bluuebunny/crossref_metadata_2025 huggingface dataset:
Twenty years of transposable element analysis in the Arabidopsis thaliana genome
Authors: Quesneville Hadi
Published: July 2020

Transposable elements (TEs) are mobile repetitive DNA sequences shown to be major drivers of genome evolution. As the first plant to have its genome sequenced and analyzed at the genomic scale,Arabidopsis thalianahas largely contributed to our TE knowledge.

The present report describes 20 years of accumulated TE knowledge gained through the study of theArabidopsisgenome and covers the known TE families, their relative abundance, and their genomic distribution. It presents our knowledge of the different TE family activities, mobility, population and long-term evolutionary dynamics. Finally, the role of TE as substrates for new genes and their impact on gene expression is illustrated through a few selected demonstrative cases. Promising future directions for TE studies in this species conclude the review.
Uganda’s experience with debt and economic growth: an empirical analysis of the effect of public debt on economic growth—1980–2016
Authors: Ssempala Richard , Ssebulime Kurayish , Twinoburyo Enoch
Published: July 2020

Background

Empirical evidence on the effect of public debt on the economic growth of a country remains ambiguous. No theoretical convergence on the respective nexus has been attained. For the case of Uganda in particular, the public debt question remains critical in the country’s development trajectory. Under the Highly Indebted Poor Countries (HIPCs) initiative, Uganda was the first country to receive a debt relief of worth US$650 million in the 1990s and later in 2006, under the Multilateral Debt Relief Initiative (MDRI), the country generously received 100% debt forgiveness/cancelation which consequently reduced the stock of country’s debt to $1.6 billion. However, of recent, the debt stock has kept on increasing from UGX 14.257 trillion ($5.5 billion) in 2000 to the current UGX 35.3 trillion (9.8b) in July 2017 and it is projected to continue increasing in the short to medium term given the robust NDPII core projects and priorities which are set to attract more borrowing. The study employs the Auto Regressive Distributed Lag (ARDL)-bounds testing approach which is superior and suitable for our small sample.

Results

The results reveal that public debt has a significant negative impact on economic growth in short run whereas in long-run debt has a mixed impact on Uganda’s economy. The total debt service has a negative impact whereas Gross debt as a share of GDP has a positive impact on the economy. The findings also reveal that Public debt has a negative effect on Uganda’s economic growth in the short run. The impact is however found to be positive in the long run. This result is in line with the study expectations and some findings by earlier researchers who found a negative impact of public debt on GDP and investment. The results suggest that the current trend of Uganda’s borrowing is to continue constraining the resources in the short run.

Conclusion

The conclusion of the study in view of emerging findings especially on debt, various policy implications have emerged. At the current rate of borrowing, Uganda is likely to have deteriorating economic growth partly because such public borrowing adversely affects investment. The study thus recommends for policies geared toward efficient use of borrowed funds especially for such projects that have high potential to unlock the production capabilities of the country. There is a need for the government of Uganda to institute mechanisms to ensure efficient use of borrowed funds.
Compositional variations along the route of Chang’e-3 Yutu rover revealed by the lunar penetrating radar
Authors: Ding Chunyu , Xiao Zhiyong , Su Yan , Zhao Jiannan , Cui Jun
Published: July 2020

Using the high-frequency lunar penetrating radar data obtained by the Chang’e-3 mission, we apply the frequency-shift method to calculate the decay rate of the electromagnetic wave in the regolith-like ejecta deposits of the Ziwei crater. The radar data are divided into segments according to the navigation points along the traverse route of the Yutu rover. For each segment, we calculate the bulk loss tangent of materials within the top ~ 50 ns of the radar data based on the frequency decreasing rate of the electromagnetic wave. The loss tangent varies from ~ 0.011–0.017 along the route of Yutu, and it is within the range of the measured loss tangent of Apollo regolith samples. Using the empirical relationship between loss tangent and TiO2 + FeO content derived from the Apollo lunar samples, we estimate the TiO2 + FeO content for the bulk regolith along the route of Yutu, which is ~ 23–30 wt.%. This value is comparable with that estimated using both orbital reflectance spectral data and in situ observation made by the Yutu rover. The loss tangent derived along the route of Yutu is larger than the average value of returned lunar samples, which is mainly caused by the larger content of TiO2 + FeO at the landing site compared to the global average. Variations of the TiO2 + FeO content along the route of Yutu are mainly due to the excavation of the Ziwei crater. The TiO2 + FeO content map derived by the radar has a much higher spatial resolution compared to orbital observation, testifying the feasibility of this technique for regional geology study.
The Siberian moth (Dendrolimus sibiricus), a pest risk assessment for Norway
Authors: Flø Daniel , Rafoss Trond , Wendell Michael , Sundheim Leif
Published: July 2020

Background

The Siberian moth (Dendrolimus sibiricus) is a serious pest of conifers in Russia, Northern Kazakhstan, Mongolia and China. The western border of the pest’s distribution in Russia is disputed, but it is present west of the 60th meridian east. The pest has the potential to defoliate a wide range of conifers.

