bluuebunny/crossref_metadata_2025 huggingface dataset:
The self-ownership proviso
Authors: Bornschein Peter
Published: March 2018

Recently, Eric Mack, Edward Feser, and Daniel Russell have argued that self-ownership justifies a constraint on the use of property such that an owner’s use of property may not severely negate the ability of others to interact with the world. Mack has labeled this constraint the self-ownership proviso. Adopting this proviso promises right-libertarians a way of avoiding the extreme implications of a no-proviso view, while maintaining a consistent and cohesive position (in contrast, arguably, to Nozick’s understanding and endorsement of Locke’s proviso). Nevertheless, I argue that self-ownership cannot ground the constraint on property use that Mack, Feser, and Russell think that it can.
Translation of the National Diabetes Prevention Program to Engage Men in Disadvantaged Neighborhoods in New York City: A Description of Power Up for Health
Authors: Gary-Webb Tiffany L. , Walker Elizabeth A. , Realmuto Lindsey , Kamler Alexandra , Lukin Jennifer , Tyson William , Carrasquillo Olveen , Weiss Linda
Published: March 2018

The Diabetes Prevention Program (DPP) landmark randomized trial demonstrated that participants with prediabetes could reduce their risk for type 2 diabetes by 58% if they achieved 5%–7% weight loss through healthy eating and increasing physical activity. The National DPP (NDPP) is a group intervention based on the DPP and has been widely disseminated by the Centers for Disease Control and Prevention (CDC) and many healthcare institutions. While data show that the program is effective in diverse populations, enrollment among men from low-income and minority communities is low. Thus, the study piloted a novel adaptation focused on men living in disadvantaged neighborhoods. The study approach to adaptation and implementation used characteristics of participatory research, including input from an expert panel of African American and Latino leaders, ongoing consultation with an Advisory Panel, and focus groups with members of the target population. Discussions with these groups focused on male perspectives regarding health promotion and barriers and facilitators to participation in health programming for men. There was general agreement when reviewing ongoing pilot program implementation that the adapted program should have male-only groups with male coaches, as the Advisory Panel had originally suggested. The pilot programs were implemented at five New York City Department of Parks and Recreation sites in Harlem, the Bronx, and Brooklyn in 2015–2016.
Association of Anthropometric Indexes With Disease Severity in Male Patients With Chronic Obstructive Pulmonary Disease in Qazvin, Iran
Authors: Sami Ramin , Sadegh Raheleh , Esmailzadehha Neda , Mortazian Sanaz , Nazem Masoomeh , Zohal Mohammadali
Published: March 2018

Malnutrition is one of the most important factors that lead to lower quality of life in patients suffering from chronic obstructive pulmonary disease (COPD). There are several methods for assessing malnutrition including anthropometric indexes. The aim of this study was to determine the association of anthropometric indexes with disease severity in male patients with COPD in Qazvin, Iran. This cross-sectional study was conducted on 72 male patients with COPD in Qazvin, Iran, from May to December 2014. Spirometry was performed for all participants. Disease severity was determined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline. Body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TSF) were measured. MAMC and TSF were categorized into three subgroups as <25th P, between 25th P and 75th P, and >75th P (Where P is the abbreviation for percentile.). Data were analyzed using ANOVA and logistic regression analysis. Mean age was 60.23 ± 11.39 years. Mean BMI was 23.23 ± 4.42 Kg/m2, mean MAMC was 28.34 ± 3.72 cm2, and mean TSF was 10.15 ± 6.03 mm. Mean BMI and MAMC in the GOLD stage IV were significantly lower than other stages. Of 72, 18.1% were underweight while 6.9% were obese. The GOLD stage IV was associated with 16 times increased risk of underweight and nine times increased risk of MAMC < 25th P. Disease severity was associated with BMI and MAMC as indexes of malnutrition in patients with COPD in the present study. The GOLD stage IV was associated with increased risk of underweight and low MAMC.
Imaging selection for acute stroke intervention
Authors: Campbell Bruce CV , Parsons Mark W
Published: March 2018

This review summarizes the current state of knowledge regarding the use of imaging to guide stroke treatment. Brain imaging plays a central role in the diagnosis of stroke and identification of the mechanism of stroke, which is relevant to acute treatment, prognosis, and secondary prevention. The chief potential modalities are computed tomography (CT) and magnetic resonance imaging (MRI). Currently, most imaging occurs in hospital but mobile stroke units have expanded CT brain imaging into the prehospital field. The proven therapies for ischemic stroke are based on achieving reperfusion and the DAWN and DEFUSE 3 trials have now firmly established a need for imaging selection based on estimated ischemic core volume to guide reperfusion decisions in patients beyond 6 h of stroke onset. However, data also indicate that estimated ischemic core volume, in conjunction with patient factors and expected time delay to reperfusion, forms one of the most useful prognostic assessments that could alter decision-making for patients within 6 h. Current trials are also investigating agents that aim to achieve neuroprotection, reduction in edema or prevention of hemorrhagic transformation. Imaging may play a role in identifying patients likely to benefit from this next generation of interventions for stroke patients.
Use of computed tomography perfusion for acute stroke in routine clinical practice: Complex scenarios, mimics, and artifacts
Authors: Garcia-Esperon Carlos , Bivard Andrew , Levi Christopher , Parsons Mark
Published: March 2018

