Extra Days Research Articles

STRESS AND SMOKING: ASSOCIATIONS WITH TERRORISM AND CAUSAL IMPACT

This study analyzes the effects of the Oklahoma City bombing and 9/11 terrorist attacks on stress, smoking, and smoking quit attempts using 1,657,985 observations from the Behavioral Risk Factor Surveillance System. Regression discontinuity results suggest that, in the fourth quarter of 2001, stress increased by nearly an extra half day per 30 days (11.9%) among ever smoking adults. In the 2 years after 9/11, smoking prevalence increased by 1.1 percentage points (2.3%) among ever smoking adults, resulting in between 950,000 and 1,300,000 adult former smokers becoming smokers again because of terrorism. The net cost to the government was between $530 million and $830 million through the end of 2003. Adults reported disproportionate stress increases based on community military participation and education. Simultaneity between smoking and stress is addressed by an instrumental variables model, providing validity to the hypothesized causal pathway between terrorism, stress, and smoking. This model suggests that an extra day of stress per 30 days causes a 3.4 percentage point increase in smoking among ever smoking adults. Results help to quantify a hidden cost of terrorism and provide a better understanding of utility maximization during periods of high stress. (JEL I12, I18)

Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot

ObjectiveThe aim of this study was to evaluate the cost-effectiveness of a home-based palliative care model relative to usual care in expediting discharge or enabling patients to remain at home.DesignEconomic...

Characterizing the relationship between in‐hospital measures and workers' compensation outcomes among severely injured construction workers using a data linkage strategy

To characterize the relationship between acute measures of severity and three important workers' compensation outcomes associated with a worker's ability to return to work and the cost of a work-related injury. Probabilistic data linkage of workers' compensation claims made by injured construction workers from 2000 to 2005 with two Illinois medical record registries. Multivariable robust regression models were built to assess the relationship between three in-hospital measures and three outcomes captured in the Workers' Compensation data. In the final multivariable models, a categorical increase in injury severity was associated with an extra $7,830 (95% CI: $4,729-$10,930) of monetary compensation awarded, though not with temporary total disability (TTD) or permanent partial disability (PPD). Our models also predicted that every extra day spent in the hospital results in an increase of 0.51 (95% CI: 0.23-0.80) weeks of TTD and an extra $1,248 (95% CI: $810-$1,686) in monetary compensation. Discharge to an intermediate care facility following the initial hospitalization was associated with an increase of 8.15 (95% CI: 4.03-12.28) weeks of TTD and an increase of $23,440 (95% CI: $17,033-$29,847) in monetary compensation. We were able to link data from the initial hospitalization for an injured worker with the final workers' compensation claims decision or settlement. The in-hospital measures of injury severity were associated with total monetary compensation as captured in the workers' compensation process.

The impact of vascular anastomosis time on early kidney transplant outcomes

BackgroundMost studies have found cold ischemic time to be an important predictor of delayed graft function in kidney transplantation. Relatively less is known about the warm time associated with vascular anastomosis and early outcomes.MethodsA retrospective cohort of 298 consecutive solitary deceased donor kidney recipients from January 2006 to August 2012 was analyzed to examine the association between anastomosis time and delayed graft function (need for dialysis) and length of hospital stay.ResultsDelayed graft function (DGF) was observed in 56 patients (18.8%). The median anastomosis time was 30 minutes (interquartile range 24, 45 minutes). Anastomosis time was independently associated with DGF in a multivariable, binary logistic regression analysis (odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, P = 0.001). An anastomosis time >29 minutes was also associated with a 3.5 fold higher (OR 3.5, 95% CI 1.6, 7.3, P = 0.001) risk of DGF. Median days in hospital was 9 (interquartile range 7, 14 days). Every 5 minutes of longer anastomosis time (0.20 days per minute, 95% CI 0.13, 0.27, P <0.001) was associated with 1 extra day in hospital in a multivariable linear regression model. An anastomosis time >29 minutes was associated with 3.8 (95% CI 1.6, 6.0, P <0.001) more days in hospital.ConclusionAnastomosis time may be an underappreciated but modifiable variable in dictating use of hospital resources. The impact of anastomosis time on longer term outcomes deserves further study.

