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Bedi, A. S. "The Decline in Primary School Enrolment in Kenya." Journal of African Economics 13, no. 1 (March 1, 2004): 1–43. http://dx.doi.org/10.1093/jae/13.1.1.
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Igberaharha, Clever Omovigho, and Moses Onyesom. "Strategies for boosting students’ enrolment into business education programme of colleges of education." International Journal of Evaluation and Research in Education (IJERE) 10, no. 3 (September 1, 2021): 1107. http://dx.doi.org/10.11591/ijere.v10i3.22005.
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<span>A close observation in recent times has shown a steady decline of students’ enrolment into business education programme especially in the colleges of education. The situation is becoming worrisome considering the social implications it has on the education industry. Thus, the study was conducted to determine strategies for boosting students’ enrolment into business education programme of colleges of education in Delta State. Design of this research was descriptive survey and 118 business education lecturers in the colleges of education in Delta State participated in the survey. Data were collected with questionnaire. The results of data analysis showed that the respondents agreed that the attracting and retaining strategies considered in the study were necessary frameworks for boosting students’ enrolment into business education programme. The test of hypotheses showed that irrespective of the years of work experience of the respondents, their responses did not differ significantly. This indicated that the examined attracting and retaining strategies were critical for boosting students’ enrolment. It was concluded that the attracting and retaining strategies determined by the study are effective means of reversing the steady decline of students’ enrolment experienced in recent years at the colleges of education in Delta State, Nigeria.</span>
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Hamid, Shahnaz, and Rehana Siddiqui. "Gender Differences in Demand for Schooling." Pakistan Development Review 40, no. 4II (December 1, 2001): 1077–92. http://dx.doi.org/10.30541/v40i4iipp.1077-1092.
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The comparison of human development indicators in Table 1 shows that Pakistan’s performance is below the average for South Asian countries and below the average for the developing countries. Furthermore, gender differences in human development are also significant within country and across countries. For example, in 1999, differences in male and female literacy rate was 24 points in Pakistan, higher then the difference in less developed countries (equalling 15 points). [See HDC (2001)]. Similarly, within Pakistan, male literacy rate increased from 35 percent in 1980-81 to 56.6 percent in 1998-99 whereas female literacy rate increased from 16 percent in 1980-81 to 32.6 percent in 1998-99. This shows that despite doubling of female literacy rate, the gap between male and female literacy rate widened from 19 percent in 1980-81 to 24 percent in 1998-99. Similarly, another indicator of human capital, i.e., the net enrolment rates at primary level exhibited a declining trend in 1990s, particularly among males. An important reason for the decline could be rise in poverty. Table 2 shows a sustained increase in net enrolment ratio with income, and the positive income effect is higher in urban areas. In rural areas, the enrolment rate increases with income but there is slight decline in female enrolment rate at the highest income level. Thus, despite rapid rise in female enrolment the gender, differences persist and income is the main factor affecting demand for education.
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Watkins, Peter. "SCHOOL CLOSURE: COMMUNITY PARTICIPATION AND ACTION IN THE FACE OF ENROLMENT DECLINE." Discourse: Studies in the Cultural Politics of Education 7, no. 1 (October 1986): 78–97. http://dx.doi.org/10.1080/0159630860070105.
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Pandita, Ramesh. "Enrolment & Dropout Percentage among Boys & Girls up to Secondary Level in India: A Comparative Study." International Letters of Social and Humanistic Sciences 49 (March 2015): 123–34. http://dx.doi.org/10.18052/www.scipress.com/ilshs.49.123.
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Purpose: The present paper seeks to examine the enrolment and dropout percentage of children in India, supported with empirical findings up to secondary level. Although, the study is general in nature, but the emphasis has been laid on the girl child education, which is one of the greatest concerns in the Indian school education sector. Some of the aspects studied include, enrolment and dropout of children during the period of study, under both boys and girls category, their corresponding growth rate in enrolment, their corresponding decline rate in dropout and many other allied aspects.Scope: The study is confined to secondary level education and the findings have direct bearing on the Indian school education system. Given the population size of India and the socioeconomic conditions of the country, there is a need to observe caution, while generalizing the findings for other countries.Methodology/Approach: The present study is purely based on the analysis of secondary data retrieved from the official website of the Ministry of Human Resource and Development, Govt., of India. The data lasts for the decade 2001-02 to 2010-11 and was retrieved on October 02, 2014. Since the data on the website stands up-dated up to the year 2010-11, as such the findings simply reflect a trend in the enrolment and dropout percentage in India and may show variation by the time figures are updated.Findings: The study reveals that during the period of study, the enrolment percentage of girls has improved over two fold to that of boys. As, compared to 18.17% increase in the overall enrolment of boys, the enrolment percentage of girls increased by 40.52% during the decade. The corresponding growth surely reflects the changed mindset of male dominated Indian social setup towards the girl child. Even, the average annual dropout percentage of girls remained better to that of boys, as the girls recorded a corresponding decline in their dropout percentage by 3.53%, while as in case of boys the dropout percentage declined by 2.54% annually. Despite all these positives, the discouraging part is that compared to 57.39% boys, 60.39% girls’ dropout by or before reaching the upper primary level and against 78.40% boys, 81.72% girls’ dropout by or before reaching the secondary level.Social Implications: Given the new and changed world order, no country can afford to remain elusive of basic formal education, what is commonly known as elementary education and so holds true of India. The study is a positive indicator of the growing awareness among Indian masses towards the promotion of girl child education, but still there is lot yet to be done to reduce the dropout percentage between upper primary and secondary level for both boys in general and girls in particular.