Background

Computed tomography perfusion is becoming widely accepted and used in acute stroke treatment. Computed tomography perfusion provides pathophysiological information needed in the acute decision making. Moreover, computed tomography perfusion shows excellent correlation with diffusion-weighted imaging and perfusion-weighted sequences to evaluate core and penumbra volumes. Multimodal computed tomography perfusion has practical advantages over magnetic resonance imaging, including availability, accessibility, and speed. Nevertheless, it bears some limitations, as the limited accuracy for small ischemic lesions or brainstem ischemia. Interpretation of the computed tomography perfusion maps can sometimes be difficult. The stroke neurologist faces complex or atypical cases of cerebral ischemia and stroke mimics, and needs to decide whether the “lesions” on computed tomography perfusion are real or artifact.

Aims

The purpose of this review is, based on clinical cases from a comprehensive stroke center, to describe the added value that computed tomography perfusion can provide to the stroke physician in the acute phase before a treatment decision is made.
Reliability modeling for systems degrading in K cyclical regimes based on gamma processes
Authors: Shen Jingyuan , Elwany Alaa , Cui Lirong
Published: March 2018

Regime switching models represent an important research direction in reliability engineering and degradation modeling. In practice, complex engineering systems typically operate under variable environmental conditions or mission requirements, each having distinct influence of system degradation. In this article, we study a system deteriorating in K cyclical regimes, where the degradation behavior of the system during each regime is governed by a distinct gamma process. We first derive the cumulative distribution function of the first passage time under this setting. Next, we determine system availability when maintenance actions are taken into consideration under the scenario where regime switching only takes place during the system uptime. Finally, we give some numerical examples to demonstrate and validate the proposed framework.
‘I Like to Be a Swell’: Paupers at the Pantomime
Authors: Andersen Kirsten
Published: March 2018

In January 1866, journalist James Greenwood entered the Lambeth Workhouse disguised as a vagrant. Greenwood's account of his experience inspired a host of imitators, and inaugurated a mania for slum journalism. Critics have noted the voyeurism and the homoerotic subtext of Greenwood's ‘A Night in a Workhouse', but the impact of Victorian popular theatre on his narrative has received scant attention. This essay recuperates the links between workhouse and theatre: examining paupers' reception, criticism, and appropriation of popular forms of entertainment such as the pantomime and the music hall song, analysing the representation of the workhouse on the Victorian stage, and finally proposing the concept of the workhouse itself as a performance space. Greenwood provides a valuable source of information about the theatregoing habits of the houseless poor, the most marginalised demographic within audiences at the Victorian theatre.
The EU and artificial intelligence: A human-centred perspective
Authors: Carriço Gonçalo
Published: March 2018

This article analyses the potential benefits and drawbacks of artificial intelligence (AI). It argues that the EU should become a leading force in AI development. As a goal that captures the public imagination and mobilises a variety of actors, the EU should develop mission-based innovations that focus on using this technological leadership to solve the most pressing societal problems of our time whilst avoiding potential dangers and risks. This leadership could be achieved either by adapting the EU’s available instruments to focus on AI development or by designing new ones. Be it seeking a visionary future for AI or addressing concerns about it, progress should always be driven with the human-centred perspective in mind, that is, one that seeks to augment human intelligence and capacity, and not to supersede it.
Application of Spectroscopic and Chromatographic Methods for Chemical Characterization of an Ayurvedic Herbo-Mineral Preparation: Maha Yograja Guggulu
Authors: Singh Arjun , Ota Sarada , Srikanth Narayan , Galib Ruknuddin , Bojja Sreedhar , Dhiman Kartar Sing
Published: March 2018

Rasa Shastra is an exclusive branch of ayurveda that uses processed metals and minerals in various combinations. Though the formulations are time tested, safety and quality concerns are being raised since the past two decades. In view of this, it becomes mandatory to generate quality control profiles of such formulations by following available parameters. Considering this, we attempted to develop standard manufacturing procedures of Maha Yogaraja Guggulu and generate preliminary physicochemical profiles using inductively coupled plasma mass spectrometry, X-ray diffraction, and high-performance thin-layer chromatography. The results from high-performance thin-layer chromatography revealed presence of organic constituents from plant material. X-ray diffraction indicated that the prepared drug contained cinnabar (mercury sulfide; Rasa sindhura), cassiterite (tin oxide; Vanga bhasma), litharge (lead oxide; Naga bhasma), and iron dioxide and magnetite (di-iron oxide; Loha and Mandura bhasma). The observations of the present study are preliminary and first of its kind that may be considered as baseline data for future studies.
In Vivo Evaluation of Withania somnifera–Based Indian Traditional Formulation (Amukkara Choornam), Against Chikungunya Virus–Induced Morbidity and Arthralgia
Authors: Jain Jaspreet , Narayanan Vimal , Chaturvedi Shivam , Pai Somnath , Sunil Sujatha
Published: March 2018

