bluuebunny/crossref_metadata_2025 huggingface dataset:
Choices for long-term hypertensive control in patients after first-ever hemorrhagic stroke: a nationwide cohort study
Authors: Liu Chi-Hung , Lin Yu-Sheng , Chi Ching-Chi , Liou Chia-Wei , Lee Jiann-Der , Peng Tsung-I , Lee Tsong-Hai
Published: September 2018

Background:

To compare the long-term clinical outcomes of different antihypertensive drugs in stable patients after acute hemorrhagic stroke (HS).

Methods:

From January 2001 to December 2013, patients with first-ever primary HS were identified in the National Health Insurance Research Database, Taiwan. Patients with traumatic intracerebral hemorrhage and secondary HS were excluded. Those with first-ever HS were recruited and classified into three groups: (1) angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB); (2) calcium channel blocker (CCB); and (3) other antihypertensive drugs (comparison) groups. Propensity score matching was used to balance the distribution of baseline characteristics, stroke severity, and medications between any two of the three groups. A validation study was performed using the databank of the Stroke Registry in Chang-Gung Healthcare System to reduce the bias. Primary outcomes were recurrent HS, ischemic stroke, any stroke, and all-cause mortality.

Results:

Compared to the comparison group, the ACEI/ARB group [35.4% versus 39.3%; hazard ratio (HR), 0.84; 95% confidence interval (CI), 0.74–0.95] and CCB group (33.0% versus 41.9%; HR, 0.72; 95% CI, 0.64–0.81) had a lower risk of all-cause mortality during long-term follow up. The CCB group had a similar risk of all-cause mortality to the ACEI/ARB group. Risks of recurrent HS, ischemic stroke, or any stroke were not different between the study groups.

Conclusions:

Antihypertensive drug class could be important to long-term outcomes in HS patients in addition to the target control of blood pressure. Both ACEIs/ARBs and CCBs are associated with lower risks of all-cause mortality. Our results may be applied to inform future research on hypertensive control in HS patients.
DiaDigital Apps: Evaluation of Smartphone Apps Using a Quality Rating Methodology for Use by Patients and Diabetologists in Germany
Authors: Kaltheuner Matthias , Drossel Diana , Heinemann Lutz
Published: September 2018

There are several computer applications (apps) that can be installed on smartphones to assist patients with diabetes in treating their disease. Not only does the range of use of such apps vary greatly, their quality does as well. As part of the DiaDigital initiative of the German Working Group for Diabetes Technology (AGDT), apps are evaluated using a set of criteria and a seal of distinction is then awarded ( www.diadigital.de ). The information collected in this review process is made public on this website to ensure both the necessary transparency as well as to be able to rapidly adapt voting on further app development. Until now, no such approach on evaluating the quality of diabetes apps has existed in Germany. The hope is that this will also help improve the quality of apps.
The Influence of the Smart Glucose Manager Mobile Application on Diabetes Management
Authors: Gunawardena Kasun C. , Jackson Renee , Robinett Iva , Dhaniska Lahiru , Jayamanne Shaluka , Kalpani Sumedha , Muthukuda Dimuthu
Published: September 2018

Background:

Smartphone use is rapidly growing in developing countries, providing opportunity for development of new health-based mobile applications. The present study investigated the efficacy of a newly designed mobile application, Smart Glucose Manager (SGM), in Sri Lankan patients with diabetes.

Methods:

A total of 67 patients with access to Android smartphones were randomized into an SGM (n = 27) and a control group (n = 25). Glycosylated hemoglobin (A1c) levels were measured at baseline and every 3 months afterward. The SGM group utilized the application daily, while control-group patients were instructed to continue their standard methods of diabetes management. Independent t-tests were utilized to assess A1c differences at 3 and 6 months postrandomization. A1c improvement, defined as A1c at 6 months minus baseline, was compared with SGM usage to assess effectiveness of diabetic management.

Results:

At the 6-month follow up, the SGM group had significant lower A1c levels than the control group (7.2% vs 8.17%, P < .0001). For both groups, A1c values decreased from baseline to the 3 months (SGM: 9.52% to 8.16%, P < .0001; control: 9.44% to 8.31%, P < .0001). From 3 months to 6 months, the SGM group showed further improvement of A1c (−0.96% P < .0001), whereas the control group did not ( P = 0.19). A1c improvement was positively correlated with SGM usage ( R = .81, P < .001).

