bluuebunny/crossref_metadata_2025 huggingface dataset:
WeRSort: Preliminary Results from a New Method of Remote Collaboration Facilitated by Fully Immersive Virtual Reality
Authors: Narasimha Shraddhaa , Scharett Emma , Madathil Kapil Chalil , Bertrand Jeffrey
Published: September 2018

Fully immersive virtual reality, with the unique ability to replicate the real world, could potentially aid in real-time communication. Geographically separated teams can collaborate using virtual reality. To test the viability of using virtual reality for remote collaboration, we designed a system called “WeRSort” where teams sorted cards in a virtual environment. Participants performed the task as a team of 2 in one of three conditions-controls-only condition, generic embodiment and full embodiment. Objective measures of performance, time and percentage match with master cards showed no significant difference. Subjective measures of presence and system usability also showed no statistical significance. However, overall work-load obtained from NASA-TLX showed that fully immersive virtual reality resulted in lower workload in comparison with the other two. Qualitative data was collected and analyzed to understand collaboration using the awareness evaluation model.
Recategorization of Video Game Genres
Authors: Doherty Shawn M. , Keebler Joseph R. , Davidson Shayn S. , Palmer Evan M. , Frederick Christina M.
Published: September 2018

While the categories that are typically used to discriminate games have been useful in the past, more recently game mechanics have become utilized by a wider range of games, leading to earlier definitions becoming a less valuable categorization tool. This paper attempts to provide various ways games could be classified by focusing on the types of emotions they evoke, the skills they require or their relations with personality or cognitive variables. A description of those categories and the challenge in using them to define games is outlined as well as five alternate methods that may help make distinctions between games clearer.
Randomized Controlled Trial of Lifestyle Walking for African American Women: Blood Pressure Outcomes
Authors: Wilbur JoEllen , Braun Lynne T. , Buchholz Susan W. , Miller Arlene M. , Fogg Louis , Halloway Shannon , Schoeny Michael E.
Published: September 2018

The aim of this study was to test the effects of a lifestyle physical activity intervention (group meetings alone vs supplemented by personal or automated calls) on changes in systolic/diastolic blood pressures from baseline to 24 and 48 weeks among African American women. This was a randomized controlled trial with intervention conditions randomly assigned across 6 community health care sites. Participants were 288 sedentary African American women without major signs/symptoms of cardiovascular disease. Each intervention had 6 group meetings over 48 weeks, with 1 of 3 options between meetings: (1) no calls, (2) personal motivational calls, or (3) automated motivational calls. Blood pressures were taken at baseline, 24 weeks, and 48 weeks. Separate analyses were conducted using blood pressure classifications from the 2003 and 2017 high blood pressure guidelines. Average blood pressures decreased approximately 3 mm Hg for systolic and 2 mm Hg for diastolic from baseline to 48 weeks, with no differences between conditions. For both 2003 and 2017 blood pressure classifications, the risk ratio (odds of moving to a lower classification) was 1.44 for each assessment (P < .001). This lifestyle walking intervention appears beneficial in lowering blood pressure across blood pressure classifications in midlife African American women.
Sliding mode control of the automobile electro-coating conveying mechanism with a nonlinear disturbance observer
Authors: Yuan Wei , Gao Guoqin
Published: September 2018

The trajectory-tracking performance of the automobile electro-coating conveying mechanism is severely interrupted by highly nonlinear crossing couplings, unmodeled dynamics, parameter variation, friction, and unknown external disturbance. In this article, a sliding mode control with a nonlinear disturbance observer is proposed for high-accuracy motion control of the conveying mechanism. The nonlinear disturbance observer is designed to estimate not only the internal/external disturbance but also the model uncertainties. Based on the output of the nonlinear disturbance observer, a sliding mode control approach is designed for the hybrid series–parallel mechanism. Then, the stability of the closed-loop system is proved by means of a Lyapunov analysis. Finally, simulations with typical desired trajectory are presented to demonstrate the high performance of the proposed composite control scheme.
Principals’ boundary activities and school violence: The mediating role of school management teams
Authors: Benoliel Pascale
Published: September 2018

The call for a more holistic approach to cope with school violence motivated the present study. The present model postulates that effective teamwork at the school management team level can have a positive impact on the level of school violence. Specifically, the model examined the mediating role of school management team effectiveness (in-role performance and innovation) in the relationship between the organizational-level factors of principals’ internal and external boundary activities and school violence. Data was collected from a survey of 692 school members and 92 principals in Israel. The structural equation model confirmed the main hypotheses and indicated that school management team effectiveness fully mediated the relationship of principals’ internal boundary activities to school violence. These results carry important practical implications for policymakers to help schools manage school violence issues. Understanding how the principals’ boundary activities can enhance school management team effectiveness by facilitating improved knowledge exchange and social relationships is important and may provide a mechanism to decrease school violence. The implications of these findings for both theory and practice are discussed.
Transcending Categories, Staging Autonomy: Marion Davies’s Transitions from Showgirl to Screen Star and Producer-Manager
Authors: Mok Denise K.
Published: September 2018

