bluuebunny/crossref_metadata_2025 huggingface dataset:
Female Breast Cancer in Suriname: Pathways to Treatment—A Patient’s Perception
Authors: Irving Euridice R. , Mans Dennis R. A. , Dams Els Th. M. , Lichtveld Maureen Y.
Published: July 2020

PURPOSE

Delays across the entire cancer care continuum are not uncommon. This cross-sectional study explored the health care trajectories of Surinamese women with breast cancer and identified predictors of timely diagnosis and treatment initiation.

METHODS

One hundred women age 30 years or older who were newly diagnosed with breast cancer in 2017 to 2018 were recruited from all 4 hospitals in Paramaribo. Data on their demographics, lifestyle, reproductive and medical history, health status, and family history of breast cancer and other malignancies were collected using a validated semistructured questionnaire. Using Anderson’s Model of Pathways to Treatment, we defined a patient interval (from detection to first consultation), diagnostic interval (from consultation to histopathologic diagnosis), and treatment interval (from diagnosis to first treatment). Log-transformed data were analyzed using linear regression, and variables with P ≤ .05 were considered statistically significant predictors of intervals.

RESULTS

All participants had health insurance and access to health care. Eighty-five percent of patients presented with early-stage disease. Ninety percent of patients had self-detected their disease, with 70% finding a lump. Average age was 55.6 years (± 11.8 years). Median durations of patient, diagnostic, and treatment intervals were 13 days (interquartile, range, 4-63 days), 40 days (IQR, 21-57 days), and 18 days (IQR, 8-38 days), respectively. Median duration of the entire interval was 95 days (IQR, 59-272 days). Patient-related factors associated with the intervals were religion (β = −530; P = .003), being employed (β = 149.4; P = .007), and age 50 years and older (β = −195.8; P = .037). Disease-related factors were lump as first symptom (β = −175.6; P = .038) and late-stage disease at diagnosis (β = 213.5; P = .004).

CONCLUSION

Given the limited-resource setting, delays in Suriname’s health care can be minimized by programs aimed at increasing breast cancer awareness and education; however, delays may have been underestimated as a result of the over-representation of early-stage disease and recall bias regarding the first symptom detected.
Moving Toward an Evidence-Informed Cancer Control Strategy: A Scoping Review of Oncology Research in Kenya
Authors: Manduku Veronica , Akhavan Mina , Asiki Gershim , Brand Nathan R. , Cira Mishka K. , Gura Zeinab , Kadengye Damazo T. , Karagu Alfred , Livinski Alicia A. , Meme Helen , Kyobutungi Catherine
Published: July 2020

PURPOSE

In 2017, the Kenya Ministry of Health launched the National Cancer Control Strategy 2017 to 2022. A scoping review of oncology research in Kenya was conducted to understand the scope of—and gaps in—existing research and inform the development of the national cancer research agenda.

METHODS

We searched PubMed/MEDLINE, Embase, Scopus, and Global Health databases using controlled vocabulary and keywords to identify oncology research with a study site in Kenya, published in English, from 2007 to 2017. Fifteen journals and additional gray literature sources were hand searched. Screening of titles, abstracts, and full text was completed by pairs of 2 reviewers, with a third reviewer reconciling discrepancies. From included studies, data were extracted and coded using Google Forms. Microsoft Excel was used for descriptive statistics.

RESULTS

Of the 284 included articles, a majority were analytic observational studies (66.9%). The top 5 cancers studied were cervical cancer (n = 106; 35.9%), breast cancer (n = 25; 11.9%), Burkitt lymphoma (n = 23; 8.5%), esophageal cancer (n = 15; 5.1%), and pediatric cancers (n = 12; 4.1%). Primary focus areas were early detection, diagnosis, and prognosis and cancer control, survivorship, and outcomes research. Kenyatta National Hospital, Moi Teaching and Referral Hospital, and University of Nairobi were most often cited as research host institutions. One hundred twenty-three unique funding sources were reported, with the most prevalent study funding sources by region being North America (48%), Europe (28.8%), and Middle East/Africa (17.6%). The US National Institutes of Health was cited as the leading funding source of cancer research in Kenya.

CONCLUSION

This scoping review provides an overview of the published literature on cancer research conducted in Kenya. It highlights cancer research by cancer type, location, and focus area. It also focuses attention on research gaps, as well as the need for rigorous, well-conducted population-based studies, longitudinal studies, and randomized controlled trials aligned with the cancer burden in Kenya.
Awareness of and Preference for Disease Prognosis and Participation in Treatment Decisions Among Patients With Advanced Cancer in Myanmar: Results From the APPROACH study
Authors: Mon Ssu Wynn , Zu Wah Wah Myint , Maw Myo Myint , Win Han , Thant Kyaw Zin , Yang Grace , Malhotra Chetna , Teo Irene , Finkelstein Eric , Ozdemir Semra
Published: July 2020

PURPOSE

The aim of this study was to investigate prognostic awareness, preference for prognostic information, and perceived and preferred roles in decision making among patients with advanced cancer in Myanmar.

METHODS

A cross-sectional survey was administered at Yangon General Hospital to patients with stage 4 cancer who were at least 21 years old and aware of their cancer diagnosis. Patients were asked questions about their prognosis, treatment decisions, and sociodemographic and clinical information. Data from 131 patients were analyzed using descriptive and comparative statistics.