Conclusion:

The SGM, a mobile application specifically designed to support self-management of diabetes, appeared to show long-term improvement of A1c levels in patients with diabetes residing in Sri Lanka.
Cultural Patterns Explain the Worldwide Perception/Performance Paradox in Student Self-Assessments of Math and Science Skill
Authors: Sanchez Carmen , Dunning David
Published: September 2018

Having skill does not necessarily mean more self-confidence in that skill, as shown in four panels, from 2003 to 2015 ( n ≈ 983,934), of self-assessments by eighth graders in the Trends in International Math and Science Study (TIMSS). Within a given country, self-judgments of math and science skill correlated positively with actual performance, but at the level of country average the correlation flipped. Students in countries with the best average performance held the most negative self-views of their skill, whereas students from nations with lowest average performance tended to hold the most favorable self-views. National differences in long-term orientation (LTO) versus short-term orientation (STO) accounted for this performance/perception paradox. Although LTO was associated with superior TIMSS performance, it also was associated with a general humility about the self. STO was related to lower objective performance but self-aggrandizing opinions of skill. Surprisingly, greater self-accuracy was related to individualism.
What Makes Young Russians Happy and Satisfied With Their Lives?
Authors: Allik Jüri , Mõttus Rene , Realo Anu , Rozgonjuk Dmitri
Published: September 2018

Participants ( N = 10,672 with the mean age of 20.7 years) of the Russian Character and Personality Survey (RCPS), involving 40 universities or colleges from across the Russian Federation, rated their happiness and satisfaction with life; the ratings were combined into an index of subjective well-being (SWB). Using the National Character Survey (NCS), participants also rated their own personality characteristics as well as those of an ideal person and a typical Russian living in their own region. Only two personality (test) subscales—N3: Depression and E6: Positive Emotions—were correlated with SWB on the between-individual level of analysis. Although spiritual values associated with a negative attitude toward money are typically regarded as an essential part of the Russian national character, our results demonstrated that only satisfaction with one’s own financial situation was a reliable predictor of SWB. In those regions where people had, on average, a higher life expectancy, better education, and a higher level of wealth, individuals also tended to be happier and more satisfied with their lives.
On the Relationship between the Nominal Exchange Rate and Export Demand in India
Authors: Bhattacharyya Ranajoy , Rit Bipradas
Published: September 2018

This article attempts to determine the effect of nominal exchange rates on Indian exports between 1996 and 2014. We begin by assuming that the nominal exchange rate can affect export directly as well as indirectly via its pass through on domestic prices. The analysis is conducted with quarterly data after controlling for the effect of exchange rate volatility on exports. The main results that we get are the following: There is no direct evidence that the nominal exchange rate or its volatility influences exports. However, there is a significant relationship between the relative price ratio (domestic to foreign) and export. Further, we find strong evidence of pass through of the nominal exchange rate on prices (about 54%) in the long run. We interpret this result as an evidence of the nominal exchange rate affecting exports indirectly through domestic prices. The results suggest that the debate on the influence of exchange rates on Indian export is still an open one.

JEL Classification: F14, E31, G15
Best Practices and Advice for Using Pupillometry to Measure Listening Effort: An Introduction for Those Who Want to Get Started
Authors: Winn Matthew B. , Wendt Dorothea , Koelewijn Thomas , Kuchinsky Stefanie E.
Published: September 2018

Within the field of hearing science, pupillometry is a widely used method for quantifying listening effort. Its use in research is growing exponentially, and many labs are (considering) applying pupillometry for the first time. Hence, there is a growing need for a methods paper on pupillometry covering topics spanning from experiment logistics and timing to data cleaning and what parameters to analyze. This article contains the basic information and considerations needed to plan, set up, and interpret a pupillometry experiment, as well as commentary about how to interpret the response. Included are practicalities like minimal system requirements for recording a pupil response and specifications for peripheral, equipment, experiment logistics and constraints, and different kinds of data processing. Additional details include participant inclusion and exclusion criteria and some methodological considerations that might not be necessary in other auditory experiments. We discuss what data should be recorded and how to monitor the data quality during recording in order to minimize artifacts. Data processing and analysis are considered as well. Finally, we share insights from the collective experience of the authors and discuss some of the challenges that still lie ahead.
Quotations in Tangut texts
Authors: Xiaofang Ma
Published: September 2018

The aim of the present paper is to discuss the differentiation between direct and indirect quotations in Tangut texts. Based on the analysis of Buddhist texts and translations from Chinese classics in the Khara-khoto collection preserved in the Institute of Oriental Manuscripts, RUS, the quotations in Tangut may be divided into two categories. Direct speeches are not marked or attached by a quotative marker jɨ2妒. Indirect speeches are composed by using jɨ2妒 or a compound marker jɨ2 djij2妒纓 at the end of the quote. Tangut quotation structure is closely related to the verb jɨ2妒. It is illustrated in the study of cross-linguistic typology that the semantic verb ‘say’ may usually evolve to quotative markers. The semantic and grammatical functions of the verb he semantic and grammatical functions of the verb jɨ2妒 which the quotation structure used reflected the grammaticalization from an independent verb to a grammatical marker. This phenomenon can provide a new perspective for the grammatical study of Tibetan-Burman languages.
Graph omission and abbreviation in Tangut script
Authors: Hongyin Nie
Published: September 2018

In a few Tangut manuscripts there are eight omitted graphs used for explaining the character structures and three abbreviations used for transcribing the Tibetan word badzra or Sanskrit word vajra. The latter were formed by merging two or three parts of standard graphs so as to record polysyllables or consonant clusters in other languages. The usage of this method to create new characters, though originating from an ancient tradition and being occasionally used in the Chinese writing system, proves to be accepted merely in a limited sphere and is not mentioned in any authoritative dictionaries.
咏歌之不足——谈古文字中的舞蹈
Authors: 周碧香
Published: September 2018