Chikungunya viral fever results in extreme morbidity and arthralgia in affected individuals. Currently, modern medicines providing symptomatic relief for the acute febrile phase and the chronic arthritic phase are only options available. Traditional Indian medical system, however, uses specific formulations for treatment of this infection; one such polyherbal formulation used to treat the postpyretic phase of chikungunya is amukkara choornam. The current study was undertaken to study the efficacy of amukkara choornam in the treatment of chikungunya in C57BL/6J mice. The formulation when administered to chikungunya-infected mice relieved morbidity and joint swelling. Analysis of virus clearance in brain and joint tissues on formulation treatment revealed a direct correlation of viral load in brain to morbidity during infection; likewise, joint swelling receded prior to complete viral clearance explaining possible immunomodulatory effect of amukkara choornam. This study provides insight into the possible mode of action of amukkara choornam during chikungunya.
Sex-Based Differences in Knee Kinetics With Anterior Cruciate Ligament Strain on Cadaveric Impact Simulations
Authors: Schilaty Nathan D. , Bates Nathaniel A. , Nagelli Christopher , Krych Aaron J. , Hewett Timothy E.
Published: March 2018

Background:

Females are at an increased risk of sustaining noncontact knee ligament injuries as compared with their male counterparts. The kinetics that load the anterior cruciate ligament (ACL) are still under dispute in the literature.

Purpose/Hypothesis:

The purpose of this study was to determine whether there are differences in knee kinetics between the sexes that lead to greater ACL strain in females when similar external loads are applied during a simulated drop vertical jump landing task. It was hypothesized that female limbs would demonstrate significant differences in knee abduction moment that predispose females to ACL injury when compared with males.

Study Design:

Controlled laboratory study.

Methods:

Motion analysis data of 67 athletes who performed a drop vertical jump were collected. The kinematic and kinetic data were used to categorize tertiles of relative risk, and these values were input into a cadaveric impact simulator to assess ligamentous loads during the simulated landing task. Uni- and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect kinetic data and maximum ACL strain for analysis. Conditions of external loads applied to the cadaveric limbs were systematically varied and randomized. Data were analyzed with 2-way repeated-measures analysis of variance and the Fisher exact test.

Results:

Five kinetic parameters were evaluated. Of the 5 kinetic variables, only knee abduction moment (KAM) demonstrated significant differences in females as compared with males ( F1,136 = 4.398, P = .038). When normalized to height and weight, this difference between males and females increased in significance ( F1,136 = 7.155, P = .008). Compared with males, females exhibited a 10.3-N·m increased knee abduction torque at 66 milliseconds postimpact and a 22.3-N·m increased abduction torque at 100 milliseconds postimpact. For loading condition, the condition of “maximum ACL strain” demonstrated a maximum difference of 54.3-N·m increased abduction torque and 74.5-N·m increased abduction torque at 66 milliseconds postimpact.

Conclusion:

Under the tested conditions, increased external loads led to increased medial knee translation force, knee abduction moment, and external knee moment. Females exhibited greater forces and moments at the knee, especially at KAM, when loaded in similar conditions. As these KAM loads are associated with increased load and strain on the ACL, the sex-based differences observed in the present study may account for a portion of the underlying mechanics that predispose females to ACL injury as compared with males in a controlled simulated athletic task.

Clinical Relevance:

KAM increases strain to the ACL under clinically representative loading. Additionally, this work establishes the biomechanical characteristics of knee loading between sexes.
Experiences of Head and Neck Cancer Patients in Middle Adulthood: Consequences and Coping
Authors: Grattan Kathryn , Kubrak Catherine , Caine Vera , O’Connell Dan A. , Olson Karin
Published: March 2018

The head and neck cancer (HNC) rate is rising among the middle-aged adult population. This trend has been attributed primarily to human papillomavirus exposure. An HNC diagnosis and its complex treatments may trigger life-changing physical, emotional, and social consequences. An interpretive descriptive study was conducted to describe the experiences of a purposive sample of 10 middle-aged adults who had experienced HNC. Two main themes were identified: consequences of HNC and coping with HNC. Subthemes of consequences of HNC included: voicelessness; being or looking sick; shifts in family dynamics; and sexual practices, sexual feelings, and stigma. Subthemes of coping with HNC included seeking information, discovering inner strengths, relying on a support network, establishing a sense of normalcy, and finding meaning within the experience. Supportive nursing interventions were identified by considering results from the standpoint of King’s theory of goal attainment.
Mediator Effect of Balance Problems on Association Between Grip Strength and Falls in Older Adults: Results From the KORA-Age Study
Authors: Arvandi Marjan , Strasser Barbara , Volaklis Konstantinos , Ladwig Karl-Heinz , Grill Eva , Matteucci Gothe Raffaella , Horsch Alexander , Laxy Michael , Siebert Uwe , Peters Annette , Thorand Barbara , Meisinger Christa
Published: March 2018

Objective: To examine the association between grip strength and history of falls among older individuals, and to assess the possible mediating effect of balance problems on this relationship. Method: Data originate from KORA (Cooperative Health Research in the Region of Augsburg)-Age Study of 808 individuals (65 years and above). Follow-up assessment occurred 3 years later. Results: The risk of falls within the last 12 months was reduced on average by 3% (odds ratio [OR] 95% confidence interval [95% CI] = 0.97 [0.94, 0.99]; p value = .026) per 1-kg increase in maximum grip strength after adjusting for age and gender. There was a trend toward an indirect effect of grip strength through the mediator variable balance problems ( p value = .043). Discussion: Increased muscular strength is associated with a reduced risk of falls in older age after adjustment for age and gender. The association is partially mediated by balance problems. Thus, in older adults, muscle-strengthening exercises may decrease the risk of falling.
Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors
Authors: Orenius Tage , LicPsych  , Säilä Hanna , Mikola Katriina , Ristolainen Leena
Published: March 2018