RESULTS

Only 15% of patients surveyed were aware that their cancer was advanced, and only 26% knew that it was terminal. One third of patients (34%) had prognostic awareness, defined as the knowledge that treatment intent is noncurative. The likelihood of awareness was higher among patients who were male, high income, and aware that they had advanced cancer. Approximately 60% of patients reported playing an active or collaborative role in treatment decisions, with a strong preference (59%) for the latter. For the majority of patients (69%), perceived and preferred roles in decision making were the same. Sociodemographic characteristics did not predict perceived and preferred roles in decision making.

CONCLUSION

To our knowledge, this is the first effort to analyze prognostic awareness and decision-making practices among patients with advanced stage cancer in Myanmar. Patients had inadequate knowledge of their disease progression and intent of treatment. Yet, a majority of them were keen to be involved in treatment decisions. Thus, physicians should effectively communicate prognosis and treatment intent, encouraging patients to participate in decisions whenever possible.
Democratizing Access to Best Practice Cancer Care in Low-Resource Settings: Project ECHO
Authors: Bouchonville Matthew F. , Cirolia Lucca
Published: July 2020

PURPOSE

The aim of this study was to understand how telementoring and training through the ECHO model can build the cancer workforce and bring best practice cancer care to low-resource settings.

METHODS

The ECHO Institute launched a 5-year project to expand the use of the ECHO model to improve the capacity of local providers to bring cancer prevention, diagnostic, treatment, and survivorship knowledge to rural and underserved populations. The ECHO model leverages technology, telementoring, and case-based learning to connect rural populations to specialty cancer care, improve access to evidence-based therapies and practices, and provide state-of-the-art training and mentorship to build the cancer workforce, particularly in underserved regions. Through the ECHO model, local providers are paired with experts and doctors at National Cancer Institute–designated Comprehensive Cancer Care Centers and academic medical centers for ongoing training, technical assistance, and mentorship. Although originally developed to bring best practice care for hepatitis C to rural communities, the ECHO model is now being used to treat 70 conditions or topics globally.

RESULTS

Since 2016, the ECHO model has been replicated by 73 partner hubs in 13 countries that are operating 130 cancer programs focused on diverse cancer prevention and treatment topics, including increasing clinical trial enrollment, cancer control and best practices, cervical cancer prevention and treatment, tobacco cessation, and more. To date, 21 peer-reviewed publications have documented the ECHO model’s efficacy in improving the use of best practices in cancer care and expanding access to care in low-resource settings.

CONCLUSION

Use of the ECHO model to train and mentor local providers is building the cancer workforce and increasing capacity to address critical topics in cancer screening, diagnosis, care, and survivorship. The ECHO Institute is successfully strengthening the cancer health system and accelerating the transmission of best practice cancer care from cancer centers to health care workers in underserved communities.
Setting Up Telemedicine: Internet of Things to Support Rural Oncology Clinics in a Low- and Middle-Income Country—A Pilot Project in Kenya
Authors: Sigu Lamech , Chite Fredrick , Achieng Emma , Koech Andrew
Published: July 2020

PURPOSE

The Internet of Things (IoT) is a technology that involves all things connected to the Internet that share data over a network without requiring human-to-human interaction or human-to-computer interaction. Information collected from IoT devices can help physicians identify the best treatment process for patients and reach accurate and expected outcomes.

METHODS

The International Cancer Institute is partnering to set up remote oncology clinics in sub-Saharan Africa. Medical oncologists and expert teams from across the world connect with oncology clinics in other Kenyan counties—Kisumu, Meru, Makueni, Garissa, Kakamega, Bungoma, Siaya, and Vihiga counties. The furthest county is Garissa, approximately 651.1 km from Eldoret, and the nearest is Vihiga at 100.4 km from Eldoret. This study began July 2019, and as of November 30th, the team has hosted 21 sessions with an average of 11 participants attending a session led by a medical oncologist.

RESULTS

IoT devices have become a way by which a patient gets all the information he or she needs from a physician without going to the clinic. Patient monitoring can be done in real time, allowing access to real-time information with improved patient treatment outcomes and a decrease in cost. Through IoT-enabled devices, the International Cancer Institute has set up weekly virtual tumor boards during which cancer cases are presented and discussed by all participating counties. An online training module on cancer is also offered. Furthermore, remote monitoring of a patient’s health helps to reduce the length of hospital stay and prevents readmissions.

CONCLUSION

In our setting, which has a few oncologists, use of IoT and tumor boards has helped to improve patient decision support as well as training for general physicians.
Improving Access to Vitally Important Chemotherapy Treatments in Northern Nigeria Through the African Access Initiative
Authors: Faruk Mohammed , Olasinde Tajudeen , Adamu Abdullahi , LeJeune-Stodieck Analise , Hunthausen Noah , Graef Katy , Dent Jennifer
Published: July 2020

PURPOSE

Cancer now kills more Africans than malaria. Without intervention, the number of cancer deaths in Africa is projected to double by 2040. BIO Ventures for Global Health (BVGH) launched the African Access Initiative (AAI) to address Africa’s cancer crisis by establishing sustainable access to cancer medicines. Through AAI, BVGH and the Ahmadu Bello University Teaching Hospital (ABUTH) are piloting a first-of-its-kind program focused on improving Nigeria’s access to affordable, gold-standard cancer drugs manufactured by multinational pharmaceutical companies.

