Following the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first 6 weeks. Satisfaction scores were high for virtual consultations (90/100 for patients and 78/100 for clinicians); however, outside of the COVID-19 pandemic, video consultations would be preferred less than 50% of the time. Information to support the future redesign of outpatient services was collected. CONCLUSIONS: This report demonstrates that virtual consultations can be rapidly implemented in response to COVID-19 and that they are largely acceptable. Further initiatives are required to support clinically appropriate and acceptable virtual consultations beyond COVID-19. REGISTRATION: This project was submitted to the RNOH's Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).

Within-lesion heterogeneity of subcortical DWI lesion evolution, and stroke outcome: A voxel-based analysis.

The fate of subcortical diffusion-weighted imaging (DWI) lesions in stroke patients is highly variable, ranging from complete tissue loss to no visible lesion on follow-up. Little is known about within-lesion heterogeneity and its relevance for stroke outcome. Patients with subcortical stroke and recruited through the prospective DEDEMAS study (NCT01334749) were examined at baseline (n = 45), six months (n = 45), and three years (n = 28) post-stroke. We performed high-resolution structural MRI including DWI. Tissue fate was determined voxel-wise using fully automated tissue segmentation. Within-lesion heterogeneity at baseline was assessed by free water diffusion imaging measures. The majority of DWI lesions (66%) showed cavitation on six months follow-up but the proportion of tissue turning into a cavity was small (9 ± 13.5% of the DWI lesion). On average, 69 ± 25% of the initial lesion resolved without any visually apparent signal abnormality. The extent of cavitation at six months post-stroke was independently associated with clinical outcome, i.e. modified Rankin scale score at six months (OR = 4.71, p = 0.005). DWI lesion size and the free water-corrected tissue mean diffusivity at baseline independently predicted cavitation. In conclusion, the proportion of cavitating tissue is typically small, but relevant for clinical outcome. Within-lesion heterogeneity at baseline on advanced diffusion imaging is predictive of tissue fate.

So pretty! The neural correlates of self-other vs familiar-other attractiveness comparisons.

Previous research has demonstrated that comparing two persons activates a frontoparietal network associated with numbers and nonsocial magnitudes. However, it is unclear whether this network is also recruited by comparisons involving the self. Self-reflection engages self-serving motivations (e.g., the maintenance of a positive self-image) and is associated with specific brain structures, such as the medial prefrontal cortex (MPFC), the anterior insula (AI) and the anterior cingulate cortex (ACC). Self-other comparisons may thus rely on distinct neural activity. To clarify this question, we used fMRI and asked female participants to compare their own attractiveness (or the attractiveness of a familiar woman) to pictures of unknown women. Participants were slower for comparisons with targets whose attractiveness was similar to their own (or their familiar other). Yet although this behavioral result resembles the distance effect reported for nonsocial magnitudes, at the brain level, it was linked to the activity of the AI, the ACC and the MPFC. The effect of distance in these regions was stronger for self-other than familiar-other comparisons. We interpret these results in relation to previous literature in social psychology and social neuroscience.

Serum Neurofilament Light Chain Levels Are Related to Small Vessel Disease Burden.

BACKGROUND AND PURPOSE: Neurofilament light chain (NfL) is a blood marker for neuroaxonal damage. We assessed the association between serum NfL and cerebral small vessel disease (SVD), which is highly prevalent in elderly individuals and a major cause of stroke and vascular cognitive impairment. METHODS: Using a cross-sectional design, we studied 53 and 439 patients with genetically defined SVD (Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy [CADASIL]) and sporadic SVD, respectively, as well as 93 healthy controls. Serum NfL was measured by an ultrasensitive single-molecule array assay. We quantified magnetic resonance imaging (MRI) markers of SVD, i.e., white matter hyperintensity volume, lacune volume, brain volume, microbleed count, and mean diffusivity obtained from diffusion tensor imaging. Clinical characterization included neuropsychological testing in both SVD samples. CADASIL patients were further characterized for focal neurological deficits (National Institutes of Health stroke scale [NIHSS]) and disability (modified Rankin scale [mRS]). RESULTS: Serum NfL levels were elevated in both SVD samples (P<1e-05 compared with controls) and associated with all SVD MRI markers. The strongest association was found for mean diffusivity (CADASIL, R2=0.52, P=1.2e-09; sporadic SVD, R2=0.21, P<1e-15). Serum NfL levels were independently related to processing speed performance (CADASIL, R2=0.27, P=7.6e-05; sporadic SVD, R2=0.06, P=4.8e-08), focal neurological symptoms (CADASIL, NIHSS, P=4.2e-05) and disability (CADASIL, mRS, P=3.0e-06). CONCLUSIONS: We found serum NfL levels to be associated with both imaging and clinical features of SVD. Serum NfL might complement MRI markers in assessing SVD burden. Importantly, SVD needs to be considered when interpreting serum NfL levels in the context of other age-related diseases.