The purpose of this clinical update is to provide an overview of the fear of needles and needle phobia in children and adolescents including characteristics and diagnosis, prevalence and epidemiology, etiological factors, and treatment options. Needle-related fear and needle phobia present as significant needle-related distress and avoidance behavior. The etiology is biopsychosocial. These challenging conditions are more common in children and adolescents than in adults. The nurse–patient relationship enables the provision of suitable preparation before injection procedures. Nurses can use exposure-based interventions and incorporate coping strategies and teaching of parents and children. Nurses play a pivotal role in noticing the need for further treatment. Procedural needle-related distress is a complex phenomenon representing a continuum ranging from needle fear to more severe needle phobia. For patients with needle fear management and training methods used by nurses can possibly prevent a progression of the condition into needle phobia. In cases of needle phobia, a correct diagnosis made by a psychiatrist is necessary and enables referral to a psychotherapist with experience in treating children and adolescents with needle phobia.
Pattern of Opioid Analgesic Prescription for Adults by Dentists in Nova Scotia, Canada
Authors: Jimoh K.O. , Matthews D.C. , Brillant M. , Sketris I.
Published: March 2018

Global consumption of prescription opioid analgesics has increased dramatically in the past 2 decades, outpacing that of illicit drugs in some countries. The increase has been partly ascribed to the widespread availability of prescription opioid analgesics and their subsequent nonmedical use, which may have contributed to the epidemic of opioid abuse, addiction, and overdose-related deaths. International studies report that dentists may be among the leading prescribers of opioid analgesics, thus adding to the societal impact of this epidemic. Between 2009 and 2011, dentists in the United States prescribed 8% to 12% of opioid analgesics dispensed. There is little information on the pattern of opioid analgesic prescription by dentists in Canada. The aim of this study was to examine the pattern of opioid analgesics prescription by dentists in Nova Scotia (NS), Canada. This retrospective observational study used the provincial prescription monitoring program’s record of oral opioid analgesics and combinations dispensed to persons 16 y and older at community pharmacies that were prescribed by dentists from January 2011 to December 2015. During the study period, more than 70% of licensed dentists in NS wrote a prescription for dispensed opioid analgesics, comprising about 17% of all opioid analgesic prescribers. However, dentists were responsible for less than 4% of all prescriptions for dispensed opioid analgesics, prescribing less than 0.5% of the total morphine milligram equivalent (MMEq) of opioid analgesics dispensed over the 5 y. There was a significant downward trend in total MMEq of dispensed opioid analgesics prescribed by dentists from about 2.23 million MMEq in 2011 to 1.93 million MMEq in 2015 (r = –0.97; P = 0.006). Opioid prescription is common among dentists, but their contribution to the overall availability of opioid analgesics is low. Furthermore, there has been a downward trend in total dispensed MMEq of opioid analgesics prescribed by dentists.

Knowledge Transfer Statement: This study will serve to inform dentists and policy makers on the types and dosage of opioid analgesics being prescribed by dentists. The study may prompt dentists to reflect on and adjust their practice of opioid analgesic prescription in view of the current opioid analgesic epidemic.
How I treat the postthrombotic syndrome
Authors: Rabinovich Anat , Kahn Susan R.
Published: March 2018

The postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that imposes significant morbidity, reduces quality of life, and is costly. After DVT, 20% to 50% of patients will develop PTS, and up to 5% will develop severe PTS. The principal risk factors for PTS are anatomically extensive DVT, recurrent ipsilateral DVT, obesity, and older age. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will reduce occurrence of PTS. The effectiveness of elastic compression stockings (ECSs) for PTS prevention is controversial. Catheter-directed thrombolysis is not effective to prevent PTS overall but may prevent more severe forms of PTS and should be reserved for select patients with extensive thrombosis, recent symptoms onset, and low bleeding risk. For patients with established PTS, the cornerstone of management is ECS, exercise, and lifestyle modifications. Surgical or endovascular interventions may be considered in refractory cases. Because of a lack of effective therapies, new approaches to preventing and treating PTS are needed. This article uses a case-based approach to discuss risk factors for PTS after DVT, how to diagnose PTS, and available means to prevent and treat PTS, with a focus on new information in the field.
Epidemiology, clinical features, and outcome of HTLV-1–related ATLL in an area of prevalence in the United States
Authors: Malpica Luis , Pimentel Agustin , Reis Isildinha M. , Gotuzzo Eduardo , Lekakis Lazaros , Komanduri Krishna , Harrington Thomas , Barber Glen N. , Ramos Juan C.
Published: March 2018

Key Points

ATLL presents more aggressively in US Afro-Caribbean than Japanese patients and continues to have a poor outcome despite modern therapies. AZT-IFN is a reasonable up-front option for aggressive, nonbulky, leukemic ATLL subtypes, resulting in long PFS after a complete response.
Bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis: a multicentre cohort study in Korea
Authors: Kim Cheon Tae , Kim Tae-Ok , Shin Hong-Joon , Ko Young Chun , Hun Choe Yeong , Kim Hak-Ryul , Kwon Yong-Soo
Published: March 2018

Relatively little is known about the efficacy and safety of the programmatic use of bedaquiline and delamanid in multidrug-resistant tuberculosis (MDR-TB) treatment.

