Discontinuation of first-line disease-modifying therapy in relapse onset multiple sclerosis.

BACKGROUND: It is not known if and when first-line disease modifying therapy (DMT) can safely be discontinued in relapse onset multiple sclerosis (MS) patients. OBJECTIVES: To investigate the characteristics of patients who discontinued first-line DMT, and the occurrence of clinical and radiological inflammatory disease activity after discontinuation. METHODS: We collected clinical and MRI parameters from patients with relapse onset MS in the MS Center Amsterdam and Rijnstate Hospital Arnhem who discontinued first-line DMT with no intention of restarting or switching treatment. RESULTS: In total, 130 patients were included in the analyses. After discontinuation, 78 patients (60%) experienced disease activity. Sixty-three patients (48.5%) showed MRI activity after DMT discontinuation, 40 patients (30.8%) experienced relapse(s), and 29 patients (22.3%) restarted DMT. Higher age at DMT discontinuation was associated with a lower risk of MRI activity (45 -55 vs. <45 years: OR 0.301, p = 0.007, >55 vs. <45 years, OR: 0.296, p = 0.044), and with a lower risk of relapse(s) after discontinuation (45-55 vs. <45 years: OR=0.495, p = 0.106, >55 vs. <45 years: OR=0.081, p = 0.020). CONCLUSION: Higher age at first-line DMT discontinuation is associated with lower risk and severity of radiological disease activity in MS, and a lower risk of relapse(s) after discontinuation.

Objective QbTest and subjective evaluation of stimulant treatment in adult attention deficit-hyperactivity disorder.

PURPOSE: To evaluate the QbTest as an objective measure versus self-reported ADHD Rating Scale (ADHD-RS) before and during stimulant treatment in adults with ADHD. PATIENTS AND METHODS: We used the subjective ADHD Rating Scale (ADHD-RS), and the objective computerized QbTest, which is a 20-minute unconditional identical pairs test that measures attention, impulsivity, and also hyperactivity using a motion-tracking system. Patients were assessed before (baseline) and during medical treatment with stimulants (follow-up) in an observational study design. RESULTS: Data of n=145 patients at baseline and n=82 patients at follow-up were analyzed. There were significant symptom reductions on all symptom domains, but correlations between the tests were weak. Improvement on the QbTest was independent of the patient's age, gender, educational level, ADHD subtype, co-morbid disorders, and use of other medications. Patients with worst QbTest results at baseline showed most improvement at follow-up. The QbTest was more sensitive to medication effects than the ADHD-RS. QbTest objectified clinical significant medication effect in 54% of patients who subjectively did not report any clinical effects. DISCUSSION: Symptoms dimensions of objective and subjective tests refer to different psychological constructs. CONCLUSION: The QbTest is a valuable addition to existing subjective measures to assess medication effects in ADHD patients who have difficulties reporting treatment effects.

A pathway to empowerment: evaluating a cancer education and support programme in New Zealand.

Support programmes often benefit cancer patients and their families. This study evaluates how the Living Well Cancer Education Programme (LWCEP), from the Cancer Society of New Zealand, meets the needs of its clients. A purposeful sample of 21 participants representing the normal range of demographic characteristics (age, gender, diagnosis and geographical location) for the programme, participated in semi-structured interviews. Demographic data were subjected to a frequency analysis. Main data were collected and analysed using a constructivist grounded theory approach regarding the experiences of the participants with being on the programme and recommendations for future development. Of the 21 participants, 14 were cancer patients (eight women and six men) and seven were support people (five women and two men). The LWCEP was described as a safe, supportive and stimulating environment, provided a powerful sense of belonging, empowered participants to gain perspective, enhance their confidence and communication skills and make increasingly informed choices. Consistent with a previous evaluation focussing on the facilitators of the LWCEP, there was a strong desire for better promotion of the programme to the wider community, establishment of a better referral pathway and the potential to offer two separate programmes depending on the stage of a patient's journey.

Evaluating stress, burnout and job satisfaction in New Zealand radiation oncology departments.