Results

The pest is not present in Norway or other European countries, except Russia. Natural spread and human mediated transport are potential pathways for the pest. Human mediated pathways considered are: Living trees for planting, coniferous wood in the rough and foliage and branches. There has been no import of living trees from Russia to Norway during the past 30 years, and there is currently no import of coniferous wood commodities containing bark from areas, where D. sibiricus occurs.

Conclusions

The probability of D. sibiricus entry by natural spread is unlikely, mainly because of the geographical distance and the partial sea barriers between Norway and the infested areas. The probability of entry by human mediated pathways is unlikely due to the very limited volume of the import. Should the pest enter Norway, the probability of establishment and spread is unlikely, due to the suboptimal climatic conditions, and the fact that the two dominant conifers in the country, Norway spruce (Picea abies) and Scots pine (Pinus sylvestris), are intermediate and poor hosts, respectively. The potential damage, should D. sibiricus enter Norway, is considered low.
EPAS1 and VEGFA gene variants are related to the symptoms of acute mountain sickness in Chinese Han population: a cross-sectional study
Authors: Zhang Ji-Hang , Shen Yang , Liu Chuan , Yang Jie , Yang Yuan-Qi , Zhang Chen , Bian Shi-Zhu , Yu Jie , Gao Xu-Bin , Zhang Lai-Ping , Ke Jing-Bin , Yuan Fang-Zheng-Yuan , Pan Wen-Xu , Guo Zhi-Nian , Huang Lan
Published: July 2020

Background

More people ascend to high altitude (HA) for various activities, and some individuals are susceptible to HA illness after rapidly ascending from plains. Acute mountain sickness (AMS) is a general complaint that affects activities of daily living at HA. Although genomic association analyses suggest that single nucleotide polymorphisms (SNPs) are involved in the genesis of AMS, no major gene variants associated with AMS-related symptoms have been identified.

Methods

In this cross-sectional study, 604 young, healthy Chinese Han men were recruited in June and July of 2012 in Chengdu, and rapidly taken to above 3700 m by plane. Basic demographic parameters were collected at sea level, and heart rate, pulse oxygen saturation (SpO2), systolic and diastolic blood pressure and AMS-related symptoms were determined within 18–24 h after arriving in Lhasa. AMS patients were identified according to the latest Lake Louise scoring system (LLSS). Potential associations between variant genotypes and AMS/AMS-related symptoms were identified by logistic regression after adjusting for potential confounders (age, body mass index and smoking status).

Results

In total, 320 subjects (53.0%) were diagnosed with AMS, with no cases of high-altitude pulmonary edema or high-altitude cerebral edema. SpO2 was significantly lower in the AMS group than that in the non-AMS group (P = 0.003). Four SNPs in hypoxia-inducible factor-related genes were found to be associated with AMS before multiple hypothesis testing correction. The rs6756667 (EPAS1) was associated with mild gastrointestinal symptoms (P = 0.013), while rs3025039 (VEGFA) was related to mild headache (P = 0.0007). The combination of rs6756667 GG and rs3025039 CT/TT further increased the risk of developing AMS (OR = 2.70, P < 0.001).

Conclusions

Under the latest LLSS, we find that EPAS1 and VEGFA gene variants are related to AMS susceptibility through different AMS-related symptoms in the Chinese Han population; this tool might be useful for screening susceptible populations and predicting clinical symptoms leading to AMS before an individual reaches HA.

Trial registration

Chinese Clinical Trial Registration, ChiCTR-RCS-12002232. Registered 31 May 2012.
Role of 18-FDG/PET in evaluation of hepatocellular carcinoma managed locally by transarterial chemoembolization compared to triphasic computed tomography
Authors: Gomaa Manal Ibraheim
Published: July 2020

Background

This study was done to evaluate the role of FDG/PET compared to CECT in evaluating HCC after local interventional treatment. We evaluate forty-six patients with known history of TACE as a locoregional treatment of pathologically proved HCC. There were forty-three males and three females.

Results

The collected data were statistically analyzed, and we found that FDG-PET has a sensitivity of 94%, specificity of 84%, positive predictive value of 86.7%, negative predictive value of 86.4%, and accuracy of 93.4% in the detection of residual or recurrent at the managed tumor bed compared to CECT which shows a sensitivity of 94%, specificity of 84%, positive predictive value of 86.7%, negative predictive value of 86.4%, and accuracy of 93.4 %). Combined views ( FDG-PET/CT ) are better in evaluation.

Conclusion

FDG-PET is better in the detection of residual or recurrence in HCC which is locally managed by TACE.
Perspectives of GCSE students attending a psychiatry summer school in south London
Authors: Wyke Clementine , de Bernier Glori-Louise , Sin Fai Lam Chun Chiang , Holt Clare , Butler Sophie , Rajamani Anto Praveen Rajkumar , Wilson Jones Charlotte
Published: July 2020

Aims and Method

This study evaluated a pilot psychiatry summer school for GCSE students in terms of participant experience, effects on attitudes to mental illness and perception of psychiatry as a career option. This was done using the Community Attitudes towards the Mentally Ill scale, career choice questionnaires and a discussion group following the week-long programme attended by 26 students.