This study evaluated 61 patients with MDR-TB treated with bedaquiline (n=39), delamanid (n=11) or both, either sequentially (n=10) or in coadministration (n=1), for >1 month, combined with a World Health Organization-recommended regimen.

Of these, 49 (80.3%) were male and 12 (19.7%) were female. The median (interquartile range (IQR)) age was 53 (38.5–61.0) years. 42 (68.9%) patients had fluoroquinolone-resistant MDR-TB and 16 (26.2%) had extensively drug-resistant TB. The median (IQR) duration of treatment with bedaquiline and/or delamanid was 168 (166.5–196.5) days, with 33 (54.1%) receiving linezolid for a median (IQR) of 673 (171–736) days. Of the 55 patients with positive sputum cultures at the start of bedaquiline and/or delamanid treatment, 39 (70.9%) achieved sputum culture conversion within a median of 119 days. Treatment was halted in four patients (6.6%) because of prolonged Fridericia's corrected QT interval.

Bedaquiline and delamanid were effective and safe for treating MDR-TB, with initial evidence of sequential administration of these two drugs as a viable treatment strategy for patients when an adequate treatment regimen cannot be constructed.
Characteristics and Triggering Conditions for Naturally Deposited Gravelly Soils that Liquefied following the 2008 Wenchuan Mw 7.9 Earthquake, China
Authors: Chen Longwei , Yuan Xiaoming , Cao Zhenzhong , Sun Rui , Wang Weiming , Liu Huida
Published: March 2018

The 2008 Mw 7.9 Wenchuan, earthquake caused naturally deposited ravelly soils to liquefy over a wide area. Although liquefaction of gravely soils is recognized by the geotechnical profession, observations of liquefaction and nonlique-faction case histories within the literature are few. Through several years of systematic study following the 2008 Wenchuan earthquake (Mw 7.9), 92 locations of gravel liquefaction were identified, described, and mapped. These locations lie within an approximately 3,000 km2 area of the Chengdu Plain. Peak ground accelerations estimated at the sites range from 0.15 g to 0.49 g. Taken collectively, these studies reveal the necessary conditions for liquefaction triggering in gravelly materials. Grain size analyses indicates that the ejecta was much finer than the gravels that liquefied. Gravel contents of liquefied soils ranged from 5% to more than 85%. The liquefied gravelly soils were loose, but their measured shear wave velocities range from 133 m/s to 267 m/s, with corrected values ranging from 154 m/s to 31 4m/s. The unique depositional conditions under Chengdu Plain provide favorable conditions for extensive liquefaction of gravelly soils. The shallow soil profiles consist of a 0.5 m to 5.5 m impermeable soil (i.e., the capping layer) overlying gravels ranging in thickness from a few meters to hundreds of meters.
Quantifying the Epistemic Uncertainty in the Probabilistic Seismic Hazard from Two Major Faults in Western Nevada
Authors: Anderson John G.
Published: March 2018

The probabilistic seismic hazards in the larger cities of western Nevada are dominated by the Mount Rose and Carson Range faults. These are normal faults; Reno and Carson City are on the hanging wall. This paper finds the sensitivity of the hazard posed by these faults to epistemic uncertainty of dip, slip rate, magnitude, and choice of ground motion prediction equation (GMPE) for an earthquake that ruptures the length of each fault. SA(0.01 s) with exceedance probability of 2% in 50 years was determined for each branch of a logic tree for those properties. This paper uses tools of probability theory to characterize this logic tree distribution with a lognormal distribution function, and to suggest an estimate of uncertainty in the mean hazard. In this case, which should not be considered general, on the hanging wall, the uncertainties in fault dip and the choice of the GMPE are the dominant contribution to the standard deviation of the lognormal distribution function. Elsewhere nearby, uncertainties in fault slip rate dominate, while at larger distances uncertainties in the magnitude dominate.
Barriers and Facilitators of Human Papillomavirus (HPV) Vaccination During the Implementation of the School-Based HPV Vaccine Program in Manizales, Colombia
Authors: Cordoba Verónica , Tovar-Aguirre Olga Lucía , Franco Sandra , del Pilar Escobar María , Arias Nelson Enrique , Louie Karly , Sanchez Gloria Ines , Garces-Palacio Isabel
Published: March 2018

Abstract 43

Purpose

Colombia implemented a school-based human papillomavirus (HPV) vaccination program that consisted of a three-dose series in girls age 9 years in 2012. In 2014, the program included girls up to the last grade of high school, and the second and third doses were scheduled at 6 and 60 months. After a mass psychogenic response after vaccination that occurred from May to October 2014 in Carmen de Bolivar, vaccination rates dropped from 80% in 2012 and 2013 to 18% in 2014. The aim of the current study was to identify barriers and facilitators of HPV vaccine uptake in Colombia.

Methods

To develop quantitative instruments for a population-based survey, we conducted 19 qualitative interviews and 18 focus groups between September 2016 and February 2017. Participants were girls who were eligible to receive vaccination between 2012 and 2014 and their parents or legal representatives.