Marion Davies (1897–1961) transitioned from showgirl and musical theatre performer in the 1910s to silent screen star and actress-producer in the 1920s. In addition to her comedic talents, she multitasked as producer-manager of her production unit, ‘Marion Davies Productions’ at Cosmopolitan Productions. She used her professional collaborations with screenwriter-friend Frances Marion and strong directors such as King Vidor to make appealing pictures that also transformed her star image. This paper argues that her years of discipline and professionalism on the stage and in show business contributed to her subsequent screen successes and as actress-producer of the films in which she starred. Her career complicates the notions of stardom and creative agency in the ‘lively arts’ of the late 1910s–1930s.
Termination of pregnancy
Authors: Stace Catherine
Published: September 2018

Termination of pregnancy (TOP) refers to a medical or surgical procedure to end a pregnancy. It is a safe and well-tolerated procedure with limited evidence to suggest any long-term psychological sequelae. It is also a common procedure, and given the number of women who will undergo a TOP, it is crucial that GPs understand the procedure and the care of women requesting it. This article aims to outline referral processes, legislation, and ongoing care and support of women. It will not consider TOP after 24 weeks gestation, or in emergencies, as these are arranged within secondary care.
Power of the Past, Celebrate the Present, Force of the Future, Part 3: Interview With NASN Leaders
Authors: Minchella Lindsey , Fekaris Nina , Combe Laurie G.
Published: September 2018

For Part 3 of the NASN School Nurse series exploring NASN’s past, present, and future, Lindsey Minchella interviews NASN President, Nina Fekaris and President-elect, Laurie Combe to discuss their school nursing perspective and philosophies. These three school nursing leaders discuss what is responsible for their long tenure as school nurses, changes witnessed in student health over the years, how NASN makes a difference for students and school nurses, the future of school nursing, and the power of NASN members’ voices to improve student health and academic outcomes.
Using Data as an Instrument for Change
Authors: Maughan Erin D. , Molner Claire
Published: September 2018

This is the companion interview to the “data and school nursing” articles series, sharing practical examples of how frontline school nurses use data. This interview is with Claire Molner who not only shares how she used data for her practice but also addresses how she shares the importance of data with school nursing colleagues.
Field testing and probabilistic assessment of ballistic penetration of steel plates for small calibre military ammunition
Authors: Stewart Mark G , Dorrough Brianna , Netherton Michael D
Published: September 2018

The penetration of projectiles into semi-infinite targets helps in the understanding and modelling of terminal ballistics. The article describes field test results of 5.56×45 mm F1 Ball and 7.62×51 mm M80 Ball ammunition. The targets were 25-mm-thick mild and high strength steel plates of Grade 250 MPa and 350 MPa, respectively. The tests recorded penetration depth, muzzle and impact velocities, and bullet mass. Despite its smaller calibre, the 5.56 mm × 45 mm F1 Ball ammunition recorded deeper penetrations than the larger calibre 7.62 mm × 51 mm M80 Ball ammunition. This is due to the 5.56 mm ammunition comprising a hardened steel penetrator and lead core, whereas the 7.62 mm ammunition comprised only a lead core. Multiple shots were fired for each type of munition. The coefficient of variation of steel penetration is approximately 0.10 and 0.03 for 5.56 mm and 7.62 mm rounds, respectively. The article also presents predictive models of steel penetration depth and compares these to the field test results.
The Illusion of Uniformity Does Not Depend on the Primary Visual Cortex: Evidence From Sensory Adaptation
Authors: Suárez-Pinilla Marta , Seth Anil K. , Roseboom Warrick
Published: September 2018

Visual experience appears richly detailed despite the poor resolution of the majority of the visual field, thanks to foveal-peripheral integration. The recently described uniformity illusion (UI), wherein peripheral elements of a pattern take on the appearance of foveal elements, may shed light on this integration. We examined the basis of UI by generating adaptation to a pattern of Gabors suitable for producing UI on orientation. After removing the pattern, participants reported the tilt of a single peripheral Gabor. The tilt aftereffect followed the physical adapting orientation rather than the global orientation perceived under UI, even when the illusion had been reported for a long time. Conversely, a control experiment replacing illusory uniformity with a physically uniform Gabor pattern for the same durations did produce an aftereffect to the global orientation. Results indicate that UI is not associated with changes in sensory encoding at V1 but likely depends on higher level processes.
Crowding and the Furrow Illusion
Authors: Anstis Stuart , Cavanagh Patrick
Published: September 2018

A spot moves vertically across a large grating of oblique parallel lines. When viewed peripherally, the motion path looks oblique, close to the orientation of the background grating. Even when the grating’s orientation is concealed by crowding, it can still deflect the spot’s perceived motion path.
Combination of Methotrexate and Prednizone Decreases Circulating Concentrations of Interleukin 1Beta and Interleukin 6 in Patients with Rheumatoid Arthritis. Poor Correlation of Cytokine Suppression with Clinical Improvement
Authors: Nowak D. , Lewandowicz J. , Dbkowska B. , Marczak J.
Published: September 2018

Objective

To evaluate the effect of methotrexate (MTX) in combination with prednizone on cytokine levels, acute phase proteins and thiobarbituric acid reactive substances (TBAR - an indicator of peroxidative damage to tissue lipids) in the blood of rheumatoid arthritis (RA) patients and to investigate their assgciations with clinical disease activity.