Results

Students were significantly more likely to choose psychiatry after the summer school (P = 0.01). There were statistically significant changes in scores for social restrictiveness (P = 0.04) and community mental health ideology (P = 0.02). Qualitative analysis generated four themes: variation in expectations, limited prior knowledge, perception of the summer school itself and uniformly positive attitudes to psychiatry after the summer school.

Clinical implications

Targeting students at this early stage appears to be an underexplored positive intervention for improving both attitudes towards mental illness and recruitment to psychiatry.
Real-world effectiveness, its predictors and onset of action of cholinesterase inhibitors and memantine in dementia: retrospective health record study
Authors: Vaci Nemanja , Koychev Ivan , Kim Chi-Hun , Kormilitzin Andrey , Liu Qiang , Lucas Christopher , Dehghan Azad , Nenadic Goran , Nevado-Holgado Alejo
Published: July 2020

Background

The efficacy of acetylcholinesterase inhibitors and memantine in the symptomatic treatment of Alzheimer's disease is well-established. Randomised trials have shown them to be associated with a reduction in the rate of cognitive decline.

Aims

To investigate the real-world effectiveness of acetylcholinesterase inhibitors and memantine for dementia-causing diseases in the largest UK observational secondary care service data-set to date.

Method

We extracted mentions of relevant medications and cognitive testing (Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores) from de-identified patient records from two National Health Service (NHS) trusts. The 10-year changes in cognitive performance were modelled using a combination of generalised additive and linear mixed-effects modelling.

Results

The initial decline in MMSE and MoCA scores occurs approximately 2 years before medication is initiated. Medication prescription stabilises cognitive performance for the ensuing 2–5 months. The effect is boosted in more cognitively impaired cases at the point of medication prescription and attenuated in those taking antipsychotics. Importantly, patients who are switched between agents at least once do not experience any beneficial cognitive effect from pharmacological treatment.

Conclusions

This study presents one of the largest real-world examination of the efficacy of acetylcholinesterase inhibitors and memantine for symptomatic treatment of dementia. We found evidence that 68% of individuals respond to treatment with a period of cognitive stabilisation before continuing their decline at the pre-treatment rate.
Low-Cost Technology for the Prevention of Cervical Cancer in Cameroon
Authors: Blaise Nkegoum , Liliane Mboumtou
Published: July 2020

PURPOSE

Our aim was to assess the accuracy of visual inspection with acetic acid (VIA) as a screening method for cervical lesions.

METHODS

VIA and cytologic smears were carried out on the cervices of nonpregnant women age 30 to 60 years with no previous history of cervical cancer. Cervices with acetowhite lesions or positive Pap smears, as well as 1 in 10 negative cervices (control), were biopsied.

RESULTS

Of patients, 10,020 women were enrolled and 9,626 (96.1%) were screened. With screening, 9,534 patients (99.0%) had adequate cytology smears, 1,148 (11.9%) underwent colposcopy, and 3,486 biopsies were obtained, of which 1,056 were controls. Sensitivity of VIA was 70.4% versus 47.7%, specificity was 77.6% versus 94.2%, positive predictive value was 44.0% versus 67.2%, and negative predictive value was 91.3% versus 87.8% for Papanicolau test, respectively.

CONCLUSION

VIA has acceptable test qualities and is now well implemented as a large-scale screening method in Cameroon.
Access to Breast Cancer Diagnostic Devices in the East African Community: Moving the Needle
Authors: Wagner Claire M. , Rubagumya Fidel , Mutebi Miriam , Mutiibwa David , Ngendahayo Louis , Nyagabona Sarah K. , Oromo Seriano , Farmer Paul E. , Binagwaho Agnes , Milner Dan A.
Published: July 2020

PURPOSE

Globally, two million women develop breast cancer each year. Low-income countries bear a disproportionate burden as a result of systems strapped by limited resources. Inadequate access to diagnostic services is widely recognized as a driver of unfavorable outcomes, yet baseline data on supply, use, and pricing for breast cancer diagnostic devices are scant. The purpose of this study was to assess access to cancer biopsy devices in Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda, and to ascertain related pricing, procurement, and payment models.

METHODS

We conducted an observational online survey to capture institution-based data that address demographics, facility capacity, human capital, pathology systems, device sourcing and pricing, supply chains, and workarounds. Additional manufacturer information was obtained through public sources and communication with industry.

RESULTS

We received 58 survey responses from the 6 East African Community countries, most representing urban public hospitals (68%). Pathology laboratory capacity varied drastically: Although basic histopathology was consistently performed (92% of respondents), hormone receptor, human epidermal growth factor receptor 2, and genetic studies were not (63%, 53%, and 11%, respectively). Training varied among practitioners performing biopsies—for example, surgeons or nurses—and most practitioners did not have ultrasound guidance (80%). Both disposable and reusable core needle devices were in use, and stockouts were reported by most respondents (69%). Workarounds included reuse of disposable devices, alternative procedures (eg, surgical excision or fine-needle aspiration), patient rescheduling, and referral. Most patients received results at follow up, but one fifth of all respondents reported that some patients never received results. Of importance, there was no observable pattern to procurement channels or pricing.