Results

Forty-nine girls who were selected from six schools of low (n = 2), medium (n = 2), and high (n = 2) socioeconomic level and 58 of their parents participated in the study. Eighty-one percent (40 of 49) of girls were age 12 to 15 years at the time of interview. No girls from schools of a low socioeconomic level and only two of 20 of their parents knew the etiology of cervical cancer. Pap smear cytology and condom use were the methods of cervical cancer prevention that were most often mentioned by parents. Only vaccinated girls from schools of a high socioeconomic level considered the HPV vaccine to be a good prevention alternative. Facilitators in adults were the desire to prevent disease in general and HPV. For both girls and their parents, listening to positive information about the vaccine facilitated vaccine uptake. Negative media information about the effects of the vaccine from the 2014 psychogenic event was the main barrier for vaccine uptake or series completion. Fifty-seven percent of girls and 30% of parents mentioned that, at the time of vaccination, information about the HPV vaccine was received mainly through government massive media campaigns, whereas approxiamtely one half of both parents and girls did not receive information from schools or health care services.

Conclusion

Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program, including mass media information about the HPV vaccine.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Barriers to Timely Surgery for Breast Cancer in Rwanda
Authors: Schleimer Lauren E. , Dusengimana Jean-Marie Vianney , Butonzi John , Kigonya Catherine , Natarajan Abirami , Umwizerwa Aline , O’Neil Daniel S. , Shulman Lawrence N. , Keating Nancy L. , Shyirambere Cyprien , Mpunga Tharcisse , Pace Lydia E.
Published: March 2018

Abstract 81

Purpose

Surgery is the mainstay of treatment for nonmetastatic breast cancer. Little is known about the quality of breast surgical care in sub-Saharan Africa. Research at the Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center, has suggested that access to timely surgery is inadequate, but barriers have not been systematically examined. The aim of the current study was to gain an understanding of the barriers to breast cancer surgery among patients who were diagnosed at BCCOE by investigating delays and interruptions in care.

Methods

We used a standardized chart abstraction instrument to collect demographic, treatment, and outcome data as of November 2017 for all patients who were diagnosed with breast cancer at BCCOE in 2014 and 2015. We recorded all visits and treatments received until surgery, disease progression, or loss to follow-up for all patients with stage I to III breast cancer.

Results

During 2014 and 2015, 91 patients were diagnosed with stage I to III breast cancer and were treated with curative intent—67 patients (74%) underwent surgery, with 22 undergoing surgery at BCCOE and 45 elsewhere. Of the 24 patients with no surgery, 16 were lost to follow-up and eight experienced disease progression before surgical evaluation. Median time from diagnosis to surgery was 103 days (range, 30 to 826 days) for patients without neoadjuvant chemotherapy (NAC) and 268 days (range, 108 to 794 days) for patients with NAC. We defined surgical delays as > 120 days from diagnosis without NAC or > 365 days from diagnosis if NAC was administered. Of the 67 patients who had surgery, 26 patients (39%) experienced delays. When documented, reasons for delay included patient factors, such as social and/or financial issues (n = 5), seeking alternate treatment (n = 2), refusing referral to Kigali (n = 3), or any surgery (n = 1); system factors, such as surgeon nonavailability (n = 1); and changes in clinical status, such as pregnancy (n = 5), treatment-associated adverse events (n = 4), or the need for a second surgical opinion (n = 2). Unexplained failure to complete the initial surgical referral (n = 5) and missed NAC treatment appointments (n = 6) were frequent contributors. Some patients had multiple reasons for delay. For five patients, there was no documented explanation.

Conclusion

We observed high rates of loss to follow-up, surgical delays, and lapses in care at the point of surgical referral. Identification of the barriers to completing referrals could guide strategies for improving access to timely surgery. Efforts are needed to address social and financial barriers and explore patients’ refusals to undergo surgery.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Predictors of Radiation Therapy Incompletion Among Patients With Esophageal Cancer in Tanzania
Authors: Xu Melody J. , Mushi Beatrice , Kutika Sarah , Zhang Li , Deardorff Katrina , Merritt Megan , Mgisha William , Mwaiselage Julius , Feng Mary , Mmbaga Elia , Van Loon Katherine
Published: March 2018

Abstract 96

Purpose

The incidence of esophageal cancer in East Africa is disproportionately high. In Tanzania, radiation therapy (RT) is routinely offered for definitive and palliative therapy; however, many patients do not complete RT or die shortly thereafter. The current study aimed to characterize RT treatment patterns in Tanzania and identify predictive factors for RT incompletion.

Methods

We performed a retrospective chart abstraction for patients with esophageal cancer who were treated with RT at a national referral cancer center in Tanzania from 2011 to 2013. Definitive intent was defined as RT prescriptions with at least 20 fractions with concurrent chemotherapy. Other fractionation regimens were considered palliative. Wilcoxon rank-sum tests, χ2 tests, and logistic regression models were used to identify factors that are associated with palliative or definitive RT incompletion.

