bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peptide Receptor Radionuclide Therapy in the Management of Neuroendocrine Tumors (Neoplasms): Fundamentals and Salient Clinical Practice Points for Medical Oncologists
Authors: Basu Sandip , Parghane Rahul , Ranade Rohit , Thapa Pradeep , Ramaswamy Anant , Ostwal Vikas , Sirohi Bhawna , Panda Dipanjan , Shrikhande Shailesh V 
Published: October 2019

AbstractThis editorial commentary is an expert summary of “Peptide Receptor Radionuclide Therapy (PRRT),” encompassing the essential fundamentals and salient clinical practice points, deliberated and designed in a point-wise manner with theme-based subheadings. Emphasis has been laid on the topics of practical relevance to the referring oncologists with relevant finer points where necessary. A part of the presented overview has been generated from the authors' own practical experience of more than 3500 successful therapies delivered over the last 9 years at a large tertiary care PRRT setting by the joint efforts of Radiation Medicine Centre (RMC), Bhabha Atomic Research Centre (BARC), and Gastrointestinal services of Tata Memorial Hospital (TMH) at the TMH-RMC premises. While the technical indigenization is beyond the scope of this treatise, we must mention here that India had been one of the frontrunners in this treatment modality, and the PRRT services in this country were developed purely as an indigenous effort right from the production of the radionuclide (177-Lutetium) at the reactor and radiolabeling and production of the radiopharmaceutical (177Lu-DOTATATE) by the radiopharmaceutical scientists at the BARC and RMC; such an endeavor allowed this very specialized therapy to be delivered at a very affordable cost in our setting which could be viewed as a major societal contribution of the atomic energy research in this country.
Knowledge, Attitudes, and Beliefs About Breast Cancer and Barriers to Breast Self-Examination Among Sikkimese Women
Authors: Yambem Leima Chanu Shakti , Rahman Hafizur 
Published: October 2019

Abstract
Objectives: The objectives of this study are to assess women's awareness on breast cancer; and their awareness, attitudes, and barriers to practice of breast self-examination (BSE). Methodology: This cross-sectional study was conducted from May 1, 2015 to June 30, 2015, involving 302 women between 18 and 65 years of age attending the Outpatient Department of Central Referral Hospital, Gangtok. Face-to-face semi-structured questionnaire-based interview was conducted among the participant women, after taking their written consent. Results: Three-fourths of the participants were aware of breast cancer. Eighty percent of the women who had heard about breast cancer were not aware of its risk factors. Forty-six percent of the participants were aware of BSE. Most common source of knowledge was from health professionals. Of the 138 women who were aware of BSE, 41.3% ever practiced BSE. Majority had started BSE between 21 and 45 years of age. Thirty-seven percent of the participants practiced BSE once in a year. Working women and students were found to be twice more likely to practice BSE compared to homemakers. Similarly, women belonging to lower socioeconomic status were 70% less likely to practice BSE than women of affluent class. Conclusions: Knowledge of the breast cancer and BSE practices is poor among indexed Sikkimese reproductive women attending tertiary hospital of Sikkim. There is an urgent need for information on the airwaves and in print, and for education at health centers on warning symptoms of breast cancer and various methods of screening for breast cancer including BSE.
The Knowledge, Attitude, and Practice Regarding Pap Smear, Cervical Cancer, and Human Papillomavirus among Women Attending a Mother and Child Health Clinic in Kuantan, Malaysia
Authors: Nurjihan Tg. Faten , Rahman Tg. Abdul , Rahman Nor Azlina A. , Shafri Mohd Affendi Mohd , Haque Mainul 
Published: October 2019