摘要

语言影响着思维模式, 以及人类看待世界的视角。文字是语言的纪录, 透过文字重新解读先民的思维与文化, 是当前汉字教学的着力点和文化传承的接力棒。传统儒家教育, 讲究温柔敦厚, 视 “舞” 为诗、歌之后的行动。舞蹈透由手足动作、节奏旋律表达情感, 其间敬神畏神、求雨祈福的情感, 已然不是言语、嗟叹、咏歌得以准确传达的, 故手舞之、足蹈之, 故是情感表达的极致手段。本文尝试梳理与 “舞蹈” 有关的古文字, 了解古代舞蹈的动作、物品及场域；运用文化语言学的观点, 解读其意义与文化底蕴。
Cytotoxic and Hepatocurative Effect of Aqueous Fraction of Tapinanthus bangwensis Against Paracetamol-Induced Hepatotoxicity
Authors: Ihegboro Godwin O. , Ononamadu Chimaobi J. , Afor E. , Odogiyan Gladys D.
Published: September 2018

Medicinal plants over time have proven to have potential to manage a huge number of diseases and disorders and thus have become a great source of pharmaceutical drugs. One of such plants is Tapinanthus bangwensis (African mistletoe). It is a semiparasitic and epiphytic plant growing on citrus tree, obtaining its food photosynthetically while its nutrient and water is got from the host plant. The aim of this study was to determine the cytotoxicological and hepatocurative effect of aqueous fraction of T bangwensis in acetaminophen (paracetamol)-induced Wistar rats. The antioxidant potential of the plant was determined by 2,2-diphenyl-1-picrylhydrazine scavenging and ferric reducing power assays. The cytotoxic effect was determined using Allium cepa test while the liver biochemical indices were determined by standard protocols. Data obtained were analyzed by 2-way analysis of variance at 95% confidence level and reported as mean ± standard deviation. The concentrated aqueous fraction of T bangwensis was found to be 23.3 g (58.25%). Quantitative determination of some vital phytochemicals revealed the following: flavonoid (84.6 ± 0.41 mg/100 g), phenol (147.5 ± 1.07 mg/100 g), tannin (31 ± 0.85 mg/ 100 g), alkaloid (23.45 ± 0.09 mg/100 g), and saponin (0.146 ± 0.0 mg/100 g). Treatment of rats with the aqueous extract of T bangwensis significantly decreased paracetamol-induced elevation of activities of liver function indices, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, triglyceride, total cholesterol level and increased the albumin, total protein, and high-density lipoprotein levels. The plant extract also attenuated the paracetamol elevated lipid peroxidation product, malondialdehyde. The research findings suggest that aqueous extract of T bangwensis is slightly cytotoxic, possesses appreciable antioxidant property and exhibited hepatocurative effect against paracetamol-induced hepatoxicity.
ASXL1 impairs osteoclast formation by epigenetic regulation of NFATc1
Authors: Rohatgi Nidhi , Zou Wei , Collins Patrick L. , Brestoff Jonathan R. , Chen Timothy H. , Abu-Amer Yousef , Teitelbaum Steven L.
Published: September 2018

Additional sex comb-like 1 (ASXL1) mutations are commonly associated with myeloid malignancies and are markers of aggressive disease. The fact that ASXL1 is necessary for myeloid differentiation raises the possibility it also regulates osteoclasts. We find deletion of ASXL1 in myeloid cells results in bone loss with increased abundance of osteoclasts. Because ASXL1 is an enhancer of trithorax and polycomb (ETP) protein, we asked if it modulates osteoclast differentiation by maintaining balance between positive and negative epigenetic regulators. In fact, loss of ASXL1 induces concordant loss of inhibitory H3K27me3 with gain of H3K4me3 at key osteoclast differentiation genes, including nuclear factor for activated T cells 1 (NFATc1) and itgb3. In the setting of ASXL1 deficiency, increased NFATc1 binds to the Blimp1 (Prdm1) promoter thereby enhancing expression of this pro-osteoclastogenic gene. The global reduction of K27 trimethylation in ASXL1-deficient osteoclasts is also attended by a 40-fold increase in expression of the histone demethylase Jumonji domain-containing 3 (Jmjd3). Jmjd3 knockdown in ASXL1-deficient osteoclast precursors increases H3K27me3 on the NFATc1 promoter and impairs osteoclast formation. Thus, in addition to promoting myeloid malignancies, ASXL1 controls epigenetic reprogramming of osteoclasts to regulate bone resorption and mass.
Identification of IRF8 as a potent tumor suppressor in murine acute promyelocytic leukemia
Authors: Gaillard Coline , Surianarayanan Sangeetha , Bentley Trevor , Warr Matthew R. , Fitch Briana , Geng Huimin , Passegué Emmanuelle , de Thé Hugues , Kogan Scott C.
Published: September 2018

