bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Urbanization and Climate Change on Peak Flows over the San Antonio River Basin, Texas
Authors: Zhao Gang , Gao Huilin , Cuo Lan 
Published: July 2016

Abstract
A thorough understanding of the peak flows under urbanization and climate change—with the associated uncertainties—is indispensable for mitigating the negative social, economic, and environmental impacts from flooding. In this paper, a case study was conducted by applying the Distributed Hydrology Soil Vegetation Model (DHSVM) to the San Antonio River basin (SARB), Texas. Historical and future land-cover maps were assembled to represent the urbanization process. Future climate and its uncertainties were represented by a series of designed scenarios using the Change Factor (CF) method. The factors were calculated by comparing the model ensemble from phase 5 of the Coupled Model Intercomparison Project (CMIP5) with baseline historical climatology during two future periods (2020–49, period 1; 2070–99, period 2). It was found that with urban impervious areas increasing alone, annual peak flows may increase from 601 (period 1) to 885 m3 s−1 (period 2). With regard to climate change, annual peak flows driven by forcings from maximum, median, and minimum CFs under four representative concentration pathways (RCPs) were analyzed. While the median values of future annual peak flows—forced by the median CF values—are very similar to the baseline under all RCPs, in each case the uncertainty range (calculated as the difference between annual peak flows driven by the maximum and minimum CFs) is very large. When urbanization and climate change coevolve, these averaged annual peak flows from the four RCPs will increase from 447 (period 1) to 707 m3 s−1 (period 2), with the uncertainties associated with climate change more than 3 times greater than those from urbanization.
Can Gridded Precipitation Data and Phenological Observations Reduce Basis Risk of Weather Index–Based Insurance?
Authors: Dalhaus Tobias , Finger Robert 
Published: July 2016

Abstract
Adverse weather events occurring at sensitive stages of plant growth can cause substantial yield losses in crop production. Agricultural insurance schemes can help farmers to protect their income against downside risks. While traditional indemnity-based insurance schemes need governmental support to overcome market failure caused by asymmetric information problems, weather index–based insurance (WII) products represent a promising alternative. In WII the payout depends on a weather index serving as a proxy for yield losses. However, the nonperfect correlation of yield losses and the underlying index, the so-called basis risk, constitutes a key challenge for these products. This study aims to contribute to the reduction of basis risk and thus to the addition of risk-reducing properties of WII. More specifically, the study tests whether grid data for precipitation (vs weather station data) and phenological observations (vs fixed time windows for index determination) that are provided by public institutions can reduce spatial and temporal basis risk and thus improve the performance of WII. An empirical example of wheat production in Germany is used.
No differences were found between using gridded and weather station precipitation, whereas the use of phenological observations significantly increases expected utility. However, even if grid data do not yet reduce basis risk, they enable overcoming several disadvantages of using station data and are thus useful for WII applications. Based on the study’s findings and the availability of these data in other countries, a massive potential for improving WII can be concluded.
Tackling Health System Delays for Cancer Patients in LMICs: An Innovative Multicomponent Programmatic Intervention in Botswana
Authors: Tapela Neo M. , Pusoentsi Malebogo , Botebele Kerapetse , Peluso Michael , Nkele Isaac , Efstathiou Jason , Barak Tomer , Dryden-Peterson Scott 
Published: July 2016

