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Adhikari, Shiva Hari. "Remittances and Development in Nepal: A Disaggregated Analysis." Journal of Management and Development Studies 30, no. 1 (April 8, 2021): 37–50. http://dx.doi.org/10.3126/jmds.v30i1.36350.
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Remittance flows into low/middle-income counties are on a continuous rise and this trend is seen in Nepal as well. There is a constant increase in the number of the Nepalese workers migrating for foreign employment and that has been instrumental to boost the remittance inflow into the country. Remittance is contributing significantly to Gross Domestic Product and is emerging as a backbone of the country’s economy. However, the ways remittances contribute to social development necessitates that many facets of development be explored because they affect the country’s development in multiple ways. This study attempts to analyse the possibility that remittance positively contributes to social development, considering health and educational development as its proxies. Based on the latest available disaggregated educational enrolment and nutrition data of 2009 A.D. by districts, this study analyses the impact of the remittances on school enrolment and improvement in health status of families who remain at home. The results show a significant relationship between remittance and school enrolment but it also shows an insignificant relationship between remittance and health. The findings may be of interest to the countries and the policy makers with remittance being the dominant source of foreign currency. As the results of this study have indicated that remittances may serve as a contributing factor to the educational enrolment for social development.
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Muja, Naser, and Steven H. Appelbaum. "MBA program enrolment as a catalyst for boundaryless career goals (part one)." Industrial and Commercial Training 46, no. 3 (April 1, 2014): 135–42. http://dx.doi.org/10.1108/ict-02-2013-0011.
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Purpose – Further investigation of the thoughts and attitudes contributing to the voluntary pursuit of an MBA degree and career change is necessary to better understand career motivations and to satisfy career goals. This two-part article attempts to achieve this objective. Design/methodology/approach – Factors contributing to the cognitive decision to enrol in an MBA program and the subsequent impact of self-discovery gained on program entry on career strategy were explored using a 32-question survey based on empirical research findings. Findings – Part-time and full-time MBA students exhibited differences in decision criteria applied for MBA program entry. Following program enrolment, opportunities for career growth led to upward goal revision and increasingly focused goals. Research limitations/implications – Participation was potentially limited by survey distribution during a demanding academic period where many project reports and group presentations were due. A single MBA program in the downtown Montreal area may not be representative of all programs in the population. Practical implications – Anchoring individual career identity and social identity has become increasingly complex as employers in many industries undergo continuous transformational change. Social implications – Integration within the work environment of identified career roles requires additional attention to validate an individual's strategic career efforts. Originality/value – Surveying MBA candidates about career decisions and goal-revision allows for a valuable “snapshot” of career evolution over time. By promoting increased self-awareness, applied knowledge gained through MBA program activities acts as a catalyst for self-efficacy beliefs which results in upward distal goal-revision or increased goal focus.
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Muja, Naser, and Steven H. Appelbaum. "MBA program enrolment as a catalyst for boundaryless career goals (part two)." Industrial and Commercial Training 46, no. 4 (May 27, 2014): 201–8. http://dx.doi.org/10.1108/ict-02-2013-0012.
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Purpose – Further investigation of the thoughts and attitudes contributing to the voluntary pursuit of an MBA degree and career change is necessary to better understand career motivations and to satisfy career goals. The purpose of this two-part paper is to achieve this objective. Design/methodology/approach – Factors contributing to the cognitive decision to enroll in an MBA program and the subsequent impact of self-discovery gained upon program entry on career strategy were explored using a 32-question survey based on empirical research findings. Findings – Part-time and full-time MBA students exhibited differences in decision criteria applied for MBA program entry. Following program enrollment, opportunities for career growth led to upward goal revision and increasingly focussed goals. Research limitations/implications – Participation was potentially limited by survey distribution during a demanding academic period where many project reports and group presentations were due. A single MBA program in the downtown Montreal area may not be representative all programs in the population. Practical implications – Anchoring individual career identity and social identity has become increasingly complex as employers in many industries undergo continuous transformational change. Social implications – Integration within the work environment of identified career roles requires additional attention to validate an individual's strategic career efforts. Originality/value – Surveying MBA candidates about career decisions and goal-revision allows for a valuable “snapshot” of career evolution over time. By promoting increased self-awareness, applied knowledge gained through MBA program activities acts as a catalyst for self-efficacy beliefs which results in upward distal goal-revision or increased goal focus.
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Igbinedion, Sunday Osahon, and Clement Atewe Ighodaro. "MIGRANTS’ REMITTANCES AND PUBLIC EXPENDITURE ON EDUCATION NEXUS: EVIDENCE FROM AN OIL-DEPENDENT ECONOMY." Oradea Journal of Business and Economics 4, no. 2 (September 2019): 112–25. http://dx.doi.org/10.47535/1991ojbe083.
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This study examined migrants’ remittances, public expenditure on education and their implications for educational development in Nigeria, using Secondary School enrolment rates (SSER) as a proxy for the latter for the period 1981 to 2017. The study utilised Cointegration and error correction modelling approach in order to minimise the likelihood of producing explosive regression estimates. The empirical findings of the study indicate that Migrants’ remittances received, Public expenditures on Education and Per Capita Income growth rate exert statistically significant positive impacts on educational development in the country, while the association turned negative in the case of population growth rate. The fundamental role played by both migrant’s remittances received and Public expenditures on Education in stimulating educational development was evidently established in the study. The study therefore recommends, among others, the adoption of strategic measures that will help boost the rate of school enrolment in the country by encouraging migrants’ remittances through continuous engagement of Nigerians in the Diaspora in the country’s political and socio-economic affairs, progressive increment in budgetary allocations to the nation’s education sector, as well as enhancing the per capita income of the country through investments in key sectors of the nation’s economy.
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Micic, D., J. Jiang, L. Chen, T. Fan, F. Mu, A. Satija, N. Downes, et al. "P431 Teduglutide use and nutritional outcomes in short bowel syndrome with intestinal failure: a real-world claims database analysis." Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S433—S434. http://dx.doi.org/10.1093/ecco-jcc/jjab076.555.
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Abstract Background Teduglutide (TED) is a glucagon-like peptide 2 analogue approved for the treatment of patients with short bowel syndrome (SBS) requiring parenteral support (PS). SBS is a rare condition resulting from a reduced absorptive surface area of the small intestine, most commonly due to inflammatory bowel disease (IBD). Patients with SBS with intestinal failure (SBS-IF) remain dependent on PS to maintain adequate calorie, fluid, electrolyte and micronutrient stability. In phase 3 clinical trials, TED reduced PS requirements in patients with SBS-IF. This study aimed to assess PS use and discontinuation rates among patients with SBS on TED using real-world data. Methods This retrospective cohort study of adults with SBS-IF (≥18 years) with ≥1 TED pharmacy claim(s) used the US-based administrative healthcare claims IBM MarketScan database (2009–2019). The first TED claim was defined as the index date. Patients required ≥6 months of continuous enrolment prior to index date (baseline period) and no history of malignancy. Primary analysis was conducted during the follow-up period (index date to earliest of continuous enrolment end or 2 years post-index). A sensitivity analysis was also conducted among the cohort during the TED utilization period (index date to the earliest of continuous enrolment end or TED discontinuation). Patients required PS use during both baseline and follow-up/TED utilization periods (primary and sensitivity analyses). PS discontinuation was defined as a PS utilization gap of ≥30 days. A generalized estimating equation linear regression model evaluated if PS use (days/week) changed significantly from baseline to selected time points post-index. Results Of 110 identified patients with SBS-IF, mean age was 53.4 (SD 13.2) years and 77 (70%) were women. Included were 51 (46%) patients with Crohn’s disease and 20 (18%) with ulcerative colitis. The main comorbidities were renal disease (23%) and liver disease (15%). PS frequency was 4.6 (2.5), 3.3 (2.9), 2.9 (3.0) and 3.6 (3.0) days/week at baseline and months 6 (p<0.0001), 12 (p<0.0001), and 24 (p=0.0267), respectively. PS discontinuation increased over time to 34.4%, 46.7% and 65.2% at 3, 6, and 12 months, respectively. The sensitivity analysis demonstrated similar rates of PS use and discontinuation. Conclusion In this real-world study of adults with SBS-IF, including >50% with IBD, TED was associated with PS reductions comparable to those achieved in clinical trials and higher PS discontinuation rates even when using a conservative analysis approach. Future research will be required to determine individual predictive factors of PS discontinuation.
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Chikusvura, Namatirai, Lwazi Sibanda, and Joyce Mathwasa. "The Competence-Based Advanced Level Mathematics Curriculum: Implications for Students’ Enrolment in one University in Zimbabwe." Randwick International of Education and Linguistics Science Journal 2, no. 1 (March 30, 2021): 8–19. http://dx.doi.org/10.47175/rielsj.v2i1.194.
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The study set out to examine the relevance of the competence-based Advanced Level mathematics curriculum for entry into university mathematics-related degree programmes. The study adopted a qualitative approach ingrained in the interpretive paradigm which employed a case study design. Four A-Level mathematics teachers, eighteen Lower Sixth and six Upper Sixth mathematics major students were purposively sampled to respond to semi-structured face-to-face interviews and focus group interviews. The study found that the implementation of the competence-based Advanced Level mathematics curriculum was negatively affected by incompetent teachers and supervisors, lack of resources and lack of support from other stakeholders. The study concluded that these impediments impacted negatively on students who aspired to pursue mathematics-related degree programmes at university and that there is a mismatch on the mathematics units in the competence-based Advanced Level mathematics curriculum and university requirements for mathematics-related degree programmes. The study recommends ministerial corroboration fostering university degree programmes requirements to be taught in high school, stakeholder involvement and continuous professional development for mathematics teachers and supervisors.
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Iqbal, Fahad Mujtaba, Meera Joshi, Sadia Khan, Hutan Ashrafian, and Ara Darzi. "Implementation of Wearable Sensors and Digital Alerting Systems in Secondary Care: Protocol for a Real-World Prospective Study Evaluating Clinical Outcomes." JMIR Research Protocols 10, no. 5 (May 4, 2021): e26240. http://dx.doi.org/10.2196/26240.
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Background Advancements in wearable sensors have caused a resurgence in their use, particularly because their miniaturization offers ambulatory advantages while performing continuous vital sign monitoring. Digital alerts can be generated following early recognition of clinical deterioration through breaches of set parameter thresholds, permitting earlier intervention. However, a systematic real-world evaluation of these alerting systems has yet to be conducted, and their efficacy remains unknown. Objective The aim of this study is to implement wearable sensors and digital alerting systems in acute general wards to evaluate the resultant clinical outcomes. Methods Participants on acute general wards will be screened and recruited into a trial with a pre-post implementation design. In the preimplementation phase, the SensiumVitals monitoring system, which continuously measures temperature, heart, and respiratory rates, will be used for monitoring alongside usual care. In the postimplementation phase, alerts will be generated from the SensiumVitals system when pre-established thresholds for vital parameters have been crossed, requiring acknowledgement from health care staff; subsequent clinical outcomes will be analyzed. Results Enrolment is currently underway, having started in September 2017, and is anticipated to end shortly. Data analysis is expected to be completed in 2021. Conclusions This study will offer insight into the implementation of digital health technologies within a health care trust and aims to describe the effectiveness of wearable sensors for ambulatory continuous monitoring and digital alerts on clinical outcomes in acute general ward settings. Trial Registration ClinicalTrials.gov NCT04638738; https://clinicaltrials.gov/ct2/show/NCT04638738. International Registered Report Identifier (IRRID) DERR1-10.2196/26240
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Mease, Philip J., Carol J. Etzel, William J. Huster, Talia M. Muram, April W. Armstrong, Jeffrey R. Lisse, Sabrina Rebello, et al. "Understanding the association between skin involvement and joint activity in patients with psoriatic arthritis: experience from the Corrona Registry." RMD Open 5, no. 1 (May 2019): e000867. http://dx.doi.org/10.1136/rmdopen-2018-000867.