Although the role of promyelocytic leukemia/retinoic acid receptor α (PML/RARA) fusion protein is well recognized in acute promyelocytic leukemia (APL), its contribution to initiation and maintenance of leukemogenesis is not completely understood. Transcriptome analysis in the murine MRP8-PML/RARA APL model has demonstrated modest alterations in gene expression accompanied by expansion of the promyelocyte compartment. Of particular interest, mice expressing PML/RARA showed downregulation of the transcription factor Irf8 mRNA. Interferon regulatory factor 8 (IRF8) is a known regulator of hematopoiesis. Previous research had implicated IRF8 as a tumor suppressor for myeloid neoplasia, and mice lacking IRF8 develop a well-differentiated myeloproliferative neoplasm characterized by expansion of neutrophilic lineage cells. We hypothesized that PML/RARA-mediated downregulation of Irf8 transcript levels contributes to the initiation of APL. We observed significant downregulation of IRF8 protein levels in highly purified promyelocyte populations of PML/RARA transgenic mice. We also found that loss of IRF8 results in expansion of promyelocytes in vivo, partially phenocopying the impact of PML/RARA expression. Moreover, survival experiments showed that complete loss of IRF8 leads to acceleration of APL onset in our PML/RARA mice. Collectively, these data identify IRF8 downregulation as an important factor in APL initiation and highlight a tumor-suppressor role for IRF8 in this acute leukemia.
Economic evaluation of a comprehensive self-management programme in patients with moderate to severe chronic obstructive pulmonary disease
Authors: Monninkhofe E , Van der valk P , Schermer T , Van der palen J , Van herwaarden C , Zielhuis G
Published: September 2018

Aims: The main objective of this study was to investigate whether a comprehensive self-management programme, including self-treatment guidelines for exacerbations and a fitness programme, is an efficient treatment option for chronic obstructive pulmonary disease (COPD) patients. Method: We randomly allocated 248 COPD patients to either self-management (127) or usual care (121). Data on preference-based utilities (EuroQol-5D), health-related quality of life (HRQoL), health-care resource use and productivity losses associated with exacerbations were prospectively collected. Quality-adjusted life years (QALYs) were calculated. The economic analysis took the societal perspective and the observation period was one year. Results: As we observed that the groups were equally effective in terms of QALYs and HRQoL (SGRQ), we described a cost minimization analysis only. The self-management programme-specific costs amounted to 6642 per patient. In the base-case cost analysis, the incremental cost difference amounted to 838 per patient per year in favour of usual care. When only direct medical costs were included, the incremental annual cost of self-managementrelative to usual care was 179 per person per year. If time costs for the fitness programme were set to zero, the costs for self-management diminished to 542. Sensitivity analysis showed that these results were robust to changes in the underlying assumptions. Conclusion: We conclude that the COPE self-management programme is not an efficient treatment option for moderate to severe COPD patients who rate their HRQoL relatively high. The programme was twice as expensive as usual care and had no measurable beneficial effects on QALYs or HRQoL.
Measurement of dyspnea in chronic obstructive pulmonary disease: what is the tool telling you?
Authors: Meek P M
Published: September 2018

Aims: Dyspnea is the most common symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and is linked to decreases in patient activity levels and quality of life. Use of standardized tools to measure dyspnea has a long history in respiratory care. However, in many cases it is not clear what is being quantified when using a particular tool. This review will consider the definition of and mechanisms believed to contribute to dyspnea, attempting to clarify what is being quantified in common tools currently available for dyspnea measurement.
Accurate and Efficient Simulation of Cyclic Behavior of Diagonally Reinforced Concrete Coupling Beams
Authors: Han Sang Whan , Koh Hyeyoung , Lee Chang Seok
Published: September 2018

Diagonally reinforced concrete coupling beams (DRCB) play an important role in coupled shear wall systems since these members dissipate most seismic input energy during earthquakes. For reliable seismic performance evaluation using nonlinear response history analyses, it is important to use an accurate analytical model for DRCBs. In this study, the Pinching4 model is used as a base model to simulate the cyclic behavior of DRCBs. To simulate the cyclic behavior of DRCBs using the Pinching4 model, the constituent modeling parameters for backbone curve, pinching, and cyclic deterioration in strength and stiffness should be computed. To determine the proper values of the constituent modeling parameters accurately and efficiently, this study proposes empirical equations for the modeling parameters using forward stepwise regression analyses. This study shows that the cyclic behavior of DRCBs is accurately simulated using the Pinching4 model with constituent parameters calculated from the proposed empirical equations.
The Burden of Comorbidities in Cancer Patients in Southwestern Nigeria
Authors: Salako O. , Okediji P. , Habeeb M. , Fatiregun O. , Awofeso O. , Joseph A.
Published: September 2018