METHODS

BVGH, the Federal Ministry of Health, and Nigerian oncologists held a stakeholder meeting to prioritize cancers and their associated drugs. After the meeting, pharmaceutical companies were invited to submit proposals outlining the terms by which the prioritized drugs could be made available. In parallel, Nigeria’s regulatory agency, the National Agency for Food and Drug Administration and Control, was engaged to discuss expediting its review and approval of priority drugs.

RESULTS

Forty-one priority cancer drugs covering 8 of Nigeria’s most prevalent cancers were selected for this program. Requests for proposals were sent to 14 multinational pharmaceutical companies. Companies responded with deeply discounted access prices, the majority of which were more affordable than cancer drugs available through ABUTH’s current procurement structure. On the basis of the companies’ proposed prices, BVGH crafted a budgeting tool tailored to the cancer treatment protocols offered at ABUTH. Using this tool, ABUTH, together with 7 northern Nigerian teaching hospitals and under the leadership of Ahmadu Bello University, calculated the number of patients they could treat and drug quantities they could purchase with their current budget. The relevant funds will be placed in an externally managed escrow account to ensure oversight of the drug procurement process. BVGH is working with the pharmaceutical companies and National Agency for Food and Drug Administration and Control to hasten approval of priority drugs.

CONCLUSION

The AAI drug access model is not donation based. Instead, it is an innovative, demand-driven program that is uniquely positioned to ensure affordable and sustainable access to cancer drugs in Africa.
Strategies to Improve Pediatric Cancer Pathology and Tissue Handling for Clinical Care and Research in Low-Resource Settings
Authors: Lubega Joseph , Nabadda Susan , Wasswa Peter , Mbabazi Olive , Cubbage Mike , Munube Deogratias , Gaikwad Amos , Elghetany Tarek , Adesina Adekunle , Allen Carl , Lutwama Fredrick , Scheurer Michael , Gastier-Foster Julie
Published: July 2020

PURPOSE

Evidence-based pediatric cancer control is dependent on accurate, timely cancer diagnosis, as well as maintenance of tissue integrity and annotation for clinical diagnosis and clinical/translational research. Scarcity of cancer pathology infrastructure and the delinkage of clinical pathology and research workflows in low- and middle-income countries thwarts real-time, high-resolution diagnosis, risk stratification, and maintenance of tissue integrity for future research. This renders the application of evidence-based treatments and conduct of translational research and clinical trials, particularly across multiple centers in low- and middle-income countries, impractical. We present the innovative approach and impact of a Texas Children’s Global HOPE model designed to overcome these systemic obstacles in a sub-Saharan Africa setting.

METHODS

We designed a pathology algorithm at Mulago Hospital Complex in Uganda with the following goals: integrate clinical and research workflows, ensure safe and optimal tissue biopsies, and maintain tissue integrity for clinical and research assays. We introduced new assays built on locally available technology platforms for anatomic pathology and immunophenotyping.

RESULTS

The novel workflow and assays enabled consistent real-time hematoxylin and eosin microscopy, immunohistochemistry, and multiparametric flow cytometry. The proportion of cancer diagnoses based on tissue pathology increased from 67.5% to 100%. Streamlined pathology processes improved the timeliness of commencement of treatment from 4 to 6 weeks to 24 hours in the case of acute leukemias. The refined diagnosis process has enabled implementation of risk-adapted treatment regimens. Overall, these strategies contributed to improved overall survival from 30% to 85% at 1 month, and have revealed hitherto unrecognized clinical patterns of pediatric cancers in sub-Saharan Africa.

CONCLUSION

Accurate real-time pathology for pediatric cancers improves survival. Improvements should aim at enhancing the capabilities of existing in-country platforms and skilled personnel. Future efforts will focus on scaling up these practices to other sites and integrating molecular diagnostics that reduce overall cost and improve diagnostic accuracy or risk stratification.
Cancer Knowledge and Practices Among Indigenous Women in Guatemala
Authors: Hurtado-de-Mendoza Alejandra , Gómez-Trillos Sara , Arana-Chicas Evelyn , Cartujano-Barrera Francisco , Xinico Ajú Silvia Angélica , Braithwaite Dejana , Monsalve Natalia , Morales Daniela , Palacardo Federico , Cupertino Ana Paula
Published: July 2020

PURPOSE

Guatemala, a low- and middle-income country, has some of the poorest worldwide health indicators, including a high cancer incidence. We explored general cancer knowledge and breast and cervical cancer screening practices among Indigenous women in Lake Atitlán, Guatemala.

METHODS

We conducted 14 in-person, semistructured interviews and one focus group with 5 traditional midwives (comadronas). All participants were Mayan women from a rural community in Lake Atitlán (median age, 43.5 years; range, 18-72 years). The interviews and focus group were conducted in the participant’s preferred language, Spanish or Kaqchikel. Three coders analyzed the data using a process of inductive thematic analysis.

RESULTS

Participants had little knowledge and awareness about cancer in general, including screening and prevention. They associated the term cancer with death. Most had more knowledge about cervical cancer risk factors and screening compared with breast cancer. Participants voiced misinformation that breast cancer is caused by bad breast milk and that screenings for cervical cancer involve a hysterectomy. The terms uterine, ovarian, and cervical cancer were used interchangeably. None of the participants had ever been screened for breast cancer and all participants reported not knowing anyone who had been screened in the community. Some participants reported having received pap smears in the past. Major barriers reported include the cost and travel to health institutions and fear that the procedures may hurt. There was a strong preference for female doctors to conduct screenings given stigma. Participants reported experiencing discrimination and language barriers when attending hospitals. Participants mostly relied on family members and natural traditional medicine when they felt sick. Community and family support seemed to be key for health-seeking behaviors.