Methods

We measured blood concentrations of interleukin-1 R (IL-1p), interleukin- 6 (IL-6), TBARs and classical clinical and laboratory indices of disease activity in 36 RA subjects before and after 3 and 6 month treatment with MTX and prednizone. Only RA subjects who stopped any disease-modifying anti rheumatic drugs treatment for last 3 months were included in the study. Baseline cytokine and TBARs levels were compared with those obtained with 20 healthy controls.

Results-

Compared to controls RA subjects had elevated levels of circulating IL-1beta (63.3 ±47.6 vs 13.7 ± 7.8 pg/ml, p< 0.01), IL-6 (147.2 ± 76.5 vs 15.9 ± 13.3 pg/ml, p< 0.001) and TBARs (3.11 ± 0.42 vs 1.34 ± 0.45 nmol/1, p< 0.001) concentrations. MTX in combination with prednizone improved patient clinical status that was accompanied by 1.96-, 1.25-, and 1.35-fold decrease in IL-1beta, IL-6 and TBARs after 6 month treatment (p<0.001), respectively. Although, IL-1 and IL-6 revealed a few correlations with classical indices of disease activity no association was found between patient clinical status improvement and cytokine changes over 6 month treatment. Conclusions: MTX in combination with prednizone decreases blood levels of IL-1beta and IL-6 and inhibits the intensity of free radical- mediated processes in RA subjects. Monitoring of plasma concentrations of these cytokines could not predict the treatment efficacy.
Traumatic Lumbar Spondylolisthesis: A Systematic Review and Case Series
Authors: Ver Mikhail Lew P. , Dimar John R. , Carreon Leah Y.
Published: September 2018

Study Design:

Systematic review and case series.

Objectives:

Any acute injury to the posterior elements of the lumbar spine resulting in listhesis is considered a traumatic spondylolisthesis. This rare injury caused by high-energy trauma is variably described in the literature as fracture-dislocation, where only case reports and series have been published. Our objectives were to propose evidence-based treatment recommendations and a new classification system for this injury.

Methods:

A systematic review of literature from PubMed, EMBASE, and Cochrane without time frame limitations was performed, which included 77 level IV and V articles and 9 patients as case series in the analysis.

Results:

A total of 125 cases were reviewed with mean age of 30.5 years. Half of the cases resulted from a vehicular accident. Back pain presented in 82%, while 50% had neurologic deficits. Operative treatment was performed in 93.6% (posterior decompression [PD] = 4%; posterior spinal fusion [PSF] = 43.2%; interbody fusion [IB] = 46.4%) with overall fusion rates of 74%. Binomial regression analysis for achieving solid fusion showed a 28.6× higher odds for IB compared to PSF ( P = .008, r2 = 0.633). Subanalysis of cases with disc injuries revealed higher fusion outcomes for IB (87%) compared to PSF (46%; P = .006), while there were no significant differences for patients without disc injury. Pain and neurological symptoms improved significantly on final follow-up ( P < .001). Overall complication rate was 22%.

Conclusion:

Operative management with reduction, decompression for neurologic deficits, instrumentation, and fusion is recommended for traumatic spondylolisthesis. Interbody fusion is recommended to achieve better fusion outcomes especially with preoperatively identified disc lesions.
Atrial Fibrillation in a Patient With an Accessory Pathway
Authors: Silverman Andrew , Taneja Sonia , Benchetrit Liliya , Makusha Peter , McNamara Robert L. , Pine Alexander B.
Published: September 2018

A 24-year-old man with history of unspecified arrhythmia presented with palpitations and chest pain. Initial electrocardiogram (ECG) revealed irregular tachycardia with varying QRS width: 150 to 200 beats per minute for narrow complexes and 300 beats per minute for wide complexes. Following cardioversion, ECG revealed sinus tachycardia with a preexcitation pattern of positive delta waves in the anterolateral leads and negative delta waves in inferior leads. The patient remained in sinus rhythm and underwent successful ablation of a right posteroseptal accessory pathway. Subsequent ECG showed upright T waves in the leads I, aVL, and V2-6, large inverted T waves in leads III and aVF, and no delta waves. This case serves as an important reminder that atrial fibrillation (AF) in the presence of an accessory pathway may present with confounding ECG features, potentially leading to incorrect diagnoses and treatments that may be life threatening. Despite 10% to 30% prevalence of AF in the presence of an accessory pathway and the relative awareness of Wolff-Parkinson-White syndrome among general internal medicine providers, the clinical recognition of Wolff-Parkinson-White syndrome may be hindered in the presence of preexcited AF.
The Association Between the Processing of Binaural Temporal-Fine-Structure Information and Audiometric Threshold and Age: A Meta-Analysis
Authors: Füllgrabe Christian , Moore Brian C. J.
Published: September 2018

