bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Public Goods, Public Policy and Human Development: A State-wise Analysis
Authors: Singh Jitender 
Published: July 2016

The provision of quality public goods not only addresses market failures but is also a precondition for well-functioning markets for economic growth, inclusive development and overall quality of life in the country. Government failure to adequately provide public goods can lower the quality of life and diminish public welfare. This study provides a framework to examine the role of public policy in provisioning public goods. It also examines the status of the quality of government-produced goods (GPGs) across major states in India. Finally, it explores the link of quality of GPGs to human development and income poverty in India. Without appropriate public policy intervention, the quality of a public good tends to remain low. Using a comprehensive definition of quality, we classify different types of quality attributes and identify the role of public policy in the promotion of quality. It is found that the quality of GPGs varies across the states but remains low. It is also found that a better quality of public goods would lead to higher human development and lower poverty.
The Feasibility of Creating Partnerships Between Palliative Care Volunteers and Healthcare Providers to Support Rural Frail Older Adults and Their Families: An Integrative Review
Authors: Connell Braydon , Warner Grace , Weeks Lori E. 
Published: July 2016

Background/Question: Volunteers are important in the support of frail older adults requiring palliative care, especially in rural areas. However, there are challenges associated with volunteer supports related to training, management and capacity to work in partnership with healthcare providers (HCP). This review addresses the question: What is the feasibility of a volunteer-HCP partnership to support frail older adults residing in rural areas, as they require palliative care? Methods: This integrative review identified ten articles that met the identified search criteria. Articles were appraised using the Critical Appraisal Skills Programme (CASP) checklists, designed for use across a range of quantitative and qualitative studies. Results: Studies were drawn from international sources to understand how volunteer roles vary by culture and organization; the majority of studies were conducted in North America. Studies varied in methodology, including quantitative, qualitative and educational commentary. Identified factors that were crucial to the feasibility of volunteer-HCP partnerships in rural areas included volunteer training dynamics, relationships between volunteers and HCP, and rural environmental factors. Conclusion: Preliminary evidence indicates that a volunteer-HCP palliative partnership is feasible. However, training policies/procedures, volunteer-HCP relationships, and rural specific designs impact the feasibility of this partnership. Additional research is needed to further establish the feasibility of implementing these partnerships in rural settings.
Independent validation of the Pain Management Plan in a multi-disciplinary pain team setting
Authors: Quinlan Joanna , Hughes Richard , Laird David 
Published: July 2016

Context/background: The Pain Management Plan (PP) is a brief cognitive behavioural therapy (CBT) self-management programme for people living with persistent pain that can be individually facilitated or provided in a group setting. Evidence of PP efficacy has been reported previously by the pain centres involved in its development. Objectives: To provide a fully independent evaluation of the PP and compare these with the findings reported by Cole et al. Methods: The PP programme was delivered by the County Durham Pain Team (Co. Durham PT) as outlined in training sessions led by Cole et al. Pre- and post-quantitative/patient experience measures were repeated with reliable and clinical significant change determined and compared to the original evaluation. Results: Of the 69 participants who completed the programme, 33% achieved reliable change and 20% clinical significant change using the Pain Self-Efficacy Questionnaire (PSEQ). Across the Brief Pain Inventory (BPI) interference domains between 11% and 22% of participants achieved clinical significant change. There were high levels of positive patient feedback with 25% of participants scoring 100% satisfaction. The mean participant satisfaction across the population was 88%. Conclusion: The results from this evaluation validate those reported by Cole et al. It demonstrates clinically significant improvement in pain and health functioning and high patient appreciation results. Both evaluations emphasise the potential of this programme as an early intervention delivered within a stratified care pain pathway. This approach could optimise the use of finite resources and improve wider access to pain management.
Chronic Myeloid Leukemia in India
Authors: Ganesan Prasanth , Kumar Lalit 
Published: July 2016