CONCLUSION

Findings highlight the lack of knowledge, limited screening practices, and numerous barriers among Mayan women in Guatemala. Efforts should focus on health promotion through educational workshops and increased accessibility to health services.
Reducing Oncologic Disparities by Standardizing Cancer Care
Authors: Popli Pallvi , Shah Mansi R. , Ralefala Tlotlo B. , Toppmeyer Deborah , Strair Roger , Lebelonyane Refeletswe , Mompe Atlang , Gaolathe Tendani , Antony Reena , Marlink Richard , Mayer Tina M.
Published: July 2020

PURPOSE

Shortages in oncology-trained health care providers pose a major challenge in low- and middle-income countries (LMICs) and contribute to delays in the diagnosis and treatment of cancer. Presently, the sole oncologist in the public sector at Princess Marina Hospital, Botswana’s largest oncology referral center, is overextended, causing medical officers to be the primary providers for patients with cancer. Medical officers do not possess formal oncology training, which can potentially lead to imprecise management and suboptimal treatment. In addition, there is no standardized patient interview process in the hematology clinic, leading to inadequately captured patient records. These realities highlight the need for the dissemination and implementation of evidence-based guidelines and intake forms to standardize the delivery of cancer care for practitioners with varying degrees of training.

METHODS

To serve as a reference for medical officers and oncologists, we reviewed clinical guidelines for the most prevalent cancers in Botswana, namely breast, cervical, prostate, colorectal, and head and neck cancer. We incorporated American Joint Committee on Cancer 8th edition staging criteria into the preexisting guidelines approved by Ministry of Health and Wellness Botswana. We further customized them on the basis of radiology, pathology, and pharmaceutical resource availability in Botswana. Finally, to streamline patient visits, we created intake forms to capture comprehensive hematology-pertinent information. As a quality improvement project, we will record the use and impact of these forms as a tool to standardize the medical records.

RESULTS

Standardized cancer care guidelines were updated and are under review by the Ministry of Health and Wellness Botswana before circulation. In addition, feedback regarding the new intake forms and their use is currently being recorded.

CONCLUSION

In low- and middle-income countries, the development of cancer-specific treatment guidelines optimizes disease management through incorporation of evidence-based, resource-adjusted recommendations for clinicians and may aid in reducing global oncologic disparities. As the next phase in the implementation of guidelines, we plan to develop quick-reference cancer pathways for use in public institutions without existing oncologic expertise.
Can We Leverage HIV Prevention Programs for Breast Cancer Interventions? Preliminary Findings From a Study in Nigerian Women Working in the Informal Work Sector
Authors: Oluwasanu Mojisola M. , Wang Yue , Oladepo Oladimeji , Huo Dezheng , Olopade Olufunmilayo
Published: July 2020

PURPOSE

Breast cancer (BC) is the leading cause of cancer-related deaths in Nigerian women. A large proportion of Nigerian women work as artisans in the informal work sector. As a population, they are unreached and underserved with poor access to BC information and screening services. Studies have demonstrated the feasibility of implementing HIV prevention programs through artisan groups. Integrating BC programs to existing HIV prevention programs may offer potentials to tap synergies and could lead to sustainable integrated interventions. This study assessed BC screening practices and the feasibility of implementing integrated HIV and BC programs among artisans.

METHODS

A cross-sectional study was carried out in 3 local government areas in Ibadan, Nigeria. Data were collected using an electronic data capture tool from 400 consenting respondents selected through a multistage sampling technique. Knowledge of BC and HIV were measured on 14- and 8-item scales. Data were analyzed using descriptive statistics and inferential tests at P < .05.

RESULTS

A quarter of the 400 respondents were age ≥ 40 years, a third were Muslims, and 64.8% had secondary level education or less. One third (32.8%) of the respondents had adequate knowledge of BC signs and symptoms. Of the respondents, 11.3% of the women received clinical breast examination, while the mammography rate for women age ≥ 40 years was 9.0%. In contrast, the proportion of artisans with adequate knowledge of HIV’s modes of transmission was 92.7% and HIV screening was 74%. Educational level, religion, and knowledge of BC signs and symptoms were significantly associated with BC screening ( P < .05). Rate of willingness to participate in an integrated HIV and BC intervention was 95.5%.

CONCLUSION

BC knowledge and screening practices are low. Findings will inform the development of an integrated intervention that can serve as a model with the potential to expand coverage, and reduce missed opportunities for early detection and treatment of BC and other noncommunicable diseases.
Breast Cancer Survival Disparities in Mexican Women Under a Comprehensive Health Reform
Authors: Huerta-Gutierrez Rodrigo , Lajous Martin , Zamora-Muñoz Salvador , Hernández-Ávila Juan Eugenio , Mohar Alejandro , Muñoz-Aguirre Paloma
Published: July 2020

PURPOSE

One of the goals of Seguro Popular, Mexico’s landmark healthcare reform, was bridging the existing disparities in access to health care and health status. In 2007, this program began reimbursement of breast cancer treatment of previously uninsured Mexican women. We evaluated geographic disparities in breast cancer survival in women treated under this program and explored potential sources of heterogeneity.

METHODS

We classified women who were treated between 2007 and 2016 as having early (stages 0-IIA), locally advanced (stages IIB-IIIC), or metastatic (stage IV) disease. We categorized women based on a widely used marginalization index that considers education, household characteristics, rural population, and poverty levels in Mexican municipalities (low, moderate, high, and very high marginalization). We cross-linked reimbursement data with a national death registry and estimated 5-year overall survival according to clinical stage, marginalization levels, and state where women received treated.