The ability to process binaural temporal fine structure (TFS) information, which influences the perception of speech in spatially distributed soundscapes, declines with increasing hearing loss and age. Because of the relatively small sample sizes used in previous studies, and the population-unrepresentative distribution of hearing loss and ages within study samples, it has been difficult to determine the relative and combined contributions of hearing loss and age. The aim of this study was to survey published and unpublished studies that assessed binaural TFS sensitivity using the TFS-low frequency (LF) test. Results from 19 studies were collated, yielding sample sizes of 147 to 648, depending on the test frequency. At least for the test frequency of 500 Hz, there were at least 67 listeners in each of four adult age groups and the distribution of audiometric thresholds at the test frequency within each group was similar to that for the population as a whole. Binaural TFS sensitivity declined with increasing age across the adult lifespan and with increasing hearing loss in old adulthood. For all test frequencies, both audiometric threshold and age were significantly negatively correlated with TFS-LF sensitivity ( r ranging from −0.19 to −0.64) but the correlation was always significantly higher for age than for audiometric threshold. Regression analyses showed that the standardized regression coefficient was greater for age than for audiometric threshold, and that there was a significant interaction; the effect of increasing age among older listeners was greater when the hearing loss was ≥30 dB than when it was < 30 dB.
A textual research on Tangut philological work Tongming Zazi
Authors: Peipei Wang
Published: September 2018

This paper discusses a recently found Tangut xylograph Zeyao Changchuan Tongming Zazi. The two prefaces of this book state that it was compiled for recognizing and reading Tangut characters correctly. Its main purpose is to help people to read sūtras, so the author is expected to be a Buddhist. The prefaces mentioned two well-known Tangut dictionaries, Homophone and Synonymous, which were printed in 1170 and 1188. Therefore, Tongming Zazi was printed no earlier than 1188.
A preliminary study on the Tangut version of the Mañjuśirī-dhaāraṇī-sūtra
Authors: Guo Yaoyao
Published: September 2018

There is a Tangut version of the Mañjuśirī-dhāraṇī-sūtra entitled Sūtra of Counting the Merits and Virtues of Rosaries in the Mañjuśirī-dhāraṇī preserved in the Institute of Oriental Manuscripts, Russian Academy of Sciences. The paper proves by collating the nomenclatures that the Tangut text was a translation from the Chinese version of the text by Yijing rather than that of Baosiwei.
Hepatotoxicity With Elevated Bilirubin Secondary to Prophylactic Doses of Unfractionated Heparin: A Case Report and Review of Heparin-Induced Hepatotoxicity
Authors: Bosco Michael , Kish Troy
Published: September 2018

Objective: To report a case of heparin-induced hepatotoxicity in a patient without prior liver dysfunction who received prophylactic doses of unfractionated heparin (UFH). Case Summary: A 70-year-old man with no prior liver dysfunction was admitted to the hospital for presyncope, secondary to dehydration, and new-onset congestive heart failure. Prophylactic UFH was initiated for deep vein thrombosis prophylaxis. Within 2 days, he developed increases in aspartate aminotransferase and alanine aminotransferase. By day 4, aspartate aminotransferase and alanine aminotransferase were greater than 5 and 9 times the upper limit of normal, respectively. Alkaline phosphatase and bilirubin were markedly elevated as well. UFH was discontinued on day 4, and liver enzymes subsequently normalized. Discussion: Hepatotoxicity, defined as increases in transaminases greater than 3 times the upper limit of normal, is relatively rare—estimated to occur in only 5% of those receiving therapy with UFH. Concurrent elevations in bilirubin have rarely been reported. Enzymes typically begin to rise after 4 to 5 days of UFH use and return to normal within 2 weeks of discontinuation. Previously published case reports of heparin-induced hepatotoxicity have occurred with therapeutic doses of either UFH or low-molecular-weight heparins. Conclusions: Heparin-induced hepatotoxicity may occur more rapidly than previously described, and even with the use of prophylactic doses of UFH. Given their widespread use, it is important for clinicians to consider heparins in their differential as a potential cause of hepatotoxicity especially in patients without underlying hepatic disease.
Inhibition of MEK and ATR is effective in a B-cell acute lymphoblastic leukemia model driven by Mll-Af4 and activated Ras
Authors: Chu S. Haihua , Song Evelyn J. , Chabon Jonathan R. , Minehart Janna , Matovina Chloe N. , Makofske Jessica L. , Frank Elizabeth S. , Ross Kenneth , Koche Richard P. , Feng Zhaohui , Xu Haiming , Krivtsov Andrei , Nussenzweig Andre , Armstrong Scott A.
Published: September 2018