How much are households willing to contribute to the cost recovery of drinking water supply? Results from a household survey

Abstract. Financial resources are crucial to improve existing urban drinking water supply in developing countries typically characterized by low cost recovery rates and high and rapidly growing demand for more reliable services. This study examines the willingness to pay for improved urban drinking water supply employing a choice model (CM) in an urban context in Ethiopia, Hawassa, with a household survey of 170 respondents. The design of the choice model allows the estimation of the values of two attributes of urban drinking water service (extra day water delivery per week and safer water). The findings indicate that households are willing to pay up to 60% extra for improved levels of water supply over and above their current water bill. Especially those households living in the poorest part of the city with the lowest service levels demonstrate that they are willing to pay more despite significant income constraints they are facing. Women value the improvement of water quality most, while a significant effect is found for averting behavior and expenditures. The estimated economic values can be used in policy appraisals of investment decisions.

Severe lower respiratory tract infection in infants and toddlers from a non-affluent population: viral etiology and co-detection as risk factors.

BackgroundLower respiratory tract infection (LRTI) is a major cause of pediatric morbidity and mortality, especially among non-affluent communities. In this study we determine the impact of respiratory viruses and how viral co-detections/infections can affect clinical LRTI severity in children in a hospital setting.MethodsPatients younger than 3 years of age admitted to a tertiary hospital in Brazil during the months of high prevalence of respiratory viruses had samples collected from nasopharyngeal aspiration. These samples were tested for 13 different respiratory viruses through real-time PCR (rt-PCR). Patients were followed during hospitalization, and clinical data and population characteristics were collected during that period and at discharge to evaluate severity markers, especially length of hospital stay and oxygen use. Univariate regression analyses identified potential risk factors and multivariate logistic regressions were used to determine the impact of specific viral detections as well as viral co-detections in relation to clinical outcomes.ResultsWe analyzed 260 episodes of LRTI with a viral detection rate of 85% (n = 222). Co-detection was observed in 65% of all virus-positive episodes. The most prevalent virus was Respiratory Syncytial Virus (RSV) (54%), followed by Human Metapneumovirus (hMPV) (32%) and Human Rhinovirus (HRV) (21%). In the multivariate models, infants with co-detection of HRV + RSV stayed 4.5 extra days (p = 0.004), when compared to infants without the co-detection. The same trends were observed for the outcome of days of supplemental oxygen use.ConclusionsAlthough RSV remains as the main cause of LRTI in infants our study indicates an increase in the length of hospital stay and oxygen use in infants with HRV detected by RT-PCR compared to those without HRV. Moreover, one can speculate that when HRV is detected simultaneously with RSV there is an additive effect that may be reflected in more severe clinical outcome. Also, our study identified a significant number of children infected by recently identified viruses, such as hMPV and Human Bocavirus (HBov), and this is a novel finding for poor communities from developing countries.

Delay of transfer from the intensive care unit: a prospective observational study of incidence, causes, and financial impact

