bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and Facilitators of Human Papillomavirus (HPV) Vaccination During the Implementation of the School-Based HPV Vaccine Program in Manizales, Colombia
Authors: Cordoba Verónica , Tovar-Aguirre Olga Lucía , Franco Sandra , del Pilar Escobar María , Arias Nelson Enrique , Louie Karly , Sanchez Gloria Ines , Garces-Palacio Isabel 
Published: March 2018

Abstract 43 Purpose Colombia implemented a school-based human papillomavirus (HPV) vaccination program that consisted of a three-dose series in girls age 9 years in 2012. In 2014, the program included girls up to the last grade of high school, and the second and third doses were scheduled at 6 and 60 months. After a mass psychogenic response after vaccination that occurred from May to October 2014 in Carmen de Bolivar, vaccination rates dropped from 80% in 2012 and 2013 to 18% in 2014. The aim of the current study was to identify barriers and facilitators of HPV vaccine uptake in Colombia. Methods To develop quantitative instruments for a population-based survey, we conducted 19 qualitative interviews and 18 focus groups between September 2016 and February 2017. Participants were girls who were eligible to receive vaccination between 2012 and 2014 and their parents or legal representatives. Results Forty-nine girls who were selected from six schools of low (n = 2), medium (n = 2), and high (n = 2) socioeconomic level and 58 of their parents participated in the study. Eighty-one percent (40 of 49) of girls were age 12 to 15 years at the time of interview. No girls from schools of a low socioeconomic level and only two of 20 of their parents knew the etiology of cervical cancer. Pap smear cytology and condom use were the methods of cervical cancer prevention that were most often mentioned by parents. Only vaccinated girls from schools of a high socioeconomic level considered the HPV vaccine to be a good prevention alternative. Facilitators in adults were the desire to prevent disease in general and HPV. For both girls and their parents, listening to positive information about the vaccine facilitated vaccine uptake. Negative media information about the effects of the vaccine from the 2014 psychogenic event was the main barrier for vaccine uptake or series completion. Fifty-seven percent of girls and 30% of parents mentioned that, at the time of vaccination, information about the HPV vaccine was received mainly through government massive media campaigns, whereas approxiamtely one half of both parents and girls did not receive information from schools or health care services. Conclusion Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program, including mass media information about the HPV vaccine. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Predictors of Survival After Head and Neck Cancer in South America: Preliminary Results of the InterCHANGE Study
Authors: Abrahao Renata , Perdomo Sandra , Kowalski Luis , Vilensky Marta , Oliveira Jose Carlos , Ribeiro Luis Felipe , De Podesta Jose Roberto , Cuello Mauricio , Rodríguez Paula Andrea , Keogh Ruth , Brennan Paul , Curado Maria Paula 
Published: March 2018

Abstract 65 Purpose Incidence of head and neck cancer (HNC) is high in South America, and survival data are scarce in this region. The InterCHANGE study was established by clinical groups from across South America and the International Agency for Research on Cancer, with the primary aim to study the impact of human papillomavirus (HPV) infection and sociodemographic, clinic, and lifestyle factors on survival after this malignancy. The current study examined the main predictors of survival after HNC in South America and estimated overall and conditional survival probabilities. Methods Patients were recruited during 2010 to 2016 from seven centers in Argentina, Brazil, Colombia, and Uruguay. A questionnaire obtained information on age, stage, and body mass index at diagnosis; sex; education; race; and comprehensive smoking and alcohol history. Blood samples were collected for HPV16 E6 testing—a surrogate marker for HPV16 infection. The Kaplan-Meier method and Cox proportional hazards regression were used for statistical analyses. Results Of 1,314 patients, 348 had oropharynx cancer and 966 nonoropharynx cancer (larynx, n = 381; hypopharynx, n = 75; and oral cavity, n = 510). All cases were confirmed by histology or cytology. Most patients were male (81%), of white race (64%), ever smokers (85%), ever drinkers (82%), had a median age at diagnosis of 60 years, and only a basic education (54%). The majority of patients (66%) was diagnosed with stage IV disease, ranging from 53% for larynx to 83% for oropharynx disease. Median follow-up time for patients who died or survived was 0.9 years of 2.3 years, respectively. By October 31, 2017, 628 patients (48%) had died. Three-year overall survival was 53% for larynx, 47% for oral cavity, 40% for oropharynx, and 36% for hypopharynx disease. Main predictors of worse survival were late stage at diagnosis, older age, and underweight (body mass index < 18.5kg/m2) at diagnosis, with some variation according to tumor site. In a subset analysis of 156 patients with oropharynx cancer with available HPV16 E6 serology, those who were negative for HPV16 E6 had significantly lower 3-year survival (27% v 73%), and a corresponding 3.5 times higher mortality rate (adjusted hazard ratio, 3.5; CI, 1.2 to 10.6) than those who were positive for HPV16 E6. Conclusion Most patients presented with strikingly advanced disease, and stage at diagnosis was an important predictor of survival. The reasons for late diagnosis are unclear, and efforts to improve survival will largely depend on efforts to diagnose HNC at an early stage. Patients with HPV-related versus HPV-unrelated oropharynx cancer had better survival, which supports previous results from Europe and North America. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Barriers to Timely Surgery for Breast Cancer in Rwanda
Authors: Schleimer Lauren E. , Dusengimana Jean-Marie Vianney , Butonzi John , Kigonya Catherine , Natarajan Abirami , Umwizerwa Aline , O’Neil Daniel S. , Shulman Lawrence N. , Keating Nancy L. , Shyirambere Cyprien , Mpunga Tharcisse , Pace Lydia E. 
Published: March 2018