RESULTS

Among 53,990 women treated for breast cancer the mean age was 52.9 years (± SD 12.4). Most patients had locally advanced disease (57.4%, n = 30,996). Early disease was more common in women with very low marginalization levels compared with women with very high levels (34% v 19%). Survival was 89.4% (95% CI: 88.8 to 89.9) for early disease, 69.8% (95% CI: 69.2 to 70.4) for locally advanced disease, and 36.1% (95% CI: 34.6 to 37.6) for metastatic disease. The least marginalized state experienced the highest survival for locally-advanced disease [76.0% (95% CI: 71.4 to 80.0)] whereas the most marginalized state experienced the lowest survival [50.2% (95% CI: 45.5 to 54.7)]. Survival in women from very highly marginalized communities was 68.7% (95% CI: 64.7 to 72.4), whereas survival in women from low marginalized communities was 74.8% (95% CI: 74.1 to 75.5).

CONCLUSION

In the face of a new wave of healthcare reform, Mexico will need to monitor and evaluate health disparities to achieve universal care for women with breast cancer.
Objective Measurement of Carcinogens Among Dominican Republic Firefighters Using Silicone-Based Wristbands
Authors: Caban-Martinez Alberto J. , Feliciano Paola Louzado , Baum Jeramy , Bakali Umer F. , Santiago Katerina M. , Solle Natasha Schaefer , Rivera Geovanny , Ramirez Cesar E. , Deo Sapna , Miric Marija , Perez-Then Eddy , Kobetz Erin N. , Daunert Sylvia
Published: July 2020

PURPOSE

Firefighters around the world are exposed to physical hazards and toxic chemical agents during fire incident response. Occupational epidemiologic studies of the firefighter workforce have documented an excess cancer risk for brain, digestive, genitourinary, and lymphohematopoietic organs compared with the general population. Despite the elevated cancer risk, little is known about what specific types of carcinogenic chemicals first responders encounter during a typical work shift, particularly in low-resources settings, like the Dominican Republic. This pilot study characterizes objective measurements of carcinogenic exposure using passive sampling silicone-based wristbands among Dominican firefighters.

METHODS

Firefighters from a metropolitan fire service in the Dominican Republic were asked to wear a silicone-based wristband during one typical 24-hour shift. A pre- and postshift survey was administered to the firefighter to assess their self-reported sociodemographic, employment, and work shift characteristics. Wristbands were collected after their 24-hour shift and processed for the type and quantity of polycyclic aromatic hydrocarbons (PAHs), a family of known carcinogenic compounds, to which firefighters were exposed.

RESULTS

Among 15 firefighters who wore a wristband during their 24-hour shift, 73.3% responded to a fire with an average of 3.7 calls during the shift. Fire incident responses included structural fires (54.5%), outside and other fires (36.4%), and vehicle fires (9.1%). Total PAH exposure was significantly higher among Dominican firefighters who responded to a fire compared with firefighters with no fire during their shift (261 parts per billion [ppb] v 117 ppb, respectively; P = .003). Among the 19 PAHs quantified, low-molecular-weight phenanthrene was present in the highest concentration (32 ppb) among firefighters not responding to fires.

CONCLUSION

Passive objective sampling of PAHs using silicone-based wristbands among Dominican firefighters showed direct exposure to carcinogenic compounds during a typical 24-hour firefighter shift. Firefighters not attending a fire had lower levels of PAHs, suggesting carcinogenic contaminants are present at the fire station.
Avelumab in Patients With Gestational Trophoblastic Tumors With Resistance to Single-Agent Chemotherapy: Cohort A of the TROPHIMMUN Phase II Trial
Authors: You Benoit , Bolze Pierre-Adrien , Lotz Jean-Pierre , Massardier Jérome , Gladieff Laurence , Joly Florence , Hajri Touria , Maucort-Boulch Delphine , Bin Sylvie , Rousset Pascal , Devouassoux-Shisheboran Mojgan , Roux Adeline , Alves-Ferreira Marine , Grazziotin-Soares Daniele , Langlois-Jacques Carole , Mercier Catherine , Villeneuve Laurent , Freyer Gilles , Golfier Francois
Published: July 2020

PURPOSE

Women with gestational trophoblastic tumors (GTT) resistant to single-agent chemotherapy receive alternative chemotherapy regimens, which, although effective, cause considerable toxicity. All GTT subtypes express programmed death-ligand 1 (PD-L1), and natural killer (NK) cells are involved in trophoblast immunosurveillance. Avelumab (anti–PD-L1) induces NK cell–mediated cytotoxicity. The TROPHIMMUN trial assessed avelumab in women with chemotherapy-resistant GTT.

METHODS

In this phase II multicenter trial (ClinicalTrials.gov identifier: NCT03135769 ), women with GTT who experienced disease progression after single-agent chemotherapy received avelumab 10 mg/kg intravenously every 2 weeks until human chorionic gonadotropin (hCG) normalization, followed by 3 consolidation cycles. Rate of hCG normalization was the primary endpoint (2-step Simon design).

