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Purpose: To examine incidence and characteristics of women who developed secondary breast cancer after uterine cancer., Methods: This is a population-based retrospective cohort study utilizing the National Cancer Institute's Surveillance, Epidemiology, and End Result Program from 1973 to 2013. Women with uterine cancer who did not have synchronous or a history of breast cancer were followed after their uterine cancer diagnosis (N = 236,561). A time-dependent competing risk analysis was performed to examine cumulative incidences and clinico-pathological characteristics of those who subsequently developed breast cancer., Results: There were 7110 (3.0%) women who developed secondary breast cancers after uterine cancer with 5-, 10-, and 20-year cumulative incidence rates of 1.5, 2.8, and 4.7%, respectively. The increase in the rate of secondary breast cancer was particularly high in the first 3 years after a uterine cancer diagnosis (annual percent change [APC] 4.9), followed by 3-7 years (APC 1.6) after diagnosis (P < 0.001). The median time to develop secondary breast cancer was 6.4 years. Older women had significantly shorter time intervals between uterine and breast cancer diagnoses (3.7 years for aged > 71, 5.9 for aged 64-71, 7.6 for aged 56-63, and 9.4 for aged < 56, P < 0.001). In a multivariable analysis, older age, White race, married status, endometrioid, serous, and mixed histology types, and early-stage tumors remained as independent factors of developing secondary breast cancer (all, P < 0.05)., Conclusion: Tumor factors with endometrioid and serous histology types and early-stage disease were the factors associated with secondary breast cancer after uterine cancer diagnosis. Older women had shorter time to develop secondary breast cancer., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) more...

Objectives: The aim of this study was to investigate whether receiving a clinical diagnosis of interstitial cystitis (IC) or bladder pain syndrome (BPS) improves patients' symptoms, health-related quality of life (HRQOL), or ability to cope with their symptoms., Methods: In this cross-sectional study, participants with self-reported IC/BPS completed an online questionnaire recalling their perceived change in symptoms after diagnosis and treatment. The questionnaire included demographic information, overall HRQOL measured on a visual analog scale (VAS), O'Leary-Sant Interstitial Cystitis Problem Index, the Urinary Impact Questionnaire, and questions regarding patient beliefs about diagnosis. HRQOL and symptom impact scales were compared before and after diagnosis and treatment. Demographic data, symptom data, and beliefs were examined for correlation with improvement in quality of life after diagnosis., Results: A total of 1052 participants initiated the survey and were included in the analysis; most of them identified as female, non-Hispanic, and white (90%). Before symptom onset, median VAS HRQOL score was 87 (interquartile range [IQR], 77-95). Median scores nadired at 34 (IQR, 20-59) after symptom onset before diagnosis, but improved to 61 after diagnosis and treatment (IQR, 38-74; all P < 0.001). Scores remained stable after diagnosis and initiation of treatment with a median score of 65 at the time of survey (IQR, 37-80; P > 0.05). Age, insurance type, and improvement in scores on the symptom impact scale predicted improvement in HRQOL after diagnosis and treatment in the multivariable model., Conclusions: Participants reported improvements on global and symptom-specific quality of life measures after diagnosis and treatment for IC/BPS., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.) more...

For migrant children, many obstacles stand in the way of them securing even the most basic of necessities, and many live with the constant threat of being returned to countries where their very lives are in danger. These children and families, many of whom have experienced multiple forms of trauma, both in their home countries and on the journey to the United States, have extensive needs (for medical, mental health, educational, and legal services) that are not being met. Although pediatric medical professionals cannot respond to all issues, they are well situated to assist these vulnerable children., (Copyright © 2019 Elsevier Inc. All rights reserved.) more...

Previous studies have shown the filamentary structures in the cosmic web influence the alignments of nearby galaxies. We study this effect in the LOWZ sample of the Sloan Digital Sky Survey using the 'Cosmic Web Reconstruction' filament catalogue. We find that LOWZ galaxies exhibit a small but statistically significant alignment in the direction parallel to the orientation of nearby filaments. This effect is detectable even in the absence of nearby galaxy clusters, which suggests it is an effect from the matter distribution in the filament. A non-parametric regression model suggests that the alignment effect with filaments extends over separations of 30-40 Mpc. We find that galaxies that are bright and early-forming align more strongly with the directions of nearby filaments than those that are faint and late-forming; however, trends with stellar mass are less statistically significant, within the narrow range of stellar mass of this sample. more...