Abstract 81 Purpose Surgery is the mainstay of treatment for nonmetastatic breast cancer. Little is known about the quality of breast surgical care in sub-Saharan Africa. Research at the Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center, has suggested that access to timely surgery is inadequate, but barriers have not been systematically examined. The aim of the current study was to gain an understanding of the barriers to breast cancer surgery among patients who were diagnosed at BCCOE by investigating delays and interruptions in care. Methods We used a standardized chart abstraction instrument to collect demographic, treatment, and outcome data as of November 2017 for all patients who were diagnosed with breast cancer at BCCOE in 2014 and 2015. We recorded all visits and treatments received until surgery, disease progression, or loss to follow-up for all patients with stage I to III breast cancer. Results During 2014 and 2015, 91 patients were diagnosed with stage I to III breast cancer and were treated with curative intent—67 patients (74%) underwent surgery, with 22 undergoing surgery at BCCOE and 45 elsewhere. Of the 24 patients with no surgery, 16 were lost to follow-up and eight experienced disease progression before surgical evaluation. Median time from diagnosis to surgery was 103 days (range, 30 to 826 days) for patients without neoadjuvant chemotherapy (NAC) and 268 days (range, 108 to 794 days) for patients with NAC. We defined surgical delays as > 120 days from diagnosis without NAC or > 365 days from diagnosis if NAC was administered. Of the 67 patients who had surgery, 26 patients (39%) experienced delays. When documented, reasons for delay included patient factors, such as social and/or financial issues (n = 5), seeking alternate treatment (n = 2), refusing referral to Kigali (n = 3), or any surgery (n = 1); system factors, such as surgeon nonavailability (n = 1); and changes in clinical status, such as pregnancy (n = 5), treatment-associated adverse events (n = 4), or the need for a second surgical opinion (n = 2). Unexplained failure to complete the initial surgical referral (n = 5) and missed NAC treatment appointments (n = 6) were frequent contributors. Some patients had multiple reasons for delay. For five patients, there was no documented explanation. Conclusion We observed high rates of loss to follow-up, surgical delays, and lapses in care at the point of surgical referral. Identification of the barriers to completing referrals could guide strategies for improving access to timely surgery. Efforts are needed to address social and financial barriers and explore patients’ refusals to undergo surgery. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Predictors of Radiation Therapy Incompletion Among Patients With Esophageal Cancer in Tanzania
Authors: Xu Melody J. , Mushi Beatrice , Kutika Sarah , Zhang Li , Deardorff Katrina , Merritt Megan , Mgisha William , Mwaiselage Julius , Feng Mary , Mmbaga Elia , Van Loon Katherine 
Published: March 2018