Results

A total of 300 patients—202 male and 98 female patients—were identified with a median age of 60 years (interquartile range [IQR], 48 to 70 years). Nearly 100% (299 of 300) of patients reported dysphagia to solids, and 54% (155 of 288) reported dysphagia to liquids. Median duration of symptoms before presentation was 4 months (IQR, 2 to 6 months), and median time from diagnosis to RT was 1.2 months (IQR, 0.8 to 1.9 months). Overall, 23% were unable to complete RT as a result of death or clinical decompensation. Palliative treatment was administered to 149 patients, and 26% did not complete RT. Definitive treatment was administered to 151 patients, and 20% did not complete RT ( P = .24). Patients younger than age 60 years were less likely to complete palliative RT (odds ratio [OR], 2.4; P = .02). Tobacco use (OR, 2.7; P = .04) and RT initiation within 30 days of diagnosis (OR, 3.5; P = .004) were associated with incomplete definitive RT.

Conclusion

In Tanzania, approximately 23% of patients die or decompensate before completing esophageal RT. Patients younger than age 60 years were less likely to complete palliative RT. Tobacco use and RT initiation within 30 days of diagnosis was associated with definitive treatment incompletion, perhaps reflecting differences in cancer biology or pace of disease. Additional understanding of how these factors contribute to RT incompletion may inform supportive care resource allocation and patient selection for esophageal RT in Tanzania and similar resource-limited settings.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs were provided by the authors.
A Multiplexed Human Papillomavirus 16 and 18 Diagnostic Chip for Cervical Cancer in Limited-Resource Settings
Authors: Wong Winnie S. , Klapperich Catherine M.
Published: March 2018

Abstract 16

Purpose

Despite being treatable, cervical cancer is responsible for 300,000 deaths annually and is the second most frequent cause of cancer-related death worldwide. The burden of cervical cancer disproportionately falls on developing countries, where 87% of deaths occur from limited or no resources for screening. Of cervical cancer cases, 99% are caused by human papillomavirus (HPV), with more than 70% of cases from HPV genotypes 16 and 18. We developed a low-cost cervical cancer diagnostic chip to detect HPV 16 and 18 DNA quickly and reliably in limited-resource settings (LRSs).

Methods

Unlike conventional HPV diagnostics that use polymerase chain reaction and resource-intensive equipment, our chip used isothermal—one temperature—amplification, specifically loop-mediated amplification, and required only a heat source, which made it suitable for LRSs. Amplified DNA was visually detected on a lateral flow strip, which is similar to a pregnancy test, providing a simple yes or no readout. Specific line patterns indicated the presence of HPV 16, 18, both, or neither. Each chip was single use and self-contained to be easily disposed of as biohazard waste, which reduced the risk of contamination and false positives.

Results

The loop-mediated amplification assay was optimized to detect HPV 16 and 18 simultaneously. Sensitive and specific amplification of cloned HPV 16 and 18 DNA was achieved and confirmed via specific restriction enzyme digests. The lower limit of detection was 104 and 103 copies for HPV 16 and 18, respectively. Clinical samples, namely discarded cervical swab samples, were also tested with the chip. Results were comparable with the gold standard of polymerase chain reaction, which proves that the chip is feasible for clinical samples. Time to result was less than 1 hour, making the chip appropriate for LRSs.

Conclusion

Our multiplexed HPV 16 and 18 diagnostic chip is clinically relevant and provides a much-needed screening method for LRSs. The chip will increase access to screening for a treatable cancer and provide a faster route to treatment as well as a decrease in deaths from cervical cancer.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Screen and Triage to Facilitate Screen and Treat by Community Health Extension Workers: Task-Sharing Strategy to Achieve Universal Cervical Cancer Screening in Nigeria
Authors: Awolude Olutosin A. , Oyerinde Sunday O. , Akinyemi Joshua O.
Published: March 2018

Abstract 31

Purpose

Universal access to cervical cancer screening remains elusive in most low- to middle-income countries, which shoulder the greatest burden of this preventable disease. Whereas a cytology-based screening strategy is logistically impossible, the shortage of health care workers (HCWs) and appropriate training limit the implementation of cheaper and equally effective methods, such as visual inspection after application of acetic acid (VIA); however, effective use of task shifting and sharing to involve community health extension workers (CHEWs) in HIV program delivery in low- to middle-income countries has brought innovation to bear in overcoming the HCW shortage. Hence, this study leveraged this novel strategy to pilot the provision of cervical cancer screening by CHEWs in Nigeria. The current study aimed to train and support the available health care workforce in rural communities to achieve population coverage for cervical cancer screening and reduce the cervical cancer burden in Nigeria.

Methods

We piloted improving the knowledge and practice skills of CHEWs/CHOs in a rural local government area of Oyo state, Nigeria, to provide community-level cervical cancer screening service. Improvement in knowledge and skills was accomplished through training, technical and infrastructural support, and participatory supervision for HCWs in the PHCs and general hospital in the local government area using the VIA method and by linking VIA-positive cases to the general hospital to screen and treat.

Results

Fifty-one HCWs, including physicians, nurses, and CHEWs/CHOs, were trained with five PHCs, and the general hospital was provided with materials with which to administer cervical cancer screening services. Participants’ knowledge improved from an average of 50.5% at pretraining to 88.8% immediately post-training. Of the 950 eligible women who were screened in 1 year, 848 (89.3%) were screened by CHEWs/CHOs. Of the 66 who were screened as VIA positive by CHEWs/CHOs, 58 (88.1%) agreed with the supervisory team review compared with 18 (92.3%) of 19 who were screened by nurses (κ statistics, 0.84 and 0.76, respectively). Three cases of invasive cervical cancer were diagnosed during this period, two of which were by CHEWs/CHOs.