Abstract
Background: Cervical cancer (CC) is a foremost reason of global cancer death in women, and a good portion remains with the developing countries. This study was conducted to assess the knowledge, attitude, and practice regarding Pap smear, CC, and Human Papillomavirus (HPV) among the women attending a Mother and Child Health Clinic in Kuantan, Malaysia. Materials and Methods: A total of 120 respondents involved in this cross-sectional study. The convenience sampling was to select the respondents. The data were collected from in 2013. Results: The mean age 32.19 years. Up to 54.2% of respondents never had Pap smear in the past 5 years, while over 67.5% of respondents never had HPV vaccination. There was a significant correlation between knowledge with attitude (P < 0.001) and attitude with practice (P < 0.001) regarding Pap smear, CC, and HPV. However, knowledge and practice regarding Pap smear, CC, and HPV was not significantly correlated (P = 0.525). There was no significant correlation between mean age and knowledge (P = 0.455) while there was a significant correlation between mean age with attitude (P = 0.011) and practice (P < 0.001) regarding Pap smear, CC, and HPV. It was also shown that there were differences between races in term of knowledge and attitude (P < 0.05). However, there was no significant difference in term of practice regarding Pap smear, CC, and HPV (P > 0.05) between races. Conclusions: Important barriers to Pap smear screening among women are highlighted through this study. The health institution involved needs to come up with better strategies to deal with these barriers to improve the awareness of women regarding Pap smear, CC, and HPV.
Symptom Palliation in Patients with Bone Metastases Treated with Radiotherapy
Authors: Rastogi Kartick , Gupta Shivani , Bhaskar Sandeep , Bhatnagar Aseem-Rai , Bairwa Subhash-Chand , Jain Sandeep 
Published: October 2019

Abstract
Context: Skeleton is the most common organ affected by metastases. Bone pain is the most common symptom of metastatic bone disease. The treatment of bone metastasis is primarily palliative requiring multidisciplinary therapies; radiotherapy (RT), however, remains the cornerstone of the treatment. Aims: The aim of this study is to measure the effectiveness of RT in terms of symptomatic relief in pain and insomnia, improvement in stability/movement, and decrease in the requirement of analgesics by patients using the Hundred Paisa Pain Scale. Subjects and Methods: The RT records of 226 patients with bone metastasis treated at the department of Radiotherapy, SMS Medical College, Jaipur; from July 2015 to December 2016 over cobalt-60 teletherapy unit were analyzed. The RT dose fractionation ranged from 30 Gy in 10 daily fractions, 20 Gy in 5 daily fractions, 12.5 Gy in 2 weekly fractions, and 8 Gy in single fraction. Results: The median age of the cohort was 54 (range, 29–84) years. The most common site of primary tumor was lung (30.1%), followed by breast (12.4%) and prostate (11.9%). The most common bone involved was vertebrae (71.2%), followed by pelvis (14.6%); among vertebrae, thoracic vertebrae were most commonly involved (63.9%), followed by lumbar vertebrae (57.8%). The maximum relief in pain was seen with 6.25 Gy/fraction schedule, whereas the maximum improvement in stability/movement was noted with 3 Gy/fraction schedule. The 8 Gy single-fraction schedule was associated with maximum relief in insomnia and decrease in analgesic requirement. Conclusion: The current institutional protocol of weekly hypofractionated palliative RT of 6.25 Gy per fraction up to a maximum of four fractions given on Saturday has shown results comparable with other schedules with well tolerance and achievement of acceptable symptom palliation. This weekly schedule is practically convenient to both the patients who mostly came from far-flung areas and the institute as it spares the already overburdened machine to carry on conventional RT from Monday to Friday.
Docetaxel-Induced Lung Injury: An Under-Recognized Complication of a Commonly Used Chemotherapeutic Agent
Authors: Manuprasad Avaronnan , Ganesan Prasanth , Mahajan Vandana , Ganesan Trivadi S , Radhakrishnan Venkatraman , Dhanushkodi Manikandan , Sagar Tenali Gnana 
Published: October 2019