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ObjectiveTo compare the characteristics of patients with psoriatic arthritis among patient groups stratified by degree of skin and joint involvement, and to evaluate the relationship between skin severity and joint activity.MethodsBody surface area (BSA) and Clinical Disease Activity Index (CDAI) at enrolment were analysed. Patient characteristics were stratified by skin severity and joint activity. Baseline patient characteristics, clinical and disease characteristics and patient-reported outcomes were compared. The strength of the relationship of skin severity and joint activity was evaluated using methods for categorical variables (χ2 test, Cramer’s V) and continuous variables (linear regression).Results1542 adult patients in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry enrolled between 21 May 2013 and 20 September 2016 were analysed. Most patients in the BSA >3%/CDAI moderate/high subgroup had worse clinical and patient-reported outcomes. A significant (p<0.001) modest association (Cramer’s V=0.1639) between skin severity and joint activity was observed among all patients at enrolment. Patients with higher skin severity were two times more likely to have higher joint involvement (OR 2.27, 95% CI 1.71 to 3.01). A significant linear relationship between CDAI and BSA was observed. Effect modification showed this linear relationship was modified by age, gender, insurance, work status, current therapy, Health Assessment Questionnaire, Nail visual analogue scale, minimal disease activity, dactylitis count, patient-reported pain and fatigue.ConclusionSkin severity is modestly correlated with joint activity, and patients with higher skin severity are two times more likely to have increased joint involvement. Clinicians need to address both skin severity and joint activity in treatment decisions.
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Brezavšček, Alenka, Mirjana Pejić Bach, and Alenka Baggia. "Markov Analysis of Students’ Performance and Academic Progress in Higher Education." Organizacija 50, no. 2 (May 1, 2017): 83–95. http://dx.doi.org/10.1515/orga-2017-0006.
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Abstract Background: The students’ progression towards completing their higher education degrees possesses stochastic characteristics, and can therefore be modelled as an absorbing Markov chain. Such application would have a high practical value and offer great opportunities for implementation in practice. Objectives: The aim of the paper is to develop a stochastic model for estimation and continuous monitoring of various quality and effectiveness indicators of a given higher education study programme. Method: The study programme is modelled by a finite Markov chain with five transient and two absorbing states. The probability transition matrix is constructed. The quantitative characteristics of the absorbing Markov chain, like the expected time until absorption and the probabilities of absorption, are used to determine chosen indicators of the programme. Results: The model is applied to investigate the pattern of students’ enrolment and their academic performance in a Slovenian higher education institution. Based on the students’ intake records, the transition matrix was developed considering eight consecutive academic seasons from 2008/09 until 2016/17. The students’ progression towards the next stage of the study programme was estimated. The expected time that a student spends at a particular stage as well as the expected duration of the study is determined. The graduation and withdrawal probabilities were obtained. Besides, a prediction on the students’ enrolment for the next three academic years was made. The results were interpreted and discussed. Conclusion: The analysis presented is applicable for all higher education stakeholders. It is especially useful for a higher education institution’s managers seeing that it provides useful information to plan improvements regarding the quality and effectiveness of their study programmes to achieve better position in the educational market.
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Renganathan, BS, Sridhar Nagaiyan, SP Preejith, Shameer Gopal, Susovan Mitra, and Mohanasankar Sivaprakasam. "Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India." Journal of the Intensive Care Society 20, no. 4 (October 11, 2018): 309–15. http://dx.doi.org/10.1177/1751143718804682.
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Purpose Hospital-acquired pressure ulcers are a significant cause of morbidity and consume considerable financial resources. Turn protocols (repositioning patients at regular intervals) are utilized to reduce incidence of pressure ulcers. Adherence to turn protocols is particularly challenging for nursing teams, given the high number of interventions in intensive care unit, and lack of widely available tools to monitor patient position and generate alerts. We decided to develop and evaluate usefulness of a continuous patient position monitoring system to assist nurses in improving turn protocol compliance. Methods We conducted a prospective, non-randomized, multiphase, multicentre trial. In Phase I (control group), the function of the device was not revealed to nurses so as to observe their baseline adherence to turn protocol, while Phase II (intervention group) used continuous patient position monitoring system to generate alerts, when non-compliant with the turn protocol. All consecutive patients admitted to one of the two intensive care units during the study period were screened for enrolment. Patients at risk of acquiring pressure ulcers (Braden score < 18) were considered for the study (Phase I (N = 22), Phase II (N = 25)). Results We analysed over 1450 h of patient position data collected from 40 patients (Phase I (N = 20), Phase II (N = 20)). Turn protocol compliance was significantly higher in Phase II (80.15 ± 8.97%) compared to the Phase I (24.36 ± 12.67%); p < 0.001. Conclusion Using a continuous patient position monitoring system to provide alerts significantly improved compliance with hospital turn protocol. Nurses found the system to be useful in providing automated turn reminders and prioritising tasks.
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Zhang, Chang, and Hongfei Wang. "The Development of Chinese Language Education in Ireland: Issues and Prospects." TEANGA, the Journal of the Irish Association for Applied Linguistics 25 (November 15, 2018): 34–51. http://dx.doi.org/10.35903/teanga.v25i0.48.
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There has been a massive growth in trade and communication between Ireland and China in the past decade. Under such influence, Irish third level institutions have established Chinese or Chinese-related degree programmes, and post-primary schools have been offering Chinese courses as Transition Year1 modules. However, the continuous development of Chinese language education in Ireland also faces many challenges. Though the Junior Cycle Short Course2 in Chinese has been designed and published for three years now, there are still very few schools offering this course for a variety of educational and sociocultural reasons. In higher education, Chinese programmes are showing decreasing enrolment, and learners were found to suffer from demotivation issues. This paper briefly reviews the development of Chinese language education in Ireland in the past decade. It aims to suggest means of addressing some existing issues from three general perspectives regarding the course syllabi and materials, the Chinese teachers and the relevant research in an Irish context.
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He, Xuan, Kun-Ming Cheng, Linlin Zhang, Hongqiu Gu, Xin Qu, Yuan Xu, Penglin Ma, and Jian-Xin Zhou. "Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial." BMJ Open 10, no. 11 (November 2020): e040939. http://dx.doi.org/10.1136/bmjopen-2020-040939.
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IntroductionPostoperative delirium (POD) is prevalent in patients after major surgery and is associated with adverse outcomes. Several studies have reported that dexmedetomidine, a highly selective α2-adrenergic receptor agonist, can decrease the incidence of POD. However, neurosurgical patients are usually excluded from previous studies. The present study was designed to investigate the impact of prophylactic use of low-dose dexmedetomidine on the incidence of POD in patients after intracranial operation.Methods and analysisThis is a multicentre, randomised, double-blinded and placebo-controlled trial. Seven hundred intensive care unit admitted patients after elective intracranial operation for brain tumours under general anaesthesia are randomly assigned to the dexmedetomidine group or the placebo group with a 1:1 ratio. For patients in the dexmedetomidine group, a continuous infusion of dexmedetomidine will be started at a rate of 0.1 μg/kg/hour immediately after enrolment on the day of operation and continued until 08:00 on postoperative day 1. For patients in the placebo group, normal saline will be administered at the same rate as in the dexmedetomidine group. The patients will be followed up for 28 days after enrolment. The primary endpoint is the incidence of POD, which is assessed two times per day using the Confusion Assessment Method for the intensive care unit (ICU), during the first 5 postoperative days. The secondary endpoints include the incidence of dexmedetomidine-related adverse events and non-delirium complications, the length of stay in the ICU and hospital and all-cause 28-day mortality after the operation.Ethics and disseminationThe study protocol was approved by the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (No KY2019-091-02) and registered at ClinicalTrials.gov. The results of the trial will be presented at national and international conferences relevant to subject fields and submitted to international peer-reviewed journals.Trial registration numberTrial registration number: NCT04399343; Pre-results.
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Badu, Eric, Peter Agyei-Baffour, Isaac Ofori Acheampong, Maxwell Preprah Opoku, and Kwasi Addai-Donkor. "Households Sociodemographic Profile as Predictors of Health Insurance Uptake and Service Utilization: A Cross-Sectional Study in a Municipality of Ghana." Advances in Public Health 2018 (2018): 1–13. http://dx.doi.org/10.1155/2018/7814206.
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Introduction. Attempts to use health insurance in Low and Middle Income Countries (LMICs) are recognized as a powerful tool in achieving Universal Health Coverage (UHC). However, continuous enrolment onto health insurance schemes and utilization of healthcare in these countries remain problematic due to varying factors. Empirical evidence on the influence of household sociodemographic factors on enrolment and subsequent utilization of healthcare is rare. This paper sought to examine how household profile influences the National Health Insurance Scheme (NHIS) status and use of healthcare in a municipality of Ghana. Methods. A cross-sectional design with quantitative methods was conducted among a total of 380 respondents, selected through a multistage cluster sampling. Data were collected using a semistructured questionnaire. Data were analysed using descriptive and multiple logistics regression at 95% CI using STATA 14. Results. Overall, 57.9% of respondents were males, and average age was 34 years. Households’ profiles such as age, gender, education, marital status, ethnicity, and religion were key predictors of NHIS active membership. Compared with other age groups, 38–47 years (AOR 0.06) and 58 years and above (AOR = 0.01), widow, divorced families, Muslims, and minority ethnic groups were less likely to have NHIS active membership. However, females (AOR = 3.92), married couples (AOR = 48.9), and people educated at tertiary level consistently had their NHIS active. Proximate factors such as education, marital status, place of residence, and NHIS status were predictors of healthcare utilization. Conclusion. The study concludes that households’ proximate factors influence the uptake of NHIS policy and subsequent utilization of healthcare. Vulnerable population such as elderly, minority ethnic, and religious groups were less likely to renew their NHIS policy. The NHIS policy should revise the exemption bracket to wholly cover vulnerable groups such as minority ethnic and religious groups and elderly people at retiring age of 60 years.
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Karki, C., D. Latremouille-Viau, I. Gilaberte, G. Hantsbarger, H. Romdhani, and A. Lightner. "P340 Real-world treatment patterns and recurrence rates of rectovaginal fistulas in patients with Crohn’s disease: A retrospective cohort database analysis." Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S364—S365. http://dx.doi.org/10.1093/ecco-jcc/jjab076.464.
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Abstract Background Rectovaginal fistulas (RVF) are a difficult to treat perianal complication of Crohn’s disease (CD) with a significant impact on quality of life. Management of RVF includes both medical and surgical interventions. Few studies have assessed real-world treatment patterns for CD-related RVF. This retrospective US cohort database analysis aimed to assess the rate of, and time to RVF episodes of care in CD, and describe treatment patterns. Methods IBM Truven Health MarketScan® databases (Commercial and Medicare supplemental administrative claims [01/01/01 to 31/12/19]) were used. Adult females with a diagnosis code for CD, ≥1 medical claim with a RVF-specific diagnosis/procedure ICD-9/10 code on or after the date of first observed CD diagnosis, and ≥180 and ≥720 days of continuous health plan enrolment before and after index (date of first RVF-related code after first CD diagnosis date), respectively, were included. Treatment patterns were assessed during the 6 months pre-index (baseline period) and any time post-index. The first RVF episode of care (episode) started on the date of the first RVF-related code after CD diagnosis. RVF-related codes ≤90 days apart were considered as the same episode. Time to subsequent episodes was assessed by Kaplan–Meier (KM) analysis. Only descriptive statistics were reported for the proportion of patients with episodes and subsequent treatment patterns. Results Of 274 096 adult females diagnosed with CD during a continuous eligibility period, 2540 (0.9%) had a RVF-specific code. Overall, 963 patients met the inclusion criteria (median age: 46.0 years). The median follow-up (time between the index date and end of continuous health plan enrolment or data availability) was 48.5 months. During the follow-up period, 963 (100%), 430 (44.7%) and 217 (22.5%) patients had at least one, two or three episodes, respectively. KM analysis showed the probability of having a subsequent episode within 1, 2 and 5 years of their first or second episode (Figure). During the baseline period, 775 (80.5%) and 287 (29.8%) patients received non-biologic or biologic therapies, respectively, and 929 (96.5%) and 494 (51.3%) at any time post-index. At any time post-index, 587 (61.0%) patients had ≥1 RVF-related surgery. Conclusion This study showed patients with CD-related RVF required recurrent episodes of medical and surgical care in a US real-world setting. In addition, post-index, an important proportion of patients were observed with biologics use (>50%) and nearly two-thirds of patients had RVF-related surgery. Patients with CD-related RVF had varied treatment patterns and more studies are needed to inform the standard of care for patients with RVF. Sponsor: Takeda Pharmaceuticals, Inc.