Abstract 96 Purpose The incidence of esophageal cancer in East Africa is disproportionately high. In Tanzania, radiation therapy (RT) is routinely offered for definitive and palliative therapy; however, many patients do not complete RT or die shortly thereafter. The current study aimed to characterize RT treatment patterns in Tanzania and identify predictive factors for RT incompletion. Methods We performed a retrospective chart abstraction for patients with esophageal cancer who were treated with RT at a national referral cancer center in Tanzania from 2011 to 2013. Definitive intent was defined as RT prescriptions with at least 20 fractions with concurrent chemotherapy. Other fractionation regimens were considered palliative. Wilcoxon rank-sum tests, χ2 tests, and logistic regression models were used to identify factors that are associated with palliative or definitive RT incompletion. Results A total of 300 patients—202 male and 98 female patients—were identified with a median age of 60 years (interquartile range [IQR], 48 to 70 years). Nearly 100% (299 of 300) of patients reported dysphagia to solids, and 54% (155 of 288) reported dysphagia to liquids. Median duration of symptoms before presentation was 4 months (IQR, 2 to 6 months), and median time from diagnosis to RT was 1.2 months (IQR, 0.8 to 1.9 months). Overall, 23% were unable to complete RT as a result of death or clinical decompensation. Palliative treatment was administered to 149 patients, and 26% did not complete RT. Definitive treatment was administered to 151 patients, and 20% did not complete RT ( P = .24). Patients younger than age 60 years were less likely to complete palliative RT (odds ratio [OR], 2.4; P = .02). Tobacco use (OR, 2.7; P = .04) and RT initiation within 30 days of diagnosis (OR, 3.5; P = .004) were associated with incomplete definitive RT. Conclusion In Tanzania, approximately 23% of patients die or decompensate before completing esophageal RT. Patients younger than age 60 years were less likely to complete palliative RT. Tobacco use and RT initiation within 30 days of diagnosis was associated with definitive treatment incompletion, perhaps reflecting differences in cancer biology or pace of disease. Additional understanding of how these factors contribute to RT incompletion may inform supportive care resource allocation and patient selection for esophageal RT in Tanzania and similar resource-limited settings. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs were provided by the authors.
A Multiplexed Human Papillomavirus 16 and 18 Diagnostic Chip for Cervical Cancer in Limited-Resource Settings
Authors: Wong Winnie S. , Klapperich Catherine M. 
Published: March 2018

Abstract 16 Purpose Despite being treatable, cervical cancer is responsible for 300,000 deaths annually and is the second most frequent cause of cancer-related death worldwide. The burden of cervical cancer disproportionately falls on developing countries, where 87% of deaths occur from limited or no resources for screening. Of cervical cancer cases, 99% are caused by human papillomavirus (HPV), with more than 70% of cases from HPV genotypes 16 and 18. We developed a low-cost cervical cancer diagnostic chip to detect HPV 16 and 18 DNA quickly and reliably in limited-resource settings (LRSs). Methods Unlike conventional HPV diagnostics that use polymerase chain reaction and resource-intensive equipment, our chip used isothermal—one temperature—amplification, specifically loop-mediated amplification, and required only a heat source, which made it suitable for LRSs. Amplified DNA was visually detected on a lateral flow strip, which is similar to a pregnancy test, providing a simple yes or no readout. Specific line patterns indicated the presence of HPV 16, 18, both, or neither. Each chip was single use and self-contained to be easily disposed of as biohazard waste, which reduced the risk of contamination and false positives. Results The loop-mediated amplification assay was optimized to detect HPV 16 and 18 simultaneously. Sensitive and specific amplification of cloned HPV 16 and 18 DNA was achieved and confirmed via specific restriction enzyme digests. The lower limit of detection was 104 and 103 copies for HPV 16 and 18, respectively. Clinical samples, namely discarded cervical swab samples, were also tested with the chip. Results were comparable with the gold standard of polymerase chain reaction, which proves that the chip is feasible for clinical samples. Time to result was less than 1 hour, making the chip appropriate for LRSs. Conclusion Our multiplexed HPV 16 and 18 diagnostic chip is clinically relevant and provides a much-needed screening method for LRSs. The chip will increase access to screening for a treatable cancer and provide a faster route to treatment as well as a decrease in deaths from cervical cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Screen and Triage to Facilitate Screen and Treat by Community Health Extension Workers: Task-Sharing Strategy to Achieve Universal Cervical Cancer Screening in Nigeria
Authors: Awolude Olutosin A. , Oyerinde Sunday O. , Akinyemi Joshua O. 
Published: March 2018