CONCLUSION

Reliable, accurate, and timely diagnosis is vital to improving outcomes for patients with breast cancer in low-income countries. Significant variation related to operations, human capital management, product mix, procurement methods, and pricing was observed between and within the East African Community countries. Additional investigation is needed to identify opportunities for applying best practices and leveraging regional synergies for impact.
Performance of Lung Cancer Screening With Low-Dose Computed Tomography in Gejiu, Yunnan: A Prospective, Population-Based, Screening Cohort Study
Authors: Wei Meng-Na , Su Zheng , Wang Jian-Ning , Yu Xiao-Yun , Zhou Qing-Hua , Fan Ya-Guang , Qiao You-Lin
Published: July 2020

PURPOSE

Low-dose computed tomography (LDCT) screening has been recommended for individuals with high lung cancer risk, but the performance of lung cancer screening with LDCT in China is uncertain. This study aims to evaluate the performance of LDCT lung cancer screening in the Chinese setting.

METHODS

From June 2014 through December 2014, a prospective cohort of patients to undergo lung cancer screening with LDCT was established in Gejiu, Yunnan Province, using one screening center of the Lung Cancer Screening Program in Rural China. Participants received baseline screening and 4 rounds of annual screening with LDCT until June 2019. The participation rate, detection rate, early detection rate, and clinical characteristics of lung cancer were reported.

RESULTS

Of participants, 2,006 had complete baseline screening results with a compliance rate of 98.4%. Of these, 1,411 were high-risk and 558 were non–high-risk individuals. During this period, 40 lung cancer cases were confirmed, and of them, 35 were screen detected, 4 were postscreening, and 1 was an interval case. The positive rate of baseline and annual screening was 9.7% and 9.0%, respectively, whereas the lung cancer detection rate was 0.4% and 0.6%, respectively. The proportion of early lung cancer increased from 37.5% in T0 to 75.0% in T4. Adenocarcinoma was the most common histologic subtype. Lung cancer incidence according to the criteria of the Lung Cancer Screening Program in Rural China and the National Lung Cancer Screening Trial was 513.31 per 100,000 person-years and 877.41 per 100,000 person-years, respectively

CONCLUSION

The lung cancer screening program with LDCT was a successful performance in Gejiu, Yunnan; however, additional studies are warranted to refine the high-risk population who will benefit most from LDCT screening and reduce the high false-positive results.
Genotypes and Prevalence of High-Risk Human Papillomavirus Among Patients Diagnosed With Head and Neck Cancer at Alexandria Cancer Centre
Authors: Ombiro Eva M. , Kwena Arthur , Melly Elias , Kamau Tabitha , Maiyoh Geoffrey K.
Published: July 2020

PURPOSE

The purpose of this study was to provide original data on the prevalence of head and neck cancer (HNC) and high-risk human papillomavirus (HPV) genotypes among patients diagnosed with HNC in Kenya. Globocan 2018 findings indicate that cervical cancer is the second most frequent cancer in women in East Africa, which suggests a high prevalence of oncogenic HPV among the general population in this region.

METHODS

This was a retrospective study with laboratory analysis involving histologically confirmed head and neck tissue samples between January 2017 and December 2018. Stored tissues were retrieved and subjected to repeat microscopy, p16 immunohistochemistry, and HPV polymerase chain reaction at the Pathologists Lancet Group of Laboratories. Data were analyzed using descriptive statistics with Excel.

RESULTS

HNC accounted for 8.8% of all malignancies at Alexandria Cancer and Palliative Care Hospital. There were more males (64%) than females (36%). Mean age was 50.9 years (± 17.6 years). Most patients came from the western Kenya region. Approximately one third (35.7%) of participants were farmers and students combined. The following were most common subsites identified: nasopharynx (n = 25), larynx (n = 12), and tongue (n = 10); 93.5% were squamous cell carcinoma. Sixteen samples (55.2%) tested p16 positive, of these 2 (12.5%) tested positive with HPV polymerase chain reaction. One of these was from an 87-year-old female who was diagnosed with tongue cancer. Molecular analysis revealed the genotype to be HPV52, and the other was from a 49-year-old male with cancer of the postnasal space who had multiple coinfection with HPV35, -52, and -59 genotypes.

CONCLUSION

HNC represented 8.8% of the malignancies at Alexandria Cancer and Palliative Care Hospital; 55.2% tested p16 positive and the study managed to detect 3 high-risk HPV genotypes, HPV35, HPV52, and HPV59.
Improving Care for Children With Cancer in Sub-Saharan Africa Through Distance-Based Nursing Education
Authors: Hockenberry Marilyn , Mulemba Tadala , Nedege Aisha , Madumetse Kitsiso , Higgins Jennifer
Published: July 2020

PURPOSE

Nursing specialization in the care of children with cancer provides the foundation for implementing successful pediatric oncology treatment programs throughout the world. Whereas the burden of childhood cancer care is highest in low- and middle-income countries (LMICs), opportunities for continuing nursing specialization are extremely limited. The Global HOPE Initiative, part of Texas Children’s Hospital in Houston, TX, has developed and implemented a distance-based training program for nurses working in sub-Saharan Africa.