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Burris, Howard A., Judy Sing-Zan Wang, Melissa Lynne Johnson, Gerald Steven Falchook, Suzanne Fields Jones, Donald K. Strickland, Carol Greenlees, et al. "A phase I, open-label, first-time-in-patient dose escalation and expansion study to assess the safety, tolerability, and pharmacokinetics of nanoparticle encapsulated Aurora B kinase inhibitor AZD2811 in patients with advanced solid tumours." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): TPS2608. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.tps2608.
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TPS2608 Background: Aurora kinase B performs key roles in the regulation of the cell cycle and represents a potential target for anticancer therapy. AZD2811, formerly designated AZD1152 hydroxy-quinazoline pyrazole anilide (AZD1152 hQPA), is a potent and selective inhibitor of Aurora B kinase activity and has been incorporated into a polymer nanoparticle carrier for intravenous (IV) administration. The phosphate pro-drug of AZD2811, known as AZD1152 (barasertib), reached Phase II of clinical development as a continuous IV infusion. While promising efficacy was seen with barasertib in elderly acute myeloid leukaemia (AML) patients ( Kantarjian HG et al., Cancer 2013;119:2611-19), continuous intravenous drug delivery precluded subsequent development in this disease setting and there were limited clinical responses in solid tumour patients due to dose-limiting myelotoxicity. AZD2811 nanoparticle has been designed to overcome these issues. Methods: Patients with relapsed advanced solid malignancies with no standard treatments are eligible for the part A dose escalation. Primary endpoint is to determine the maximum tolerated dose of AZD2811 nanoparticle using a 3+3 design. Patients with refractory/relapsed small cell lung cancer (SCLC) will be eligible for the part B expansion, where the safety, PK and anti-tumour activity of AZD2811 nanoparticle will be assessed as monotherapy and in combination with chemotherapy. Study enrolment is ongoing. Clinical trial information: NCT02579226.
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Costa, Francesco Vittorio. "Trends in prescribing and persistence with antihypertensive therapy: results of the study PAPEETE (Population-based Analysis of Persistence and Economics of treatment with telmisartan) study." Farmeconomia. Health economics and therapeutic pathways 10, no. 4 (January 15, 2009): 161–69. http://dx.doi.org/10.7175/fe.v10i4.190.
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This paper summarizes the results of the PAPEETE study (Population-based Analysis of PErsistence with treatment and Economics of TElmisartan) that assessed trends in prescriptions, determinants and timing of treatment discontinuation and/or changes in antihypertensive drug therapy in a cohort of hypertensive patients living in Pavia. In the study were included all new users 18 years old or over receiving a first prescription for diuretics, beta-blockers, calcium channel-blockers, ACE inhibitors (ACEi) or angiotensin receptor blockers (ARBs) between 1 January 2003 and 31 December 2006. The follow-up period for each patient was 12 months starting from enrolment date. Based in the presence of continuous therapy, patients were defined as persistent and non-persistent users. A total of 61,493 patients was included in the study of whom 11.2% were persistent. Persistence with the treatment seems to be associated with patient-related factors and with the class of anti-hypertensive drug initially prescribed with the lowest persistence to antihypertensive treatment with diuretics (3.0%) and the highest with ARBs (18.8%).
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Csapó, Zsolt, András Nábrádi, Krisztián Kovács, and Tünde Csapóné Riskó. "MBA education at the University of Debrecen and its further development towards Double Degree Programmes." Applied Studies in Agribusiness and Commerce 11, no. 1-2 (June 30, 2017): 167–70. http://dx.doi.org/10.19041/apstract/2017/1-2/20.
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University of Debrecen is the oldest higher educational institution in continuous operation in Hungary based in the same city. MBA training at Debrecen Agricultural University was initiated by 0257-91/1 Tempus Joint European Project Grant. The project was coordinated by the Netherlands Institute for Management (RVB) Maastricht. Participating institutions include University College in Dublin, Agricultural University in Wageningen and Debrecen Agricultural University. Minimum requirements established were a BSc (or equivalent) degree, an English certificate of language proficiency and one letter of reference from work supervisors or former teachers. Application requirements included a completed application form, Curriculum vitae, a certified copy of degree(s), an official copy of language knowledge certificate, a letter of recommendation and the receipt of registration fee payment. The academic year began on 1 September 1991, and project studies were carried out in small groups. Practical experience that had been gained before enrolment was taken into account and after the successful completion of the requirements students were granted MBA degrees.
JEL CODE: I21, I25
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Soyer, Kemal, Hale Ozgit, and Husam Rjoub. "Applying an Evolutionary Growth Theory for Sustainable Economic Development: The Effect of International Students as Tourists." Sustainability 12, no. 1 (January 6, 2020): 418. http://dx.doi.org/10.3390/su12010418.
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In this globalized era of strict competition, all actors in countries must focus on their strengths for continuous growth, which would presumably lead to sustainable economic development. Amongst the three components of sustainable development, this paper focuses on the economic and social aspects. Many countries are becoming service-oriented for economic growth. Education is a form of human capital investment which significantly contributes to countries’ national income via students, particularly international cross-border students in higher education institutions. While endogenous growth models dismiss the importance of governments in the growth process, in this paper, the Keynesian and new growth theories are combined to form an evolutionary growth theory. This research aims to analyze the short and long-term relationships between macroeconomic variables, international students, and their impact on the gross domestic product (GDP) of a small island with the intention of policy implications for stakeholders to reach or maintain sustainable economic development. Using an evolutionary growth theory with 34 years of time-series data on quarterly base, the vector autocorrection (VAR) model helps reveal the short and long-run relationships as well as impacts on the economy for sustainable economic growth. The results confirmed a long-run relationship via cointegration. Moreover, they approved bidirectional causality between student numbers, general secondary school enrolment, and GDP. Findings suggest significant implications for all stakeholders, particularly for higher education institutions, the government, and local citizens due to the importance of micro and macro-economic variables’ effect on GDP. The results prove that educated human capital contributes to economic growth. Governments should continue their existing strategy regarding secondary school enrolment rates as it is found to be the most effective variable in the long-run. As education, knowledge, and information transfer rises, it contributes to sustainable development through promoting social stability. Limitation of the unavailability of the total yearly population, GDP was opted instead of GDP per capita.
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Tebbutt, Niall C., Timothy Jay Price, Katrin Marie Sjoquist, Anne-Sophie Veillard, Merryn Hall, Danielle Angela Ferraro, Nicole Wong, et al. "Final results of AGITG ATTAX3 study: Randomized phase II study of weekly docetaxel (T), cisplatin, and fluoropyrimidine (F) with or without panitumumab (P) in advanced esophagogastric (OG) cancer." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 4081. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.4081.
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4081 Background: This randomized phase II study evaluated the efficacy and safety of P, a fully human mAb against the epidermal growth factor receptor combined with T-based chemotherapy in advanced OG cancer. Methods: Eligible pts had histologically confirmed metastatic OG cancer (adeno-carcinoma and squamous cell carcinoma) were ≥18 years of age, PS 0-2, with adequate renal, haematologic and liver function with measurable disease. All pts provided informed consent. Selection was not based on kras determination. Pts received T 30mg/m2 d1,8, C 60mg/m2 d1 and F; investigator choice of 5FU infusion 160mg/m2/d or capecitabine 500mg/m2bd continuous ±P 9 mg/kg d1 q3w. Treatment was administered for 8 cycles or until PD. The primary endpoint was response rate according to RECIST (1.1) assessed q6w. Planned enrolment target was 100 pts. Stratification variables included histology, PS and choice of F. Results: From April 2010 to November 2011, 77 pts were enrolled from 15 institutions. A safety alert from the REAL3 study (also involving P in OG cancer) prompted an unplanned review of data from ATTAX3 by the IDMC. The IDMC found no evidence of adverse outcomes associated with P, but as it did not appear that P would significantly improve efficacy, they recommended cessation of the study to new enrolment. Previously enrolled pts were treated and followed according to protocol. Median follow up is 24m. Treatment arms were well balanced; median age 59, 64y, male 77%, 87%, PS0-1 95%,90%, adenocarcinoma 90%,90%, capecitabine 67%, 66% for TCF/TCF-P, respectively. Common grade 3/4 toxicities include infection 18%,24%, febrile neutropenia 10%, 5%, anorexia 10%, 24%, nausea 18%,30%, stomatitis 3%,5%, diarrhoea 15%,24% , acneiform rash 0%, 8%, fatigue 18%, 30%, hypomagnesemia 10%, 16% for TCF/TCF-P. Efficacy outcomes are summarized in Table. Conclusions: The addition of P to T-based chemotherapy in advanced OG cancer did not improve efficacy and was associated with an increase in some toxicities. Clinical trial information: ACTRN12609000109202. [Table: see text]
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Popic, Mia, and Snezana Anticevic. "Stigmatization towards persons with mental and intellectual difficulties." Temida 16, no. 2 (2013): 43–56. http://dx.doi.org/10.2298/tem1302043p.
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Persons with mental and intellectual difficulties are the most stigmatized social groups of all. Consequences of stigma towards these people present themselves in a wide range including social withdrawal; feelings of loneliness; low self-esteem; failure to take care of oneself; avoidance of seeking help; low enrolment in any kind of treatment; financial poverty and total social marginalization. Although most of the attempts to overcome stigmatization towards this population have shown a very pessimistic perspective, it is important to overcome our own helplessness in treating this issue and continue with the efforts to combat stigma. The only way to succeed is through continuous and careful analysis of the factors that contribute to a human tendency to stigmatize that could then be utilized as the ground base in development of mechanisms to battle this issue. This paper summarizes ways that the stigmatization of persons with mental and intellectual difficulties is manifested as well as the negative influences it has on the people who are stigmatized. Factors that contribute to the stigmatization of persons are carefully considered, as well as possible mechanisms that could be utilized as part of efforts to combat stigma.
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P.M, Rejimon, and Smitha R. "HUMAN RESOURCE THROUGH EDUCATION OF SCHEDULED CASTE IN KERALA." International Journal of Advanced Research 8, no. 12 (December 31, 2020): 116–21. http://dx.doi.org/10.21474/ijar01/12131.
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This paper analyses the policy of reservation for Scheduled castes in Kerala. The paper provides a brief overview of the caste system and discusses the types of groups that are eligible for reservation, based on data from government reports. The stance of this paper is that affirmative action has not benefited the lower castes due to contextual factors like low school enrolment and completion rates, and high dropout and failure rates. Also, continuous addition of more and more castes to the fold of reserved categories has diluted the positive impact of the reservation policy. This paper suggests that under-representation of any social group in educational institutions should be assessed with reference to sub-populations of secondary school completers and argues that, unlike Scheduled Castes and Tribes, Other Backward Castes are not markedly under-represented. Hence, the 27% quota declared by the government recently is not justified. The paper also highlights the human resources through the education social, pedagogic, psychological and political issues involved in the policy of reservation, and suggests that quotas should be based on economic criteria rather than on caste considerations.