Abstract 67 Background: Health system delays are a major contributor to poor outcomes among cancer patients in low- and middle-income countries (LMICs). In Botswana, while median time from cancer-related symptom onset to first presentation at local health facility is 29 days, median time to initiation of cancer treatment is 401 days. Challenges to timely diagnosis and care include clinicians' lack of knowledge, limited diagnostic capacity, poor coordination between facilities, and socioeconomic barriers of patients that impede follow-up. We sought to develop an intervention to improve access to prompt cancer care. Methods: Participating facilities are all public health facilities (21 health posts, 14 clinics, 2 hospitals) in Botswana's Kweneng-East district as well as the national referral hospital. The five components of intervention are a) training of clinicians at primary facilities on evaluation of patients with suspected cancer, b) implementation of a standardized referral algorithm for cancer suspects, c) introduction of care-coordinator role to support patient and clinician navigation of the health system, d) use of SMS-based platform to support follow-up, e) provision of transport support for vulnerable patients. The primary endpoints are stage at cancer diagnosis and time from initial presentation to initiation of cancer treatment. Evaluation of the intervention's impact will include comparing endpoints following intervention with those at baseline and those among patients residing outside the Kweneng-East district. Results: Implementation of the above multi-component intervention will be presented, including a standardized algorithm to guide the evaluation, triage and referral of patients, an intensive one-day didactic training program that adapts curricula employed in the region, and the impact of training on knowledge. Conclusion: In conducting this study, we hope to identify effective program-based measures to reduce delays and improve cancer outcomes in Botswana. These measures may be scaled to other districts, and may be applicable to similar settings in the region. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Neo M. Tapela No relationship to disclose Malebogo Pusoentsi No relationship to disclose Kerapetse Botebele No relationship to disclose Michael Peluso No relationship to disclose Isaac Nkele No relationship to disclose Jason Efstathiou Honoraria: Medivation/Astellas, Bayer Healthcare Pharmaceuticals Consulting or Advisory Role: Medivation/Astellas, Bayer Healthcare Pharmaceuticals Tomer Barak No relationship to disclose Scott Dryden-Peterson No relationship to disclose
Development of a Single-Board Computer High-Resolution Microendoscope (PiHRME) to Detect Cervical Cancer in Low-Resource Settings
Authors: Parra Sonia , Keahey Pelham , Schmeler Kathleen , Maza Mauricio , Castle Philip , Richards-Kortum Rebecca R. 
Published: July 2016

Abstract 35 Almost 90% of cervical cancer deaths occur in developing countries, with the highest incidence rates occurring in Central and South America and sub-Saharan Africa.1 While early detection and treatment of cervical precancerous lesions effectively prevent the development of invasive cervical cancer, limited resources and infrastructure make it difficult to implement standard cervical cancer screening methods in low-resource areas. In many low-resource areas, health workers use visual inspection of the cervix following the application of acetic acid (VIA) to identify precancerous lesions. While VIA reduces cervical cancer mortality, it is associated with a low specificity. A number of recent studies have shown that high-resolution optical imaging can identify precancerous lesions in vivo with higher specificity than VIA; however, the cost of these imaging systems is a barrier to wider scale implementation. We therefore have developed a low-cost, high-resolution microendoscope controlled by a single-board computer (PiHRME) to detect cervical precancerous lesions at the point-of-care. The PiHRME allows healthcare providers to image the cervix in vivo and view cervical epithelial cells in real time with sub-cellular resolution. Here we demonstrate that a low cost ($35) single-board computer, the Raspberry Pi, can be used to reduce the cost and improve the mobility of a high-resolution optical imaging system without compromising its spatial resolution. Thus, HRME screening of cervical cancer can be made more accessible in low-resource areas. The PiHRME is currently being evaluated in a pilot study in El Salvador to assess its effectiveness at the point-of-care. 1American Cancer Society. Global Cancer Facts & Figures 3rd Edition. Atlanta: American Cancer Society; 2015. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Sonia Parra No relationship to disclose Pelham Keahey No relationship to disclose Kathleen Schmeler Research Funding: Cepheid Patents, Royalties, Other Intellectual Property: UpToDate Mauricio Maza No relationship to disclose Philip Castle Honoraria: Roche, Cepheid Consulting or Advisory Role: Cepheid, GE Healthcare, Guided Therapeutics, ClearPath, Merck, Genticel, Teva, Inovio Pharmaceuticals, Hologic Rebecca R. Richards-Kortum Honoraria: Jannsen Global Services Research Funding: Merck Patents, Royalties, Other Intellectual Property: Patents
Successful Implementation of a Pediatric Early Warning Score in a Resource-Limited Pediatric Oncology Hospital in Guatemala
Authors: Agulnik Asya , Soberanis Vasquez Dora Judith , García Ortiz Jose Emigdio , Mora Robles Lupe Nataly , Mack Ricardo , Antillón Federico , Kleinman Monica , Rodriguez-Galindo Carlos 
Published: July 2016