Background: Noncommunicable diseases (NCDs) in sub-Saharan Africa are a major cause of morbidity and mortality. There is especially a paucity of data on the burden of hypertension, diabetes mellitus and other NCDs coexisting with cancer in Nigerian cancer patients. Comorbidities influence the survival of patients with cancer; lead to presentation at advanced disease stages; and result in increased risk of treatment complications, higher rates of postoperative mortality, and a greater consumption of medical resources. Aim: To determine the magnitude and pattern of comorbidities in Nigerian cancer patients. Methods: This is a retrospective study, for which data were extracted from hospital records of patients presenting for oncology care between January 2015 and December 2016 in the Departments of Radiotherapy and Oncology of two tertiary health facilities in Lagos, Nigeria. Comorbidities were identified, ranked and weighted using the Charlson Comorbidity Index (CCI). Results: Eight hundred and forty-eight (848) cancer cases were identified, with breast (50.1%) and cervical (11.1%) cancers being the most prevalent. Comorbidities were present in 228 (26.9%) patients, and the most common comorbidities were hypertension (75.9%), diabetes (25.0%), and peptic ulcer disease (7.9%). Patients with prostate (41.5%), colorectal (34.0%), cervical (25.5%), nasopharyngeal (25.0%), and breast (24.0%) cancers are most likely to have comorbidities. The mean ages of patients with comorbidities and without was 60.1 ± 11.8 years and 52.5 ± 13.7 years respectively ( P < 0.0001). Hypertension-augmented CCI scores were 0 (15.6%), 1-3 (62.1%), 4-6 (21.7%), and ≥ 7 (0.6%). Patients with lower mean CCI scores were more likely to receive chemotherapy (2.2 ± 1.6 vs. 2.5 ± 1.9; P < 0.05) and/or surgery (2.1 ± 1.5 vs. 2.4 ± 1.7; P < 0.05). Conclusion: Comorbidities occur in at least one in four Nigerian cancer patients, and significantly influence the treatment outcome and prognosis of these patients. There is a need for a high index of suspicion and routine evaluation of cancer patients for comorbidities, with the aim of instituting appropriate and immediate multidisciplinary management measures where necessary.
IARC Handbook of Cancer Prevention Vol. 17 - Colorectal Cancer Screening
Authors: Lauby-Secretan B. , Vilahur N. , Straif K. ,   on behalf of the Working Group for IARC Handbook 17
Published: September 2018

The IARC Handbook of Cancer Prevention conduct evidence-based expert evaluations on the cancer preventive effects of interventions and strategies for primary and secondary prevention. In November 2017, 23 experts from 15 countries met at the International Agency for Research on Cancer in Lyon, France to evaluate different methods of screening for CRC. Evaluations were conducted for the stool-based tests of occult blood (guaiac fecal occult blood test, and immunochemical fecal test), endoscopic techniques (colonoscopy and sigmoidoscopy) and computed tomographic (CT) colonography. The Working Group critically reviewed all available evidence from randomized controlled trials, observational studies and modeling studies, and assessed the benefits in reducing mortality and incidence, and the benefit-harm ratio taking into account potential adverse effects. The Working Group also reviewed the literature on related topics, including availability of CRC screening worldwide, determinants of participation to screening, emerging CRC screening techniques and screening in high-risk groups. Overall, there is sufficient evidence that screening for colorectal cancer with stool-based tests of occult blood or with endoscopic techniques decreases the risk of colorectal cancer mortality; there is also sufficient evidence for a positive benefit-harm ratio with these methods, although colonoscopy may induce more substantial harms. With CT colonography, evidence for a reduction in colorectal cancer incidence and/or mortality is limited, and a minority of the Working Group rated the evidence as inadequate.
Cost-Effectiveness of Smoking Cessation Within a Lung Cancer Screening Program in Canada
Authors: Gauvreau C. , Fitzgerald N. , Flanagan W. , Memon S. , Goffin J. , Miller A. , Evans W.
Published: September 2018

Background: Demonstrated lung cancer mortality reductions through low-dose computed tomography (LDCT) has encouraged some jurisdictions to consider implementing organized LDCT screening. A retrospective analysis of former smokers in the National Lung Screening Trial (NLST) suggested that abstention from smoking coupled with low-dose computed tomography (LDCT) screening realized more mortality benefits than abstinence alone or LDCT alone. Aim: We evaluated the potential costs and cost-effectiveness of lung cancer screening with integrated smoking cessation using OncoSim-Lung (version 2.5), a microsimulation model led by the Canadian Partnership Against Cancer, with model development by Statistics Canada. Methods: We compared organized LDCT screening without smoking cessation to various plausible scenarios of screening with cessation. Assumptions included: annual screening of 55-74 year-old individuals with a 30-pack-yr history; a 42% participation rate reached over 10 years; cessation therapy (nicotine replacement therapy + varenicline + 12 weeks' counseling) at a cost of $490; and up to 10 cessation attempts, with a permanent quit rate of 5% per attempt. Cost-effectiveness was estimated with a lifetime horizon, health system perspective and 1.5% discount rate. Costs are in 2016 CAD. Results: OncoSim-Lung projected that LDCT screening integrated with cessation would cost approximately $76 million annually (undiscounted) from 2017 to 2036 in Canada. About 110 fewer lung cancer (LC) cases and 50 fewer LC deaths would occur annually, compared with screening without cessation. Additionally, many other smoking-related deaths would be prevented. Using a lifetime horizon, smoking cessation would cost $14,000/QALYs gained. In one-way sensitivity analysis, with a 72% participation rate there would be 260 fewer deaths, at $24,000/QALY. With a 10% quit rate, cost-effectiveness would improve to $6,000/QALY. A 50% increase in the cost of the cessation intervention would decrease cost-effectiveness to $22,000/QALY. Conclusion: Robust smoking cessation efforts within a LDCT screening program could save lives and be relatively cost-effective. Cancer control planners should consider integrating smoking cessation when implementing a lung cancer screening initiative.
Effectiveness of Warning Labels at Increasing Awareness of Alcohol-Related Cancer Risk Among Heavy Drinkers
Authors: Jongenelis M. , Pratt I.S. , Slevin T. , Pettigrew S.
Published: September 2018