Infant B-cell acute lymphoblastic leukemias (B-ALLs) that harbor MLL-AF4 rearrangements are associated with a poor prognosis. One important obstacle to progress for this patient population is the lack of immunocompetent models that faithfully recapitulate the short latency and aggressiveness of this disease. Recent whole-genome sequencing of MLL-AF4 B-ALL samples revealed a high frequency of activating RAS mutations; however, single-agent targeting of downstream effectors of the RAS pathway in these mutated MLL-r B-ALLs has demonstrated limited and nondurable antileukemic effects. Here, we demonstrate that the expression of activating mutant N-RasG12D cooperates with Mll-Af4 to generate a highly aggressive serially transplantable B-ALL in mice. We used our novel mouse model to test the sensitivity of Mll-Af4/N-RasG12D leukemia to small molecule inhibitors and found potent and synergistic preclinical efficacy of dual targeting of the Mek and Atr pathways in mouse- and patient-derived xenografts with both mutations in vivo, suggesting this combination as an attractive therapeutic opportunity that might be used to treat patients with these mutations. Our studies indicate that this mouse model of Mll-Af4/N-Ras B-ALL is a powerful tool to explore the molecular and genetic pathogenesis of this disease subtype, as well as a preclinical discovery platform for novel therapeutic strategies.
Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis
Authors: Volkert Jana , Gablonski Thorsten-Christian , Rabung Sven
Published: September 2018

Background

Personality disorder is a severe health issue. However, the epidemiology of personality disorders is insufficiently described and surveys report very heterogeneous rates.

Aims

We aimed to conduct a meta-analysis on the prevalence of personality disorders in adult populations and examine potential moderators that affect heterogeneity.

Method

We searched PsycINFO, PSYNDEX and Medline for studies that used standardised diagnostics (DSM-IV/-5, ICD-10) to report prevalence rates of personality disorders in community populations in Western countries. Prevalence rates were extracted and aggregated by random-effects models. Meta-regression and sensitivity analyses were performed and publication bias was assessed.

Results

The final sample comprised ten studies, with a total of 113 998 individuals. Prevalence rates were fairly high for any personality disorder (12.16%; 95% CI, 8.01–17.02%) and similarly high for DSM Clusters A, B and C, between 5.53 (95% CI, 3.20–8.43%) and 7.23% (95% CI, 2.37–14.42%). Prevalence was highest for obsessive–compulsive personality disorder (4.32%; 95% CI, 2.16–7.16%) and lowest for dependent personality disorder (0.78%; 95% CI, 0.37–1.32%). A low prevalence was significantly associated with expert-rated assessment (versus self-rated) and reporting of descriptive statistics for antisocial personality disorder.

Conclusions

Epidemiological studies on personality disorders in community samples are rare, whereas prevalence rates are fairly high and vary substantially depending on samples and methods. Future studies investigating the epidemiology of personality disorders based on the DSM-5 and ICD-11 and models of personality functioning and traits are needed, and efficient treatment should be a priority for healthcare systems to reduce disease burden.

Declaration of interest

None.
The Severity of Fatigue Among Bone Marrow Transplantation Patients
Authors: Abdalrahman O. , Almashaikh E. , Aljarrah H.
Published: September 2018

Background: Fatigue interferes with the individual´s functioning and quality of life in cancer patients specifically, after chemotherapy and post–bone marrow transplantation (BMT), fatigue is not adequately addressed and prioritized among health care providers. Aim: The purpose of this study is to determine the severity and prevalence of fatigue among cancer patients post-BMT after receiving chemotherapy. Methods: A descriptive, cross-sectional and correlational design was used, Piper fatigue scale (PFS) Arabic version was used to measure participants' level of fatigue, the scale measures four dimensions of subjective fatigue: behavioral, affective, sensory, and cognitive. Patients above 18 years old, received chemotherapy and do BMT between Oct 2016 and Oct 2017, were included in this study. Results: 100 patient participated in this study, 52% (N: 52) diagnosed with leukemia, 32% (N: 32) lymphoma, and 16% (N: 16) hematology. Thirty-nine patients (39%) had no or mild fatigue level, they do not need medical intervention, 47% (N: 47) and 14% (N: 14) classified as moderate and sever level of fatigue respectively, equal to 61% of the total sample who need medical intervention. Overall fatigue severity categories; mild, moderate, and sever shows that there is significant difference in term of severity subscale in sensory and behavioral dimensions ( P = 0.03, 0.004) respectively, and the other subscale dimension did not significantly differ among patient ( P > 0.05), the highest mean subscale score occurred in the behavioral dimension (M = 4.8, SD = 2.37), while the lowest mean subscale score occurred in cognitive dimension, (M=2.59, SD=2.35). The overall score mean of the male patients regarding the fatigue severity was 45.18 (n=74), and for the female patients the mean was 57.03 (n=26), and the result shows that there was significant difference in the overall mean scores between male patients and female patients (t (98)= −2.2, P < 0.05). Conclusion: Fatigue-related to BMT is a serious and prevalent problem among patients with cancer. Fatigue may impair quality of life among this group of patients; further study may be conducted to assess the effect of fatigue on quality of life and activity of daily living. It is essential to include fatigue assessment as a priority for the BMT patients.
Think Pink - Jordan Breast Cancer Program (JBCP) Community Mobilization Initiative
Authors: Qatamish N. , Nusairat T.
Published: September 2018