Abstract 25 Background: Hospitalized pediatric oncology patients are at high risk for clinical decline and mortality, particularly in resource-limited settings. Pediatric Early Warning Scores (PEWS) are commonly used to aid with early identification of clinical deterioration; however, these scores have never been studied in oncology patients in low-resource settings. We describe the successful implementation of a modified PEWS at Unidad Nacional de Oncología Pediátrica (UNOP), a national pediatric oncology hospital in Guatemala. Methods: The PEWS used at Boston Children's Hospital (BCH) was modified through key informant meetings at UNOP, adjusting for practice variations between the two hospitals. After an initial pilot of the tool, the PEWS was implemented in all non-ICU inpatient areas at UNOP (60 beds with about 2,000 admissions/year). During implementation, systems were created to monitor errors in calculating PEWS, patient transfers to a higher level of care, and high PEWS scores for ongoing quality improvement. Results: Hospital-wide implementation occurred over 6 months, when 113 nurses were trained in the PEWS tool and algorithm. Compliance with PEWS performance and documentation was 100% by the end of the implementation period, with 300 to 400 PEWS measured daily and less than 10% errors. Monitoring of PEWS results reports an average of 5 high PEWS per week with 30% transferring to a higher level of care. Among patients requiring ICU transfer, 86% had an abnormal PEWS prior to transfer, which is similar to results at BCH (90%). Staff surveys showed a high degree of satisfaction with PEWS (4.6/5) and minimal difficulty using the score (2.3/5) (n=67). Conclusions: We describe the successful implementation of a PEWS in a pediatric oncology hospital in Guatemala. This work demonstrates that PEWS is a feasible, well-accepted, and low-cost quality improvement measure in this resource-limited setting. We now plan to evaluate the effects of this implementation on patient care and outcomes. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Introduction of Radiotherapy in Suriname: Impact on the Treatment of Cervical Cancer
Authors: Dams E.T.M. , Hawkins W.B. , Lichtveld M.Y. 
Published: July 2016

Abstract 7 Background: Cervical cancer is the second most frequent cancer and is the leading cause of cancer-related death in Surinamese women. Radiotherapy is an essential part of treatment, but until recently was not available in Suriname. Previously, affected women were treated abroad. This study evaluated the effect of the introduction of radiotherapy in 2012 on treatment coverage and quality of care. Methods: A retrospective cohort study was conducted, comparing treatment of women diagnosed with cervical cancer in the period 2008-2011, prior to introduction of radiotherapy, to treatment of women diagnosed in the period 2012-2013, who received radiotherapy locally. Results: During the study period January 2008–December 2013, 339 women received a first diagnosis of cervical cancer, corresponding to an average annual incidence rate of 21.3 ± 1.7 per 100,000 female population, with no significant changes during the study period. More than 80% of the women presented with late-stage disease. Creoles and indigenous women showed much higher incidence rates than the other ethnic groups. The proportion of women receiving appropriate radiotherapy increased from 71.6% in the period 2008-2011 to 82.4% in 2012-2013. The waiting time between diagnosis and treatment diminished with 38 days on average. In addition, the percentage women with a delay of >150 days decreased from 29% to 7%. Conclusion: Cervical cancer continues to pose an important health problem for women in Suriname. The introduction of radiotherapy has demonstrated improved treatment of invasive cervical cancer. However, additional prevention and early detection strategies are needed to lower incidence and mortality rates. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Higher Serum Selenium Concentration is Associated with a Higher Prevalence of Esophageal Squamous Dysplasia in Bomet, Kenya
Authors: Pritchett Natalie R. , Mwachiro Michael M. , Burgert Stephen L. , Murphy Gwen , Brockman John D. , Abnet Christian C. , Dawsey Sanford M. 
Published: July 2016