RESULTS

Between December 2016 and September 2018, 15 patients were treated. Median age was 34 years; disease stage was I or III in 53.3% and 46.7% of women, respectively; and International Federation of Gynecology and Obstetrics (FIGO) score was 0-4 in 33.3%, 5-6 in 46.7%, and ≥ 7 in 20% of patients. Prior treatment included methotrexate (100%) and actinomycin D (7%). Median follow-up was 25 months, and median number of avelumab cycles was 8 (range, 2-11). Grade 1-2 treatment-related adverse events occurred in 93% of patients, most commonly (≥ 25%) fatigue (33.3%), nausea/vomiting (33.3%), and infusion-related reaction (26.7%). One patient had grade 3 uterine bleeding (treatment unrelated). Eight patients (53.3%) had hCG normalization after a median of 9 avelumab cycles; none subsequently relapsed. Probability of normalization was not associated with disease stage, FIGO score, or baseline hCG. One patient subsequently had a healthy pregnancy. In avelumab-resistant patients (46.7%), hCG was normalized with actinomycin D (42.3%) or combination chemotherapy/surgery (57.1%).

CONCLUSION

In patients with single-agent chemotherapy-resistant GTT, avelumab had a favorable safety profile and cured approximately 50% of patients. Avelumab could be a new therapeutic option, particularly in patients who would otherwise receive combination chemotherapy.
Effect of serotonin modulation on dystrophin-deficient zebrafish
Authors: Spinazzola Janelle M. , Lambert Matthias R. , Gibbs Devin E. , Conner James R. , Krikorian Georgia L. , Pareek Prithu , Rago Carlo , Kunkel Louis M.
Published: July 2020

Duchenne muscular dystrophy (DMD) is a progressive muscle-wasting disease caused by mutation of the dystrophin gene. Pharmacological therapies that function independently of dystrophin and complement strategies aimed at dystrophin restoration could significantly improve patient outcomes. Previous observations have suggested that serotonin pathway modulation ameliorates dystrophic pathology, and reapplication of serotonin modulators already used clinically would potentially hasten availability to DMD patients. In our study, we used dystrophin-deficient sapje and sapje-like zebrafish models of DMD for rapid and easy screening of several classes of serotonin pathway modulators as potential therapeutics. None of the candidate drugs tested significantly decreased the percentage of zebrafish exhibiting the dystrophic muscle phenotype in the short-term birefringence assay or lengthened the lifespan in the long-term survival assay. Although we did not identify an effective drug, we believe our data is of value to the DMD research community for future studies, and there is evidence that suggests serotonin modulation may still be a viable treatment strategy with further investigation. Given the widespread clinical use of selective serotonin reuptake inhibitors, tricyclic antidepressants, and reversible inhibitors of monoamine oxidase, their reapplication to DMD is an attractive strategy in the field's pursuit to identify pharmacological therapies to complement dystrophin restoration strategies.
Revealed Preference Analysis with Normal Goods: Application to Cost-of-Living Indices
Authors: Cherchye Laurens , Demuynck Thomas , De Rock Bram , Surana Khushboo
Published: July 2020

We present a revealed preference methodology for nonparametric demand analysis under the assumption of normal goods. Our methodology is flexible in that it allows for imposing normality on any subset of goods. We show the usefulness of our methodology for empirical welfare analysis through cost-of-living indices. An illustration to US consumption data drawn from the Panel Study of Income Dynamics (PSID) demonstrates that mild normality assumptions can substantially strengthen the empirical analysis. It obtains considerably tighter bounds on cost-of-living indices and a significantly more informative classification of better-off and worse-off individuals after the 2008 financial crisis. (JEL D11, D12, E31, G01)
First draft genome assembly of the desert locust, Schistocerca gregaria
Authors: Verlinden Heleen , Sterck Lieven , Li Jia , Li Zhen , Yssel Anna , Gansemans Yannick , Verdonck Rik , Holtof Michiel , Song Hojun , Behmer Spencer T. , Sword Gregory A. , Matheson Tom , Ott Swidbert R. , Deforce Dieter , Van Nieuwerburgh Filip , Van de Peer Yves , Vanden Broeck Jozef
Published: July 2020

Background: At the time of publication, the most devastating desert locust crisis in decades is affecting East Africa, the Arabian Peninsula and South-West Asia. The situation is extremely alarming in East Africa, where Kenya, Ethiopia and Somalia face an unprecedented threat to food security and livelihoods. Most of the time, however, locusts do not occur in swarms, but live as relatively harmless solitary insects. The phenotypically distinct solitarious and gregarious locust phases differ markedly in many aspects of behaviour, physiology and morphology, making them an excellent model to study how environmental factors shape behaviour and development. A better understanding of the extreme phenotypic plasticity in desert locusts will offer new, more environmentally sustainable ways of fighting devastating swarms.

Methods: High molecular weight DNA derived from two adult males was used for Mate Pair and Paired End Illumina sequencing and PacBio sequencing. A reliable reference genome of Schistocerca gregaria was assembled using the ABySS pipeline, scaffolding was improved using LINKS.

Results: In total, 1,316 Gb Illumina reads and 112 Gb PacBio reads were produced and assembled. The resulting draft genome consists of 8,817,834,205 bp organised in 955,015 scaffolds with an N50 of 157,705 bp, making the desert locust genome the largest insect genome sequenced and assembled to date. In total, 18,815 protein-encoding genes are predicted in the desert locust genome, of which 13,646 (72.53%) obtained at least one functional assignment based on similarity to known proteins.