We present significant evidence of halo assembly bias for SDSS redMaPPer galaxy clusters in the redshift range [0.1, 0.33]. By dividing the 8,648 clusters into two subsamples based on the average member galaxy separation from the cluster center, we first show that the two subsamples have very similar halo mass of M&#95;{200m}≃1.9×10^{14}  h^{-1}M&#95;{⊙} based on the weak lensing signals at small radii R≲10  h^{-1}Mpc. However, their halo bias inferred from both the large-scale weak lensing and the projected autocorrelation functions differs by a factor of ∼1.5, which is a signature of assembly bias. The same bias hypothesis for the two subsamples is excluded at 2.5σ in the weak lensing and 4.4σ in the autocorrelation data, respectively. This result could bring a significant impact on both galaxy evolution and precision cosmology. more...

Purpose: The aims of this pilot were to examine dance as a feasible intervention for persons with multiple sclerosis (MS), specifically to examine issues of tolerability and its longitudinal effects on participants. Dance is an enjoyable physical activity that has been investigated in other neurodegenerative populations but has yet to be studied in MS., Method: A 4-week, two 60-min classes per week, pilot salsa dance intervention was administered to eight individuals with MS. The outcomes measured were effects on gait, balance, self-efficacy, motivation, physical activity and MS symptoms. They were administered at baseline, immediately post-intervention and at 3- and 6-month follow-ups., Results: Statistically significant pre-post intervention gains were found for the Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Activities-specific Balance Confidence Scale and Godin Leisure Time Questionnaire. Significant improvements were also found for the TUG, DGI and MS Walking Scale between baseline and 3-month follow-up assessments. Participants did not report any problems with fatigue or intolerability with the 60-min suggestions, further supporting the feasibility for the concept of a dance intervention., Conclusions: This study suggests that dance for persons with MS may have promise for improving physical activity, gait and balance., Implications for Rehabilitation: Although structured dance has reported benefits in elderly populations and in individuals with cardiovascular and neurological impairments, there is virtually nothing known regarding dance in the MS population. This pilot salsa dance study shows that structured dance demonstrates promise of being well-tolerated, safe and effective at promoting physical activity in people with MS without increased fatigue. A 12-week study has been initiated to test the robustness of initial observations and further examine factors influencing participants' physical activity adherence and behavioral change. more...

Although general relativity underlies modern cosmology, its applicability on cosmological length scales has yet to be stringently tested. Such a test has recently been proposed, using a quantity, E(G), that combines measures of large-scale gravitational lensing, galaxy clustering and structure growth rate. The combination is insensitive to 'galaxy bias' (the difference between the clustering of visible galaxies and invisible dark matter) and is thus robust to the uncertainty in this parameter. Modified theories of gravity generally predict values of E(G) different from the general relativistic prediction because, in these theories, the 'gravitational slip' (the difference between the two potentials that describe perturbations in the gravitational metric) is non-zero, which leads to changes in the growth of structure and the strength of the gravitational lensing effect. Here we report that E(G) = 0.39 +/- 0.06 on length scales of tens of megaparsecs, in agreement with the general relativistic prediction of E(G) approximately 0.4. The measured value excludes a model within the tensor-vector-scalar gravity theory, which modifies both Newtonian and Einstein gravity. However, the relatively large uncertainty still permits models within f(R) theory, which is an extension of general relativity. A fivefold decrease in uncertainty is needed to rule out these models. more...