Abstract 15 Background: East Africa is a region of high esophageal squamous cell carcinoma (ESCC) incidence, and is known to have low soil selenium levels. Low selenium status measured in blood has been associated with ESCC risk. We measured serum selenium in a cross-sectional study of subjects from Bomet, Kenya, a region with a high incidence of ESCC and esophageal squamous dysplasia (ESD), its precursor lesion. Methods: An age and sex-stratified sample of 294 asymptomatic adult residents completed questionnaires and underwent endoscopy with Lugol's iodine and biopsy for detection of ESD in this community-based study. Serum selenium concentrations were measured using instrumental neutron activation analysis. Odds ratios (OR) and confidence intervals (95% CI) for associations between serum selenium and ESD were calculated using unconditional logistic regression, adjusting for multiple potential confounders. Ethical approval was obtained from the National Cancer Institute, Tenwek Hospital, and Kenyatta National Hospital. Results: Higher serum selenium (quartile 4) was associated with prevalence of ESD (OR: 3.03; 95% CI:1.05, 8.74) relative to lower serum selenium (quartile 1). This association remained significant after adjusting for potential confounders (Q4 vs Q1: OR: 4.24; 95% CI: 1.16, 15.46). Serum selenium concentration did differ significantly by geographic location (p=0.001); however, this did not explain the association between selenium and ESD. Conclusions: We found a significant adverse association between higher serum selenium levels and risk of ESD. These results are in contrast to our hypothesis derived from previous observations of an inverse association between selenium and ESCC. The discrepancy may be due to the difference in endpoint of ESD rather than ESCC. Further work is needed to better understand the potential role of selenium in esophageal cancer prevention and control strategies. Funding: This work was supported by the Intramural Research Program, Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Natalie R. Pritchett No relationship to disclose Michael M. Mwachiro No relationship to disclose Stephen L. Burgert Employment: Centers for Gastroenterology, Fort Collins, Colorado, USA Research Funding: Covidien Gwen Murphy No relationship to disclose John D. Brockman No relationship to disclose Christian C. Abnet No relationship to disclose Sanford M. Dawsey No relationship to disclose
High-Risk Human Papillomavirus (HR-HPV) Genotypes Among Women With Cervical Precancer and Cancer in Myanmar
Authors: Shwe Mu Mu , Nyunt Kyi Kyi , Aye Khin Saw , Thu Hlaing Myat , Mo Hla Myat Mo , Win Zin Mon Kay Knine , Kyaw Ohnmar , Maw Khin Than , Thant Kyaw Zin 
Published: July 2016

Abstract 11 In Myanmar, cervical cancer ranks as the first most frequent cancer among women aged between 15 to 44 years and Human Papillomavirus (HPV) vaccination program is not established yet. Information on HPV genotypes distribution in cervical cancer is crucial to predict the future impact of HPV vaccines. This study aimed to determine the HPV-DNA and genotypes among women with cervical pre-cancer and cancer in Myanmar. A cross-sectional descriptive study was performed in 169 women with cervical neoplasia during 2012 to 2014. After obtaining informed consent, cervical cells were collected from 134 women with cervical intraepithelial neoplasia (CIN) and 35 with squamous cell carcinoma (SCC) of the cervix attending Sanpya General Hospital, Yangon, and Central Women Hospital, Mandalay. HPV-DNA testing and genotyping was performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). HR-HPV was identified in CINI (39.3%), CINII (58.6%), CINIII (66.7%), and SCC (77.1%). Overall, the most common genotypes were HPV-16 (68.1%), followed by HPV-31 (16.5%), HPV-18 (7.7%), HPV-58 (6.6%), and HPV-35 (1.1%). Among SCC, HPV-16 was the most common genotype (66.7%) followed by HPV-18 (14.8%), HPV-31 (11.1%), HPV-35 (3.7%), and HPV-58 (3.7%). In CINI, the most common genotype were HPV-16 (69.7%) followed by HPV-31 (21.2%), HPV-18 (6.1%) and HPV-58 (3.0%). In CINII, HPV-16 was most commonly determined (52.9%) followed by HPV-31 (23.5%), HPV-58 (17.6%), and HPV-18 (5.9%). In CINIII, HPV-16 was also the most common genotype (85.7%) followed by HPV-31 (7.1%) and HPV-58 (7.1%). Vaccine preventable genotype, HPV-16 was the most common genotype in Myanmar. This study highlighted that the establishment of National HPV vaccination program is needed to reduce the incidence and mortality of cervical cancer in Myanmar.[Table: see text][Table: see text] AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
ASCP's Partners for Cancer Diagnosis and Treatment in Africa
Authors: Milner Danny A. , Holladay Blair 
Published: July 2016

