Characteristics Associated With Nonreceipt of Surveillance Testing and the Relationship With Survival in Stage II and III Colon Cancer.

We investigated characteristics of patients with colon cancer that predicted nonreceipt of posttreatment surveillance testing and the subsequent associations between surveillance status and survival outcomes. This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Patients diagnosed between 2002 and 2009 with disease stages II and III and who were between 66 and 84 years of age were eligible. A minimum of 3 years' follow-up was required, and patients were categorized as having received any surveillance testing (any testing) versus none (no testing). Poisson regression was used to obtain risk ratios with 95% confidence intervals for the relative likelihood of No Testing. Cox models were used to obtain subdistribution hazard ratios with 95% confidence intervals for 5- and 10-year cancer-specific and noncancer deaths. There were 16,009 colon cancer cases analyzed. Patient characteristics that predicted No Testing included older age, Black race, stage III disease, and chemotherapy. Patients in the No Testing group had an increased rate of 10-year cancer death that was greater for patients with stage III disease (subdistribution hazard ratio = 1.79, 95% confidence interval: 1.48, 2.17) than those with stage II disease (subdistribution hazard ratio = 1.41, 95% confidence interval: 1.19, 1.66). Greater efforts are needed to ensure all patients receive the highest quality medical care after diagnosis of colon cancer.

Escherichia coli antimicrobial resistance increased faster among geriatric outpatients compared with adult outpatients in the USA, 2000-10.

OBJECTIVES: Few studies have examined Escherichia coli antimicrobial resistance across age groups over time. The objective of this study was to compare urinary E. coli antimicrobial resistance trends among adult and geriatric outpatients from 2000 to 2010. METHODS: Antimicrobial susceptibility results for E. coli urine isolates from adult (aged 16-64 years) and geriatric (aged ≥65 years) outpatients were analysed using data from The Surveillance Network Database-USA. RESULTS: Susceptibility test results from adult (n = 6 412 025) and geriatric (n = 3 395 297) outpatients showed that E. coli antimicrobial resistance increased faster among geriatric outpatients for all agents studied. The greatest increases in resistance over the study time period were for ciprofloxacin (9.4% and 23.5% increases among adult and geriatric individuals, respectively), trimethoprim/sulfamethoxazole (4.3% and 10.5%) and ampicillin (2.0% and 13.6%). CONCLUSIONS: Urinary E. coli antimicrobial resistance increased faster among geriatric outpatients than adult outpatients in the USA. Rising antimicrobial resistance disproportionately affects geriatric populations and presents a threat to public health.

The lived experiences of young people (13-16 years) with Type 1 diabetes mellitus and their parents--a qualitative phenomenological study.

AIMS: Within a programme of research aiming to develop a technology-based educational intervention for young people with Type 1 diabetes, this study aimed to explore adolescents' and parents' experiences of living with Type 1 diabetes from an interpretive phenomenological perspective. METHODS: In-depth interviews were conducted with 20 adolescents with Type 1 diabetes from a diabetes clinic in North West England, and 27 of their parents. RESULTS: Living with Type 1 diabetes in adolescence was characterized by three distinct stages: (1) adapting to the diagnosis; (2) learning to live with Type 1 diabetes; (3) becoming independent. Experiential learning was key to adolescents developing self-management skills and independence. Parents and health professionals were instrumental in facilitating environments that gave adolescents the freedom to learn through trial and error. They also provided the support, feedback and discussion necessary to facilitate such learning. CONCLUSIONS: For adolescents to become independent in Type 1 diabetes self-management, they must develop capability through experiential learning. It is important that parents and health professionals understand the important role they play in this process and have the skills to support adolescents in this way. Data from this study have been used to develop an online interactive 'Adolescent Diabetes Needs Assessment Tool', which assesses individual learning and support needs to aid the process of feedback and discussion.

Visible-laser acceleration of relativistic electrons in a semi-infinite vacuum.

We demonstrate a new particle acceleration mechanism using 800 nm laser radiation to accelerate relativistic electrons in a semi-infinite vacuum. The experimental demonstration is the first of its kind and is a proof of principle for the concept of laser-driven particle acceleration in a structure loaded vacuum. We observed up to 30 keV energy modulation over a distance of 1000 lambda, corresponding to a 40 MeV/m peak gradient. The energy modulation was observed to scale linearly with the laser electric field and showed the expected laser-polarization dependence. Furthermore, as expected, laser acceleration occurred only in the presence of a boundary that limited the laser-electron interaction to a finite distance.

Preparticipation echocardiographic screening for cardiovascular disease in a large, predominantly black population of collegiate athletes.