Background: Breast cancer consists 20.8% of all cancers, and 39% of females cancers in Jordan. Due to increasing prevalence; the Jordanian Breast Cancer Program (JBCP) was founded in 2007, to orchestrate national efforts and increase awareness on breast cancer screening and early detection. Several approaches have been taken, such as conducting home-visits, awareness lectures, campaigns, etc. The JBCP adopted the social responsibility as a robust tool for spreading awareness, which would allow the individuals to participate in raising awareness via different methods according to their capabilities, and embedding accountability in the community. In 2015, JBCP handled the responsibility in creating and leading for the first time the 'Think Pink Initiative' during October. Aim: The objective for; both public and private, is to build social responsibilities toward breast cancer cause and take actions to participate in educating their communities. Many private and public foundations, schools, universities, NGOs and ministries took part in this initiative transforming it in to a movement. The initiative is a new way to emphasize the importance of advocates and to encourage all institutions to support their employees by facilitating the early detection methods of breast cancer. It reflected JBCP's infiltration among Jordanian's community and the level of awareness reached all through the kingdom. Methods: Myriad of activities were steered under this initiative that initiated with aid of different departments in King Hussein Cancer Foundation by recruiting all sectors such as ministries, NGOs, schools, companies, and survivors. Tailored awareness was done by setting brainstorming meetings for the exchange of ideas for the events where the JBCP provided support for the events. In addition, awareness was complemented by providing free clinical breast exam for women above 20. Moreover, the social media portal of JBCP was also used to spread awareness. Results: Since the birth of initiative, a total of 404 events were done for the initiative in October. Initially, only 50 events done by the community compared with the following year, there was 152% increase where 126 events were done. In 2017, an 80% increase was observed where 230 events done signifying the viral effect of the initiative. Additionally, the message of the importance of breast cancer early detection and screening was successfully spread by the community itself to 50,620 members in only one month. As a result of the fund-raised money, 2,043 women were screened for breast cancer. Conclusion: Raising awareness among the community on breast cancer screening and early detection is a vital feat to initiate the cycle of decreasing the mortality and morbidity rate. The initiative planted the seed of responsibility for spreading awareness and transformed the concept into actions at all community levels. JBCP's dedications are to maintain the fight against breast cancer and save the lives of Jordanian women.
Costs Related to Skin Cancer Prevention in Victoria and Australia
Authors: Shih S. , Carter R. , Heward S. , Sinclair C.
Published: September 2018

Background: The aim of this presentation is to provide an update on the economic evaluation of the Australian SunSmart program as well as outline the cost of skin cancer treatment to the Victorian public hospital system. This follows the publication of two recently released published economic evaluations that discusses the potential effects of skin cancer prevention inventions. Aim: 1. To highlight the cost effectiveness of skin cancer prevention in Australia 2. To highlight the costs of skin cancer treatment in the Victorian public hospital system 3. To provide strong evidence to inform governments of the value of skin cancer prevention to reduce the costs of treatment in future years. Methods: Program cost was compared with cost savings to determine the investment return of the program. In a separate study, a prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using state service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Results: With additional $AUD 0.16 ($USD 0.12) per capita investment into skin cancer prevention across Australia from 2011 to 2030, an upgraded SunSmart Program would prevent 45,000 melanoma and 95,000 NMSC cases. Potential savings in future healthcare costs were estimated at $200 million, while productivity gains were significant. A future upgraded SunSmart Program was predicted to be cost-saving from the funder perspective, with an investment return of $3.20 for every additional dollar the Australian governments/funding bodies invested into the program. In relation to the costs to the Victorian public hospital system, total annual costs were $48 million to $56 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). Conclusion: The study demonstrates the strong economic credentials of the SunSmart Program, with a strong economic rationale for increased investment. Increased funding for skin cancer prevention must be kept high on the public health agenda. This would also have the dual benefit of enabling hospitals to redirect resources to nonpreventable conditions.
Breast Screening Reminder Letters and Phone Calls to Women in Their Language
Authors: Scanlon M. , Pridmore V. , Davis M. , Cooper A. , Beauchamp A. , Mohebbi M.
Published: September 2018