Abstract
Background: Docetaxel-induced pneumonitis is a rare, but potentially serious complication of a commonly used chemotherapeutic agent. Methods: We performed an audit of patients with suspected docetaxel pneumonitis from the tertiary cancer center. Results: Out of 477 patients who received docetaxel over a 1 year period, eight patients (1.7%) developed lung injury. All patients (median age: 43 years [34–65]) had breast cancer (four metastatic on palliative docetaxel, two were on neoadjuvant, and two were on adjuvant therapy) and had received a median of three cycles of docetaxel 75 mg/m2 in a 3 weekly schedule (7 as single agent and 1 in combination with cyclophosphamide). One patient had the preexisting pulmonary disease (localized bronchiectasis), and four had received prior radiation to the chest wall or dorsal spine. The median time from administration of the last dose was 16 days (8–28). Most (n = 6/8, 75%) required hospitalization. Three patients with CTCAE Grade 3 pneumonitis required oxygen support. Radiology showed a pattern of interstitial pneumonitis in most patients. All the patients responded to steroids and follow-up imaging showed resolution of infiltrates. The median duration of hospital stay was 8.5 days (7–18 days). There was no mortality due to this condition. Conclusions: Drug-induced lung injury should be considered in patients presenting with respiratory symptoms after administration of docetaxel. Timely initiation of steroids could reduce complications.
Does fiscal consolidation hurt economic growth? Empirical evidence from Spanish regions
Authors: Lago-Peñas Santiago , Vaquero-Garcia Alberto , Sanchez-Fernandez Patricio , Lopez-Bermudez Beatriz 
Published: October 2019

Abstract
This article brings empirical evidence on the effect of fiscal consolidation in decentralized countries. The focus on Spain is justified by three reasons. First, it is one of the OECD countries most affected by the Great recession in terms of both GDP and public deficit. Second, Spain is one of the most decentralized countries in the world. Third, compliance with fiscal consolidation targets has been very diverse across regions. Using both time series econometrics and the Synthetic Control Method approach (SCM), we show that compliance with fiscal targets at the regional level has not involved lower GDP growth rates in the short-run. Openness and economic integration of regional economies involve that fiscal multipliers tend to fade. Hence, while a fiscal stimulus would not work on this scale, the opposite is also true: the potentially negative demand effects of a stronger regional fiscal consolidation strategy would be exported to other regions.
Guinea
Authors:   International Monetary Fund. Fiscal Affairs Dept.
Published: October 2019

This Article IV Consultation discusses declining oil prices, US dollar appreciation, and limited access to international financing, which have worsened the fiscal, economic, and financial outlook. The focus of discussions was that despite the weak prospects there are still downside risks in the event that oil prices fall again, external financing becomes even more constrained, or confidence in the economy and the banking system begins to weaken. In the financial system, the main concern resides in a short-term risk of liquidity shortfalls, but credit quality concerns dominate over the medium term. The authorities’ policy response to the imbalances has been timely but still insufficient given the size of the shocks, the urgent nature of the vulnerabilities, and reduced foreign currency reserves. Real GDP is expected to contract significantly this year and next. In order to prevent liquidity risks in the financial system, the authorities should limit recourse to domestic financing and, as necessary, assist in a timely way banks that develop liquidity or capital shortfalls, as well as enhance crisis preparedness and contingency planning.
The extreme drought of 1842 in Europe as described by both documentary data and instrumental measurements
Authors: Brázdil Rudolf , Demarée Gaston R. , Kiss Andrea , Dobrovolný Petr , Chromá Kateřina , Trnka Miroslav , Dolák Lukáš , Řezníčková Ladislava , Zahradníček Pavel , Limanowka Danuta , Jourdain Sylvie 
Published: October 2019