Background: Although alcoholic beverages were classed as a Group 1 carcinogen over a quarter of a century ago, there is a lack of public awareness of this cancer risk relative to other alcohol-related risks. Increasing drinkers’ awareness of the cancer risk associated with alcohol consumption has therefore been identified as an important component of alcohol harm minimization strategies, with mandatory health warning labels on alcoholic beverage containers considered an important component of such strategies. Aim: To assess the overall effectiveness of a warning statement advising of the cancer risk associated with alcohol consumption and effectiveness relative to statements advising of other health risks. Methods: An online survey was administered to 364 Australians (72% male) who reported drinking at levels associated with long-term risk of harm. Respondents were randomly exposed to one of five statements relating to the risks associated with alcohol consumption (cancer, liver damage, diabetes, mental illness, heart disease). Pre and post measures of risk beliefs and drinking intentions were taken. Results: Exposure to a warning statement advising of the cancer risk associated with alcohol consumption resulted in (i) a significant increase in the extent to which respondents exposed to that statement believed alcohol to be a risk factor for cancer and (ii) a significant reduction in consumption intentions. Exposure to the cancer risk statement was associated with the second largest pre to post change in consumption intentions behind the diabetes risk statement. Conclusion: Warning statements informing drinkers of the cancer risk associated with alcohol consumption can produce (i) increases in the awareness of alcohol-related cancer risk and (ii) favorable changes in drinking intentions.
Global Impact of Tyrosine Kinase Inhibitors on Chronic Myeloid Leukemia Epidemiology Over the Next Ten Years
Authors: Tadwalkar S. , Hughes M.
Published: September 2018

Background: The advent of tyrosine kinase inhibitors (TKIs) has transformed the prognosis of CML. Prolonged survival has already been achieved in most patients with access to these drugs, and as access improves in more resource-constrained settings, it should be expected that this improvement will become more common, thus increasing the prevalence of CML. Aim: Through this analysis, we aim to understand the global impact of targeted therapy on CML prevalence over the next ten years. Methods: Using a critically appraised set of country-specific cancer registries, CML incidence was estimated for 45 countries, representing approximately 90% of the world population in 2018. An assumptions-based 10-year forecast model was used to incorporate the effects of improving access to TKIs in developing countries using an observed correlation between gross domestic product per capita, CML risk, and survival ( Fig 1 ). To represent the continuing optimization of TKI-based treatments, survival was further trended based on an attenuated historical trend. Prevalence was estimated as cumulative incidence over 20 years from diagnosis, with deductions for all-cause mortality. To estimate prevalent CML globally, countries were grouped into economically- and geographically-defined regions. Regional totals were projected upwards to account for the countries for whom direct estimates were not made. A control forecast was also developed where no improved survival attributed to improved access to TKIs in resource-constrained settings was assumed. The results between the two models were then compared with measure the difference attributable to the effects of improved TKI access. Results: In 2018, there will be an estimated 503,000 prevalent cases of CML globally with 267,000 of these estimated to be living in resource-constrained settings. When assuming no improvements in survival across developing countries due to TKI access, we expect this number would have been 221,000 cases. That is, 46,000 people are living with CML in resource-constrained settings now who would not be alive had it not been for access to TKIs. Conclusion: The prevalence of CML is expected to rise globally which can be primarily attributed to prolonged survival and improved access to TKIs.

[Figure: see text]
MeMoSa: Mobile Mouth Screening Anywhere for Early Detection of Oral Cancer
Authors: Ching C. Sok ,   Memosa Working Group
Published: September 2018