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Moon, T. D., J. R. Burlison, M. Blevins, B. E. Shepherd, A. Baptista, M. Sidat, A. E. Vergara, and S. H. Vermund. "Enrolment and programmatic trends and predictors of antiretroviral therapy initiation from President's Emergency Plan for AIDS Relief (PEPFAR)-supported public HIV care and treatment sites in rural Mozambique." International Journal of STD & AIDS 22, no. 11 (November 2011): 621–27. http://dx.doi.org/10.1258/ijsa.2011.010442.
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Summary Many countries in sub-Saharan Africa have made antiretroviral therapy (ART) available in urban settings, but the progress of treatment expansion into rural Africa has been slower. We analysed routine data for patients enrolled in a rural HIV treatment programme in Zambézia Province, Mozambique (1 June 2006 through 30 March 2009). There were 12,218 patients who were ≥15 years old enrolled (69% women). Median age was 25 years for women and 31 years for men. Older age and higher level of education were strongly predictive of ART initiation (P < 0.001). Patients with a CD4+ count of 350 cells/μL versus 50 cells/μL were less likely to begin ART (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.16-0.23). In rural sub-Saharan Africa, HIV testing, linkage to care, logistics for ART initiation and fears among some patients to take ART require specialized planning to maximize successes. Sustainability will require improved health manpower, infrastructure, stable funding, continuous drug supplies, patient record systems and, most importantly, community engagement.
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Michie, Susan, Jamie Brown, Adam W. A. Geraghty, Sascha Miller, Lucy Yardley, Benjamin Gardner, Lion Shahab, John A. Stapleton, and Robert West. "A randomised controlled trial of a theory-based interactive internet-based smoking cessation intervention (‘StopAdvisor’): Study protocol." Journal of Smoking Cessation 8, no. 2 (August 16, 2013): 63–70. http://dx.doi.org/10.1017/jsc.2013.21.
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Background: Internet-based interventions can help smokers to quit compared with brief written materials or no intervention. However, they are not widely used, particularly by more disadvantaged smokers, and there is significant variation in their effectiveness. A new smoking cessation website (‘StopAdvisor’) has been systematically developed on the basis of PRIME theory, empirical evidence, web-design expertise and user-testing with socio-economically disadvantaged smokers. This paper reports the protocol of a randomised controlled trial to evaluate the efficacy of StopAdvisor and determine whether it translates across the social spectrum.Methods: The trial has two arms with participants randomised to the offer of the interactive ‘StopAdvisor’ website (intervention condition) or a non-interactive, static website (control condition). Participants are adults from the UK, who smoke every day and are willing to make a serious quit attempt within a month of enrolment. At least 4260 participants will be recruited with a minimum of 2130 in each of two socio-economic sub-groups. The intervention comprises a structured quit plan and a variety of theory- and evidence-based behaviour change techniques for smoking cessation. Tailored support is offered in the form of a series of tunnelled sessions and a variety of interactive menus for use up to a month before, and then for one month after quitting (http://www.lifeguideonline.org/player/play/stopadvisordemonstration). The control is a static website that presents brief and standard advice on smoking cessation. Assessments are at baseline and 2-, 4- and 7-months post-enrolment. The primary outcome measure will be Russell Standard 6-months sustained abstinence, defined as self-reported continuous abstinence verified by saliva cotinine or anabasine at 7-month follow-up. Secondary outcome measures will include 7-day point-prevalence abstinence at 7-month follow-up, self-reported abstinence at 2- and 4-month follow-ups, satisfaction ratings of the website and quantitative indices of website interaction. All analyses will be by intention to treat and the main analysis will compare the two conditions on the primary outcome measure using a logistic regression model, adjusted for baseline characteristics. The efficacy of the intervention across the social spectrum will be assessed by a logistic regression focusing on the interaction between condition and socio-economic disadvantage.Trial registration: ISRCTN99820519.
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Jones, Danielle, Emanuella De Lucia Rolfe, Kirsten L. Rennie, Linda M. Oude Griep, Laura C. Kusinski, Deborah J. Hughes, Soren Brage, Ken K. Ong, Kathryn Beardsall, and Claire L. Meek. "Antenatal Determinants of Childhood Obesity in High-Risk Offspring: Protocol for the DiGest Follow-Up Study." Nutrients 13, no. 4 (March 31, 2021): 1156. http://dx.doi.org/10.3390/nu13041156.
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Childhood obesity is an area of intense concern internationally and is influenced by events during antenatal and postnatal life. Although pregnancy complications, such as gestational diabetes and large-for-gestational-age birthweight have been associated with increased obesity risk in offspring, very few successful interventions in pregnancy have been identified. We describe a study protocol to identify if a reduced calorie diet in pregnancy can reduce adiposity in children to 3 years of age. The dietary intervention in gestational diabetes (DiGest) study is a randomised, controlled trial of a reduced calorie diet provided by a whole-diet replacement in pregnant women with gestational diabetes. Women receive a weekly dietbox intervention from enrolment until delivery and are blinded to calorie allocation. This follow-up study will assess associations between a reduced calorie diet in pregnancy with offspring adiposity and maternal weight and glycaemia. Anthropometry will be performed in infants and mothers at 3 months, 1, 2 and 3 years post-birth. Glycaemia will be assessed using bloodspot C-peptide in infants and continuous glucose monitoring with HbA1c in mothers. Data regarding maternal glycaemia in pregnancy, maternal nutrition, infant birthweight, offspring feeding behaviour and milk composition will also be collected. The DiGest follow-up study is expected to take 5 years, with recruitment finishing in 2026.
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Pennucci, Francesca, Sabina De Rosis, and Claudio Passino. "Piloting a web-based systematic collection and reporting of patient-reported outcome measures and patient-reported experience measures in chronic heart failure." BMJ Open 10, no. 10 (October 2020): e037754. http://dx.doi.org/10.1136/bmjopen-2020-037754.
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ObjectivesTo evaluate the feasibility of a digital and continuous collection and reporting of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) for chronic heart failure (CHF).DesignA single-site pilot study was settled for evaluating the feasibility of the intervention, both using qualitative and quantitative data (ie, workshop, surveys).SettingThe pilot has been implemented in a Tuscan specialised hospital (Italy).Participants162 patients were involved. Inclusion criteria were: a previous diagnosis of HF, age ≥18 years, absence of cognitive impairment or active tumours, ability to provide informed consent to study participation.InterventionThe continuous collection and reporting of PROMs and PREMs has been designed and implemented in 2018. PREMs questionnaires for patients were developed, while Kansas City Cardiomyopathy Questionnaire-12 was used for assessing PROMs. Questionnaires are administered at specific time points: discharge; 30 days, 7 and 12 months after the discharge. Enrolment of patients, administration and real-time reporting of questionnaires are carried on through a digital platform.Outcome measuresEnrolment, response and drop-out rates were considered to assess the feasibility of the intervention. Qualitative data were collected during meetings and workshops with health workers. The representativeness of the recruited sample with respect to the population characteristics was also evaluated.ResultsThe system has been successfully implemented during 2018. Response rates have been consistently above 50%, demonstrating patients’ transversal willingness to participate. All the involved stakeholders acknowledged the feasibility of the design. The recruited sample is significantly different in terms of age and educational level compared with the overall population characteristics.ConclusionIt is possible to run a web-based systematic collection and reporting system for CHF patient-reported data. Systematic collection and reporting of PROMs and PREMs data allows professionals to increasingly assume CHF patient perspective in their daily work. Limitations will be used to improve the system.
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Martin-Smith, Rhona, Ashley Cox, Duncan S. Buchan, Julien S. Baker, Fergal Grace, and Nicholas Sculthorpe. "High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies." International Journal of Environmental Research and Public Health 17, no. 8 (April 24, 2020): 2955. http://dx.doi.org/10.3390/ijerph17082955.
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Background: High Intensity Interval Training (HIIT) is a sustainable and effective method for improving Cardiorespiratory Fitness (CRF) in adolescents. HIIT is proven to produce equal or greater improvements in CRF when compared to moderate intensity continuous exercise (MICE) in adolescents. Methods: The studies included were considered eligible if: (1) Participants were adolescents (11–18 years old); (2) Examined changes in CRF measured either directly or indirectly; (3) Included a non-exercising control group or MICE comparison group; (4) Participants were matched at enrolment; (5) Reported HIIT protocol information; (6) Provided HIIT intensity. A meta-analysis was conducted to determine the effect of HIIT on CRF. Meta-regression and moderator analyses were performed out to quantitatively examine moderators of protocol design on CRF improvements. Results: HIIT displays a moderate effect to improve CRF (g = 0.86, 95% CI 0.518–1.106, p < 0.001). Neither study duration (weeks), nor total or weekly accumulated HIIT volume (min) displayed any significant moderation effect on pooled improvement on CRF (p > 0.05). Conclusions: HIIT is an effective method to improve CRF in adolescents, irrespective of body composition. Notably, meta regression analysis identified that prolonged high volume HIIT programs are similarly effective to short term low volume HIIT programs. This becomes of particular interest for those involved in school curricula, where short HIIT exercise may provide a pragmatic adjunct to the health benefits of Physical Education (PE) lessons.
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Cescon, David W., Aaron Richard Hansen, Albiruni Ryan Abdul Razak, Lee-Anne Stayner, John Frederick Hilton, Daniel John Renouf, Trisha Denny, et al. "Phase I study of CFI-402257, an oral TTK inhibitor, in patients with advanced solid tumors." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): TPS2619. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.tps2619.
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TPS2619 Background: TTK (MPS1), a dual-specificity serine-threonine kinase, is critical for the spindle assembly checkpoint (SAC), chromosome alignment and error correction in mitosis. Inhibition of TTK causes premature mitotic exit with unattached chromosomes, resulting in chromosomal missegregation, aneuploidy and cell death. TTK is overexpressed in several tumor types, which may contribute to survival and proliferation of aneuploid cells, and higher expression correlates with adverse outcomes. The Campbell Family Therapeutics Group at the University Health Network (UHN) has developed CFI-402257, a potent (Ki = 0.09 nM, IC50 = 1.2 nM), highly selective and orally active inhibitor of TTK, with negligible activity towards 265 other kinases. Robust suppression of tumor growth was achieved upon oral dosing of single agent CFI-402257 at tolerated doses in several cell line (breast, colorectal) and patient-derived (ovarian) xenograft models. Pharmacodynamic effects including reduction in phospho-histone H3 were observed. In syngeneic mouse colorectal cancer models, CFI-402257 + PD-1 immune checkpoint blockade demonstrated greater activity than either agent alone, and resulted in tumor regressions and immunity to rechallenge. Methods: This multi-center Phase I dose escalation study (3+3 design) will determine the safety, tolerability and maximum tolerated dose (MTD) of CFI-402257 administered as daily continuous oral treatment. Secondary and correlative endpoints include plasma PK, antitumor activity, and molecular features associated with response or clinical benefit. An expansion cohort (n = 12) will be enrolled at the MTD. Key inclusion criteria: adult patients with advanced solid tumors, measurable disease (RECIST 1.1), adequate organ function and performance status (ECOG 0-1). Exclusion criteria: uncontrolled medical illness, CNS metastases (unless stable x 3 months). CFI-402257 will be dosed once daily on a continuous schedule in 28-day cycles, beginning at 5 mg/day with planned escalation to 56 mg/day. DL1 completed enrolment 01/2017 and accrual is ongoing. Phase II studies are planned (Stand Up to Cancer Canada Breast Cancer Dream Team). Funding: UHN, CIRM. Clinical trial information: NCT02792465.
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Areo, Samuel Olusola, O. O. Oyewale, and O. R. Oyewumi. "Youth Participation in Forestry Education in Nigeria." International Journal of Current Aspects 3, no. IV (July 24, 2019): 150–56. http://dx.doi.org/10.35942/ijcab.v3iiv.53.