IntroductionA paucity of literature exists regarding delays in transfer out of the intensive care unit. We sought to analyze the incidence, causes, and costs of delayed transfer from a surgical intensive care unit (SICU).MethodsAn IRB-approved prospective observational study was conducted from January 24, 2010, to July 31, 2010, of all 731 patients transferred from a 20-bed SICU at a large tertiary-care academic medical center. Data were collected on patients who were medically ready for transfer to the floor who remained in the SICU for at least 1 extra day. Reasons for delay were examined, and extra costs associated were estimated.ResultsTransfer to the floor was delayed in 22% (n = 160) of the 731 patients transferred from the SICU. Delays ranged from 1 to 6 days (mean, 1.5 days; median, 2 days). The extra costs associated with delays were estimated to be $581,790 during the study period, or $21,547 per week. The most common reasons for delay in transfer were lack of available surgical-floor bed (71% (114 of 160)), lack of room appropriate for infectious contact precautions (18% (28 of 160)), change of primary service (Surgery to Medicine) (7% (11 of 160)), and lack of available patient attendant ("sitter" for mildly delirious patients) (3% (five of 160)). A positive association was found between the daily hospital census and the daily number of SICU beds occupied by patients delayed in transfer (Spearman rho = 0.27; P < 0.0001).ConclusionsDelay in transfer from the SICU is common and costly. The most common reason for delay is insufficient availability of surgical-floor beds. Delay in transfer is associated with high hospital census. Further study of this problem is necessary.

Determining the success of varying short-term confinement time during simulated translocations of the endangered pygmy bluetongue lizard (Tiliqua adelaidensis)

Translocation is a powerful tool in conservation management, but one of the major problems of this tool is dispersal after release. Translocated animals might disperse from prime habitat and face unsuitable habitat and possible increased exposure to predators. This might lead to decline of a translocated population and could compromise the success of translocation. We assessed whether short-term confinement within enclosures at the translocation site can significantly decrease post release movement, if confinement allowed animals to become familiar with the new habitat, and to overcome handling related stress. We simulated the translocation of an Australian lizard, the endangered pygmy bluetongue lizard Tiliqua adelaidensis, into the centre of a large enclosure and compared the behaviour between individuals confined to the central region for one or five days before release. We found that lizards confined for five days spent less time basking, and were more likely to disperse than lizards confined for just one day. We suggest that short-term confinement of lizards induces additional stress and that extra days of short-term confinement will not necessarily improve the success of a translocation. Future research could determine the effectiveness of different durations of confinement for releasing animals at translocation sites.

Correlation of Surgical Times with Laparoscopic Live Donor Kidney Transplant Outcomes

Most studies revealed that ischemic time has substantial role in occurrence of delayed graft function (DGF) after deceased donor kidney transplantation. However, less is known about the potential impact of surgical times on early outcomes following live donor kidney transplantation. A retrospective cohort of 189 consecutive laparoscopic live donor kidney transplant (LDKT) recipients from January 2006 to August 2012 was analyzed to reveal the impact of pneumoperitoneum time (PT) and anastomosis time (AT) on donor and recipient length of hospital stay and early graft function (EGF). DGF was observed in 13 (6.8%) patients while slow graft function (SGF) was seen in 27 (14%) of the recipients. The median AT was 28 minutes (interquartile range 23, 35 minutes). AT was associated with DGF (Odds Ratio [OR] 1.044, per minute, 95% CI 1.007, 1.082, p = 0.018). Median recipient length of hospital stay was 8 (interquartile range 7, 11) days. Every 13.5 minutes of longer AT was associated with 1 extra day in hospital. The median PT was 180 minutes (interquartile range 144, 234 minutes). PT was associated with both DGF (OR 1.013 per minute, 95% CI 1.005, 1.021, p = 0.001) and SGF (OR 1.009 per minute, 95% CI 1.002, 1.016, p = 0.016). Every extra hour of PT was associated with 0.42 more days in hospital for the donor. Surgical times may be underestimated variables in dictating use of hospital resources. The effect of surgical times on long term hard outcomes entails further study.