Abstract 38 A primary goal of any health care system should be to attain universal access for all patients within a catchment area. The cancer care model requires that physicians encountering patients who they suspect of having a malignancy have access to a system that ensures rapid, accurate, and reliable pathology for primary diagnosis of cancer. Sub-Saharan Africa faces immense challenges in providing adequate coverage. Each region, country, and district has unique obstacles to overcome when meeting the health needs of the population. The American Society of Clinical Pathology (ASCP), in partnership with the White House Office of Science Technology Policy and the Clinton Global Initiative, recently launched a $26.5 million multi-year initiative. The initiative begins with assessment of potential countries with the greatest need--including collaboration and capacity program building with local officials and staff--to deploy full service pathology infrastructure for eligible countries to strategically meet their population needs. Working in parallel and together, steering committees for Diagnostics and Technology, Care and Treatment, In-Country Medical Education, Bioethics, and Monitoring & Evaluation have focused on each potential country to optimize success. The maximal intervention includes deployment of automated histopathology systems and integrated whole slide imaging systems. Imaging systems are linked through a customized laboratory information system to a dedicated team of pathologists from the United States. This long-term project will roll out to 10 or more countries in Africa as well as Haiti. An overview of the project will be presented as well as experiences data from countries launched to date. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from either author.
Using a Novel Peer Mentoring Program to Foster Conversion from Mentee to Mentor Among Clinician/Researchers-in-Training in Uganda
Authors: Phipps Warren T. , Kafeero James , Orem Jackson , Kansiime Rachel , Casper Corey , Morrow Rhoda Ashley 
Published: July 2016

Abstract 54 Program Purpose: The Uganda Cancer Institute (“UCI”)/Hutchinson Center Cancer Alliance studies infection-related cancers and builds capacity for research and medical care. Weekly research in progress (RIP) meetings for Alliance scientists and staff were started in 2010 and, in 2013, were converted to a structured, facilitated Peer-driven Mentoring and Career Development program (“PMCD”). PMCD includes weekly RIP, monthly consultant lectures or skills workshops (N=16), monthly peer-run journal clubs (N=16), and, recently, quarterly bioethics workshops (N=2). Long-term goals of PMCD include: 1) developing leadership and 2) generating confident, skilled mentors. Evaluation: Confidential surveys (30 questions; 18 scaled 1-5) were conducted at PMCD launch, after one year, and, reported here, after two years (N=58; including 6 Alliance junior investigators, 28 UCI medical/nursing officers, 21 staff, and 3 students). Surveys probed history of PMCD participation and PMCD usefulness. Scaled questions (1=strongly disagree to 5=strongly agree) measured confidence, leadership, and research skills. Outcomes: Eleven (26%) respondents indicated they “often” (vs sometimes, rarely or never) mentored others in the previous year for research-related issues (“R-Mentors”); most (82-91%) had attended PMCD activities for >12 months. Weighted averages of R-Mentors were significantly higher (t-test) than non-mentors (N=32) for career confidence, leadership, and sense of support from PMCD: “I have developed ability to lead research team members.” (4.50 vs 2.97; P<0.001). “PMCD has helped develop my leadership skills (4.70 vs 3.61; P<0.001); or confidence.” (4.27 vs 3.48; P<0.05). “I feel a sense of community in PMCD meetings.” (4.60 vs 3.87; P<0.05) “I know where to turn for help.” (4.36 vs 3.72; P<0.05) “I do not feel alone in facing research challenges.” (4.70 vs 3.52; P<0.001) Conclusion: PMCD is a cost-effective, transferable method to foster development of clinician-scientists who have the leadership, confidence and support to mentor others; a major step toward building capacity for independent research science in Uganda. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Warren T. Phipps No relationship to disclose James Kafeero No relationship to disclose Jackson Orem No relationship to disclose Rachel Kansiime No relationship to disclose Corey Casper Leadership: Temptime Coporation Consulting or Advisory Role: Janssen Pharmaceuticals Research Funding: Janssen Pharmaceuticals Travel, Accommodations, Expenses: Temptime Corporation, Glaxo Smith Kline Rhoda Ashley Morrow No relationship to disclose