A Novel Imaging Marker for Small Vessel Disease Based on Skeletonization of White Matter Tracts and Diffusion Histograms.

OBJECTIVE: To establish a fully automated, robust imaging marker for cerebral small vessel disease (SVD) and related cognitive impairment that is easy to implement, reflects disease burden, and is strongly associated with processing speed, the predominantly affected cognitive domain in SVD. METHODS: We developed a novel magnetic resonance imaging marker based on diffusion tensor imaging, skeletonization of white matter tracts, and histogram analysis. The marker (peak width of skeletonized mean diffusivity [PSMD]) was assessed along with conventional SVD imaging markers. We first evaluated associations with processing speed in patients with genetically defined SVD (n = 113). Next, we validated our findings in independent samples of inherited SVD (n = 57), sporadic SVD (n = 444), and memory clinic patients with SVD (n = 105). The new marker was further applied to healthy controls (n = 241) and to patients with Alzheimer's disease (n = 153). We further conducted a longitudinal analysis and interscanner reproducibility study. RESULTS: PSMD was associated with processing speed in all study samples with SVD (p-values between 2.8 × 10(-3) and 1.8 × 10(-10) ). PSMD explained most of the variance in processing speed (R(2) ranging from 8.8% to 46%) and consistently outperformed conventional imaging markers (white matter hyperintensity volume, lacune volume, and brain volume) in multiple regression analyses. Increases in PSMD were linked to vascular but not to neurodegenerative disease. In longitudinal analysis, PSMD captured SVD progression better than other imaging markers. INTERPRETATION: PSMD is a new, fully automated, and robust imaging marker for SVD. PSMD can easily be applied to large samples and may be of great utility for both research studies and clinical use. Ann Neurol 2016;80:581-592.

Neural correlates of valence generalization in an affective conditioning paradigm.

In case of uncertainty, predictions that are based on prior, similar experiences guide our decision by processes of generalization. Over-generalization of negative information has been identified as an important feature of several psychopathologies, including anxiety disorders and depression, and might underlie biased interpretation of ambiguous information. Here, we investigated the neural correlates of valence generalization to ambiguous stimuli using a translational affective conditioning task during fMRI. Twenty-five healthy individuals participated in a conditioning procedure with (1) an initial acquisition phase, where participants learned the positive and negative valence of two different tones (reference tones) through their responses and subsequent feedback and (2) a test phase, where participants were presented with the previously learned reference tones and three additional tones with intermediate frequency to the learned reference tones. By recording the responses to these intermediate stimuli we were able to assess the participantsí interpretation of ambiguous tones as either positive or negative. Behavioral results revealed a graded response pattern to the three intermediate tones, which was mirrored on the neural level. More specifically, parametric analyses OF BOLD responses to all five tones revealed a linear effect in bilateral anterior insula and SMA with lowest activation to the negative reference tone and highest activation to the positive negative tone. In addition, a cluster in the SMA showed a reverse-quadratic response, i.e., the strongest response for the most ambiguous tone. These findings suggest overlapping regions in the salience network that mediate valence generalization and decision-making under ambiguity, potentially underlying biased ambiguous cue interpretation.

A phonologically congruent sound boosts a visual target into perceptual awareness.

Capacity limitations of attentional resources allow only a fraction of sensory inputs to enter our awareness. Most prominently, in the attentional blink the observer often fails to detect the second of two rapidly successive targets that are presented in a sequence of distractor items. To investigate how auditory inputs enable a visual target to escape the attentional blink, this study presented the visual letter targets T1 and T2 together with phonologically congruent or incongruent spoken letter names. First, a congruent relative to an incongruent sound at T2 rendered visual T2 more visible. Second, this T2 congruency effect was amplified when the sound was congruent at T1 as indicated by a T1 congruency × T2 congruency interaction. Critically, these effects were observed both when the sounds were presented in synchrony with and prior to the visual target letters suggesting that the sounds may increase visual target identification via multiple mechanisms such as audiovisual priming or decisional interactions. Our results demonstrate that a sound around the time of T2 increases subjects' awareness of the visual target as a function of T1 and T2 congruency. Consistent with Bayesian causal inference, the brain may thus combine (1) prior congruency expectations based on T1 congruency and (2) phonological congruency cues provided by the audiovisual inputs at T2 to infer whether auditory and visual signals emanate from a common source and should hence be integrated for perceptual decisions.

Regulating the blink: Cognitive reappraisal modulates attention.