Abstract. Extreme droughts are weather phenomena of considerable
importance, involving significant environmental and societal impacts. While
those that have occurred in the comparatively recent period of instrumental
measurement are identified and dated on the basis of systematic,
machine-standardized meteorological and hydrological observations, droughts
that took place in the pre-instrumental period are usually described only
through the medium of documentary evidence. The extreme drought of 1842 in
Europe presents a case in which information from documentary data can be
combined with systematic instrumental observations. Seasonal, gridded
European precipitation totals are used herein to describe general DJF, MAM,
and JJA precipitation patterns. Annual variations in monthly temperatures
and precipitation at individual stations are expressed with respect to a
1961–1990 reference period, supplemented by calculation of selected drought
indices (Standardized Precipitation Index, SPI; Standardized Precipitation
Evapotranspiration Index, SPEI; and Palmer Z index). The mean circulation patterns
during the driest months are elucidated by means of sea-level pressure (SLP) maps, the North
Atlantic Oscillation Index (NAOI), and the Central European
Zonal Index (CEZI). Generally drier patterns in 1842 prevailed in January–February and
at various intensities between April and August. The driest patterns in 1842
occurred in a broad zonal belt extending from France to eastern central
Europe. A range of documentary data is used to describe the peculiarities of
agricultural, hydrological, and socio-economic droughts, with particular
attention to environmental and societal impacts and human responses to them.
Although overall grain yields were not very strongly influenced, a
particularly bad hay harvest, no aftermath (hay from a second cut), and low
potato yields led to severe problems, especially for those who raised
cattle. Finally, the 1842 drought is discussed in terms of long-term drought
variability, European tree-ring-based scPDSI (self-calibrated Palmer Drought Severity Index) reconstruction, and the broader
context of societal impacts.
Improving the Quality of Data Exchange Formats in the U.S. National Tuberculosis Surveillance System
Authors: Bonney Wilfred , Price Sandy F , Miramontes Roque 
Published: October 2019

Objective: The objective of this presentation is to use a congruence of standardization protocols to effectively ensure that the quality of the data elements and exchange formats within the NTSS are optimal for users of the system.Introduction: Disease surveillance systems remain the best quality systems to rely on when standardized surveillance systems provide the best data to understand disease occurrence and trends. The United States National Tuberculosis Surveillance System (NTSS) contains reported tuberculosis (TB) cases provided by all 50 states, the District of Columbia (DC), New York City, Puerto Rico, and other U.S.-affiliated jurisdictions in the Pacific Ocean and Caribbean Sea [1]. However, the NTSS currently captures phenotypic drug susceptibility testing (DST) data and does not have the ability to collect the rapid molecular DST data generated by platforms such as Cepheid GeneXpert MTB/RIF, Hain MTBDRplus and MTBDRsl, Pyrosequencing, and Whole Genome Sequencing [2-6]. Moreover, the information exchanges within the NTSS (represented in HL7 v2.5.1 [7]) are missing critical segments for appropriately representing laboratory test results and data on microbiological specimens.Methods: The application of the standardization protocols involves: (a) the revision of the current Report of Verified Case of Tuberculosis (RCVT) form to include the collection of molecular DST data; (b) the enhancement of the TB Case Notification Message Mapping Guide (MMG) v2.03 [8] to include segments for appropriately reporting laboratory test results (i.e., using Logical Observation Identifiers Names and Codes (LOINC) as a recommended vocabulary) and microbiology related test results (i.e., using Systematized Nomenclature of Medicine -- Clinical Terms (SNOMED CT) as a recommended vocabulary); and (c) the standardization of the laboratory testing results generated by the variety of molecular DST platforms, reported to TB health departments through electronic laboratory results (ELR), using those same standardized LOINC and SNOMED CT vocabularies in HL7 v2.5.1 [7].Results: The application of the standardization protocols would optimize early detection and reporting of rifampin-resistant TB cases; provide a high-quality data-driven decision-making process by public health administrators on TB cases; and generate high-quality datasets to enhance reporting or analyses of TB surveillance data and drug resistance.Conclusions: This study demonstrates that it is possible to apply standardized protocols to improve the quality of data, specifications and exchange formats within the NTSS, thereby streamlining the seamless exchange of TB incident cases in an integrated public health environment supporting TB surveillance, informatics, and translational research.
Farm Biosecurity at backyard poultry of Bangladesh and its role in spread of HPAI
Authors: Asaduzzanab Muhammad 
Published: October 2019