Purpose: Patients preparing to undergo surgery should not suffer needless anxiety. This study aimed to evaluate anxiety levels on the day before surgery as related to the information known by the patient regarding the diagnosis, surgical procedure, or anesthesia., Method: Patients reported their knowledge of diagnosis, surgery, and anesthesia. The Spielberger State-Trait Anxiety Inventory (STAI) was used to measure patient anxiety levels., Results: One hundred and forty-nine patients were selected, and 82 females and 38 males were interviewed. Twenty-nine patients were excluded due to illiteracy. The state-anxiety levels were alike for males and females (36.10 +/- 11.94 vs. 37.61 +/- 8.76) (mean +/- SD). Trait-anxiety levels were higher for women (42.55 +/- 10.39 vs. 38.08 +/- 12.25, P = 0.041). Patient education level did not influence the state-anxiety level but was inversely related to the trait-anxiety level. Knowledge of the diagnosis was clear for 91.7% of patients, of the surgery for 75.0%, and of anesthesia for 37.5%. Unfamiliarity with the surgical procedure raised state-anxiety levels (P = 0.021). A lower state-anxiety level was found among patients who did not know the diagnosis but knew about the surgery (P = 0.038)., Conclusions: Increased knowledge of patients regarding the surgery they are about to undergo may reduce their state-anxiety levels. more...

Context: The interaction between a physician and his or her patient is complex and occurs by means of technical performance and through a personal relationship., Objective: To assess the interaction between the medical professional and his or her patient with the participation of medical students assuming a role as observers and participants in a medical appointment in an outpatient office., Design: Questionnaire interview study., Setting: General Medicine outpatient offices, Hospital das Clínicas, Faculty of Medicine, University of São Paulo., Participants: Medical students performed an ethnographical technique of observation, following 199 outpatient medical appointments with Clinical Medicine Residents., Main Measurements: A questionnaire filled out by observer students measured the physician's attitudes towards patients, as well as patients' expectations regarding the appointment and his or her understanding after its completion., Results: Patients showed higher enthusiasm after the appointment (4.47 +/- 0.06 versus 2.62 +/- 0.10) (mean +/- SEM), as well as some negative remarks such as in relation to the waiting time. The time spent in the consultation was 24.66 +/- 4.45 minutes (mean +/- SEM) and the waiting time was 123.09 +/- 4.91 minutes. The physician's written orientation was fairly well recalled by the patient when the doctor's letter could be previously understood., Conclusion: Patients benefit from physicians who keep the focus on them. In addition, this program stimulated the students for their accomplishment of the medical course. more...

A critical objective for any wastewater reuse program is to close the gap between supply of and demand for water and to minimize health and environmental hazards. Thus, the effects of treated effluent on crops, soils and community health must be considered carefully. When applying wastewater to soil-plant systems, it is to be noted that the passage of water through the soil reduces considerably the number of microorganisms carried out by the reclaimed wastewater. Nevertheless, there is a need to study the real rate of organism decay subject to water quality, soil and vegetable characteristics, and irrigation method. The aim of this work is to determine the fate of the fecal coliforms, coliphages F+ and CN13, and helminth eggs survival during the application of reclaimed wastewater in a vineyard orchard near the City of Arad (Israel) via onsurface and subsurface drip irrigation systems. Wastewater obtained from a stabilization pond, and soil samples were tested and an important decrease of microorganisms was reached in both cases, with the better values obtained with the sub-surface drip irrigation system. more...

This is the second part of a two-part comprehensive review of lateral ankle sprains. In the first part of our review, we discussed the etiology, natural history, pathoanatomy, mechanism of injury, histopathogenesis of healing, and diagnostic approach to acute and chronic lateral ligamentous ankle injuries. Conservative intervention and treatment of grade I-III and chronic, recurrent sprains of the lateral ankle ligaments and appropriate rehabilitation guidelines are the topics of this article. We review the use and benefit of different modalities and external supports and outline our five-phase intervention program of rehabilitation based on the histopathogenesis of ligament healing. We discuss the expected timing of recovery of the acute injury as well as the management of chronic, recurrent ankle sprains. Treatment of acute ankle sprains depends on the severity of the injury. Conservative therapy has been found to be uniformly effective in treating grade I and II ankle sprains. Some controversy exists regarding the appropriate treatment of grade III injuries, particularly in high-level athletes. Our belief is that the majority of these patients may also be treated well with conservative management. Other options for the management of grade III sprains will be briefly discussed at the end of this article. more...