Abstract 31 Purpose Universal access to cervical cancer screening remains elusive in most low- to middle-income countries, which shoulder the greatest burden of this preventable disease. Whereas a cytology-based screening strategy is logistically impossible, the shortage of health care workers (HCWs) and appropriate training limit the implementation of cheaper and equally effective methods, such as visual inspection after application of acetic acid (VIA); however, effective use of task shifting and sharing to involve community health extension workers (CHEWs) in HIV program delivery in low- to middle-income countries has brought innovation to bear in overcoming the HCW shortage. Hence, this study leveraged this novel strategy to pilot the provision of cervical cancer screening by CHEWs in Nigeria. The current study aimed to train and support the available health care workforce in rural communities to achieve population coverage for cervical cancer screening and reduce the cervical cancer burden in Nigeria. Methods We piloted improving the knowledge and practice skills of CHEWs/CHOs in a rural local government area of Oyo state, Nigeria, to provide community-level cervical cancer screening service. Improvement in knowledge and skills was accomplished through training, technical and infrastructural support, and participatory supervision for HCWs in the PHCs and general hospital in the local government area using the VIA method and by linking VIA-positive cases to the general hospital to screen and treat. Results Fifty-one HCWs, including physicians, nurses, and CHEWs/CHOs, were trained with five PHCs, and the general hospital was provided with materials with which to administer cervical cancer screening services. Participants’ knowledge improved from an average of 50.5% at pretraining to 88.8% immediately post-training. Of the 950 eligible women who were screened in 1 year, 848 (89.3%) were screened by CHEWs/CHOs. Of the 66 who were screened as VIA positive by CHEWs/CHOs, 58 (88.1%) agreed with the supervisory team review compared with 18 (92.3%) of 19 who were screened by nurses (κ statistics, 0.84 and 0.76, respectively). Three cases of invasive cervical cancer were diagnosed during this period, two of which were by CHEWs/CHOs. Conclusion This pilot project demonstrated that, with appropriate competency training and necessary support, CHEWs/CHOs can successfully identify cervical dysplasia. These HCWs are important resources to leverage to achieve universal coverage of cervical cancer screening services in Nigeria. We plan to expand this program to involve the seven health zones in Oyo state, Nigeria, in a hub and spoke manner to establish its wider feasibility. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Association of fat mass profile with natriuretic peptide receptor alpha in subcutaneous adipose tissue of medication-free healthy men: A cross-sectional study
Authors: Dinas Petros C. , Nintou Eleni , Psychou Dimitra , Granzotto Marnie , Rossato Marco , Vettor Roberto , Jamurtas Athanasios Z. , Koutedakis Yiannis , Metsios George S. , Flouris Andreas D. 
Published: March 2018

Background: Atrial natriuretic peptide increases lipolysis in human adipocytes by binding to natriuretic peptide receptor-A (NPRA). The aim of the current study was to examine the associations of NPRA mRNA of subcutaneous adipose tissue with fat mass, fat-free mass, body mass index (BMI) and arterial blood pressure in medication-free healthy men. Method: Thirty-two volunteers [age (years): 36.06±7.36, BMI: 27.60±4.63 (kg/m2)] underwent assessments of body height/weight, % fat mass, fat-free mass (kg), blood pressure, and a subcutaneous adipose tissue biopsy via a surgical technique. Results: We found that NPRA mRNA was negatively associated with % fat mass (r=-0.40, R2=0.16, p=0.03) and BMI (r=-0.45, R2=0.20, p=0.01). Cohen’s f2 effect size analyses showed a small effect size between NPRA mRNA and BMI (f2=0.25). One-way analysis of variance with Bonferroni post-hoc tests showed a tendency for mean differences of NPRA mRNA across BMI categories (p=0.06). This was confirmed by Cohen’s d effect size analyses revealing a large effect size of NPRA mRNA between obese individuals (BMI≥30 kg/m2) and either normal weight (BMI=19-25 kg/m2; d=0.94) or overweight (BMI=25-30 kg/m2; d=1.12) individuals. Conclusions: NPRA mRNA is negatively associated with % fat mass and BMI in medication-free healthy men, suggesting a possible role of NPRA in the control of fat mass accumulation.
Management of Paediatric Testicular Torsion – Are we adhering to Royal College of Surgeons (RCS) recommendations
Authors: Thakkar HS , Yardley I , Kufeji D 
Published: March 2018