Objective: We have conducted this study to characterise the movement and contact patterns of poultry in Bangladesh that could be associated with transmission of newly-introduced subtypes of avian influenza virus in two districts of Bangladesh as well as to summarise the patterns arising from the network analysis in a way that can inform the parameterisation of spatially explicit stochastic models of transmission of newly-introduced subtypes of avian influenza virus in the two types of areas.Introduction: Bangladesh is a South Asian country with large human and poultry populations which is highly affected with frequent outbreaks of both high and low pathogenic avian influenza since 2007. Very few studies have been carried out to reveal the farm biosecurity at backyard poultry that might have contributed to the spread of avian influenza in Bangladesh, specially rural areas. Therefore, we aimed to characterize biosecurity practices of poultry farm including the movement of live birds which is a well-known risk factor for the geographic dissemination of the virus among poultry flocks and personnel hygiene of poultry workers for rapid detection and effective risk management of incursion of HPAI and LPAI viruses.Methods: This cross sectional survey was carried out using pretested questionnaire in backyard Poultry holdings of Kalkini Upazila of Madaripur district in Dhaka division which has a relatively low proportion of commercial poultry farms and high proportion of backyard poultry holdings.1-mode and 2-mode social network analysis was also carried out to show the farm to farm movements. From each primarily selected farm, details of the last 2 movements of live poultry along with source/destination details was collected with pre-tested questionnaire. Later, data was stored in Epi-Info, analysed with STATA 14 and UCINET. 315 backyard HH from 2 villages of Kalkini Upazila, Madaripur District were randomly selected.Results: The study revealed that majority backyard farm owners do not maintain the standard biosecurity measures whereas a significant amount of the study included farms rear multiple poultry species. No poultry workers found to use any personal protective equipments (PPEs) while cleaning the litter/mats (Figure 2). The farms with multiple poultry species feed them in same container and keep them in same shed which is a major risk factor for disease transmission.Movement patterns differed in a number of aspects (Table 1) and this information is useful for the establishment of the movement parameter settings in a simulation model of avian influenza incursion.Conclusions: The findings on farm biosecurity practices and movement pattern from this study will support to develop risk-based surveillance and contingency policies as well as to minimize the spread between poultry units and also from poultry to people for novel AI viruses in Bangladesh.
Why You Should Participate in HHS (Health and Human Services) Regional Epi Groups
Authors: Colettta Michael 
Published: October 2019

Objective: Within the BioSense Platform, users have the ability to view HHS Region level data that can provide insight into what may be happening around the country. Epidemiologists can examine this information for changes in trends of subsyndromes or other potential issues of public health concern and compare it to their local data. However, the insight that regional data can provide is limited without better understanding of what is happening in the jurisdictions that make up the region. This round table will discuss the benefits of engaging with other jurisdictions within regions and attempt to define rules of engagement that can be used to facilitate interactions.Introduction: One of the early successes for the National Syndromic Surveillance Program’s (NSSP’s) BioSense Platform was community agreement on what should make up national and regional picture of the data. For NSSP to meet program objectives, National level surveillance and situational awareness had to be made available – not just to CDC, but to the entire community. To make this possible, the community had to agree on a limited dataset that would be sufficient to produce national and regional picture. Currently when NSSP staff at CDC or a particular program review HHS Regional data, they can only see trends at high levels. Although, this information is proving useful, when very unusual data spikes occur there is insufficient information to determine its public health significance. CDC would like to set up HHS Regional Epi groups made up of syndromic surveillance practitioners within regions in order to communicate about potentially unusual findings and discuss implications for local jurisdictions.Description: This round table will use case examples of data spikes for sub-syndromes in HHS Regions and discuss the following:- What observations might warrant communications with local sites and potentially even warrant further investigation- How the information should be communicated- Ideas for ways that jurisdictions could collaborate on an investigation- Any challenges to the current concept of operations.How the Moderator Intends to Engage the Audience in Discussions on the Topic: The moderator will lay out two or three real world examples that might have benefited from having an HHS Regional Epi group to address the issue. Then the audience will be asked to comment on the following questions:- What are the potential pros of such HHS regional epi groups?- What are the potential cons of such HHS regional epi groups?- What are best practices for communicating with HHS Regional epi groups (i.e. through list serve, forum, Event Communications System within ESSENCE, etc.)?- What are the best ways to keep these HHS Regional Epi groups properly engaged and responsive without overwhelming them with requests?- How can these HHS Regional Epi groups be used by other HHS Regions that are looking to collaborate?