Conclusions: The desert locust genome data will contribute greatly to studies of phenotypic plasticity, physiology, neurobiology, molecular ecology, evolutionary genetics and comparative genomics, and will promote the desert locust’s use as a model system. The data will also facilitate the development of novel, more sustainable strategies for preventing or combating swarms of these infamous insects.
The effects of crop diversity and crop type on biological diversity in agricultural landscapes: a systematic review protocol
Authors: Moss Cami , Lukac Martin , Harris Francesca , Outhwaite Charlotte L. , Scheelbeek Pauline F.D. , Green Rosemary , Berstein Fernanda Morales , Dangour Alan D.
Published: July 2020

Agricultural intensification is a well-known driver of biodiversity loss. Crop diversity and its changes over space and time drive land use intensity and impact biodiversity of agricultural landscapes, while meeting the growing demand for human food and nutrition resources. Loss of biodiversity in agricultural landscapes reduces primary productivity and soil health and erodes a range of other ecosystem services. At present, while having partial understanding of many processes, we lack a general synthesis of our knowledge of the links between crop diversity and biodiversity. We will therefore conduct a systematic review by searching multiple agriculture, ecology and environmental science databases (e.g. Web of Science, Geobase, Agris, AGRICOLA, GreenFILE) to identify studies reporting the impacts of crop diversity and crop type on the biological diversity of fauna and flora in agricultural landscapes. Response variables will include metrics of species richness, abundance, assemblage, community composition and species rarity. Screening, data coding and data extraction will be carried out by one researcher and a subset will be independently carried out by a second researcher for quality control. Study quality and risk of bias will be assessed. Evidence will first be mapped to species/taxa then assessed for further narrative or statistical synthesis based on comparability of results and likely robustness. Gaps in the evidence base will also be identified with a view toward future research and policy directions for nutrition, food systems and ecology.
A Theory of Entanglement
Authors: Gudder Stan
Published: July 2020

This article presents the basis of a theory of entanglement. We begin with a classical theory of entangled discrete measures. Then, we treat quantum mechanics and discuss the statistics of bounded operators on a Hilbert space in terms of context coefficients. Finally, we combine both topics to develop a general theory of entanglement for quantum states. A measure of entanglement called the entanglement number is introduced. Although this number is related to entanglement robustness, its motivation is not the same and there are some differences. The present article only involves bipartite systems and we leave the study of multipartite systems for later work.Quanta 2020; 9: 7–15.
Assortment Rotation and the Value of Concealment
Authors: Ferreira Kris Johnson , Goh Joel
Published: July 2020

Assortment rotation—the retailing practice of changing the assortment of products offered to customers—has recently been used as a competitive advantage for both brick-and-mortar and online retailers. We focus on product categories where consumers may purchase multiple products during a season and investigate a new reason why frequent assortment rotations can be valuable to a retailer. Namely, by distributing its seasonal catalog of products over multiple assortments rotated throughout the season, as opposed to selling all products in a single, fixed assortment, the retailer effectively conceals a portion of its full product catalog from consumers, injecting uncertainty into the consumer’s relative product valuations. Rationally acting consumers may respond to this structural difference by purchasing more products, thereby generating additional sales for the retailer. We refer to this phenomenon as the value of concealment and show that the retailer enjoys a positive and significant value of concealment under quite general conditions. However, we show that when consumers are forward looking, the value of concealment is context dependent. We present insights and discuss intuition regarding which product categories likely lead to a positive versus negative value of concealment.

This paper was accepted by Vishal Gaur, operations management.
A RESISTÊNCIA DO PASSADO: CONTORNOS DO GÓTICO EM "THE FLUTED GIRL"
Authors: Bravo Pires Ferreira Bárbara , Cabral de Almeida Cardoso André
Published: July 2020

O presente artigo propõe uma leitura do conto distópico “The Fluted Girl” (2003), de Paolo Bacigalupi, centrada nos possíveis desdobramentos do gótico presentes no texto. Partimos da compreensão do conto como uma narrativa que tenta representar os mecanismos de consumo e poder através de uma visão negativa do mundo, que o aproxima das noções de gótico tal como apresentadas por Botting (1999) e França (2017), associando-as com os impactos dos avanços tecnológicos sobre a sociedade. Além disso, analisamos as configurações corporais das personagens, sejam elas humanas ou não, como evidência dessas influências do gótico sobre a distopia.
MAIS MONSTRUOSOS QUE OS MONSTROS: ANSIEDADES TECNOLÓGICAS E O FUTURO FANTASMAGÓRICO EM ANDROIDES SONHAM COM OVELHAS ELÉTRICAS?
Authors: Penteado Marina Pereira , Espinelly Luiz Felipe Voss
Published: July 2020

Este trabalho busca analisar as relações entre monstruosidade e tecnologia na obra Androides sonham com ovelhas elétricas? (1968), de Philip K. Dick, a partir de uma aproximação do romance distópico em questão com o gótico e com estudos sobre o período no qual ele foi escrito. Sabendo que a literatura gótica foi muitas vezes descrita como uma expressão das ansiedades relacionadas a crises epistemológicas e sociais próprias de contextos históricos específicos, sua relação com a distopia é bem próxima, uma vez que o subgênero, que tem como base a crítica às estruturas e sistemas que regem a sociedade, também se utiliza de um discurso de desilusão frente ao mundo. Tendo isso em vista, este artigo propõe uma reflexão sobre a visão sombria do final da década de 1960, como surge no romance de Dick, e sua relação com a estética gótica.
‘My first day in ICU will forever stay with me’
Authors: Latinwo Oluseyi
Published: July 2020

