Effect of cognitive load on articulation rate and formant frequencies during simulator flights.

It was explored how three types of intensive cognitive load typical of military aviation (load on situation awareness, information processing, or decision-making) affect speech. The utterances of 13 male military pilots were recorded during simulated combat flights. Articulation rate was calculated from the speech samples, and the first formant (F1) and second formant (F2) were tracked from first-syllable short vowels in pre-defined phoneme environments. Articulation rate was found to correlate negatively (albeit with low coefficients) with loads on situation awareness and decision-making but not with changes in F1 or F2. Changes were seen in the spectrum of the vowels: mean F1 of front vowels usually increased and their mean F2 decreased as a function of cognitive load, and both F1 and F2 of back vowels increased. The strongest associations were seen between the three types of cognitive load and F1 and F2 changes in back vowels. Because fluent and clear radio speech communication is vital to safety in aviation and temporal and spectral changes may affect speech intelligibility, careful use of standard aviation phraseology and training in the production of clear speech during a high level of cognitive load are important measures that diminish the probability of possible misunderstandings.

One-year morbidity after sentinel node biopsy and breast surgery.

Posttreatment morbidity within 1 year after sentinel node biopsy was evaluated objectively by physical examination and also by evaluating patients self-reports of symptoms in a questionnaire. These patients were compared with patients who underwent axillary clearance. At 2 weeks after surgery patients who had undergone sole sentinel node biopsy had made significantly better recoveries than those who had undergone axillary clearance. Although every fourth patient complained of at least mild arm symptoms 1 year after sole SNB, the risk of severe long-term morbidity is minimal. In particular, the risk of disabling lymphoedema seems to be negligible after SNB only.

The impact of sentinel node biopsy and axillary staging strategy on hospital costs.

BACKGROUND: The aim of the study was to evaluate total hospital costs of three different sentinel node biopsy (SNB) protocols compared to those of diagnostic axillary lymph node dissection (ALND). PATIENTS AND METHODS: The study included 237 consecutive breast cancer patients who underwent SNB with frozen section diagnosis. The sequence of the treatment procedures for each patient was recorded. The sequences of treatment procedures for the same patients were evaluated using three hypothetical scenarios: diagnostic ALND, SNB without frozen section diagnosis and SNB as day case surgery prior to the breast operation. The total hospital costs were calculated in all protocols. RESULTS: The hospital costs per patient were 3750euro;. The hospital costs per patient would have been 3020euro; when using the ALND model, 4087euro; had the frozen section not been applied and 4573euro; using 'SNB as day case surgery' model. The costs with or without frozen section diagnosis would have been equal with a threshold false negative rate of 35%. CONCLUSIONS: SNB seems to be associated with higher hospital costs than diagnostic ALND. Frozen section diagnosis seems to be worthwhile as long as the false negative rate is <35%.

Sentinel nodes outside level I-II of the axilla and staging in breast cancer.

BACKGROUND: The aim of the study was to evaluate the incidence of sentinel nodes and sentinel node metastases outside levels I-II of the axilla in breast cancer. PATIENTS AND METHODS: Altogether 170 breast cancer patients with 172 clinically node-negative T1-T2 tumours underwent lymphoscintigraphy and were included in a prospective study. RESULTS: The lymphoscintigraphy showed sentinel node(s) in the axilla in 150 (87%) breast cancer cases. Thirty (17%) patients had sentinel nodes outside the axilla. Lymphatic drainage solely outside the axilla was encountered in two patients. Lymph node metastases were found in the axilla in 40% and outside the axilla in 17% of the 30 patients with extra-axillary sentinel nodes. Two patients with sentinel node metastases outside the axilla had no axillary metastases. CONCLUSION: The biopsy of sentinel nodes outside the axilla is a potential tool for more accurate staging in breast cancer, since it provides additional information as compared to axillary staging alone.