METHODS

After a needs assessment, the program was developed using the Internet-based, open-sourced education platform, MOODLE. MOODLE is an acronym for Modular Object-Oriented Dynamic Learning Environment, an online learning management system that provides custom learning environments. As Internet access can be difficult at the clinical sites, computer tablets are provided with all educational materials downloaded from the MOODLE learning site. Courses are taught using a modular approach and core competencies established for each module. Zoom and WhatsApp technologies are used for shared learning discussions. A Project ECHO (Extension for Community Healthcare Outcomes) for Global HOPE Nursing was implemented monthly to support the growth of the distance-based learning network.

RESULTS

This distance-based education program teaches the principles of nursing care for a child with cancer and has been implemented in Malawi, Uganda, and Botswana, where 35 nurses are now enrolled. Formal course evaluation includes written pre- and post-tests and simulated checkoffs on essential pediatric oncology nursing competencies, such as chemotherapy administration. Sixteen nurses have completed the program in the first year and significant improvement in knowledge, self-competency, and skills was found.

CONCLUSION

The success of this distance-based learning program emphasizes the importance of formal training for nurses in LMICs to become full-time specialists in pediatric oncology nursing. Education programs that build capacity to develop specialists in pediatric oncology nursing are essential to improve global cure rates for children with cancer in LMICs.
Toward Cervical Cancer Elimination: Evaluation of Access to Diagnostic Services After Referral to a Specialist Gynecologist Clinic at a Major Referral Hospital in Kisumu, Kenya
Authors: Mungo Chemtai , Omoto Jackton , Gwer Stephen , Wameyo Akwabi , Kays Muruka , Ganda Gregory
Published: July 2020

PURPOSE

Women in low- and middle-income countries bear a disproportionate burden of cervical cancer incidence and mortality. WHO recommends screening with visual inspection with acetic acid (VIA), followed by treatment in a screen-and-treat approach. We evaluate access to diagnostic services after referral for VIA-positive or suspicious lesions to a gynecologist-led colposcopy clinic at a major government referral and teaching hospital in Kisumu, Kenya.

METHODS

Data on women who were referred for colposcopy at a gynecologist clinic at the Jaramogi Oginga Odinga Teaching and Referral Hospital with positive VIA from referral clinics from 2014 to 2017 were abstracted. We determined the proportion of referred women screening positive after colposcopy-based screening by a gynecologist, the proportion accessing diagnostic biopsy, and histologic results after positive or suspicious lesions. Treatment ascertainment is ongoing.

RESULTS

Four hundred five women were evaluated after referral for positive VIA screening or suspicious lesions. Mean age was 40.2 years and mean parity was 4 children, with 53% of women self-reporting positive HIV status. Two hundred thirty-three referred women (57.5%) were found to have positive or suspicious lesions after colposcopy-based screening by a gynecologist. Of these women, 147 (63%) had a biopsy performed and results were available for 110 patients (74.8%). Eighty-six women did not receive biopsy, despite positive colposcopy, primarily because of associated costs or lack of supplies. Among women with biopsy results, 25 (22.7%) were benign, 18 (16.4%) had cervical intraepithelial neoplasia grade 1, 9 (8.2%) had cervical intraepithelial neoplasia grade 2 and 3, 57 (51.8%) had squamous cell carcinoma, and 1 (0.9%) had nondiagnostic results.

CONCLUSION

While drawing from observational, paper-based clinical data with incomplete records, our evaluation demonstrates significant challenges in the cervical cancer prevention cascade at a tertiary referral hospital. This calls for strengthening the ability of facilities to adequately evaluate at-risk women, remove financial barriers, and invest in database systems to facilitate evaluation.
Implementation of Tanzania’s National Cancer Treatment Guidelines: A Qualitative Approach to Clinical Systems
Authors: Luhar Rohan , Nyagabona Sarah K. , Tarimo Edith , Said Mwamvita , Selekwa Msiba , Meena Stephene S. , Mushi Beatrice , Mvungi Nanzoke , Siu Sadiq , Ngoma Mamsau , Van Loon Katherine , Ndumbalo Jerry , DeBoer Rebecca J.
Published: July 2020

PURPOSE

In response to the increasing burden of cancer in Tanzania, the Tanzanian Ministry of Health Community Development, Gender, Elderly, and Children plans to launch their first National Cancer Treatment Guidelines. These guidelines will provide an opportunity to improve and standardize care at Ocean Road Cancer Institute (ORCI), the national cancer center, where previous data suggest that patients do not consistently receive standard treatment. A theory-informed implementation strategy will be conducted to facilitate the routine use of guidelines among health care providers at ORCI. As part of the needs assessment for this effort, this study explored the barriers to and facilitators of guideline-concordant care at ORCI.

METHODS

We conducted three focus groups with participants stratified by profession, which included oncologists, radiotherapists, oncology residents, and nurses. A discussion guide was used to generate discussion about multiple aspects of current clinical processes at ORCI. Audio recordings were transcribed and translated to English, and data were analyzed using the framework method.