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The concept of forestry education cuts across all its facets that is, the professional, technical and vocational. In view of continuous technological changes, forestry education must not be static. It must be versatile in order to be able to meet evolving contemporary challenges. This can be attested to by the great transformation in curriculum development between 1963 and 1986. Though there are presently 20 Universities in Nigeria offering forestry and allied courses, this has not actually impacted on students’ enrolment. This scenario poses enormous challenges to forestry education. Therefore, in order to reposition forestry education in Nigeria, this paper suggested among other factors that forestry curricula should be well positioned, flexible and adaptable; forestry teachers should be made to undertake pedagogical studies for effective teaching delivery; establishment of forestry education at secondary school level and funding, which is very crucial to an effective delivery of forestry education should be made readily available. The study therefore concluded by stressing the need for massive public enlightenment on forestry education and its prospects. There is a need for forestry education to be repackaged to make it more competitive in terms of student enrollment and future career options. There is also an urgent need to review the curricula of forestry courses in many secondary schools and introduced into curriculum. Forestry education in Africa must graduate from the current theory-based learning process to include much of the needed practical training.
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Brescianini, Sonia, Corrado Fagnani, Virgilia Toccaceli, Emanuela Medda, Lorenza Nisticò, Cristina D'Ippolito, Sabrina Alviti, et al. "An Update on the Italian Twin Register: Advances in Cohort Recruitment, Project Building and Network Development." Twin Research and Human Genetics 16, no. 1 (October 22, 2012): 190–96. http://dx.doi.org/10.1017/thg.2012.85.
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The Italian Twin Register has been in place for more than 10 years. Since its establishment, it has been focusing, on the one hand, on a continuous update of the existing information, and on the other hand, on new phenotypes and sample collection. Demographic data on about 140,000 twins have been updated using the municipality registries. The Italian Twin Register has been carrying out several new studies during the last few years. A birth cohort of twins, Multiple Births Cohort Study, has been started and the enrolment is ongoing. For this cohort, data on pregnancy and birth are collected, and periodical follow-ups are made. DNA is being collected for the twins and their parents. In the area of behavioral genetics, most efforts have been directed to psychological well being assessed with self-reported tools. Research on age-related traits continues with studies on arteriosclerosis development, early biomarkers in mild cognitive impairment, and the relation between lifestyle habits and mutagen sensitivity. The Italian Twin Register biobanking has grown in its size and in its know-how in terms of both technical issues and ethical procedures implementation. Furthermore, attitudes toward biobank-based research, together with willingness and motivation for donation, are being investigated. A valuable key resource for the Italian Twin Register is the possibility of linking twin data with disease registries. This approach has been yielding several important results, such as the recent study on the heritability of type 1 diabetes.
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Rajabalee, Banoor Yousra, Mohammad Issack Santally, and Frank Rennie. "A study of the relationship between students’ engagement and their academic performances in an eLearning environment." E-Learning and Digital Media 17, no. 1 (October 17, 2019): 1–20. http://dx.doi.org/10.1177/2042753019882567.
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The concept of online learning has witnessed an increase in the higher education sector, where enrolment rates in online courses have significantly grown in recent years. According to the literature, one of the critical components of quality online education is to ensure learner engagement. In short, the need to effectively measure learner engagement is imperative to determine the performances and the successful achievements of learners. In this research, the aim was to understand the relationship between students’ engagement in an online module with their overall performances by analysing students’ learning activities in an online module. Three measurable indicators were identified and considered relevant within the current research context and based on the available data, and from research literature for assessing learner engagement within the module. These were (i) the number of completed learning activities; (ii) importance level (as per course outcomes) of completed learning activities; and (iii) activities requiring platform presence. It was found that there is a significant but weak positive correlation between the engagement of students in the online module and their performances in the final learning activity. It was further observed that when continuous learning activities were considered, there was a very strong positive correlation between engagement and performances. In general, the average engagement level of students was significantly higher for good performers as compared to low performers. Similarly the mean performance of highly engaged students was significantly better than those with low engagement levels.
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Marvel, Jessica, Anna Vlahiotis, Amy Sainski-Nguyen, Tina Willson, and Alexandra Kimball. "Disease burden and cost of hidradenitis suppurativa: a retrospective examination of US administrative claims data." BMJ Open 9, no. 9 (September 2019): e030579. http://dx.doi.org/10.1136/bmjopen-2019-030579.
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ObjectivesHidradenitis suppurativa (HS) causes substantial morbidity and quality-of-life impairment. We examined demographic/clinical characteristics of patients with HS and treatment patterns, prevalence and healthcare resource utilisation/expenditures related to HS in the real-world.DesignRetrospective claims data of MarketScan Commercial, Medicare Supplemental and Medicaid databases (2009–2014).SettingUSA.ParticipantsPatients aged ≥12 years with ≥3 non-diagnostic outpatient or inpatient claims with an HS diagnosis code and ≥12 months continuous enrolment with medical and pharmacy benefits before (preindex) and after (postindex) the earliest diagnosis of HS (index) were included.ResultsThere were 11 325 Commercial/Medicare patients (mean age 37.4 years) and 5164 Medicaid patients (mean age 28.3 years). HS was more common in Medicaid than Commercial/Medicare patients (0.301% and 0.098%, respectively, in 2014). Cellulitis and psychiatric disorders were the most common comorbidities and oral antibiotics and narcotics were the most frequently prescribed drugs preindex, with ≥10% increase postindex in both populations. HS-related inpatient costs decreased while outpatient costs increased from preindex to postindex. Medicaid patients had several risk factors that may be associated with poor outcomes (eg, high rates of prescription pain medication use, comorbidities, drug discontinuation/interruption/holiday, emergency department (ED) visits and hospitalisation).ConclusionsCommercial/Medicare and Medicaid HS beneficiaries experience high comorbidity burden but use different treatment modalities to manage HS. Results suggest a substantial unmet need exists among this patient population, with Medicaid patients experiencing a particularly high burden of disease and expensive healthcare resource utilisation.
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Antonini, Marco, Daniele Gaudenzi, Sara Spelta, Giancarlo Sborgia, Maria Poddi, Alessandra Micera, Roberto Sgrulletta, Marco Coassin, and Antonio Di Zazzo. "Ocular Surface Failure in Urban Syndrome." Journal of Clinical Medicine 10, no. 14 (July 9, 2021): 3048. http://dx.doi.org/10.3390/jcm10143048.
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Background: Nowadays, the continuous increase in air pollution has significantly changed air quality, leading to the onset of the so-called urban syndrome (US), an allergic-like conjunctivitis triggered by pollutants. These patients are characterized by persistent dysregulation of ocular surface para-inflammation, causing chronic low-grade inflammation and ocular discomfort, with significant consequences for occupational health and job productivity prospects. This study aims to investigate the effects of topical glycerophosphoinositol (GPI) eye drops on the signs and symptoms of US. Methods: A multicenter prospective open interventional study was performed. Patients affected by US, enrolled from occupational medicine clinics, were treated with eye drops containing 0.001% GPI in 0.2% HA vehicle three times a day. Ocular surface disease index (OSDI), tear break-up time (T-BUT), Schirmer test, Oxford score, hyperemia and ocular surface symptoms were recorded at patient enrolment (T0), after 1 week (T1) and after 1 month (T2) of treatment. Results: A total of 113 consecutive patients (226 eyes) were included. OSDI score displayed a significant improvement after one week (T0: 39.9 ± 19, T1: 20.8 ± 17.9, T2: 18.4 ± 15.6, p < 0.0001); T-BUT (T0: 5.2 ± 2, T1: 7.7 ± 2.2, T2: 9.7 ± 1.8, p < 0.0001) and Schirmer Test (T0: 6.6 ± 2.4, T1: 9.7 ± 2.7, T2: 12.6 ± 2.6, p < 0.0001) progressively improved from T0 to T2. Conclusions: trice-daily topic instillation of 0.001% GPI in 0.02% HA vehicle resulted an effective and well tolerated treatment in US patients.
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Singh, Navneet, Valliappan Muthu, Kuruswamy Thurai Prasad, and Milind Baldi. "Overall survival in PEMVITASTART randomized trial comparing immediate vs. conventional strategies of vitamin supplementation in NSCLC patients on 1st line pemetrexed-platinum chemotherapy." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e20538-e20538. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e20538.
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e20538 Background: PEMVITASTART ( NCT02679443 ) was an open label phase II randomized trial [Singh N, et al. Cancer (DOI: 10.1002/cncr.32028)] involving locally advanced/metastatic non-squamous NSCLC patients treated with 1st line pemetrexed-platinum chemotherapy (CTx). The trial assessed the hematological toxicity profile in Delayed Arm (DA; conventional strategy) in whom CTx was initiated after 5-7 days of vitamin B12/folate supplementation (B12-FAS) vs. Immediate Arm (IA) in whom patients received B12-FAS simultaneously (≤24 hours) with CTx initiation. All outcomes were reported in modified ITT population (patients who received ≥1 cycle). A non-significant trend towards better radiological responses was observed in IA (PR 33% vs. 18%; p = 0.06). Herein, we report exploratory post-hoc analysis of overall survival (OS) for the mITT population (n = 150; 77 IA, 73 DA) of PEMVITASTART. Methods: OS was calculated from date of enrolment to date of death/last follow up. Survival cutoff date was 28 months after last patient enrolment. Median OS was calculated by Kaplan-Meier method and group differences analyzed by log-rank test. Factors affecting OS were assessed by Cox proportional hazards (CPH) analysis and hazard ratios [HRs] with 95% confidence intervals (CIs) calculated (from univariate and stepwise multivariate models). Results: Median OS was 12.7 m (95% CI 8.0–17.4) and did not differ between IA [15.0 m (10.5-19.4)] and DA [11.7 m (4.1-19.3)]. 1 yr and 2 yr survival rates were similar (IA 42% and 21% vs. DA 44% and 23%). On univariate CPH analysis, factors associated with better OS were female gender, ECOG PS 0, absence of metastatic disease and receipt of maintenance pemetrexed CTx (mPEM) while current/ex-smoker status, disease progression (as best response) and age ≥70 years were a/w worse OS. Baseline Hb and homocysteine (both assessed as continuous variables) and receipt of packed RBC transfusions/ESAs for anemia correction did not influence OS. On multivariate CPH analysis, current/ex-smokers HR 2.2 (95% CI 1.3-3.7; p < 0.01) and mPEM HR 0.5 (95% CI 0.3-0.9; p = 0.01) were both significant. Median OS for current/ex-smokers was 7.4m (95% CI 5.4-9.4) vs. 25.6m (95% CI 16.2-35.0) for non-smokers (log rank p < 0.001) while for patients receiving mPEM, it was 22.7m (95% CI 9.9-35.4) vs. 9.7m (95% CI 4.9-14.5) for those not receiving mPEM (log rank p = 0.02). Conclusions: Smoking status and mPEM were strong and independent prognostic factors for OS in the PEMVITASTART trial. Clinical trial information: NCT02679443.
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Bardia, Aditya, Javier Cortes, Sara A. Hurvitz, Suzette Delaloge, Hiroji Iwata, Shao Zhimin, Dheepak Kanagavel, et al. "AMEERA-5: A randomized, double-blind phase III study of amcenestrant (SAR439859) + palbociclib versus letrozole + palbociclib for previously untreated ER+/HER2- advanced breast cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): TPS1104. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.tps1104.