Background: BreastScreen Victoria (BSV) provides free breast screening to women aged 40+; targeting women aged 50-74. The program reduces breast cancer-related deaths by up to 28%. BSV aims to ensure equitable participation by all women in the target population. However, women from Arabic and Italian speaking backgrounds have lower breast screening participation compared with English-speaking women. A needs analysis involving consultation with Arabic and Italian speaking women found that invitation letters and calls are important enablers to breast screening, however language is a barrier. Women suggested sending reminder letters and making outbound reminder calls in their language. Aim: The aim of this study was to determine whether, and to what extent, reminder letters and phone calls in language resulted in increased screening rates in Arabic and Italian women. Methods: Two randomized control trials ran in 2017. TRIAL 1: Women due for a routine breast screen who speak Italian or Arabic at home were randomized into one of two trial arms: women in the intervention arm received a reminder letter in language (with the English version enclosed also), and women in the control arm received a reminder letter in English only. 1032 women were included in the study; comprising 322 Arabic and 710 Italian women. TRIAL 2: Lapsed women (had not had a breast screen within 27 months) who speak Italian or Arabic at home were randomized into one of two trial arms: women in the intervention arm received an outbound call in language inviting them to book an appointment; women in the control arm did not receive a call. 219 lapsed screeners were included; comprising 93 Arabic and 126 Italian women Results: TRIAL 1: • Women in the intervention arm more frequently booked (61.2%) compared with the control group (59.8%). However, this difference was not statistically significant. • For Italian women, 64.5% in the intervention group and 66.2% in the control group booked a screening appointment within 30 days of the mail out. Among Arabic women, the rates were 53.1% and 47.5% respectively. TRIAL 2: • Women in the intervention group were 10.7 times more likely to make a booking (42.9%) compared with the control group (4%). The effect was larger for Arabic than for Italian women. Conclusion: Sending reminder letters to Italian and Arabic women in their own language did not result in a statistically significant increase in bookings. Making reminder phone calls to Italian and Arabic women in their own language did result in a large, statistically significant increase in bookings and attendance.
Cancer Drug Prices in Argentina and United Kingdom: A Comparison Study
Authors: . J , . V
Published: September 2018

Background: Cancer drugs challenge health-care systems because of their high prices. Drugs prices, health-care systems and GDP are no uniform throughout the world. United Kingdom (UK) has a 320% better GDP than Argentina (ARG). Aim: We aimed to compare the prices of cancer drugs in both countries, including originals, generics/copies and biosimilars available in ARG by July 2017. Methods: We surveyed official list prices per unit at ex-factory price level of 52 original cancer drugs in UK and ARG. Drugs were grouped in low (LPD) (10), medium (MPD) (7) and high prices (HPD) (35). We included prices of generics/copies (74 generics brands of 7 LPD and 46 generics brands of 6 MPD and HPD) and biosimilars (2) available in ARG and compared with those from originals. Surveyed prices did not include negotiated discounts as authorities and third payers use these undiscounted official lists to set health care. We calculated appropriate discounts to equate prices. Results: In ARG the difference of a drug price between generics/copies and originals has an average of 10.6% less for nonoriginals (range +5% to −24%). No nonoriginals drugs cost less than 24% of originals. Great variations of prices (57%) among generics. The difference of price between biosimilars and originals was 13.8% less for biosimilars. The differences of a drug price between UK and ARG showed that: a) LPD prices in ARG were 53% (−39% to +68%) more expensive than in UK, b) 86% of MPD are more expensive in ARG than in UK, with an average of 222% (−49% to +707%), c) 100% of HPD are more expensive in ARG than in UK, with an average of 123% (+8% to +408%). When translating to currency (all in US$) differences were an average of: a) LPD +141 (−353 to +412), b) MPD +1295 (−164 to +2531), and c) HPD +2649 (+471 to +10,359) more expensive in ARG than in UK per unit. Average discounts necessary to equate undiscounted official ARG list to undiscounted official UK list are: LPD 45% (24-64), MPD 71% (60-87), HPD 51% (13-80). Conclusion: a) Our results show great variations in prices between both countries. b) Prices are inversely related to GDP. c) 100% of HPD and 86% of MPD have overprices in ARG respect to UK with an average of 123% and 222% respectively. d) In currency these represent an average overpayment of US$ 2649 and US$ 1295 per unit respectively. e) Appropriate discounts to equate ARG list to UK list should be around 50%–70%. f) In ARG, differences of prices between generics/copies/biosimilars and originals are less than 24%, with an average of 10%–13%. g) By using undiscounted lists there is a high risk of overpayment. Unpublished final prices list may preclude a good decision making process even at physician level, considering that many of MPD and HPD are directed to stage IV noncurative patients with marginal quality of life advantages for some of these treatments. h) Our findings provide an evidence base for policy makers in nonhigh income countries.
Trends in the Incidence, Prevalence, and Survival Outcomes of Appendiceal Adenocarcinoma
Authors: Xiang W. , Cai G.
Published: September 2018