The Black Saint and the Best-Selling Writer

The Black Saint and the Best-Selling Writer Joe Miller (bio) When I first saw the “ABSTINENCE = FREEDOM” sticker on Jackie Story’s van, I wrote it down in my notebook, but I didn’t ask her about it. I wrote down “Scooby van,” too, and “light blue” and “rust.” And when I got home that night I opened my laptop and wrote from memory that it cost Jackie $85 to fill the tank, and that she had to fill it often, and that she was having to turn down friends when they asked for rides home from church because she couldn’t afford it anymore, and that that’s not the kind of person she wants to be. [End Page 34] Click for larger view View full resolution [End Page 35] I wrote this story: Jackie went to San Juan Motors, a used-car lot up the street from her church, to trade the van and sign a contract for a white Ford Escort station wagon. The guy who sold it to her went to her church. He said to her, “I’m going to put a brand-new radio in it just for you because you are so terrific.” On the way home, she picked up one of her sons from church and another from school, and every time anyone opened the car doors the tuner would reset to the left-most position on the dial and the speakers would scream with static. The radio slid right out of the dashboard and onto the floor whenever she accelerated from a full stop. Then, a week later, the wagon broke down in front of the Hobby Lobby and Cracker Barrel on a parkway in the suburban Northland of Kansas City, three and a half miles from her house. Jackie was the main character of a book about a mixed-race, inner-city Pentecostal megachurch that I never wrote. Several times a week I would follow her around, scribbling notes in a narrow notepad, asking her questions, trying to find a story and a shape to her life that would fit me and the rest of the world. She didn’t have time to be without a car. Her two youngest sons, P. J. and Jonathan, were starting public school after years of home schooling. Cameron, her second oldest, was eighteen, jobless and carless, and he still expected her to provide everything he needed and most of what he wanted. She worked as a part-time hospice aide, did some sporadic work as a model and ran an as-yet unprofitable business venture that she described to me as “kind of like a direct-marketing business opportunity, except we sell phone service, and everybody needs that.” Even when her car was working, she felt like she needed an extra hour each day and an extra day each week—a “Smonday,” as her pastor liked to say. Without a car she had to take the bus everywhere, had to hoof it an hour and a half in both directions, on a hilly stretch, just to catch the nearest ride. It had been hot that fall, too, with a couple of days in the high 90s. At times it seemed like more than she could handle. When she felt overwhelmed, she said, she imagined herself a Sherman tank, slow but relentless, and strong—just like the motivational speaker had said a year earlier in a speech at a business conference she had gone to in Anaheim. It was the climax of his pep talk, the highlight of the whole convention, when he marched back and forth across the stage, imitating a tank, and the crowd went wild, knowing they had what it would take to make their prayers come true. I’d been around Jackie long enough to know that her prayers were for easy money and for the time it would buy. Jackie wanted to give every waking minute to her sons, to [End Page 36] her brothers and sisters at her church, to herself and to God. But so long as she was poor, she had to trudge through life, and trudge harder still without a car. I offered to...

Periodic morphological changes in the radio structure of the gamma-ray binary LS 5039

Gamma-ray binaries allow us to study physical processes such as particle acceleration up to TeV energies and VHE gamma-ray emission and absorption with changing geometrical configurations on a periodic basis. These sources produce outflows of radio-emitting particles whose structure can be imaged with VLBI. LS 5039 is a gamma-ray binary that has shown variable VLBI structures in the past. We aim to characterise the radio morphological changes of LS 5039 and discriminate if they are either repeatable or erratic. We observed LS 5039 with the VLBA at 5 GHz during five consecutive days to cover the 3.9-day orbit and an extra day to disentangle between orbital or secular variability. We also compiled the available high-resolution radio observations of the source to study its morphological variability at different orbital phases. We used a simple model to interpret the obtained images. The new observations show that the morphology of LS 5039 up to projected distances of 10 milliarcseconds changes in 24 h. The observed radio morphological changes display a periodic orbital modulation. Multifrequency and multiepoch VLBI observations confirm that the morphological periodicity is stable on timescales of years. Using a simple model we show that the observed behaviour is compatible with the presence of a young non-accreting pulsar with an outflow behind it. The morphology is reproduced for inclinations of the orbit of 60-75 deg. For masses of the companion star in the range 20-50 Msun, this range of inclinations implies a mass of the compact object of 1.3-2.7 Msun. The periodic orbital modulation of the radio morphology of LS 5039 suggests that all gamma-ray binaries are expected to show a similar behaviour. The changes in the radio structure of LS 5039 are compatible with the presence of a young non-accreting neutron star, which suggests that the known gamma-ray binaries contain young pulsars.

Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.

Background The use of direct observation to monitor tuberculosis treatment is controversial: cost, practical difficulties, and lack of patient acceptability limit effectiveness. Telehealth is a promising alternative delivery method for improving implementation. This study aimed to evaluate the clinical and cost-effectiveness of a telehealth service delivering direct observation, compared to an in-person drive-around service.Methodology/Principal Findings The study was conducted within a community nursing service in South Australia. Telehealth patients received daily video calls at home on a desktop videophone provided by the nursing call center. A retrospective cohort study assessed the effectiveness of the telehealth and traditional forms of observation, defined by the proportion of missed observations recorded in case notes. This data was inputted to a model, estimating the incremental cost-effectiveness ratio (ICER) of telehealth. Semi-structured interviews were conducted with current patients, community nursing and Chest Clinic staff, concerning service acceptability, usability and sustainability. The percentage of missed observations for the telehealth service was 12.1 (n = 58), compared to 31.1 for the in-person service (n = 70). Most of the difference of 18.9% (95% CI: 12.2 – 25.4) was due to fewer pre-arranged absences. The economic analysis calculated the ICER to be AUD$1.32 (95% CI: $0.51 – $2.26) per extra day of successful observation. The video service used less staff time, and became dominant if implemented on a larger scale and/or with decreased technology costs. Qualitative analysis found enabling factors of flexible timing, high patient acceptance, staff efficiency, and Chest Clinic support. Substantial technical problems were manageable, and improved liaison between the nursing service and Chest Clinic was an unexpected side-benefit.Conclusions/Significance Home video observation is a patient-centered, resource efficient way of delivering direct observation for TB, and is cost-effective when compared with a drive-around service. Future research is recommended to determine applicability and effectiveness in other settings.

Implication of changes in Mental Health Laws in 2009–2010, a local Welsh experience

Aims & methodThis study seeks to explore the nature and extent of any increase, along with the impact of the increase on the workload of the MHA/DoLs practitioners.Retrospective collection of data from MHA department and Guardianship/Deprivation of Liberty coordinators was followed by statistically evaluating the data. ResultsOver all, there was 56% increase in the use of the MHA over the previous year; the number of Guardianship orders increased by 85% while CTO increased by 825% and the number of tribunal appeals increased by 260%. Guardianship orders were 100% for S7 with an average length of 24 months. 36% of Guardianship orders lasted less than a year. In 2009/10 there were 98 DoLs authorisations. 70% of DoLs authorisations were supervised by the Local Authorities compared to 30% by the Local Health Board. Rate of DoLs authorisations per 100,000 populations was 42.3 for Local Authorities and 6.6 for Local Health Board. The average time consumed for the all new assessments amounted to 234.4 extra days per year. Clinical implicationsThe study shows increase in the volume of MHA, Guardianships and DoLs assessments. The amendments of the Act 2007 also attract an increase in the appeal process. The use of both the Act and the Deprivation of Liberty has increased workload for all involved practitioners.

428P - Phase 1 Study of Veliparib With Concurrent Whole Brain Radiation Therapy (WBRT) in Patients (PTS) With Brain Metastases (METS)