Sudden death in young competitive athletes is most commonly due to underlying cardiovascular disease. Echocardiography has the potential to identify structural cardiovascular abnormalities, such as hypertrophic cardiomyopathy (HC), that have been incriminated in such events. In this study, echocardiography (2-dimensional and M-mode) was used as a primary screening test to assess 265 Howard University collegiate athletes for cardiovascular disease; 262 (99%) were black. Most athletes (234, 88%) had no definitive echocardiographic evidence of HC or other major cardiovascular diseases, but 30 (11%) had mitral valve prolapse, and 1 other athlete had a small atrial septal defect. In addition, 4 athletes were identified as having mild systemic hypertension. Most athletes (236 of 265) showed normal left ventricular wall thickness of less than or equal to 12 mm, but an important minority (29, 11%) had maximal ventricular septal thicknesses of greater than or equal to 13 mm that could not always be distinguished (by morphology alone) from mild anatomic expressions of nonobstructive HC. Based on this experience, preparticipation athletic screening using echocardiography as the primary test does not appear to be justified on a cost-effective basis. In addition, the substantial minority of subjects with increased wall thickness made clinical interpretation of the echocardiographic findings difficult in individual athletes.

Inhibition of acid secretion in the rat isolated stomach preparation by 5-hydroxytryptamine.

The effect of 5 hydroxytryptamine (5-HT) on gastric acid secretion by the rat isolated stomach has been studied. 5-HT (10 microM) significantly inhibited secretory responses to pentagastrin, histamine and isoprenaline but not those due to bethanechol, dibutyryl cyclic AMP or a phosphodiesterase inhibitor. The response was antagonized by methysergide (25 microM), indomethacin (28 microM) and ibuprofen (240 microM) but not by TTX (1 microM). It is concluded that 5-HT can exert a direct, inhibitory effect on acid secretion by the rat stomach and that this may involve the products of cyclo-oxygenase activity.

The inhibitory effects of 5-hydroxytryptamine on gastric acid secretion by the rat isolated stomach.

1 The effect of 5-hydroxytryptamine (5-HT) on acid secretion by a rat isolated stomach preparation has been studied. 2 5-HT at 10(-5)M in the serosal bathing fluid produced significant inhibition of the acid secretory responses to histamine, pentagastrin and isoprenaline but was without effect on basal secretion or that due to bethanechol, dibutryl cyclic adenosine 3',5'-monophosphate (db cyclic AMP) or phosphodiesterase inhibition with ICI63197. Increasing the concentration of 5-HT to 5 x 10(-5) M did not change this pattern of response whilst 5-HT at 10(-6) M did not cause consistent inhibition. 3 The inhibitory action of 5-HT could be prevented by the antagonist methysergide (2.5 x 10(-5) M). This concentration of methysergide alone did not affect responses to secretagogues or basal acid output. 4 Neither propranolol (2.5 x 10(-5) M) nor tetrodotoxin (10(-6) M) antagonized the inhibitory action of 5-HT. 5 Both indomethacin (2.8 x 10(-5) M) and ibuprofen (2.4 x 10(-4) M) antagonized the action of 5-HT. Indomethacin alone had no effect upon secretagogue responses. 6 5-HT at 10(-5) M had no inhibitory action when applied to the mucosal side of the preparation. 7 The results indicate that 5-HT can act directly on the stomach of the rat to produce inhibition of acid output. This inhibition is selective and may involve the products of cyclo-oxygenase activity.

The action of beta-adrenoceptor agonists on acid secretion by the rat isolated stomach.

1. The action of beta-adrenoceptor agonists on acid secretion by an immature rat isolated stomach preparation has been studied. 2. Isoprenaline, salbutamol, salmefamol, adrenaline and noradrenaline all stimulated acid output over a concentration range of 2 X 10(-7) M--10(-5) M. 3. These responses were antagonized by propranolol (2 X 10(-5) M), pindolol and timolol (10(-6) M). 4. The antagonism of isoprenaline and salmefamol by propranolol was consistent with competitive inhibition. 5. Selective beta-adrenoceptor antagonists (practolol, atenolol, butoxamine and ICI 118 551) caused significant inhibition of noradrenaline-stimulated secretion but not of that due to the other agonists. 6. An adult rat isolated mucosa preparation responded to adrenaline in a similar manner to the immature stomach preparation. 7. Acid secretion stimulated by beta-adrenoceptor agonists was not antagonized by atropine (10(-5) M), metiamide (10(-4) M) or prostaglandin E2 (10(-5) M). The concentrations of these three antagonists caused marked inhibition of the responses to submaximal concentrations of bethanechol, histamine and pentagastrin respectively. 8. The results are discussed in relation to the possible mechanisms of action of beta-adrenoceptor stimulation of acid secretion: it is concluded that the response is probably mediated by beta-receptors on the parietal cell.