Background: Appendiceal carcinoma is a rare malignant tumor with aggressive potentials. Appendiceal adenocarcinoma (AA) accounts for approximately two thirds of it. Aim: This study aimed to explore the epidemiologic changes of AA and reveal the possible influences of therapeutic advances on survival of patients with AA. Methods: We retrospectively identified 6066 patients with AA treated between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) program. Pertinent data were analyzed for incidence and prevalence. Survival analysis was made by the actuarial or Kaplan-Meier and compared by log-rank test. Cox proportional hazards model was adopted for prognostic variable evaluation. Results: We identified 6066 cases with AA. Its annual age-adjusted incidence was 0.47 per 100,000 in 2000 and increased to 1.11 per 100,000 by 2014. The incidence increased the steepest in patients under 50 years old, with a threefold escalation to 0.60 per 100,000 in 2014. The elevation of the incidence was noted in all the histologic types, stages and grades. The 20-year limited-duration prevalence of AA was 6 per 100,000 on January 1, 2014. The multivariable analysis showed the median survival time was statistically different in gender, year of diagnosis, grade, stage, type of surgery performed and histologic subtype. The median survival time was prolonged from 2000-2006 to 2007-2014 (hazard ratio (HR) 0.87; 95% CI, 0.80-0.94). Conclusion: These results showed an elevation in the incidence, prevalence of AA, which may be interpreted by the advancement of examining techniques. The improvement in survival may result from the development of therapies. Furthermore, these results suggested clinicians pay more attention to AA and indicated some potential research directions.
Critical Success Factors for Promoting Healthy Food Environments and Healthy Eating Through Local Policy Changes: Learning From Canada
Authors: Politis C. , Keen D.
Published: September 2018

Background and context: Policies implemented at the local level can create healthier environments that enable individuals to engage in healthier, cancer preventive behaviors - such as healthy eating. Policies support cancer preventive behaviors in a sustainable and often cost-effective manner. Many theoretical frameworks exist to describe the policy process; however in practice, policy development is often considered a complex and unfamiliar mechanism to the cancer prevention and health promotion community. Aim: To identify and better understand the critical success factors underlying cancer prevention policy success, the Canadian Partnership Against Cancer analyzed the policy outcomes - focused on food environments and healthy eating - from their pan-Canadian funding initiative Coalitions Linking Action and Science for Prevention (CLASP). Strategy/Tactics: Four projects funded through the CLASP initiative, from 2009 to 2016, have yielded 260 policy outcomes related to improving food environments and healthy eating. The policy changes were the result of evidence-based interventions implemented at the local level (i.e., municipalities, schools/child care, and workplaces). Program/Policy process: Over 220 knowledge products and evaluation documents were reviewed to identify food environment and healthy eating policy outcomes and key lessons learned. The policy outcomes were analyzed and categorized according to: a) implementation setting (municipality, school/child care, workplace); and b) policy lever addressed. Policy lever categories were sourced from the World Cancer Research Fund's (WCRF) NOURISHING Framework. Ten key informant interviews were conducted with former project members to refine and validate the lessons learned. Lessons learned were organized into a final list of critical success factors and themed into overarching categories. Outcomes: The majority of the food environment and healthy eating policy outcomes from CLASP occurred in workplace settings (n=133) and municipalities (n=111), and the least in schools/child care settings (n=16). The most frequent NOURISHING policy lever was “Offer healthy food and set standards in public institutions and other specific settings” primarily through policies to ban the sale of energy drinks (n=83) and implementing nutrition standards (n=58). Ten critical success factors were identified and described within three categories: people (n=3); tools (n=3); and approaches and ways of working (n=4). What was learned: A key takeaway from this work was a combination of cross-sectoral partnerships, tools and evidence, and collaborative ways of working were crucial to advance food environment and healthy eating policy change in municipalities, schools and child care settings, and workplaces. By utilizing the international WCRF NOURISHING Framework, it is intended that the lessons learned from this policy work in a Canadian context can inform local-level cancer prevention policy efforts around the world.
An Economic Evaluation of Everolimus As Second Line Treatment of Metastatic Renal Cell Carcinoma: A Malaysian Perspective
Authors: Nurhasni K.A.R. Ku , Sabirin J. , Puteh S.E. Wan , Dahlui M.
Published: September 2018

Background: Everolimus as second line treatment of metastatic renal cell carcinoma are significantly effective but more expensive compared with best supportive care alone. Therefore, a cost-utility analysis was needed to inform the decision makers on the potential adoption of everolimus as second line treatment of metastatic renal cell carcinoma weighing by the affordability of the healthcare provider. Aim: To estimate the economic value of everolimus as second line treatment of metastatic renal cell carcinoma. Methods: A state transition model was developed using Microsoft Excel 2010 to simulate a hypothetical cohort of patient receiving everolimus or best supportive care over 5 years time horizon. A monthly cycle was used based on the dosing schedule of everolimus. Three health states were included in the model as progression free, disease progression and dead. A discount rate of 3% was applied as recommended in the Pharmacoeconomic Guidelines for Malaysia. The clinical and utility parameters were derived from the published literatures. Total costs were estimated using unit costs from various local sources and published cost data. Results: Based on 1000 Monte Carlo simulation the mean incremental discounted cost and QALY for everolimus were RM 32,605.28 and 0.35484 respectively, yielded a probabilistic incremental cost-effectiveness ratio (ICER) of RM 91,887. A minimal reduction in the value of ICER was observed when costs associated with adverse events were excluded and variation of price per tablet was explored. Conclusion: Everolimus may be considered a cost-effective strategy at the suggested value of cost-effectiveness threshold by World Health Organization (1-3 gross domestic product (GDP) per capita). However, if the suggested cost-effectiveness threshold for Malaysia is taken into consideration (≤ 1 GDP per capita), this treatment may not be a cost-effective strategy in Malaysia.