Introduction In 2015, the Royal College of Surgeons of England (RCS) commissioned the East Midlands Clinical Network to develop a set of guidelines for the management of paediatric torsion. Two quality measures identified were the provision of surgery locally where possible and 100% of explorations within three hours. We sought to assess the adherence to these quality measures within our referral network. Materials and methods Retrospective data were collected for all paediatric scrotal explorations performed within our centre between January 2014 and July 2016. Patient demographics, sources of referral, transfer times, time to surgery and operative findings were obtained. Results A total of 100 patients underwent a scrotal exploration. Median age at presentation was 11 years (range 4 months to 15 years). Fifty-three per cent of referrals were from network hospitals. The median duration of symptoms was 25 hours (range 1–210 hours). The median transfer time from local centres was 120 minutes (range 45–540 minutes). The median time to theatre from the decision being made to operate was 60 minutes (range 30–600 minutes). Eighty-seven per cent of cases were explored within three hours. There were 13 cases of torsion with one orchidectomy. When taking into account the transfer time for external patients aged over five years without precluding comorbidities, exploration within three hours dropped to 18 of 46 (39%). Conclusion The RCS guidelines recognise the need for specialist input in very young patients. A large proportion of explorations are, however, currently taking place in older patients with unacceptably long transfer times. We propose an extension of this review nationally to work towards the local provision of care for suitable patients.
Pédagogie et dilemmes de l’enseignement de l’éthique du lobbying
Authors: Desmoulins Lucile 
Published: March 2018

Si les relations théoriques et pratiques entre lobbying et éthique sont complexes à appréhender, leur enseignement relève de la gageure. Une méthodologie pluraliste d’enquête associant l’analyse de discours à l’ethnographie organisationnelle a permis de formuler une proposition conceptuelle sur la nature même du lobbying, et d’étudier l’impérieuse nécessité de la présence d’enseignements abordant l’éthique dans les formations en lobbying. Les étudiants expriment souvent des questionnements et un souci éthique. Pour autant, le statut de l’éthique dans les formations françaises de niveau Master paraît limité à la portion congrue dans leurs supports de communication. La pédagogie des relations entre lobbying et éthique est en tension entre le souhait de répondre aux attentes d’étudiants en demande de repères clairs tels que le cadre légal ou les normes sociales, et le devoir de réaffirmation de la subjectivité des valeurs et du caractère pragmatique des questionnements éthiques.
Mots-clés : lobbying, éthique, pédagogie, intelligence économique, professionnalisation.

Since the theoretical and practical relations between lobbying and ethics are complex to grasp, teaching ethical lobbying is a challenge. A pluralistic methodology led to explore the pedagogical practices and dilemmas met when teaching the ethics of lobbying. Based on a conceptual analysis of lobbying as a sector of activity and a set of practices and techniques aimed to influence political decision-making processes, ethics courses appeal to lobbying students. However, there are very few such courses in French Master level training programs, and the term itself appears seldom in their brochures and web-sites. Yet, students prove to be keen on asking questions and getting answers on that matter during all courses of such programs. The pedagogy of the relations between lobbying and ethics is complex because it should meet students’ expectations to learn the legal framework, the codes of conducts, as well as the do and the don’t that drive from social norms, whereas teachers should recall that values are subjective and that one should be pragmatic when one meets ethical dilemmas in his daily work.
Key words: lobbying, ethics, pedagogy, business intelligence, professionalization.
Conjugate Tangent Vectors, Asymptotic Directions, Euler Theorem and Dupin Indicatrix For k-Kinematic Surfaces
Authors: KEMER Yasemin , ATA Erhan 
Published: March 2018

In this study, we define the
k-kinematic surface Mg which is obtained from
a surface M on Euclidean 3-surface E3 by applying rigid
motion described by quaternions to points of M. Then we investigate and calculate for this surface some
important concepts such as shape operator, asymptotic vectors, conjugate
tangent vectors, Euler theorem and Dupin indicatrix which help to understand a
surface differential geometrically well.