Background: The burden of oral cancer is significant in Asia, accounting for 11% of cancer deaths in Asia compared with 5% in the rest of the world. High and increasing access to mobile phones in low- and middle-income countries presents an opportunity to use telemedicine to facilitate early detection of oral cancer. Aim: To evaluate the feasibility of using the mobile phone as a documentation and communication tool for early detection of high-risk oral lesions. Methods: We determined the concordance between evaluation of oral lesions using mobile phone-captured images and clinical oral examination using kappa statistics. A mobile phone app named MeMoSA was developed and the app was tested during a routine oral cancer screening program in the community to determine the feasibility of integrating this tool for the documentation of oral lesions, and the communication between dentists and specialists with regards to management of these patients. The experience of dentists and specialists in using MeMoSA was determined using qualitative questionnaires. Results: We demonstrated that the mobile phone is a sensitive and specific tool, with a sensitivity of > 80% in detecting a lesion, an accuracy of 87% in categorizing the type of lesion and 85% concordance in patient referral compared with clinical oral examination. Having been trained to use MeMoSA, 36/36 dentists agreed that this app could improve early detection of oral mucosal lesions. All of these dentists wanted to continue using the app as screening tool in the future as they believe that it could assist them in the identification of high-risk oral mucosal lesions through direct communication with specialists. Conclusion: MeMoSA enabled documentation of the lesion through easy photography and facilitated patient management through quick communication between dentists and specialists. Because of its ease of use MeMoSA could be useful tool in early detection of high-risk oral lesions in low-resource settings and could increase the access to healthcare in geographically hard to reach populations.
Cancer Education in Rwanda: Challenges and Opportunities for Undergraduate Medical Students (The EDUCAN Project)
Authors: Manirakiza A. , Rubagumya F. , Fehr A. , Triedman S.A. , Greenberg L. , Mbabazi G. , Ntacyabukura B. , Nyagabona S.K. , Maniragaba T. , Longombe A.N. , Rulisa S. , Hammad N. ,   EDUCAN
Published: September 2018

Background: Shortage and lack of trained cancer specialists is one of the major challenges in addressing the increasing cancer burden in low and middle income countries. Inadequate undergraduate cancer education in oncology remains a major obstacle for both task shifting to general practitioners and for training of specialists. We provide the first report of cancer education in Rwanda's undergraduate program to survey how fresh graduates are prepared to provide care for cancer patients. Aim: - Identify the current status of cancer education in one of Rwanda's two medical schools; - Provide a basis for educational reforms that target improvements of cancer knowledge and management. Methods: Anonymous online survey was sent January to June 2017 to medical students in their senior clinical years (year 5 and 6). Questions related to the demographics, medical curriculum and general oncology exposure were included in the survey. Results: Of 192 eligible students, 42% (n=80) completed the survey and were analyzed. The majority were 25 to 29 years of age and 41% were female. Internal medicine was cited to provide the most exposure to cancer patients (50%) and cancer bedside teaching (55%). Close to a half (46%) have been taught oncology formally in addition to bedside teaching. A tenth (11%) of the participants felt comfortable in attending a cancer patient, and a fifth (21%) of the students felt comfortable while addressing multimodality treatment approach. The majority (99%) of the participants preferred having a formal oncology rotation. Of particular interest, 61% of the students are interested in pursuing an oncology career path. Conclusion: There is a need to modify the current oncology undergraduate curriculum to prepare future physicians for delivering cancer care in Rwanda. Raising the profile of oncology in undergraduate medical education will complement the on-going efforts to increase the country's capacity in task shifting an in training of cancer specialists.
Factors Contributing to Delays in the Management of Lung Cancer: Retrospective Study From Government Cancer Center in India
Authors: Shanthilal M. , Sathya M.
Published: September 2018

Background: Lung cancer is one of the leading causes of cancer related morbidity and mortality among both the sexes. It accounts for 13% of all new cancer cases and 19% of cancer related deaths worldwide. In India, lung cancer constitutes 6.9% of all new cancer cases and 9.3% of all cancer related deaths in both sexes. Majority of them present in advanced disease. Aim: This study aims to identify the contributing factors for delays in lung cancer diagnosis and treatment. Methods: This is a retrospective cross-sectional observational study which was conducted at Department of Oncology, Mysore Medical College and Research Institute, India. Records of the all histologically confirmed lung cancer patients from the year 2011 to 2016 were reviewed. Results: A total of 133 patients were identified with lung cancer and their records were evaluated. Out of these 133 patients, 60% of the cases were males. The median age was 63 years with the youngest being 37 and the eldest was 83 years. Majority of patients were in stage III (59%) and IV (36%). About 89% of the patients were smokers. Non–small cell lung cancer accounted 83% (squamous cell 66.5%, adenocarcinoma 30.5%, large cell 1.5% and neuroendocrine 1.5%) and small cell lung cancer was 17%. A total of 17% (26) of patient were on empirical antitubercular treatment (ATT) since the onset of current symptoms. While analyzing delay with independent T test showed mean delay of 25.01 days (± SD 6.17) in patient without ATT and with ATT delay was 57.09 days (± SD 8.05) ( P ≤ 0.01). Thirty five percentage (46) of patient received treatment within 1 month from the first hospital visit, 28% (37) within two months and 37% (50) within 3-4 months of the first hospital visit. The delay to hospital visit was shorter in advanced cancer and small cell cancer maybe because of the acute presenting symptoms. Conclusion: Various factors contributing for the delays are lag time from symptom onset to first visit with primary physician, delay due to investigation and symptomatic treatment under primary physician care, delay further aggravated by empirical but inappropriate ATT, further delay due to diagnostic procedure to establish the cancer diagnosis. Thus proper and timely referral to the specialist from primary physician will reduce these delays and help to avoid situation where curable disease become incurable and significantly alters the prognosis.
What Do Cancer Patients Value? A Unique Experience at Maggie's Cancer Caring Centre in Hong Kong
Authors: Chan S. , Chan A.
Published: September 2018