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TPS1104 Background: Selective estrogen receptor degraders (SERDs) block estrogen receptor (ER) associated signaling and have created interest for treating patients (pts) with advanced ER+ breast cancer (BC). Fulvestrant is currently the only SERD available for advanced BC but requires intramuscular administration, limiting the applied dose, exposure and receptor engagement. Amcenestrant (SAR439859) is an oral SERD that binds with high affinity to both wild-type and mutant ER, blocking estradiol binding and promoting up to 98% ER degradation in preclinical studies. In the phase I AMEERA-1 study of pretreated pts with ER+/HER2- advanced BC, amcenestrant 150–600 mg once daily (QD) showed a mean ER occupancy of 94% with plasma concentrations > 100 ng/mL and a favorable safety profile (Bardia, 2019; data on file). Combination therapy with amcenestrant + palbociclib (palbo) was also evaluated as part of this ongoing phase I study. CDK 4/6 inhibitors (CDK4/6i) combined with an aromatase inhibitor (AI), the gold standard for first line treatment for advanced breast cancer, prolong progression free survival (PFS) in pts with no prior treatment for ER+/HER2- advanced BC, but OS benefit has not been shown yet in postmenopausal pts. There remains a clinical need for more effective treatments in this setting. Methods: AMEERA-5 (NCT04478266) is an ongoing, prospective, randomized, double-blind phase III study comparing the efficacy and safety of amcenestrant + palbo with that of letrozole + palbo in pts with advanced, locoregional recurrent or metastatic ER+/HER2- BC who have not received prior systemic therapy for advanced disease. The study includes men, pre/peri-menopausal (with goserelin) and post-menopausal women. Pts with progression during or within 12 months of (neo)adjuvant endocrine therapy using any of the following agents are excluded: AI, selective estrogen receptor modulators, CDK4/6i. Pts are randomized 1:1 to either continuous amcenestrant 200 mg or letrozole 2.5 mg QD orally with matching placebos; both combined with palbo 125 mg QD orally (d1–21 every 28-d cycle). Randomization is stratified according to disease type (de novo metastatic vs recurrent disease), the presence of visceral metastasis, and menopausal status. The primary endpoint is investigator assessed progression free survival (PFS) (RECIST v1.1). Secondary endpoints are overall survival, PFS2, objective response rate, duration of response, clinical benefit rate, pharmacokinetics of amcenestrant and palbo, health-related quality of life, time to chemotherapy, and safety. Biomarkers will be measured in paired tumor biopsies and cell free deoxyribonucleic acid (cfDNA) over time. Target enrolment = 1066 pts; enrolment as of 1/2021 = 33 pts. Bardia A, et al., J Clin Oncol. 2019; 37 (15 suppl):1054 Clinical trial information: NCT04478266 .
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Pell, Lisa G., Ali Turab, Diego G. Bassani, Joy Shi, Sajid Soofi, Masawar Hussain, Shabina Ariff, Zulfiqar A. Bhutta, and Shaun K. Morris. "Effect of an integrated neonatal care kit on neonatal health outcomes: a cluster randomised controlled trial in rural Pakistan." BMJ Global Health 4, no. 3 (May 2019): e001393. http://dx.doi.org/10.1136/bmjgh-2019-001393.
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IntroductionIn 2016, 2.6 million children died during their first month of life. We assessed the effectiveness of an integrated neonatal care kit (iNCK) on neonatal survival and other health outcomes in rural Pakistan.MethodsWe conducted a community-based, cluster randomised, pragmatic, open-label, controlled intervention trial in Rahim Yar Khan, Punjab, Pakistan. Clusters, 150 villages and their lady health workers (LHWs), were randomly assigned to deliver the iNCK (intervention) or standard of care (control). In intervention clusters, LHWs delivered the iNCK and education on its use to pregnant women. The iNCK contained a clean birth kit, chlorhexidine, sunflower oil, a continuous temperature monitor (ThermoSpot), a heat reflective blanket and reusable heat pack. LHWs were also given a hand-held scale. The iNCK was implemented primarily by caregivers. The primary outcome was all-cause neonatal mortality. Outcomes are reported at the individual level, adjusted for cluster allocation. Enrolment took place between April 2014 and July 2015 and participant follow-up concluded in August 2015.Results5451 pregnant women (2663 and 2788 in intervention and control arms, respectively) and their 5286 liveborn newborns (2585 and 2701 in intervention and control arms, respectively) were enrolled. 147 newborn deaths were reported, 65 in the intervention arm (25.4 per 1000 live births) compared with 82 in the control arm (30.6 per 1000 live births). Neonatal mortality was not significantly different between treatment groups (risk ratio 0.83, 95% CI 0.58 – 1.18; p = 0.30).ConclusionProviding co-packaged interventions directly to women did not significantly reduce neonatal mortality. Further research is needed to improve compliance with intended iNCK use.
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Ahlgren, Goran M., Michael Borre, Lisa Sengelov, Teuvo L. J. Tammela, Pirkko Kellokumpu-Lehtinen, Asgerdur Sverrisdottir, and Jon Reidar Iversen. "Adverse effect of docetaxel versus surveillance after radical prostatectomy for high risk prostate cancer: Post-hoc analysis of the prospective randomized, open-label phase III SPCG 12 trial." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 30. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.30.
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30 Background: Adjuvant chemotherapy is standard treatment for other solid tumours, but so far has not proven effective in prostate cancer. Methods: Open-label, randomised multinational phase III trial. Enrolment 459 patients after prostatectomy. Inclusion criteria high risk (pT2 margin positive or pT3a Gleason score (GS) ≥4+3, pT3b or lymph node positive disease ≥GS 3+4). Patients assigned (1:1) to either six cycles of adjuvant docetaxel 75mg/m2 every three weeks without daily prednisone (ArmA) or surveillance (Arm B) until endpoint was reached. Primary endpoint was PSA progression ≥0.5ng/ml. Results: Median time to progression, death or last follow up was 56.8 months. Primary endpoint was reached in 190/459 patients (41.4%), 103 of 230 (44.8%) patients in Arm A and 87 (38.0%) of 229 in Arm B. In Kaplan-Myer analysis, there was evidence of non-proportional hazards over time. When 76 patients with PSA > 0.2 after surgery were excluded from the analysis, the outcome showed proportional hazards and favoured surveillance in the KM-analysis (p = 0.02). The significant favour of surveillance remained in a Cox multivariate analysis including Gleason score, pT-stage, surgical margins and lymph node status (p = 0.03). Limitations were that not all patients received docetaxel by protocol, some patients received radiation treatment before end-point and lack of stratification for PSA after surgery. Conclusions: Adjuvant docetaxel without hormonal therapy or continuous corticosteroids may have an adverse effect on biochemical progression in patients with low or undetectable levels of PSA after surgery. Clinical trial information: NCT00376792.
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Barry, Aissata, Marije C. Behet, Issa Nébié, Kjerstin Lanke, Lynn Grignard, Alphonse Ouedraogo, Issiaka Soulama, et al. "Functional antibodies against Plasmodium falciparum sporozoites are associated with a longer time to qPCR-detected infection among schoolchildren in Burkina Faso." Wellcome Open Research 3 (December 12, 2018): 159. http://dx.doi.org/10.12688/wellcomeopenres.14932.1.
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Background:Individuals living in malaria-endemic regions develop naturally acquired immunity against severe malarial disease, but it is unclear whether immunity that affects the establishment of infections develops following continuous natural exposure.Methods:We cleared schoolchildren in Burkina Faso of possible sub-patent infections and examined them weekly for incident infections by PCR. Plasma samples collected at enrolment were used to quantify antibodies to the pre-eryhrocytic-stage antigens circumsporozoite protein (CSP) and liver stage antigen. Sporozoite gliding inhibition by naturally acquired antibodies was assessed usingPlasmodium falciparumNF54 sporozoites; hepatocyte invasion was assessed using the human HC-04 hepatoma cell line and NF54 sporozoites. The associations between these functional pre-erythrocytic immunity phenotypes and time to PCR-detected infection were studied.Results:A total of 51 children were monitored; the median time to first detection of infection by PCR or development of clinical symptoms was 28 days. Anti-CSP antibody titres showed a strong positive association with sporozoite gliding motility inhibition (P<0.0001, Spearman’s ρ=0.76).In vitrohepatocyte invasion was inhibited by naturally acquired antibodies (median invasion inhibition, 19.4% [IQR 15.2-40.9%]), and there was a positive correlation between gliding and invasion inhibition (P=0.02, Spearman’s ρ=0.60). Survival analysis indicated longer time to infection in individuals displaying higher-than-median sporozoite gliding inhibition activity (P=0.01).Conclusions:In summary, functional antibodies against the pre-erythrocytic stages of malaria infection are acquired in children who are repeatedly exposed toPlasmodiumparasites. This immune response does not prevent them from becoming infected during a malaria transmission season, but might delay the appearance of blood stage parasitaemia and consequently needs to be considered in the evaluation of malaria vaccines.
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Florescu, Carmen, Justine Lequesne, Jean-Michel Grellard, Aurélie Parzy, Marie-Pierre Galais, Paul Lesueur, Marine Moreau, et al. "Interim analysis of a phase II study of simultaneously integrated boost intensity modulated radiation therapy (SIB-IMRT) in combination with 5-FU and mitomycin-C among patients with locally advanced anal canal cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e15501-e15501. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e15501.
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e15501 Background: Concomitant radiochemotherapy is the standard treatment of locally advanced epidermoid anal canal carcinoma (EACC) but conventional radiotherapy (RT) frequently induces significant non-hematological toxicities, resulting in long treatment breaks. Given the numerous anatomic pelvic structures, EACC has become of interest for Intensity-Modulated Radiation Therapy (IMRT) despite the induced cutaneous toxicities responsible for RT breaks. Given the deleterious effect of treatment duration on local control and survival in other epidermoid cancers, continuous IMRT is challenging to control EACC. Several SIB-IMRT schedules provided similar results with moderate doses and schedules delivering higher doses with short breaks. Yet, standard SIB-IMRT schedule in EACC still not exists. We propose to concomitantly assess the safety and efficacy of continuous SIB-IMRT without planned breaks and concurrent chemotherapy (CT) to improve the treatment of locally advanced EACC by reducing the proportion of patients (pts) requiring RT breaks for toxicities. Methods: The CANAL-IMRT-01 phase 2 trial (NCT02701088) targets pts with histologically proven EACC candidate for concomitant RT of pelvic and inguinal nodes plus CT. Applying a two-step Bryant & Day design, the main criterion is based on both efficacy and safety. Efficacy is defined as the proportion of pts alive with no local disease progression 3 months after the end of IMRT; safety is defined as the proportion of pts with no RT breaks required by grade ≥3 toxicities. Assuming the unacceptable and acceptable proportions of pts without toxicity requiring IMRT break are 60 and 80% respectively, the unacceptable and acceptable 3-month-progression-free-survival are 80 and 90%, 14 assessable pts at first step and 46 in the second are required (alpha risk 5%, 90% power). To anticipate a 10% drop out rate, 16 pts were needed in first step, with ≥11 objective local responses and ≤6 toxicity-induced IMRT breaks to pursue. Treatment consists in 50 days of concomitant CT (2 cycles of 5FU and Mitomycin-C) and SIB-IMRT delivered by helical tomotherapy: 61.2Gy/1.7Gy to the primary tumor, 57.6Gy/1.6Gy to involved nodes, and 54/1.5Gy to elective pelvic lymph nodes. Results: From December 2015 to June 2017, 16 pts were enrolled: 11 female (73%), median age 62 [55-66]. 15 pts were assessable for efficacy and safety. All 15 pts had a 3-month locoregional response (12 complete responses, 3 partial responses). SIB-IMRT breaks were required by toxicities for 4 out of 15 pts: G1 radiodermitis, G2 inguinal and epithelitis, G1 fever, G3 anorexia and vertigo. Conclusions: The planned interim analysis of continuous SIB-IMRT plus CT allowed pursuing this phase 2 trial to assess the relevance of such schedule for locally advanced ASCC. Enrolment is still ongoing. Clinical trial information: NCT02701088.
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Keogh, Justin W., Josephine Grigg, and Christopher J. Vertullo. "Is high-intensity interval cycling feasible and more beneficial than continuous cycling for knee osteoarthritic patients? Results of a randomised control feasibility trial." PeerJ 6 (May 9, 2018): e4738. http://dx.doi.org/10.7717/peerj.4738.