Conclusion

This pilot project demonstrated that, with appropriate competency training and necessary support, CHEWs/CHOs can successfully identify cervical dysplasia. These HCWs are important resources to leverage to achieve universal coverage of cervical cancer screening services in Nigeria. We plan to expand this program to involve the seven health zones in Oyo state, Nigeria, in a hub and spoke manner to establish its wider feasibility.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
An interview with Susan Strome
Authors: Maartens Aidan
Published: March 2018

Susan Strome is Distinguished Professor of Molecular, Cell and Developmental Biology at the University of California, Santa Cruz, USA. Recently appointed an editor at Development, her lab studies the regulation of germ cell development in C. elegans, with a particular focus on the epigenetic transmission of chromatin states. We caught up with Susan to discuss her early career switch from prokaryotes to worms, her experiences of small and big science, and why teaching is so important to her.
The role of tumor microenvironment in resistance to anti-angiogenic therapy
Authors: Ma Shaolin , Pradeep Sunila , Hu Wei , Zhang Dikai , Coleman Robert , Sood Anil
Published: March 2018

Anti-angiogenic therapy has been demonstrated to increase progression-free survival in patients with many different solid cancers. Unfortunately, the benefit in overall survival is modest and the rapid emergence of drug resistance is a significant clinical problem. Over the last decade, several mechanisms have been identified to decipher the emergence of resistance. There is a multitude of changes within the tumor microenvironment (TME) in response to anti-angiogenic therapy that offers new therapeutic opportunities. In this review, we compile results from contemporary studies related to adaptive changes in the TME in the development of resistance to anti-angiogenic therapy. These include preclinical models of emerging resistance, dynamic changes in hypoxia signaling and stromal cells during treatment, and novel strategies to overcome resistance by targeting the TME.
Association of fat mass profile with natriuretic peptide receptor alpha in subcutaneous adipose tissue of medication-free healthy men: A cross-sectional study
Authors: Dinas Petros C. , Nintou Eleni , Psychou Dimitra , Granzotto Marnie , Rossato Marco , Vettor Roberto , Jamurtas Athanasios Z. , Koutedakis Yiannis , Metsios George S. , Flouris Andreas D.
Published: March 2018

Background: Atrial natriuretic peptide increases lipolysis in human adipocytes by binding to natriuretic peptide receptor-A (NPRA). The aim of the current study was to examine the associations of NPRA mRNA of subcutaneous adipose tissue with fat mass, fat-free mass, body mass index (BMI) and arterial blood pressure in medication-free healthy men.

Method: Thirty-two volunteers [age (years): 36.06±7.36, BMI: 27.60±4.63 (kg/m2)] underwent assessments of body height/weight, % fat mass, fat-free mass (kg), blood pressure, and a subcutaneous adipose tissue biopsy via a surgical technique.

Results: We found that NPRA mRNA was negatively associated with % fat mass (r=-0.40, R2=0.16, p=0.03) and BMI (r=-0.45, R2=0.20, p=0.01). Cohen’s f2 effect size analyses showed a small effect size between NPRA mRNA and BMI (f2=0.25). One-way analysis of variance with Bonferroni post-hoc tests showed a tendency for mean differences of NPRA mRNA across BMI categories (p=0.06). This was confirmed by Cohen’s d effect size analyses revealing a large effect size of NPRA mRNA between obese individuals (BMI≥30 kg/m2) and either normal weight (BMI=19-25 kg/m2; d=0.94) or overweight (BMI=25-30 kg/m2; d=1.12) individuals.

Conclusions: NPRA mRNA is negatively associated with % fat mass and BMI in medication-free healthy men, suggesting a possible role of NPRA in the control of fat mass accumulation.
Reflexive pedagogics of the University
Authors: Красовский Юрий , Krasovskiy Yuriy
Published: March 2018

The monograph proposes a psychological and pedagogical approach of the author to understanding the training of undergraduate and graduate students in high school. The first Chapter reveals the pedagogical features of the educational process, which analyzes the specifics and problematic field of study in modern conditions. The author introduces a new concept - "teaching product", which turns out to be pivotal in" decoding "the reflexive understanding of" circular " learning models. Fundamentally new in this regard is the disclosure by the author of latent competencies of students. In the second Chapter, the author reveals the specifics of" learning by action " on specific examples from his own practice. Especially interesting is presented in the monograph business game "Risks". In the third Chapter, the author analyzes in detail the problems of the emergence and development of University scientific and pedagogical schools, which offer criteria for their evaluation, as well as the necessary documentation in their official recognition and consolidation. In this Chapter, the author describes the creation of its own scientific and practical school consult students on their experience as a consultant and top Manager in the holding. On this basis, the concept of "interactive learning" is worked out in the monograph, which especially characterizes the understanding of reflexive pedagogy of the University as a new phenomenon in public life. This understanding was born from the author's long-term practice of teaching managers in the concept of reflexive management. It is presented in the monograph as a Basic App.