Background: Maggie's Cancer Caring Centre in Hong Kong (“Maggie's HK”) adopted a person-centered approach advocated by Maggie Keswick Jencks, who was the founder and a cancer patient. Witnessing first-hand that many psychosocial needs of a cancer patient could not be met through the existing medical system, Maggie created a blueprint for a purposefully-designed architecture and the services complementary to the existing system. The centre aims to empower people affected by cancer, be they cancer patients or caregivers, to live with, live through and live beyond cancer via informational and psychological consultations, psychosocial support programs and a therapeutic environment. People in need are welcome to drop-in anytime to use the centre while all services/programs are free and no referral/appointment is needed. As this patient-oriented drop-in service, integrated multidisciplinary approach and the therapeutic architecture, as one of a kind would conceptually make people feel at home, feel respected, see themselves as a person rather than a patient, and gain confidence in facing and walking through the cancer journey, how does this translate into practice in Maggie's HK? Aim: To examine the uniqueness of Maggie's HK cancer care service, especially the patient-oriented drop-in service and the purposefully-designed environment, this study investigated cancer patients' related experience at Maggie's HK and its influences on their cancer adjustment and adaptive coping in the community. Methods: A qualitative study design was adopted. Thirteen semistructured focus group interviews, each with 5-6 cancer patients/care-givers at Maggie's HK, were held from August 2016 to January 2017. Each interview lasted from 1.5 to 2.5 hours and were audio recorded then transcribed verbatim. Different themes were generated through repeated readings and content analysis with constant comparison. Results: Three main themes regarding the unique experiences of the drop-in service model under a purposefully-designed environment at Maggie's HK were emerged from the focus groups: Creating a sense of home for the centre users. Users reported the centre is like their second home giving them a sense of autonomy, security, trust and comfort. Empowering users to deal with uncertainties. Users reported the (drop-in) service helps to reduce their fear, worries and doubts. Providing a nurturing context for users' needs. Users reported the design of the physical environment has catered to their specific needs at different moments in time. Conclusion: The study reveals that the innovative model of patient-oriented drop-in service under a therapeutic physical environment at Maggie's HK contributes significantly a positive experience and impact on cancer patients in the reduction of their fear and worries, while enhancing their role as active participants in their care. There is also a developed sense of autonomy, security and confidence in the cancer journey.
Epidemiological Transition of Cancer: A Systematic Analysis From the Global Burden of Disease Study 2016
Authors: Fitzmaurice C. ,   Global Burden of Disease Study Cancer Collaborators
Published: September 2018

Background: The epidemiologic transition describes the transition from high mortality due to infectious diseases to high mortality from NCDs as societies move up the socioeconomic ladder. Since some cancers have infectious etiologies, it is unclear how socioeconomic development impacts cancer burden. This knowledge, however, is crucial to inform health policies, and resource allocations. Aim: We analyzed the cancer transition between 1990 and 2016 using the Global Burden of Disease (GBD) 2016 cancer estimates. Methods: We used the GBD 2016 cancer estimates from 1990 to 2016 as well as the sociodemographic index (SDI). The SDI is a composite indicator of development including fertility, education, and income with a higher SDI representing improved socioeconomic development. To describe the cancer transition, we analyzed how cancer incidence, and mortality changed depending on the SDI with special emphasis on the most common cancers at the global level (lung, colorectal, breast cancer) as well as on common cancers with infectious etiologies (stomach, liver, cervical cancer). Findings: Within and across world regions, age-standardized total cancer incidence (ASIR) either remained stable or increased with SDI except for the regions at the highest level of SDI where ASIR either plateaued or has peaked. For most regions age-standardized total cancer mortality (ASMR) decreased with increasing SDI. For lung cancer, ASIR and ASMR increased across regions with improvements in development but have remained stable or decreased within regions with increased SDI. Colorectal cancer ASIR increased within and across regions with improvements in SDI, whereas ASMR increased with higher SDI within the least developed regions but declined with improvements in SDI for more developed regions. Breast cancer ASIR increased within and across regions and ASMR decreased within most regions with improvements in SDI. However, breast cancer ASMR showed large heterogeneity within regions of the same SDI level. Of the cancers with infectious etiologies, stomach, and cervical cancer ASIR and ASMR decreased with higher SDI within and across regions. However, for liver cancer, ASIR and ASMR by SDI varied substantially within and across regions without a clear pattern. Conclusion: The epidemiologic transition theory explains trends in incidence and mortality for certain cancers (cervical, stomach). However, even though for many cancers there is a clear pattern of changes in incidence and mortality with regards to development level, this pattern rarely supports the epidemiologic transition theory of decreases in cancers due to infectious etiologies and increases in cancers that have mainly been attributed to a “western lifestyle”. What is evident is a “fourth phase” of the epidemiologic transition where, for many cancers that are amenable to treatment, cancer mortality decreases with improvements in development despite stable or increasing incidence.