Our brain is unable to fully process all the sensory signals we encounter. Attention is the process that helps selecting input from all available information for detailed processing and it is largely influenced by the affective value of the stimuli. This study examined if attentional bias toward emotional stimuli can be modulated by cognitively changing their emotional value. Participants were presented with negative and neutral images from four different scene-categories depicting humans ("Reading", "Working", "Crying" and "Violence"). Using cognitive reappraisal subjects decreased and increased the negativity of one negative (e.g., "Crying") and one neutral (e.g., "Reading") category respectively, whereas they only had to watch the other two categories (e.g., "Working" and "Violence") without changing their feelings. Subsequently, subjects performed the attentional blink paradigm. Two targets were embedded in a stream of distractors, with the previously seen human pictures serving as the first target (T1) and rotated landmark/landscape images as the second (T2). Subjects then reported T1 visibility and the orientation of T2. We investigated if the detection accuracy of T2 is influenced by the change of the emotional value of T1 due to the reappraisal manipulation. Indeed, T2 detection rate was higher when T2 was preceded by a negative image that was only viewed compared to negative images that were reappraised to be neutral. Thus, more resources were captured by images that have been reappraised before, i.e., their negativity has been reduced. This modulatory effect of reappraisal on attention was not found for neutral images. Possibly upon re-exposure to negative stimuli subjects had to recall the previously performed affective change. In this case resources may be allocated to maintain the reappraised value and therefore hinder the detection of a temporally close target. Complimentary self-reported ratings support the reappraisal manipulation of negative images.

Prior auditory information shapes visual category-selectivity in ventral occipito-temporal cortex.

Objects in our natural environment generate signals in multiple sensory modalities. This fMRI study investigated the influence of prior task-irrelevant auditory information on visually-evoked category-selective activations in the ventral occipito-temporal cortex. Subjects categorized pictures as landmarks or animal faces, while ignoring the preceding congruent or incongruent sound. Behaviorally, subjects responded slower to incongruent than congruent stimuli. At the neural level, the lateral and medial prefrontal cortices showed increased activations for incongruent relative to congruent stimuli consistent with their role in response selection. In contrast, the parahippocampal gyri combined visual and auditory information additively: activation was greater for visual landmarks than animal faces and landmark-related sounds than animal vocalizations resulting in increased parahippocampal selectivity for congruent audiovisual landmarks. Effective connectivity analyses showed that this amplification of visual landmark-selectivity was mediated by increased negative coupling of the parahippocampal gyrus with the superior temporal sulcus for congruent stimuli. Thus, task-irrelevant auditory information influences visual object categorization at two stages. In the ventral occipito-temporal cortex auditory and visual category information are combined additively to sharpen visual category-selective responses. In the left inferior frontal sulcus, as indexed by a significant incongruency effect, visual and auditory category information are integrated interactively for response selection.

Pigeons identify individual humans but show no sign of recognizing them in photographs.

Photographs, especially of humans, are widely used as stimuli in behavioural research with pigeons. Despite their abundant use, it is not clear to what extent pigeons perceive photographs as representing three-dimensional objects. To address this question, we trained 16 pigeons to identify individual, real-life humans. This discrimination depended primarily on visual cues from the heads of the persons. Subsequently, the pigeons were shown photographs of these individuals to test for transfer to a two-dimensional representation. Successful identification of a three-dimensional person did not facilitate learning of the corresponding photographs. These results demonstrate limitations of cross-recognition of complex objects and their photographs in pigeons.

When one hemisphere takes control: metacontrol in pigeons (Columba livia).

BACKGROUND: Vertebrate brains are composed of two hemispheres that receive input, compute, and interact to form a unified response. How the partially different processes of both hemispheres are integrated to create a single output is largely unknown. In some cases one hemisphere takes charge of the response selection--a process known as metacontrol. Thus far, this phenomenon has only been shown in a handful of studies with primates, mostly conducted in humans. Metacontrol, however, is even more relevant for animals like birds with laterally placed eyes and complete chiasmatic decussation since visual input to the hemispheres is largely different. METHODOLOGY/PRINCIPAL FINDINGS: Homing pigeons (Columba livia) were trained with a color discrimination task. Each hemisphere was trained with a different color pair and therefore had a different experience. Subsequently, the pigeons were binocularly examined with two additional stimuli that combined the positive color of one hemisphere with a negative color that had been shown to the other, omitting the availability of a coherent solution and confronting the pigeons with a conflicting situation. Some of the pigeons responded to both stimuli, indicating that none of the hemispheres dominated the overall preference. Some birds, however, responded primarily to one of the conflicting stimuli, showing that they based their choice on the left- or right-monocularly learned color pair, indicating hemispheric metacontrol. CONCLUSIONS/SIGNIFICANCE: We could demonstrate for the first time that metacontrol is a widespread phenomenon that also exists in birds, and thus in principle requires no corpus callosum. Our results are closely similar to those in humans: monocular performance was higher than binocular one and animals displayed different modes of hemispheric dominance. Thus, metacontrol is a dynamic and widely distributed process that possibly constitutes a requirement for all animals with a bipartite brain to confront the problem of choosing between two hemisphere-bound behavioral options.