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Background Knee osteoarthritis (OA) patients often suffer joint pain and stiffness, which contributes to negative changes in body composition, strength, physical performance (function), physical activity and health-related quality of life. To reduce these symptoms and side effects of knee OA, moderate-intensity continuous training (MICT) cycling is often recommended. While resistance training is considered the optimal form of training to improve sarcopenic outcomes, it imposes higher joint loads and requires supervision, either initially or continuously by trained exercise professionals. Therefore, this pilot study sought to gain some insight into the feasibility and potential benefits of high-intensity interval training (HIIT) cycling as an alternative exercise option to MICT cycling for individuals with knee OA. Methods Twenty-seven middle-aged and older adults with knee OA were randomly allocated to either MICT or HIIT, with both programs involving four unsupervised home-based cycling sessions (∼25 min per session) each week for eight weeks. Feasibility was assessed by enrolment rate, withdrawal rate, exercise adherence and number of adverse effects. Efficacy was assessed by health-related quality of life (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index), physical function (Timed Up and Go (TUG), Sit to Stand (STS) and preferred gait speed) and body composition (body mass, BMI, body fat percentage and muscle mass). Results Twenty-seven of the interested 50 potential participants (54%) enrolled in the study, with 17 of the 27 participants completing the trial (withdrawal rate of 37%); with the primary withdrawal reasons being unrelated injuries or illness or family related issues. Of the 17 participants who completed the trial, exercise adherence was very high (HIIT 94%; MICT 88%). While only three individuals (one in the MICT and two in the HIIT group) reported adverse events, a total of 28 adverse events were reported, with 24 of these attributed to one HIIT participant. Pre–post-test analyses indicated both groups significantly improved their WOMAC scores, with the HIIT group also significantly improving in the TUG and STS. The only significant between-group difference was observed in the TUG, whereby the HIIT group improved significantly more than the MICT group. No significant changes were observed in the Lequesne index, gait speed or body composition for either group. Discussion An unsupervised home-based HIIT cycle program appears somewhat feasible for middle-aged and older adults with knee OA and may produce similar improvements in health-related quality of life but greater improvements in physical function than MICT. These results need to be confirmed in larger randomised controlled trials to better elucidate the potential for HIIT to improve outcomes for those with knee OA. Additional research needs to identify and modify the potential barriers affecting the initiation and adherence to home-based HIIT cycling exercise programs by individuals with knee OA.
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Kinash, Shelley, Linda Crane, John Capper, Mark Young, and Ashley Stark. "When do university students and graduates know what careers they want: A research-derived framework." Journal of Teaching and Learning for Graduate Employability 8, no. 1 (August 23, 2017): 3–21. http://dx.doi.org/10.21153/jtlge2017vol8no1art584.
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This paper reports on research which was conducted to explore how university students and those who had graduated and been subsequently employed, made career decisions. Specifically, through interviews and focus group discussions with 22 university students and 28 graduates from Australian undergraduate and postgraduate courses in a variety of disciplines, four questions were explored: Do university students know their own desired post-course employment, or in other words, what they want to be after graduation; if so, at what point in their student experience do they come to this decision; what elements come into play in university student career decision-making; and to what extent do students and graduates feel that their career decision-making is supported by their universities? Research was grounded in, and results aligned with, the ‘chaos theory of careers.’ The main findings were that at the enrolment-stage of university and during their studies, most students were pessimistic about their career outcomes and felt largely unsupported in identifying suitable career goals. However, the outcomes after graduation were unexpectedly positive in that, by this point most had identified career goals and were in careers they had desired. Most of the research participants who had been in their careers for an extended length of time were casual academics who were dissatisfied with their career progression and status. Although they had identified academic career goals and secured employment in their chosen industry, they were disappointed by continuous short-term contracts and what they perceived as poor career supports extended by their university employers. A ‘university student and graduate career-knowledge framework’ was derived. The key takeaway from this research was a set of recommendations for universities regarding how to better support students to make career choices.
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Okunade, Kehinde S., Omolola Salako, Adebola A. Adejimi, Oluwatosin J. Akinsola, Omolara Fatiregun, Muisi A. Adenekan, Olusanjo E. Moses, et al. "Impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria (mHealth-Cervix): Protocol for a randomised controlled trial." F1000Research 9 (May 4, 2020): 322. http://dx.doi.org/10.12688/f1000research.22991.1.
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Background: Incidence and mortality from cervical cancer have remained high due to many obstacles facing the implementation of organized screening programs in resource-constrained countries such as Nigeria. The application of mobile technologies (mHealth) to health services delivery has the potential to reduce inequalities, empower patients to control their health, and improve the cost-effectiveness of health care delivery. Aim: To assess the efficacy of mobile technology intervention on Pap test screening adherence compared to a control condition and also determine the factors affecting the uptake of Pap smear screening practices among women in Lagos. Methods: This is a multi-center randomized controlled trial that will involve women aged 25 to 65 years attending the General Outpatient clinics of the two tertiary health institutions in Lagos, Nigeria between April and December 2020. At baseline, a total of 200 National Health Insurance Scheme (NHIS) enrollees will be randomized to either a text message arm or usual care (control) arm. The primary outcome is the completion of a Pap smear within 6 months of enrolment in the study. The associations between any two groups of continuous variables will be tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square X2or Fisher's exact test where appropriate. Using binary logistic regression model, we will adjust for age and other relevant sociodemographic and clinical variables and adherence to Pap test screening. Statistical significance will be defined as P-value less than 0.05. Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through early detection facilitated using health promotion to improve Pap smear screening adherence. Registration: PACTR202002753354517 13/02/2020
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Kassie, Girma, and Bekele Tefera. "Effects of community-based health insurance on modern family planning utilization in Ethiopia." Gates Open Research 3 (May 9, 2019): 1461. http://dx.doi.org/10.12688/gatesopenres.12960.1.
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Background: Community-based health insurance (CBHI) has been established in a number of developing countries to expand access to modern health care service. However, few studies have focused on health care utilization of CBHI members in Ethiopia. Accordingly, the aim of this study was to assess the effect of CBHI on modern family planning (FP) utilization as part of its routine outcome monitoring activities. Methods: The USAID Transform: Primary Health Care project, conducted a continuous monitoring follow up visit using a multistage sampling technique in its four major targeted regions. A total of 3433 households were selected and 3313 women of reproductive age (15-49 years) were interviewed. The questionnaire captured the CBHI status of each household and FP use data from randomly selected women. Microsoft Access database was used to enter the data, which was then transferred to SPSS Version 20 for further analysis. Results: In total 50.8% of married women (aged 15-49 years) were found to be enrolled in CBHI. Current modern FP use is 47.5% among married women in project-supported areas. Modern FP use is 50.9% among married women who are exposed to CBHI schemes, versus 44.1% among women who are not exposed to CBHI which is statistically significant. Conclusions: Modern FP utilization among insured women was higher compared with uninsured women. While FP methods are provided for free, CBHI enrolment improves FP use among women of child-bearing age. Women who have access to CBHI may frequently visit health facilities seeking services for themselves and their families, during which they may be introduced to FP services. This in turn may improve their awareness and attitude towards FP. The results will increase awareness for program implementers of the benefits of CBHI schemes in FP programming, particularly in rural settings, and provide an opportunity to increase lifelong returns in Ethiopia.
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Drenkard, Cristina, Kirk Easley, Gaobin Bao, Charmayne Dunlop-Thomas, S. Sam Lim, and Teresa Brady. "Overcoming barriers to recruitment and retention of African–American women with SLE in behavioural interventions: lessons learnt from the WELL study." Lupus Science & Medicine 7, no. 1 (June 2020): e000391. http://dx.doi.org/10.1136/lupus-2020-000391.
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BackgroundAfrican–Americans are historically under-represented in SLE studies and engaging them in behavioural interventions is challenging. The Women Empowered to Live with Lupus (WELL) study is a trial conducted to examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among African–American women with SLE. We describe enrolment and retention challenges and successful strategies of the WELL study.MethodsThe Georgians Organized Against Lupus (GOAL) cohort, a population-based cohort established in Atlanta, Georgia, was used to enrol a sample of 168 African–American women with SLE into the CDSMP. The CDSMP is a 6-week, group-based programme led by peers to enhance self-management skills in people with chronic conditions. Study performance standards were predefined and close monitoring of recruitment and retention progress was conducted by culturally competent staff members. Continuous contact with participants, research coordinators’ notes and regular research team meetings served to assess barriers and define strategies needed to meet the desired recruitment and retention outcomes.ResultsWhile no substantial barriers were identified to enrol GOAL participants into the WELL study, WELL participants faced difficulties registering for and/or completing (attending ≥4 sessions) a CDSMP workshop. Major barriers were unpredicted personal and health-related issues, misunderstanding of the scope and benefits of the intervention, and transportation problems. Early implementation of tailored strategies (eg, CDSMP scheduled on Saturdays, CDSMP delivered at convenient/familiar facilities, transportation services) helped to reduce participant barriers and achieve a CDSMP registration of 168 participants, with 126 (75%) completers. Frequent contact with participants and compensation helped to reach 92.3% retention for the 6-month survey.ConclusionsPredefined standards and monitoring of participant barriers by a culturally competent research team and proactive solutions were critical to implementing successful strategies and achieving the desired recruitment and retention outcomes of a behavioural trial involving African–American women with SLE.Trial registration numberNCT02988661.
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Vathi Muniandy, Punitha, Abdul Jalil B.Othman, and Sharir Jamaluddin. "THE INFLUENCE OF SELF-DRIVE ON THE DEVELOPMENT OF MALAY LANGUAGE PROGRAMME: NON-NATIVE ADULTS’ PERSPECTIVE." Humanities & Social Sciences Reviews 6, no. 2 (October 18, 2018): 74–83. http://dx.doi.org/10.18510/hssr.2018.629.
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Purpose: The purpose of the study is to analyse non-native adults’ self-drive and ways that has influenced towards the development of Malay language programme in which the programme caters to their needs, expectations and self-drive in University of Malaya for Continuing Education.
Methodology: This study aims to analyse non-native adults’ self-drive in an informal adult education at a higher learning institution in Malaysia using an action research method comprising 58 non-native adult learners which was implemented from January 2014 to December 2017. The evidence gathered through feedback, observation and continuous assessment.
Findings: The outcome of this study reveals that strong self-drive among non-native adult learners encouraged and increased the effort towards the introduction of a Malay language programme that suits their needs and expectations.
Research Limitations/Implications: It was reported that the development of new Malay programme would have been more successful and benefits more language instructors and academicians. Their involvement would provide more support and critical views in the research in order to validate the formulation of the Malay programme.
Social Implications: The improvement in teaching and learning process undertaken has also accelerated adult learners’ attainment and competency in Malay language. As a result of non-native adult leaners’ excellent attainment has reinforced the Malay language educator to attract and increase the enrolment for continuing education at higher learning institutions that offer Malay programme as lifelong learning programme.
Originality/Value: The study on self-drive among non-native adults and how it has influenced towards the development of a Malay programme that caters to their needs, interests and expectations is still new, and it is a first-hand study of its kind. The results will be useful for those who are involved in adult teaching and in steering Malay as Modern Foreign Language programme at higher education.
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Mekonnen, Zeleke Abebaw, Binyam Tilahun, Kassahun Alemu, and Martin Were. "Effect of mobile phone text message reminders on improving completeness and timeliness of routine childhood vaccinations in North-West, Ethiopia: a study protocol for randomised controlled trial." BMJ Open 9, no. 11 (November 2019): e031254. http://dx.doi.org/10.1136/bmjopen-2019-031254.