This research aimed to determine the levels of occupational stress, burnout and job satisfaction among radiation oncology workers across New Zealand. All oncology staff practising in all eight radiation oncology departments in New Zealand were invited to participate anonymously in a questionnaire, which consisted of the Maslach Burnout Inventory and measures of stress intensity associated with specific occupational stressors, stress reduction strategies and job satisfaction. A total of 171 (out of 349) complete responses were analysed using spss 19; there were 23 oncologists, 111 radiation therapists, 22 radiation nurses and 15 radiation physicists. All participants, regardless of profession, reported high stress levels associated with both patient-centred and organisational stressors. Participants scored high in all three domains of burnout: emotional exhaustion, depersonalisation and personal accomplishment. Interestingly, although organisational stressors predicted higher emotional exhaustion and emotional exhaustion predicted lower job satisfaction, patient stressors were associated with higher job satisfaction. Job satisfaction initiatives such as ongoing education, mentoring and role extension were supported by many participants as was addressing organisational stressors, such as lack of recognition and support from management and unrealistic expectations and demands. New Zealand staff exhibit higher levels of burnout than Maslach Burnout Inventory medical norms and oncology workers in previous international studies.

A scripted control system for autonomous hardware-timed experiments.

We present the labscript suite, an open-source experiment control system for automating shot-based experiments and their analysis. Experiments are composed as Python code, which is used to produce low-level hardware instructions. They are queued up and executed on the hardware in real time, synchronized by a pseudoclock. Experiment parameters are manipulated graphically, and analysis routines are run as new data are acquired. With this system, we can easily automate exploration of parameter spaces, including closed-loop optimization.

A versatile high resolution objective for imaging quantum gases.

We present a high resolution objective lens made entirely from catalog singlets that has a numerical aperture of 0.36. It corrects for aberrations introduced by a glass window and has a long working distance of 35 mm, making it suitable for imaging objects within a vacuum system. This offers simple high resolution imaging for many in the quantum gas community. The objective achieves a resolution of 1.3 µm at the design wavelength of 780 nm, and a diffraction-limited field of view of 360 µm when imaging through a 5 mm thick window. Images of a resolution target and a pinhole show quantitative agreement with the simulated lens performance. The objective is suitable for diffraction-limited monochromatic imaging on the D2 line of all the alkalis by changing only the aperture diameter, retaining numerical apertures above 0.32. The design corrects for window thicknesses of up to 15 mm if the singlet spacings are modified.

Evaluation of the training and support received by facilitators of a cancer education and support programme in New Zealand.

This study evaluates the training and support provided for facilitators who deliver the Living Well programme. This education and support programme, offered by the Cancer Society of New Zealand since 1991, aims to demystify cancer and its treatments, and develop self-efficacy of cancer patients and their supporters. A purposeful sample of 17 facilitators from five regions across New Zealand participated in semi-structured interviews. Quantitative data on demographics, qualifications and history with the programme were subjected to a frequency analysis. A thematic content analysis was conducted on qualitative data regarding the experiences of the facilitators with the training programme and the level and quality of subsequent support. Facilitators (aged 35-65, 16 of whom were women), came from a variety of socio-economic and educational backgrounds with a significant number having health-related roles and qualifications. Facilitator training was seen as relevant, thorough, effective and good preparation for the demands of the role. The pairing of more experienced staff and volunteers to co-facilitate was a particularly successful aspect of the programme. The main drawbacks were limited access to support, lack of supervision and a perceived lack of appreciation from the organisation for the volunteer facilitators.

Relative intensity squeezing by four-wave mixing with loss: an analytic model and experimental diagnostic.

Four-wave mixing near resonance in an atomic vapor can produce relative intensity squeezed light suitable for precision measurements beyond the shot-noise limit. We develop an analytic distributed gain/loss model to describe the competition of mixing and absorption through the non-linear medium. Using a novel matrix calculus, we present closed-form expressions for the degree of relative intensity squeezing produced by this system. We use these theoretical results to analyze experimentally measured squeezing from a 85Rb vapor and demonstrate the analytic model's utility as an experimental diagnostic.

A slow atom source using a collimated effusive oven and a single-layer variable pitch coil Zeeman slower.

We describe a simple slow atom source for loading a rubidium magneto-optical trap. The source includes an effusive oven with a long heated collimation tube. Almost all components are standard vacuum parts. The heating elements and thermocouples are external to the vacuum, protecting them from the hostile hot alkali environment and allowing repair without breaking vacuum. The thermal source is followed by a Zeeman slower with a single-layer coil of variable winding pitch. The single-layer design is simple to construct and has low inductance which allows for rapid switching of the magnetic field. The coil pitch was determined by fitting the analytic form of the magnetic field for a variable winding pitch to the desired magnetic field profile required to slow atoms. The measured magnetic field for the constructed coil is in excellent agreement with the desired field. The source produces atoms at 35 m/s with a flux up to 2 x 10(10) cm(-2) s(-1) at 200 degrees C.

Non-iterative imaging of inhomogeneous cold atom clouds using phase retrieval from a single diffraction measurement.