ABSTRACT Background Veliparib, an oral PARP-1 and -2 inhibitor, potentiates the antitumor activity of DNA damaging agents including radiation therapy in vivo, and is shown to cross the blood-brain barrier. Updated data on safety and antitumor activity from an ongoing phase 1, dose-escalation study of veliparib with concurrent WBRT in pts with brain mets are presented here. Methods Pts with brain mets (including leptomeningeal) from primary non-CNS metastatic solid tumors (except germ cell cancer), adequate organ function, and Karnofsky performanace status (KPS) ≥70 were treated with WBRT (37.5 Gy in 15 fractions or 30 Gy in 10 fractions daily) and veliparib BID in escalating doses of 10–300 mg; the final WBRT fraction was followed by 1 extra day of veliparib. Safety and exploratory efficacy were assessed. Safety was evaluated in pts who received at least 1 dose of veliparib. Best brain tumor response (complete or partial per RECIST) rates were calculated for all pts who had at least 1 measureable lesion at baseline. Median survival time was estimated using Kaplan-Meier methodology for all dosed pts. Results To date, 66 pts (M/F, 23/43; median age 58 y) have been treated. Baseline KPS was 70, 80, 90, and 100 in 7.6, 31.8, 37.9, and 22.7% pts, respectively; primary tumor types were breast (n = 21), NSCLC (n = 23), melanoma (n = 10), colorectal (n = 3), renal (n = 1), and others (n = 8); 74.2% pts had multiple lesions, and 16.7% had prior brain stereotactic radiosurgery. Treatment-emergent dose-limiting toxicities were grade 3 hypokalemia and hyponatremia in 1 pt each at the 150 mg dose. Grade 3/4 treatment-emergent adverse events (≥4%) were fatigue (6.1%), dehydration (6.1%), anemia (4.5%), thrombocytopenia (4.5%), hyperglycemia (4.5%), and hyponatremia (4.5%). Best tumor response rate and median survival time were 36.8% and 6.6 months (m) for NSCLC, and 50% and 8.3 m for breast cancer. Conclusion Addition of veliparib up to 200 mg BID was well tolerated with concurrent standard WBRT and dose escalation is ongoing. These encouraging safety and preliminary efficacy data suggest that veliparib requires further evaluation as a radiosensitizer with WBRT in pts with NSCLC and brain mets in a randomized trial. Disclosure M.P. Mehta: Consultant: Abbott, BMS, Elekta, Merck, Novartis, Novocure, Tomotherapy, Vertex; Stock Options: Accuray, Pharmacyclics; DSMB: Apogenix; Protocol Data Review: Adnexus; Board of Directors: Pharmacyclics. W.J. Curran: Dr. Curran had served on the advisory board of Lilly, BMS, and Plexxikon. There are no conflicts. D. Wang: As a clinical investigator, and the principle investigator at Henry Ford Health System, I have conducted this clinical trial that is financially supported by Abbott Oncology. I have no other conflict of interest to be disclosed, otherwise. L. Kleinberg: I have received research funding from Abbott. J. Qian: Full-time Abbott employee and stockholder. T. Leahy: Full-time Abbott employee and stockholder. B. Desai: Full-time Abbott employee and stockholder. V.L. Giranda: Full-time Abbott employee and stockholder. All other authors have declared no conflicts of interest.

Costs of Adverse Drug Events in German Hospitals—A Microcosting Study

ObjectiveIn Germany, only limited data are available to quantify the attributable resource utilization associated with adverse drug events (ADEs). The aim of this study was twofold: first, to calculate the direct treatment costs associated with ADEs leading to hospitalization and, second, to derive the excess costs and extra hospital days attributable to ADEs of inpatient treatments in selected German hospitals. MethodsThis was a retrospective and medical record–based study performed from the hospitals' perspective based on administrative accounting data from three hospitals (49,462 patients) in Germany. Total treatment costs (“analysis 1”) and excess costs (i.e., incremental resource utilization) between patients suffering from an ADE and those without ADEs were calculated by means of a propensity score–based matching algorithm (“analysis 2”). ResultsMean treatment costs (“analysis 1”) of ADEs leading to hospitalization (n = 564) were €1,978 ± 2,036 (range €191–18,147; median €1,446; €843–2,480 [Q1–Q3]). In analysis 2, the mean costs of inpatients suffering from an ADE (n = 1,891) as a concomitant disease or complication (€5,113 ± 10,059; range €179–246,288; median €2,701; €1,636–5,111 [Q1–Q3]) were significantly higher (€970; P < 0.0001) than those of non-ADE inpatients (€4,143 ± 6,968; range €154–148,479; median €2,387; €1,432–4,701 [Q1–Q3]). Mean inpatient length of stay of ADE patients (12.7 ± 17.2 days) and non-ADE patients (9.8 ± 11.6 days) differed by 2.9 days (P < 0.0001). A nationwide extrapolation resulted in annual total treatment costs of €1.058 billion. ConclusionsThis is one of the first administrative data–based analyses calculating the economic consequences of ADEs in Germany. Further efforts are necessary to improve pharmacotherapy and relieve health care payers of preventable treatment costs.