Background In the last decade, the use of imatinib has brought a paradigm shift in the management of chronic myeloid leukemia (CML). In India, imatinib has been available for more than a decade and has been made accessible to all segments of the population because of patient assistance programs and cheaper generic versions. Despite improvements in survival, there are unique challenges in the Indian context. Methods We reviewed published data pertaining to CML in India for the period of 1990 to 2016, using PubMed advanced search with the terms chronic myeloid leukemia and India, and included studies that reported on epidemiology, monitoring for therapy, treatment outcomes, and resistance. Additionally, the references in retrieved articles were also reviewed. Results Thirty-seven studies were identified. The incidence of CML may be slightly lower in India than in the West, but there was only a single article reporting population-based data. Indian patients presented with more advanced disease. Most centers have access to imatinib as first-line therapy, but there is limited availability of molecular monitoring and second-line therapy. Most of the outcome data were retrospective but seemed comparable with that reported in Western centers. Drug adherence was impaired in at least one third of patients and contributed to poor survival. Conclusion Focused prospective studies and cooperative studies might improve the quality of data available. Future studies should focus on adherence, its effects on outcomes, and methods to address this problem.
Documentation of HIV Testing and Treatment Status Among Patients Presenting for Cancer Care in Uganda
Authors: Ghadrshenas Matine J. , Bender Ignacio Rachel A. , Low Daniel H. , Phipps Warren , Orem Jackson , Duerr Ann , Casper Corey 
Published: July 2016

Abstract 23 HIV increases the incidence and mortality of cancer; knowledge of HIV status and treatment is essential for management of patients with HIV-associated malignancies (HIVAM). In Uganda, where the prevalence of HIV infection is 7.4%, the incidence of AIDS-defining cancers (ADCs) is high, and non-AIDS defining cancers (NADCs) are increasingly common. We investigated how often cancer providers documented HIV status and clinical parameters of HIV infection among patients at the Uganda Cancer Institute (UCI). Medical records of patients aged ≥18 who registered at the UCI June - September 2015 were abstracted for demographics and cancer and HIV parameters. We calculated binomial proportions and used χ2 tests to evaluate factors associated with HIV. Among 1,130 patients in this analysis, 71% of charts documented HIV status. Of those documenting HIV status, 32% were HIV+, and 58% of HIV+ individuals had an ADC. The documented HIV prevalence in NADCs was 21%. Women were more likely to lack HIV results (RR 1.32, p=0.009); 36% of women lacked results, including 40% with cervical cancer. HIV+ patients were younger than HIV-negative patients (median age 41 vs. 49, p<0.001). 62% of HIV-infected patients had a CD4 count recorded; CD4 counts were lower among persons with ADC (median 270 cells/ml, IQR 80-460) compared with NADC (median 370, IQR 215-564), p=0.006. There was no difference in the proportion of HIV patients with ADCs and NADCs receiving ART (both 86%, p=0.45). HIV prevalence was 4.5 times higher in Ugandan cancer patients with documented status than in the general population. Though the majority of cancer patients had HIV testing performed, gaps remained in documenting HIV status, even among cancers considered AIDS-defining in HIV. This study highlights opportunities to educate cancer clinicians in Africa on the burden of HIV in cancer patients and opportunities to coordinate management of both cancer and HIV. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Matine J. Ghadrshenas No relationship to disclose Rachel A. Bender Ignacio No relationship to disclose Daniel H. Low No relationship to disclose Warren Phipps No relationship to disclose Jackson Orem No relationship to disclose Ann Duerr No relationship to disclose Corey Casper Leadership: Temptime Consulting or Advisory Role: Janssen Pharmaceuticals Research Funding: Janssen Pharmaceuticals Travel, Accommodations, Expenses: Temptime Corporation, GlaxoSmithKline
Molecular Detection of Oncogenic Human Papillomavirus (HPV) Genotypes in Vulva Cancers, Penile Cancers and Anal Cancers in Myanmar
Authors: Shwe Mu Mu , Thu Hlaing Myat , Mar Khin Shwe 
Published: July 2016