RESULTS

A total of 21 participants helped identify institutional and systemic factors that were internal and external to the clinical systems at ORCI that may affect guideline-concordant care. These can be categorized into the following: strengths and facilitators, barriers, and suggestions for improvement. Internal facilitators include multidisciplinary patient management, government-sponsored free cancer care, community engagement, and providers’ motivation for continuous learning and improvement. Internal barriers include interdepartmental and interinstitutional communication gaps, resource limitations for specialized services, high patient volumes, and patient misconceptions and nonadherence. Participants offered many practical suggestions for improving clinical systems at ORCI.

CONCLUSION

Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect the uptake of the National Cancer Treatment Guidelines. Findings have been used to recommend quality improvement and environmental restructuring measures at ORCI that will inform the broader guideline implementation strategy.
Barriers to and Facilitators of Colorectal Cancer Screening in Egypt: Examining the Perceptions of Physicians and Residents in Alexandria
Authors: Brand Bateman Lori , Khamess Somaia , Nawar Ahmed , Abdelmoneim Salah-Eldin , Arafat Waleed , Fouad Mona , Khamis Yomna , Rogers Laura Q. , Shikany James M. , Genena Doaa M. , Omar Abbas , Abdeltawab Karim S. , Abdelmoneim Randa Salah , Scarinci Isabel
Published: July 2020

PURPOSE

Colorectal cancer (CRC) screening is not routinely performed in Egypt, and more than one third of CRC cases occur in individuals age 40 and younger, with overall survival estimated at only 2 years, presumably because of late diagnoses. To lay the foundation for the development of a CRC multilevel screening program in Egypt to promote CRC prevention and early detection, this qualitative study aimed to explore the potential barriers to and facilitators of screening from the perspectives of physicians and residents in Alexandria.

METHODS

We conducted one-on-one, 1-hour, semistructured interviews with primary health care physicians and specialists—oncologists and gastroenterologists—practicing in Alexandria, Egypt. Focus groups of residents, stratified by social class and gender, were also held. Interviews and focus groups were conducted in Arabic by trained interviewers/moderator, and were audio recorded, transcribed, translated into English, and analyzed using thematic analysis.

RESULTS

Seventeen physicians participated—8 specialists and 9 primary care physicians—and 7 focus groups—7 to 8 participants each—were held. According to both interview and focus group participants, individual-level barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention in the culture, fear, and cost. Provider-level barriers as mentioned by physicians included a belief that only high-risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately. Structural-level barriers, discussed by physicians and focus group participants, included cost and a lack of testing availability. Potential facilitators of screening mentioned by physicians included implementing a media campaign emphasizing early detection and curability. Focus group participants focused on making screening tests free or low cost, obligatory, and convenient.

CONCLUSION

On the basis of the perceptions of physicians and residents of Alexandria, Egypt, multiple barriers to and facilitators of CRC screening exist. Addressing these would be important in designing a successful screening program.
Multipronged Training to Improve Screening and Management of Cervical Cancer in Nepal
Authors: Kremzier Megan , Eaton Vanessa , Sarchet Vanessa
Published: July 2020

PURPOSE

According to GLOBOCAN estimates, cervical cancer is the most common cancer among women in Nepal, with nearly 3,000 new cases and approximately 1,900 deaths in 2018. Trained health care providers are needed to prevent cervical cancer and diagnose and treat cervical cancer earlier to achieve better clinical outcomes. To address this need, ASCO used a 3-pronged approach to improve multidisciplinary cervical cancer care in Nepal, including 3 in-person training courses on cervical cancer screening and treatment, a 6-month tele-education Project ECHO program that included didactic and case presentations, and supplemental volunteer visits to provide additional clinical skills training.

METHODS

ASCO collected data from program participants via surveys and observational methods. In-person trainings and Project ECHO sessions were evaluated via surveys. Survey instruments included questions about practice changes and learning objectives. Surveys were conducted on-site and 6 months later for live trainings, and after each Project ECHO session, with a final survey to assess the program. Volunteer physicians provided observational data on physicians’ skills at the hospital site.

RESULTS

Results are available for 2 in-person trainings and the Project ECHO program. Seventy-nine percent of respondents from the in-person trainings reported making changes to their practice that included team-based care for patients with cervical cancer, increased screening for cervical cancer, and newly established or increased participation in tumor boards. All Project ECHO respondents reported incorporating changes into their work on the basis of their participation. Volunteers at the hospital site reported observing improvements in knot tying and holding of instruments, lymphadenectomy, and colposcopy.