Oluseyi Latinwo talks about how her experience as a dental nurse offered a new perspective on the healthcare and wellbeing of patients in an intensive care unit during the pandemic
Is dental nursing a pain in the neck?
Authors: Hylton Preetee , Kristy Mary
Published: July 2020

Dental nurse Preetee Hylton stands up for patient care, while Mary Kristy offers some exercises to mitigate those health risks
Promising dental career ahoy!
Authors: Connell Rosie
Published: July 2020

Don't let your progression be an afterthought, says Rosie Connell. Here, she offers a map to creating a successful journey, taking advantage of the wave of CPD opportunities along the way
It's back to work we go…
Authors: Coverley Hannah , Reyes Lady Jo , Verow Susie , Wong Jason
Published: July 2020

Dental nurse Hannah Coverley talks about her return to practice with colleagues Lady Jo Reyes and Susie Verow at The Maltings Dental Practice in Grantham, Lincolnshire, as they worked alongside newly appointed deputy chief dental officer for England, Jason Wong to welcome back their patients
‘We were planning a comeback from the moment lockdown happened’
Authors: Schroven Danielle
Published: July 2020

Dental nurse Danielle Schroven talks about the expansion of duties in a COVID-19 world and how her practice prepared for a return to work
Thinking of studying dental hygiene?
Authors: Krumova Monika
Published: July 2020

We join Monika Krumova on her journey from dental nurse to becoming a dental hygienist
Boost your confidence: learning new skills in orthodontics
Authors: Modha Bhaven
Published: July 2020

Dr Bhaven Modha's guide for prospective students to achieving success in the Certificate in Orthodontic Dental Nursing

This article provides advice from a tutor's perspective. It aims to help potential students achieve success in the Certificate in Orthodontic Dental Nursing qualification. It considers: Realistic expectations Choosing a suitable course provider The need for a supportive workplace Professionalism The Record of Competence Feedback Reflection The final examination.
Cone type majorization and its strong linear preservers
Authors: Kosuru G Sankara Raju , Saha Subhajit
Published: July 2020

This study introduces a novel notion, cone type majorization and characterizes the same. Further, the structure of linear preservers and strong linear preservers of this cone type majorization have been studied.
Les biblioteques universitàries a Catalunya (2018-2019): Actuacions i reptes de futur
Authors: Martínez Trujillo Dídac
Published: July 2020

S’analitza l’evolució dels serveis de les biblioteques universitàries catalanes durant el període 2018-2019 a partir de deu indicadors: usuaris potencials, nombre de biblioteques, visites, places de lectura, ordinadors per a usuaris, préstecs de documents, documents descarregats, assistents a formacions, cost d’adquisició en recursos d’informació en paper i digital, i, finalment, personal que hi treballa. Es detallen les actuacions i projectes més significatius durant el període analitzat. Com a conclusió, es proposen cinc reptes de futur que les biblioteques universitàries haurien d’afrontar per poder mantenir un suport innovador i de qualitat a les seves institucions acadèmiques: suport a la docència en línia i als nous models docents, gestió dels llibres digitals i electrònics, recolzament als nous plans de lectura dels estudiants i professors, gestió de la transició de la comunicació científica cap a la ciència oberta i, per acabar, transformació dels espais de les biblioteques en laboratoris d’estudi i creació.
De l’hospitalité décoloniale: l’aporie disruptive chez Derrida
Authors: Rocha Renan Goncalves
Published: July 2020

Quelles sont les implications politiques d’une hospitalité dans le contexte de domination coloniale ? Quels sont les problèmes qui se placent dans la détermination de l’identité de l’autre comme politique institutionnelle ? Dans ce travail, il s’agit de s’appuyer sur la dimension aporétique intrinsèque à la notion de l’hospitalité derridienne pour interroger la perspective coloniale de l’accueil. La pensée de l’hospitalité chez Derrida est alors avant tout un questionnement du concept même de l’accueil placé toujours du côté de « la raison du plus fort ». L’auteur remet en question même l’accueil le plus généreux, en soulignant l’ambiguïté qui s’établit entre hospitalité et pouvoir. Cette aporie établit une offre de l’accueil qui se retrouve inéluctablement reliée au point de vue du dominant, du colonisateur, de celui qui, dans la dissymétrie du pouvoir, dans l’autorité du « je t’accueille chez moi », s’impose sur l’autre.
La querella de las cosas. Marx, Lucrecio y el desorden del mundo
Authors: Villalobos Ruminott Sergio
Published: July 2020

A partir de una lectura centrada en On the Nature of Marx’s Things. Translation as Necrophilology, el siguiente artículo intenta situar la lectura de Marx desarrollada por su autor, Jacques Lezra, tanto en el contexto de sus demás contribuciones relativas a un materialismo salvaje, como en el contexto de los actuales debates sobre nuevos materialismos y ontologías orientadas al objeto. La referencia lucreciana de Lezra permite activar lo que Althusser llamó una corriente subterránea de materialismo aleatorio, cuestión que no sólo problematiza el materialismo histórico convencional, sino la dialéctica materialista y su origen hegeliano. En efecto, subyace tanto a su libro sobre Marx, como a sus demás monografías una lectura fuerte de Lucrecio y su De Rerum Natura, cuestión clave para comprender la singularidad de sus aproximaciones al problema de la traducción, de la mercancía, de la filología negativa y, sobre todo, de un republicanismo no normativo ni soberanista, constituido por instituciones defectivas y abiertas.