Abstract 12 A causal role for human papillomavirus (HPV) associated cancers of vulva, penile, and anus is supported by evidence from molecular and epidemiologic investigations. This study detected the oncogenic HPV genotypes in vulva cancers, penile cancers and anal cancers by a cross-sectional descriptive study in 2013. A total of 100 paraffin embedded biopsy tissues of histologically confirmed vulva cancers, penile cancers and anal cancers within past five years during 2008 and 2012 were studied. Those cases were 61 vulva cancers from Central Women Hospital, Yangon and 30 penile cancers and 9 anal cancers from Yangon General Hospital. HPV-DNA testing and genotyping were performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Consensus sequence primer pairs within the E6 andE7 open reading were used to amplify oncogenic HPV genotypes (HPV-16,-18,-31,-33,-35,-52b,-58). Restriction enzymes were used for determination of specific HPV genotypes. HPV was identified in 36.1% of vulva cancers (22/61), 26.7% of penile cancers (8/30) and 44.4% of anal cancers (4/9). In vulva cancers, HPV-33 was the most common genotype (40.9%) followed by HPV-16 (31.8%), HPV-31 (22.7%), and HPV-18 (4.6%). In penile cancers, HPV-16 (62.5%) was the most common genotype followed by HPV-33 (25%) and HPV-18 (12.5%). Among anal cancers, the most frequent genotypes were HPV-16 (75%) and HPV-18 (25%). This study is the first report of evidence based oncogenic HPV genotypes in vulva cancers, penile cancers and anal cancers in Myanmar. This research provides the valuable information in understanding the burden of HPV associated cancers of the vulva, penile, and anus in Myanmar and the consideration of the effectiveness of prophylactic HPV vaccination in not only cervical cancer but also non-cervical cancers. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Risk, Persistence and Multiplicity of HPV Infections among HIV Negative and HIV Positive Nigerian Women
Authors: Adebamowo Sally N. , Olawande Toyosi , Famooto Ayotunde , Dareng Eileen O. , Olaniyan Olayinka , Offiong Richard , Adebamowo Clement A. 
Published: July 2016

Abstract 64 Background: The incidence, prevalence, persistence, and multiplicity of high-risk HPV infection is different between HIV positive and HIV negative women. We examined the association between HIV, prevalent HPV, and persistent HPV infections among women in a prospective cohort in Nigeria. Methods: We enrolled women presenting at cervical cancer screening programs in Abuja, Nigeria, between 2012 and 2014 and collected information on their demographic characteristics, risk factors of HPV infection, and cervical exfoliated cells samples at baseline, 6 month and 12 month follow-up visits. DNA enzyme immunoassay (DEIA) and Roche Linear Array HPV Genotyping Test were used to characterize HPV. Persistent HPV infection was defined as a positive result on 2 consecutive DEIA tests. We used logistic regression models to estimate the association between HIV and risk of HPV infection. Results: Among the 1,020 women enrolled, the mean age (±SD) was 37(8), and 44% and 56% were HIV+ and HIV-, respectively. HPV52 and 35 were the most common HPV types in the study population. The prevalence was 34% for any HPV, 24% for persistent HPV and 9% for multiple HPV infections; these were higher among HIV+ women (p-value <0.001). The multivariate odds ratio (OR) and 95 % CI comparing HIV+ to HIV- women was 6.29 (95% CI 3.64 – 10.87, p-value <0.001) for any high-risk HPV; 6.22 (95% CI 3.02 – 12.83, p-value <0.001) for persistent high-risk HPV; and 6.46 (95% CI 2.69 – 15.52, p-value <0.001) for multiple high-risk HPV infections, Conclusions: HIV infection is associated with increased risk of persistence and multiplicity of low-risk and high-risk HPV infections. These findings may explain, in part, the increased risk of cervical cancer among women with HIV infections. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Sally N. Adebamowo No relationship to disclose Toyosi Olawande No relationship to disclose Ayotunde Famooto No relationship to disclose Eileen O. Dareng No relationship to disclose Olayinka Olaniyan No relationship to disclose Richard Offiong No relationship to disclose Clement A. Adebamowo Speakers' Bureau: Merck [Table: see text]
Application of Flexible Display Technology to Low Cost Multiplexed Point-of-Care Medical Diagnostic Testing
Authors: Katchman Benjamin A. , Smith Joseph T. , Christen Jennifer Blain , Anderson Karen S. 
Published: July 2016