CONCLUSION

Preliminary results of the project are positive according to self-reported outcomes and observed behaviors. They include improvements in multidisciplinary care, screening, and the ability to perform essential surgical procedures. The 3-pronged approach described here can be considered for other geographies and cancer types.
Development of mNavigator: Digital Health Application to Facilitate Compliance With Standardized Pediatric Cancer Treatment Protocols in Tanzania
Authors: Schroeder Kristin , Raveendran Yadurshini , Goel Kunal , Makarushka Christina , Gisiri Mwitasrobert , Daniels Jensen , Zullig Leah , Masalu Nestory , Vasudevan Lavanya
Published: July 2020

PURPOSE

Use of standardized treatment protocols has been demonstrated to improve outcomes for pediatric patients with cancer. Yet it is challenging to implement standardized treatment protocols in low- and middle-income countries as a result of infrastructure and resource constraints, as well as poor health provider compliance with treatment protocols. At Bugando Medical Centre (BMC) in Tanzania, health provider compliance with standardized paper-based treatment protocols is low at 22%. One-year overall survival rates among pediatric patients with cancer at BMC are 40% and almost one third of patients abandon treatment. We posit that improving protocol compliance in this setting may decrease treatment abandonment and improve survival rates. Use of digital case management systems has been shown to improve compliance with treatment protocols because of the ability to incorporate such features as decision-support algorithms, prompts and alerts, and checklists. The digital health application mNavigator was designed to facilitate health provider compliance with standardized pediatric cancer treatment protocols in Tanzania.

METHODS

mNavigator was developed by adapting an open-source digital case management platform called CommCare. The three stages of mNavigator development were as follows: workflow mapping and form development; form programming in CommCare; and quality assurance using mock and deidentified patient records to identify errors in information flow or outputs, assess preliminary usability, and determine areas for improvement. Standardized treatment protocols for Burkitt lymphoma and retinoblastoma were initially incorporated into mNavigator. The mNavigator prototype underwent usability testing at BMC before implementation in routine clinical practice.

RESULTS

Preliminary system usability, acceptance, and satisfaction evaluation demonstrated high usability response scores (> 80%). Perceived benefits of the mNavigator system included a user-friendly interface, improved record keeping, and assistance with patient tracking using standardized treatment protocols. Suggestions for improvement centered on the incorporation of other standardized treatment protocols (eg, Wilms tumor), improving interoperability with existing electronic recordkeeping systems, and making similar systems available for other clinical departments.

CONCLUSION

To our knowledge, mNavigator is the first digital health case management system specifically developed to improve health provider compliance with pediatric cancer treatment protocols in a low-resource setting. With high usability and acceptability, mNavigator has been implemented in routine clinical practice. Implementation and patient outcomes evaluations are ongoing and will inform the scale-up for use in other low- and middle-income countries.
Assessing Barriers to and Facilitators of Designing a Feasible Colorectal Cancer Screening Program in Mexico City
Authors: Unger-Saldaña Karla , Saldaña-Tellez Minerva , Bonvecchio Anabelle , Potter Michael B. , Lajous Martin
Published: July 2020

PURPOSE

We undertook a formative qualitative research study to identify optimal participant recruitment, education, and follow-up strategies to facilitate colorectal cancer (CRC) screening in Mexico City.

METHODS

This study included semistructured individual and focus group interviews with different stakeholders: 36 average-risk laypeople, 16 public health care leaders, 10 primary care personnel, and 4 endoscopy unit personnel. The study protocol was approved by the National Institute of Public Health Institutional Review Board. Written informed consent was obtained from all participants. We analyzed data using the constant comparison method under the theoretical perspectives of the Consolidated Framework for Implementation Research and the Health Belief Model. Tailored CRC screening educational materials—video, postcard, poster, and brochure—were developed on the basis of our findings. Materials were then pretested in 6 additional focus groups and adjusted accordingly.

RESULTS

We found multiple barriers and facilitators in different dimensions of the CFIR for successful implementation of a FIT-based CRC screening program in this community. The main barriers were the following: inner context related: understaffing and personnel resistance to new programs; individual health care personnel related: CRC misinformation and work overload; outer setting related: underinvestment in primary care and public insecurity; lay individual related: a lack of CRC awareness, low risk perception, and fear of finding out about a serious disease; and intervention related: test costs. Among the principal facilitators were the following: inner setting: a shared perception of a good working environment and strong leadership at the selected clinic; intervention related: FIT test is perceived as easy to do, and potential users liked the idea that the sample can be obtained in the privacy of their homes. Educational materials we tailored on the basis of these findings and were found to be acceptable, understandable, and culturally competent by lay participants.

CONCLUSION

Our study allowed for the design of a feasible FIT-based CRC screening program and culturally competent materials that will be used to enhance participation.
Speculum-Free Callascope for Cervical Self-Visualization: Acceptability, Feasibility, and Improved Awareness of the Reproductive System
Authors: Dotson Mary Elizabeth , Asiedu Mercy , Ramanujam Nimmi
Published: July 2020

PURPOSE

Invasive cervical cancer is preventable, yet it affects 500,000 women worldwide each year, and more than one half these women die. Barriers to cervical cancer screening include a lack of awareness of cervical cancer and the cervix, fear of the speculum, and lack of women-centric technologies. We developed a low-cost (approximately $50), cervix-imaging device called the Callascope, which consists of an imaging component, camera, and inserter that obviates the need for a speculum and enables self-insertion. Studies are lacking regarding women’s willingness to independently image their cervix and women’s ability to effectively use the Callascope for self-imaging.

METHODS

We conducted two studies: in-depth interviews to assess the willingness to self-image the cervix, perceptions of the Callascope, and knowledge, attitudes, and practices toward cervical cancer screening; and home-based self-cervix imaging with the Callascope where women recorded an audio reflection on their experience.