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IntroductionNon-attendance and delay in vaccination schedules remain a big challenge to healthcare workers. With the continuous growth of mobile network coverage and exponential penetration of mobile devices in the developing world, adoption of short message service has been shown to increase attendance for health services by targeting participant characteristics such as forgetfulness. Therefore, the aim of this trial is to determine the effect of mobile text message reminders on completeness and timeliness of childhood vaccination in North-West, Ethiopia.Methods and analysisA two-arm, parallel, superiority, randomised controlled trial study will be employed. The study arms are the intervention group (text message reminders plus routine care) and the control group (routine care only). Mother–infant pairs will be randomised to one of the groups during enrolment. The trial will consider a sample size of 434 mother–infant pairs with 1:1 allocation ratio. Mothers assigned to the intervention group will receive text message reminder 1 day before the scheduled vaccination visit at 6 weeks, 10 weeks, 14 weeks and at 9 months. Initially, descriptive statistics will be computed. For the primary outcome log-binomial regression model will be used to identify associated factors, and relative risk with 95% CI will be reported. Primarily, iIntention-to-treat analysis principle will be applied. STATA V.14 software will be used for the analysis.Ethics and disseminationThis study obtained ethical approval from the University of Gondar Institutional Ethical Review Board. The trial findings on the effectiveness of mobile text message reminders in improving vaccination uptake will help to inform decision makers on the use of mobile health interventions in developing countries like Ethiopia. The scientific findings of the trial will also be published in reputable journals.Trial registration numberPACTR201901533237287.
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Panjabi, Sumeet, Dionne M. Hines, Catherine Balderston McGuiness, Emre Yucel, Steven Yea, Zachariah McIver, and Rolin L. Wade. "Burden of relapsed/refractory (RR) acute myeloid leukemia." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19509-e19509. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19509.
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e19509 Background: To examine treatment patterns and health care costs of RRAML in the US. Methods: We identified adults with ≥ 2 outpatient or ≥ 1 inpatient claim with a diagnosis of AML from 1/1/2011 to 12/31/2017 (first AML claim = index date) using IQVIA’s fully-adjudicated Health Plan Claims Data. Continuous health plan enrolment for ≥ 12 months prior to the index date and ≥ 1-month post-index, a RRAML diagnosis on or prior to the index date, or with hematopoietic stem cell transplantation (HSCT) or chemotherapy pre-index were required. Patients were grouped by post-index treatment (high- or low-intensity chemotherapy [HIC, LIC] with and with no HSCT, HSCT only, best supportive care [BSC], or no treatment within 90 days of index [NoTx]). Costs were evaluated for 12 months following index. Results: The final sample of patients with RRAML (n = 804) were grouped by age:18-59 (n = 411; 51.2%), 60-74 (n = 318; 39.5%), and ≥75 years (n = 75; 9.3%). Treatment within the three age cohorts was: HIC (13%, 11%, 1%); LIC (27%, 38%, 52%); HIC+HSCT (14%, 7%, 0%); LIC+HSCT (2%, 3%, 0%); HSCT (9%, 9%, 0%); BSC (21%, 21%, 31%); NoTx (13%, 12%, 16%), respectively. Mean monthly costs were lowest for BSC and highest for HSCT or HIC containing treatments, irrespective of age (Table). Inpatient costs were 50 to 100% of total costs. Monthly costs across treatment/age groups were higher earlier in treatment [month 1 range: $28,627 (BSC) to $180,867 (HIC)] and declined over time [month 12 range: $2,853 (BSC) to $53,003 (HIC+HSCT)]. Conclusions: Nearly half of all patients age ≥75 years and 33% of patients < 75 years received BSC or NoTx, which highlights a significant unmet need for new treatment options. Average costs per patient, especially early in treatment are high and driven by hospital service utilization. [Table: see text]
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Stafuzza, Tássia Carina, Luciana Lourenço Ribeiro Vitor, Natalino Lourenço Neto, Daniela Rios, Thiago Cruvinel, Vivien Thiemy Sakai, Ana Beatriz Silveira Moretti, Maria Aparecida Andrade Moreira Machado, and Thais Marchini Oliveira. "Pulp liner materials in selective caries removal: study protocol for a randomised controlled trial." BMJ Open 11, no. 1 (January 2021): e029612. http://dx.doi.org/10.1136/bmjopen-2019-029612.
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IntroductionThe literature shows that selective carious tissue removal (SCTR) decreases the number and diversity of bacteria, stops the caries process and reduces the risk of pulp exposure. However, no consensus exists on which pulp liner would be suitable for teeth undergoing SCTR. So, this study will verify the in vivo response of dentine–pulp complex after SCTR in primary teeth with or without pulp liner material.Methods and analysisA randomised clinical trial, double-blinded, parallel-group and allocation concealment will be conducted with the enrolment of 384 patients from 5 to 9 years, with one maxillary/mandibular first/second primary molars with deep occlusal/occlusoproximal cavities. The remaining dentine will be lined with calcium hydroxide cement—group 1; mineral trioxide aggregate—group 2 and without liner—group 3. The primary outcome will be success of the of dentine–pulp complex evaluated clinically and radiographically at 6, 12 and 24 months, while the secondary outcomes will be the measurement of the dentine barrier on periapical radiographs. During all study, two trained and calibrated examiners will evaluate the treated teeth clinically and radiographically. Interexaminer and intraexaminer reliability will be verified by casual and systematic error. The Kolmogorov–Smirnov test will be adopted to test the normality of continuous variables. Comparisons among groups will be performed by using the χ2 test and anaylsis of variance, followed by Tukey test (p<0.05). The logistic regression will be applied, and the degrees of this association will be measured using the OR and 95% CI.Ethics and disseminationThe present protocol was submitted and approved by the Ethical Committee of the University of São Paulo, Bauru, São Paulo, Brazil (CAAE: 79123517.0.0000.5417). Consent for publication will be obtained from all parents or legal guardians. Results of this study will be reported in full through peer-reviewed journals.Trial registration numberRBR-9fsxnn.
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Stafuzza, Tássia Carina, Luciana Lourenço Ribeiro Vitor, Natalino Lourenço Neto, Daniela Rios, Thiago Cruvinel, Vivien Thiemy Sakai, Ana Beatriz Silveira Moretti, Maria Aparecida Andrade Moreira Machado, and Thais Marchini Oliveira. "Pulp liner materials in selective caries removal: study protocol for a randomised controlled trial." BMJ Open 11, no. 1 (January 2021): e029612. http://dx.doi.org/10.1136/bmjopen-2019-029612.
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IntroductionThe literature shows that selective carious tissue removal (SCTR) decreases the number and diversity of bacteria, stops the caries process and reduces the risk of pulp exposure. However, no consensus exists on which pulp liner would be suitable for teeth undergoing SCTR. So, this study will verify the in vivo response of dentine–pulp complex after SCTR in primary teeth with or without pulp liner material.Methods and analysisA randomised clinical trial, double-blinded, parallel-group and allocation concealment will be conducted with the enrolment of 384 patients from 5 to 9 years, with one maxillary/mandibular first/second primary molars with deep occlusal/occlusoproximal cavities. The remaining dentine will be lined with calcium hydroxide cement—group 1; mineral trioxide aggregate—group 2 and without liner—group 3. The primary outcome will be success of the of dentine–pulp complex evaluated clinically and radiographically at 6, 12 and 24 months, while the secondary outcomes will be the measurement of the dentine barrier on periapical radiographs. During all study, two trained and calibrated examiners will evaluate the treated teeth clinically and radiographically. Interexaminer and intraexaminer reliability will be verified by casual and systematic error. The Kolmogorov–Smirnov test will be adopted to test the normality of continuous variables. Comparisons among groups will be performed by using the χ2 test and anaylsis of variance, followed by Tukey test (p<0.05). The logistic regression will be applied, and the degrees of this association will be measured using the OR and 95% CI.Ethics and disseminationThe present protocol was submitted and approved by the Ethical Committee of the University of São Paulo, Bauru, São Paulo, Brazil (CAAE: 79123517.0.0000.5417). Consent for publication will be obtained from all parents or legal guardians. Results of this study will be reported in full through peer-reviewed journals.Trial registration numberRBR-9fsxnn.
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Bitterman, Roni, Fidi Koppel, Cristina Mussini, Yuval Geffen, Michal Chowers, Galia Rahav, Lior Nesher, et al. "Piperacillin–tazobactam versus meropenem for treatment of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae: a study protocol for a non-inferiority open-label randomised controlled trial (PeterPen)." BMJ Open 11, no. 2 (February 2021): e040210. http://dx.doi.org/10.1136/bmjopen-2020-040210.
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IntroductionThe optimal treatment for extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae bloodstream infections has yet to be defined. Retrospective studies have shown conflicting results, with most data suggesting the non-inferiority of beta-lactam–beta-lactamase inhibitor combinations compared with carbapenems. However, the recently published MERINO trial failed to demonstrate the non-inferiority of piperacillin–tazobactam to meropenem. The potential implications of the MERINO trial are profound, as widespread adoption of carbapenem treatment will have detrimental effects on antimicrobial stewardship in areas endemic for ESBL and carbapenem-resistant bacteria. Therefore, we believe that it is justified to re-examine the comparison in a second randomised controlled trial prior to changing clinical practice.Methods and analysisPeterPen is a multicentre, investigator-initiated, open-label, randomised controlled non-inferiority trial, comparing piperacillin–tazobactam with meropenem for third-generation cephalosporin-resistant Escherichia coli and Klebsiella bloodstream infections. The study is currently being conducted in six centres in Israel and one in Canada with other centres from Israel, Italy and Canada expected to join. The two primary outcomes are all-cause mortality at day 30 from enrolment and treatment failure at day seven (death, fever above 38°C in the last 48 hours, continuous symptoms, increasing Sequential Organ Failure Assessment Score or persistent blood cultures with the index pathogen). A sample size of 1084 patients was calculated for the mortality endpoint assuming a 12.5% mortality rate in the control group with a 5% non-inferiority margin and assuming 100% follow-up for this outcome.Ethics and disseminationThe study is approved by local and national ethics committees as required. Results will be published, and trial data will be made available.Trial registration numbersClinicalTrials.gov Registry (NCT03671967); Israeli Ministry of Health Trials Registry (MOH_2018-12-25_004857).
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Consorti, Giacomo, Donatella Bagagiolo, Andrea Buscemi, Luca Cicchitti, Michela Persiani, and Andrea Bergna. "Osteopathy students profile in Italy: A cross sectional census." PLOS ONE 16, no. 2 (February 24, 2021): e0247405. http://dx.doi.org/10.1371/journal.pone.0247405.
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Introduction The Osteopathy Students Analysis (OSA) aims to profile osteopathy students in Italy as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. Materials and methods The OSA used a cross-sectional design. A Web-based survey was distributed to the Italian Osteopathic Education Institutions (OEIs). The OSA survey was composed of items organised into four sections: 1. Sociodemographic characteristics (11 items); 2. Geographical distribution (5 items); 3. Health status (3 items); 4. Previous and ongoing education specifications (16 items). A descriptive sample population analysis was performed. Dichotomous and categorical variables were presented as frequencies and percentages, and continuous variables were displayed as means and standard deviations. Some variables were analysed using a pentenary distribution. Results 49 out of the 61 OEIs identified matched the inclusion criteria, and among these, 22 accepted to propose the enrolment of their students into the study. The survey was administered to 4,720 students from all the participant OEIs. A total of 3,762 students responded to the survey, accounting for an estimated response rate of 53.7%. The majority of respondents were men (54%), with an average age of 26.9 ± 6.5 years. Almost the totality of the sample was composed of the European ethnic group (99.1%). Respondents were predominantly born in Italy (97.2%). The majority of the sample reported being in good (49.5%) to excellent (38.6%) health. To date, osteopathy students are almost evenly distributed between the two types of curricula (T1 = 46.6%; T2 = 53.4%). Conclusions The OSA is the first study that aims to profile Italian osteopathy students as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. Future studies should focus on investigating the correlation between the sociodemographic characteristics of students and their academic performance.