Abstract 62 One of the key roadblocks limiting the transition of high-sensitivity and high-specificity point-of-care technologies from the research laboratory to wide spread use is the availability of a low-cost-high-volume manufacturing technology. This work presents a new interdisciplinary approach combining low cost commercial display manufacturing technology with programmable high density protein microarray printing technology to fabricate disposable point-of-care immunosensors with clinical level sensitivity. Our approach is designed to leverage advances in commercial display technology to reduce pre-functionalized biosensor substrate costs to pennies per cm2, as well as to leverage the display industry’s ability to manufacture an immense number of low cost consumer electronic products annually. For this work, we demonstrate that our new approach can offer diagnostic sensitivity at or below 10 pg/mL, which approaches the lower limit of detection of typical clinical laboratory instrumentation. Our new approach is also designed to overcome the limited analytical sensitivity of existing POC devices (>100x improved sensitivity). It also contains new capability for multiplexed biomarker detection (>10 antigens) in a single low cost POC device through an innovative disposable and scalable architecture, based on flat panel display technology. Here, we demonstrate multiplexed detection of antibodies to the HPV16 proteins E2, E6, and E7, which are circulating biomarkers for cervical as well as head and neck cancers. This detection technology has 100 percent correlation to our current laboratory-based measurement instrumentation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Benjamin A. Katchman Patents, Royalties, Other Intellectual Property: Arizona State University Joseph T. Smith Patents, Royalties, Other Intellectual Property: Arizona State University Jennifer Blain Christen Patents, Royalties, Other Intellectual Property: Arizona State University Karen S. Anderson Stock or Other Ownership: Provista Diagnostics Consulting or Advisory Role: Provista Diagnostics Patents, Royalties, Other Intellectual Property: Arizona State University
Developing a Breast Fine Needle Aspiration Biopsy Service in Peru
Authors: Ng Dianna , Ljung Britt-Marie , Bardales Ricardo , Abad Milagros , Cedano Manuel , Constant Tara Hayes , Winkler Jennifer , Balassanian Ronald 
Published: July 2016

Abstract 6 Background: Breast cancer incidence is increasing in developing countries. In 2010, 57.8% of breast cancers in Peru were at least stage III at diagnosis. Federal and regional Peruvian institutions partnered with several organizations, including UCSF, to improve access and quality of breast cancer care in Peru. Phase 1 involved screening with clinical breast exam, creating a community-based referral system for women with masses, and promoting evaluation of lesions using fine needle aspiration biopsy (FNAB) by trained physicians, with treatment at the regional cancer institute. Curricula for each activity were developed and validated. During phase 1, in-country FNAB expertise was recognized as limited. For phase 2, the critical objective was to solidify local capacity for high-quality FNAB and integrate FNAB into standard of care for breast cancer. Methods: Three main activities were completed during phase 2. 1) Develop a Training of Trainers (ToT) curriculum for FNAB, and identify master trainers and trainees. 2) Facilitate endorsement of a national approach to training FNAB and undertake preliminary rollout in La Libertad region. 3) Strengthen interpretation and reporting of FNAB results. Results: A 5-day ToT pilot course occurred during October 19-23, 2014. Prior to the course, women with palpable masses were identified during a breast screening campaign and scheduled for FNAB. Regional, national and international clinical teams observed, procured and interpreted FNAB. Four new cases of cancer and eight cases of granulomatous mastitis were diagnosed. Slide quality before and after the training intervention will be compared. Following the course, a one-day validation meeting including physicians and national leaders took place at the national cancer center in Lima, Peru. FNAB was endorsed for early diagnosis and triage. Conclusions: To ensure sustainability of FNAB, cytology fellowships and training centers are needed. Strengthening partnerships will be critical for long-term capacity. An electronic reporting system will be developed to replace paper-based methods. Funding: Norwegian Cancer Society/Norwegian Breast Cancer Society (NCS/NBCS), Susan G. Komen for the Cure, The PATH Catalyst Fund. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Facilitators and Barriers to Cervical Cancer Screening in Migori County, Kenya
Authors: Nishimura Holly , Yatich Nelly , Huchko Megan 
Published: July 2016