RESULTS

Participants in interviews (n = 12) and home study (n = 12) all indicated a preference for the Callascope over the speculum. Interview data demonstrated that 53% of participants had little knowledge of basic reproductive anatomy, and only 17% of participants understood that human papillomavirus was a direct cause of cervical cancer. Self-exam data showed that 83% of participants were able to visualize their cervix with the Callascope on the first try and 100% were able to do so by the end of the study. Of participants, 100% indicated that the home exam was an empowering and informative experience.

CONCLUSION

The Callascope is more comfortable than the speculum and women are able to successfully image their cervices from home without the need for a speculum. With improved diagnostic capabilities, the Callascope could be used by medical providers for clinical exams, particularly in low-resource settings, as a low-cost and more comfortable alternative to the SOC. The Callascope enables home self-screening for cervical cancer and a better understanding of one’s body, which could make screening more accessible in low-resource settings.
Promoting Evidence-Based Practices for Breast Cancer Care Through Web-Based Collaborative Learning
Authors: Cira Mishka K. , Dvaladze Allison , Tesfay Robel , Zujewski Jo Anne , Duncan Kalina
Published: July 2020

PURPOSE

The objective of the Project ECHO (Extension for Community Healthcare Outcomes) for Knowledge Summaries for Comprehensive Breast Cancer Control (KSBC) was to strengthen the capacity to plan and implement evidence-based, resource-appropriate breast cancer control programs using virtual case-based learning within a global network of experts and peers.

METHODS

The KSBC ECHO was a collaboration between the US National Cancer Institute Center for Global Health, Women’s Empowerment Cancer Advocacy Network, and Breast Health Global Initiative in alignment with the Breast Cancer Initiative 2.5 campaign to reduce disparities in breast cancer outcomes. Using the ECHO model, we developed a 6-month Web-based program to support the development of locally relevant, resource-appropriate cancer control programs through mentorship and use of KSBCs. The course was advertised via existing networks, conferences, and social media. Breast cancer control project teams from around the world applied and were accepted to participate in the KSBC ECHO. Fourteen biweekly ECHO sessions were held via Zoom and included case presentations, didactic presentations, and discussion. Projects spanned the care continuum and sessions addressed preplanning, assessing need/barriers, setting objectives/priorities, and implementing/evaluating. Baseline and end point surveys were used to evaluate the ECHO program. Participants identified a mentor, completed worksheets, and presented on the project status.

RESULTS

Fifteen project teams from 11 countries—64 participants: advocates, clinicians, policymakers, and researchers—were enrolled. Twenty-eight participants (57%) completed the baseline and end point surveys. Analysis of the data using a paired t-test indicates that the knowledge increase was statistically significant: The average knowledge gain was 0.76 ± 0.89 (95% CI, 0.44 to 1.08; P < .0001). Additional feedback on the Web-based collaborative learning model will be presented.

CONCLUSION

The ECHO model encouraged interaction between policymakers, clinicians, advocates, and technical experts while using evidence-based tools to develop locally relevant, resource-appropriate implementation strategies and policy recommendations.
Disseminating an Evidence-Based Tobacco Control Intervention for School Teachers in India: Overview and Preliminary Findings
Authors: Nagler Eve , Pednekar Mangesh , Sinha Dhirendra , Adhikari Keyuri , Vriniotis Mary , Gupta Prakash , Sorensen Glorian
Published: July 2020

PURPOSE

In India in 2010, tobacco use accounted for more than 1 million deaths. There is a profound need for evidence-based interventions (EBIs) that promote tobacco control on a large scale, particularly in low- and middle-income countries. Our goal was to identify creative strategies for the broad-based implementation of tobacco control EBIs that can be embedded in existing organizational infrastructures and accommodate the realities of low-resource settings. We built on an intervention for schoolteachers, called the Tobacco-Free Teachers/Tobacco-Free Society (TFT-TFS) program, which had been shown to be efficacious in increasing tobacco use cessation and tobacco policy implementation in a cluster randomized controlled trial in the Bihar School Teachers’ Study. Teachers in India are an important channel for promoting tobacco control given their roles as community leaders and role models. This study tested whether TFT-TFS can be successfully implemented by building capacity within the education department to train and support headmasters to implement TFT-TFS in their schools.

METHODS

Six blocks from 3 districts in Bihar, India, were randomly assigned into either the intervention or control arm. Using a cascade-training model, intervention cluster coordinators—who routinely interact with headmasters—were trained to train headmasters from their respective clusters to implement TFT-TFS over 1 academic year. This study used a noninferiority design to test if program implementation will not be inferior to the high standards demonstrated in the Bihar School Teachers’ Study and assessed program effectiveness in improving cessation and policy implementation.

RESULTS

Nearly all of the 46 trained intervention cluster coordinators further trained more than 90% of the 218 headmasters to implement TFT-TFS. Preliminary data also indicate that two thirds of headmasters reported implementing 3 of 4 program components. Additional findings will be available Spring 2020.

CONCLUSION

This research is innovative because it systematically examines the process of scaling up one of the first EBIs to promote tobacco use cessation among teachers in India.