The effect of timing of embryonic progression on chromosomal abnormality

To evaluate the relationship between aneuploidy and timing of blastocyst formation. Historical cohort study. Private IVF clinic. Ninety-four couples undergoing IVF treatment in combination with chromosomal screening of embryos. The mean maternal age was 39.2 years and average number of embryos per patient 5.3. A total of 530 embryos were biopsied on day 3 and underwent chromosome screening with microarray-based comparative genomic hybridization. Effect of day of embryo blastulation and morphologic grade on aneuploidy rate. Day 5 morulas that progressed to blastocysts on day 6 were significantly less likely to be aneuploid (79.8%) than day 5 morulas that did not progress to blastocysts (92.9%). However, there was no significant difference in aneuploidy rates when embryos that became blastocysts on day 5 were directly compared with embryos that became blastocysts on day 6. Delayed blastulation is not associated with increased aneuploidy rates, but absence of blastulation is associated with increased aneuploidy. Therefore, we conclude that when choosing a morula for transfer on day 5, there may be a benefit in waiting an extra day for the possibility of blastulation to occur.

Convalescence advice following gynaecological surgery

This was a survey, undertaken in the UK, which was sent to all obstetricians and gynaecologists. The aim was to establish the current advice given for activities during convalescence after commonly performed benign gynaecological surgery. Questionnaires were sent to all the obstetricians and gynaecologists working in 235 NHS hospitals in the UK. The total response rate was 30.51%. There is substantial variability in the advice for activities during convalescence following gynaecological surgery. This has enormous implications – mainly financial. The economic impact of absence from work is enormous. One extra day of sick leave given to patients has a direct cost of approximately £34 million annually. Our survey highlights the need for structured and evidence-based recommendations for convalescence activities following benign gynaecological surgery.

Reinforcing operandum: rapid and reliable learning of skilled forelimb movements by head-fixed rodents

Stereotaxic head fixation plays a necessary role in current physiological techniques, such as in vivo whole cell recording and two-photon laser-scanning microscopy, that are designed to elucidate the cortical involvement in animal behaviors. In rodents, however, head fixation often inhibits learning and performance of behavioral tasks. In particular, it has been considered inappropriate for head-fixed rodents to be operantly conditioned to perform skilled movements with their forelimb (e.g., lever-press task), despite the potential applicability of the task. Here we have solved this problem conceptually by integrating a lever (operandum) and a rewarding spout (reinforcer) into one ″spout-lever″ device for efficient operant learning. With this device, head-fixed rats reliably learned to perform a pull manipulation of the spout-lever with their right forelimb in response to an auditory cue signal (external-trigger trial, namely, Go trial) within several days. We also demonstrated stable whole cell recordings from motor cortex neurons while the rats were performing forelimb movements in external-trigger trials. We observed a behavior-related increase in the number of action potentials in membrane potential. In the next session, the rats, which had already learned the external-trigger trial, effortlessly performed similar spout-lever manipulation with no cue presentation (internal-trigger trial) additionally. Likewise, some of the rats learned to keep holding the spout-lever in response to another cue signal (No-go trial) in the following session, so that they mastered the Go/No-go discrimination task in one extra day. Our results verified the usefulness of spout-lever manipulation for behavioral experiments employing cutting-edge physiological techniques.