We demonstrate a new imaging technique for cold atom clouds based on phase retrieval from a single diffraction measurement. Most single-shot diffractive imaging methods for cold atoms assume a monomorphic object to extract the column density. The method described here allows quantitative imaging of an inhomogeneous cloud, enabling recovery of either the atomic density or the refractive index, provided the other is known. Using ideas borrowed from density functional theory, we calculate the approximate paraxial diffracted intensity derivative from the measured diffracted intensity distribution and use it to solve the Transport of Intensity Equation (TIE) for the phase of the wave at the detector plane. Back-propagation to the object plane yields the object exit surface wave and then provides a quantitative measurement of either the atomic column density or refractive index. Images of homogeneous clouds showed good quantitative agreement with conventional techniques. An inhomogeneous cloud was created using a cascade electromagnetically induced transparency scheme and images of both phase and amplitude parts of refractive index across the cloud were separately retrieved, showing good agreement with theoretical results.

Motor evoked potential: a reliable and objective measure to document the functional consequences of multiple sclerosis? Relation to disability and MRI.

OBJECTIVE: In an attempt to analyze whether MEP can serve as a valid measure for evaluating neurological dysfunction in multiple sclerosis (MS), we related MEP to clinical and MRI measures. METHODS: Transcranial magnetic stimulation was applied in 52 MS patients to determine the central motor conduction time (CMCT) to the extremities. We calculated Z-scores for each CMCT (Zcmct) corrected for height. All patients underwent two clinical measurements and a MRI scan, of which T1 and T2 brain lesion volumes, brain volume, spinal cord volume and the number of T2 spinal cord lesions were derived. RESULTS: The clinical measurements correlated significantly with various Zcmct (Spearman correlation coefficients ranged from 0.29 to 0.53; p<0.05). The number of spinal cord lesions, brain T1 and T2 lesion volume and spinal cord volume correlated with various Zcmct (r=0.31-0.53; p<0.05). Linear regression analysis revealed that the clinical measurements were explained by Zcmct left leg and T1 lesion volume (adjusted R(2)=0.38). For one clinical measurement the number of spinal cord lesions was also included (adjusted R(2)=0.43). CONCLUSION: We found a relation between MEP, brain and spinal cord MRI measures, and two clinical measures. Moreover, a model for explaining disability in MS revealed that MEP measures provide information in addition to MRI measures. SIGNIFICANCE: This study suggests that MEP is a measure that might adequately reflect pathology and neurological dysfunction in MS.

Effect of patterned slip on micro- and nanofluidic flows.

We consider the flow of a Newtonian fluid in a nano- or microchannel with walls that have patterned variations in slip length. We formulate a set of equations to describe the effects on an incompressible Newtonian flow of small variations in slip and solve these equations for slow flows. We test these equations using molecular dynamics simulations of flow between two walls which have patterned variations in wettability. Good qualitative agreement and a reasonable degree of quantitative agreement is found between the theory and molecular dynamics simulations. The results of both analyses show that patterned wettability can be used to induce complex variations in flow. Finally we discuss the implications of our results for the design of microfluidic mixers using slip.

Women's stories: ethnic variations in women's attitudes and experiences of menopause, hysterectomy, and hormone replacement therapy.

To increase understanding of women's midlife changes, 23 focus groups were held to investigate the possible ethnic variations in attitude toward and experience with menopause, hysterectomy, and hormone replacement therapy (HRT) in non-Hispanic white, Hispanic, and Navajo women in New Mexico. The medical definition of menopause, no menstrual bleeding for 12 months, did not coincide with the women's definition of menopause as the hormonal fluctuations they experienced before, during, and after any change in their menstrual cycle. More women reported having to fight to have a hysterectomy than having one unnecessarily. Women complained about the lack of information and preparation prior to having a hysterectomy and expressed dissatisfaction with doctor-patient communication, but they were satisfied with their hysterectomy because they felt better after the surgery. Although women in the study reported that menopause and hysterectomy are seldom discussed openly, they all participated freely in the storytelling focus groups. The most traditional women, primarily rural Navajo and newly immigrated Latina, related few or no menopausal symptoms with natural menopause or after hysterectomy. Many of these women had not even heard of HRT. Many women who had been prescribed HRT expressed dissatisfaction with the side effects and dosage. Unsupervised tinkering with the dosage was the rule rather than the exception. The study revealed that women are much more alike than they are different. Traditional women in all ethnic groups had more in common with each other than they did with the least traditional women in their own ethnic group.