Abstract 77 Background: Cervical cancer, a disease that is largely preventable through organized screening programs, still impacts over 500,000 women every year. Sub-Saharan Africa has the highest global incidence and mortality, largely due to lack of screening coverage. Low-cost and simple-to-implement screening technologies can potentially impact the rates of cervical cancer, if they are acceptable and scalable. As part of a trial to evaluate implementation strategies for cervical cancer prevention in western Kenya, we sought to identify the barriers and facilitators of screening, as well as opinions on a strategy employing self-collection of specimens for human papillomavirus (HPV) testing. Methods: Providers and female community members were recruited for focus groups using purposive sampling. Two focus group discussions (FGDs) with community members (n=24) and one FGD with providers (n=12) and key stakeholders were held in Migori County, Kenya, using structured guides to assess and current cervical cancer knowledge, screening practices, barriers to screening and potential strategies to facilitate screening access and uptake, including self-collected HPV testing. Results: Participants in both groups assessed the education around HPV, cervical cancer, and screening as very low in the community, and identified this lack of education as the main barrier to screening. Community members reported fear of pain and embarrassment as significant barriers to a screening pelvic exam. They also reported that lack of knowledge and discomfort among providers were significant barriers. Having undergone screening themselves or talking to someone with experience increased willingness to screen. Providers reported workload and lack of supplies and trained staff as significant barriers. Most participants in both FGDs felt that self-collection would help address barriers. Women expressed willingness to self-collect if given adequate instructions and if knowledgeable counselors were present to discuss results. Conclusion: Cervical cancer prevention strategies employing effective educational components and self-collected HPV testing could address many of the identified barriers to screening. Key findings from analysis of the focus group transcripts will be used to inform the implementation of community health campaigns. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Radiation Needs In Pediatric Oncology in the Lake Region Of Tanzania
Authors: Schroeder Kristin , Olson Adam C. , Ackerson Brad , Larrier Nicole , Masalu Nestory , Chao Nelson , Likonda Beda 
Published: July 2016

Abstract 32 Background: The majority of new pediatric cancer diagnoses are made in resource-poor countries where survival rates range from 5-25%, compared with 80% in high-resource countries. A key component of treatment includes radiation therapy, but access is extremely limited in East Africa. This study estimates the potential clinical benefit of radiation therapy for pediatric oncology patients at Bugando Medical Centre (BMC), a tertiary referral center in the lake zone of Tanzania, one of two cancer treatment centers in Tanzania. Methods: Study design is a retrospective review of recorded hospital admissions and clinic visits to the oncology department at BMC from January 2010-December 2014. The indication for radiation therapy was extrapolated from contemporary SIOP and COG protocols. The benefits of radiotherapy, both for curative and palliative intent, were estimated based on age, diagnosis and stage at presentation by two radiation oncologists. Results: A total of 221 pediatric patients were identified. The most common recorded diagnoses were Burkitt lymphoma (n=36), other non-Hodgkin lymphoma (n=33), Wilms tumor (n=32), acute leukemia (n=28) and retinoblastoma (n=23). Treatment received included chemotherapy only for 163 patients (74%), surgery only for 5 patients (2%), and a combination of chemotherapy and surgery for 30 patients (14%). No patients received radiation therapy due to lack of availability at our center. For 77 patients (35%), staging information was insufficient and the potential benefit of radiation therapy could not be determined. Of the remaining 144 cases, radiation could have been included in the treatment plan for 49 patients (34%, 95% CI 26-42%). Of these, 41 patients (84%, 95% CI 74-94%) could have been treated with curative intent and 8 patients (16%, 95% CI 6-26%) could have benefitted from palliative radiation therapy. Conclusion: Radiation therapy is an essential treatment modality for pediatric cancer but has limited availability in East Africa. In our population, roughly one third of presenting patients would have benefitted from radiation as part of their treatment. Most patients who would benefit from radiation therapy would be treated with curative intent. Introducing radiation has the potential to significantly improve pediatric cancer outcomes in the lake zone of Tanzania. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.