Phase I safety and pharmacokinetic (PK) study of veliparib in combination with whole brain radiation therapy (WBRT) in patients (pts) with brain metastases.

2013 Background: Veliparib is an oral PARP-1 and -2 inhibitor that enhances the antitumor activity of DNA damaging agents including radiation therapy in vivo. In pre-clinical models, veliparib crosses the blood-brain barrier. This ongoing phase I dose-escalation study evaluates the safety, PK, and provides preliminary antitumor activity of veliparib in combination with WBRT in pts with brain metastases. Methods: Pts with brain metastases from non-CNS primary solid malignancy, adequate organ function, RPA Class 2, and KPS ≥70 were treated with WBRT (37.5 Gy in 15 fractions or 30 Gy in 10 fractions) QD with veliparib BID with every fraction of WBRT in escalating doses of 10, 20, 30, 50, 100, 150, and 200 mg; the final WBRT fraction was followed by 1 extra day of veliparib. Safety, PK, and tumor response by RECIST were assessed. Results: At the time of reporting 59 pts (M/F, 21/38; median age 57 y) had been treated. Baseline KPS was 70, 80, 90, and 100 in 6.8, 32.2, 40.7, and 20.3% pts, respectively; primary tumor types were breast (n=20), NSCLC (n=20), melanoma (n=9), colorectal (n=2), and others (n=8); 71.2% pts had multiple lesions; and 18.6% had prior brain SRS. Grade 3/4 treatment-emergent adverse events (TEAEs; ≥5%) were fatigue (6.8%), anemia (5.1%), hyponatraemia (5.1%), and thrombocytopenia (5.1%); other TEAEs (≥20%) were fatigue (57.6%), headache (42.4%), nausea (40.7%), alopecia (28.8%), vomiting (22%), radiation skin reactions (22%), and decreased appetite (22%). PK of veliparib were approximately dose-proportional, with oral clearance of 21.6 ± 14.2 L/h (mean ± SD, n=45), minimal drug accumulation at day 15, and no significant effect of food on bioavailability. Tumor response was evaluable in 48 pts. Best tumor response and median survival were 37.5% and 10 months (m) for NSCLC, and 52.9% and 12.5 m for breast cancer (excluding pts with leptomeningeal disease). Conclusions: Addition of veliparib up to 200 mg BID was well tolerated with concurrent WBRT and dose escalation ongoing. The PK of veliparib was dose proportional with no food effect. Preliminary antitumor activity is encouraging and informative for the design of more definitive trials.

National incidence and outcomes of postoperative urinary retention in the Surgical Care Improvement Project

BackgroundThe national incidence of postoperative urinary retention (POUR), its risk factors, and associated outcomes are not well understood. MethodsWe identified patients undergoing one of the Surgical Care Improvement Project surgeries using the National Inpatient Sample. By using International Classification of Diseases, 9th revision, Clinical Modification codes (ICD-9-CM), we identified POUR and the outcomes urinary tract infection, noninfectious catheter-related complications, length of stay, and posthospitalization care. Multivariable analysis identified predictors of POUR and its associated outcomes. ResultsA total of 415,409 patients, representing 2,077,045 nationally, underwent one of the Surgical Care Improvement Project procedures with 43,030 (2.1%) developing POUR. Age, sex, type of surgery, and medical comorbidities were predictive of POUR with a .71 area under the curve. Patients with POUR had greater odds of having urinary tract infections (odds ratio [OR], 2.3; 95% confidence interval [CI], 2.2–2.5), suffering catheter-related complications (OR, 5.2; 95% CI, 3.8–7.0), and needing additional posthospitalization care (OR, 1.3; 95% CI, 1.25–1.4), and they had a greater length of stay (.24 extra days). ConclusionsPatients at risk for POUR can be identified, and they may benefit from interventions to prevent POUR.