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Rahim Hanafi, Munazza. "HIGHER EDUCATION INSTITUTIONS: ANALYSIS ON STUDENT-TEACHER RATIO, STUDENT ENROLMENT, EDUCATION EXPENDITURE AND NUMBER OF UNIVERSITIES IN SINDH." International Journal of Advanced Research 9, no. 5 (May 31, 2021): 413–23. http://dx.doi.org/10.21474/ijar01/12854.
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Development and social safety of a country rely more on all the actions that involve proficiency, knowledge and highly qualified manpower who can bridge between new opportunities and job demand. Number of higher education institutions, student-teacher ratio whichdepict quality of education, student enrolment in universities and availability of qualified teachers is vital for the promotion of quality education with a smooth transaction of academic activities across the country. This research study is an effort to measure the situation of public and private universities in Sindh by focusing on the number of universities, student-teacher ratio in public and private sector, number of teachers and Sindh education expenditure. Date included in the study to achieve the objective has been reviewed and examined from the available source (Pakistan Education Statistic). An increase can be seen in the public universities but still there are more private universities in Sindh. Data reveals that the number of teachers in both university sectors has declined and there is an increasing trend of part time teachers in respective universities. Prominent decline can be seen in public sector university enrolmentswhereas increasing percentage ofstudent enrolments has been identified in private sector universities of Sindh.
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Patel, Anuj V., Samuel M. Abrams, Charlotte A. Gaydos, Mary Jett-Goheen, Carl A. Latkin, Richard E. Rothman, and Yu-Hsiang Hsieh. "Increasing HIV testing engagement through provision of home HIV self-testing kits for patients who decline testing in the emergency department: a pilot randomisation study." Sexually Transmitted Infections 95, no. 5 (June 14, 2018): 358–60. http://dx.doi.org/10.1136/sextrans-2018-053592.
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ObjectiveUp to 60% of patients decline routine HIV testing offer in US emergency departments (EDs). The objective of this study is to determine whether the provision of HIV self-testing (HIVST) kit would increase engagement of HIV testing among these HIV test ‘Decliners’.MethodsPatients who declined a test offered in an ED-based triage nurse-driven HIV screening programme were enrolled and randomised to either the HIVST or the control group. The patients in the HIVST group received HIVST kits to take home, were encouraged to report test results to an established internet-based STI/HIV testing recruitment website ‘I Want the Kit’ (IWTK) and received five referral cards for their peers to request HIVST kits from IWTK. The control group received pamphlets about publicly available HIV testing sites. HIV testing from both groups after enrolment was determined via telephone follow-up at 1 month. Testing rate ratio (RR) was determined using χ2 tests.ResultsFifty-two patients were randomised to the HIVST group and 48 to the control group. Among all 64 patients completing any follow-up, 14/29 (48%) patients in the HIVST group tested themselves at home with the provided kit. Four of these had never had an HIV test. Only 2/35 (6%) in the control group reported having an HIV test after enrolment (RR: 8.45 (95% CI: 2.09 to 34.17)). 57% (8/14) in the HIVST group reported test results to IWTK.ConclusionProvision of HIVST kits supplements ED-based screening programme and significantly improved engagement of HIV testing among those test ‘Decliners’ in the ED.Trial registration numberNCT03021005, results.
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Kola, Aina, Jacob. "The Decline in Science Students’ Enrolment in Nigerian Colleges of Education: Causes and Remedies." International Journal of Education and Practice 6, no. 4 (2018): 167–78. http://dx.doi.org/10.18488/journal.61.2018.64.167.178.
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Blicblau, Aaron. "Engaging Materials in the K1 to K12 School Environment as the Foundation for Engineering and Technology." Advanced Materials Research 422 (December 2011): 716–21. http://dx.doi.org/10.4028/www.scientific.net/amr.422.716.
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There is a need to re-vitalize science and technology education to suit today’s world. The specific aim for this study is to determine how school science in early years of schooling impacts on years 11 and 12 science studies in the areas of materials science, and subsequent further tertiary studies. Public education records were investigated to obtain post hoc enrolment data to establish trends and decline in enrolments in physics and chemistry in the final years of high school which revealed a trend in enrolments falling over a ten year period. The student population in science of physics and chemistry were not well prepared for future studies and are a challenge for students undertaking engineering and technology studies at a tertiary level. It is proposed that primary and high school science subjects be made more popular by integrating popular aspects of materials in everyday life, so making science an appealing part of the syllabus. Initiating these syllabus changes will enhance the way science subjects are taught to encourage studies into engineering.
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Bucchieri, Salvatore, Pietro Alfano, Palma Audino, Fabio Cibella, Giovanni Fazio, Salvatore Marcantonio, and Giuseppina Cuttitta. "Lung Function Decline in Adult Asthmatics—A 10-Year Follow-Up Retrospective and Prospective Study." Diagnostics 11, no. 9 (September 7, 2021): 1637. http://dx.doi.org/10.3390/diagnostics11091637.
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Asthma may have an impact on lung function decline but conflicting results are reported in forced expiratory volume in one second (FEV1) decline. We aimed to describe the changes in FEV1 in lifelong non-smoking adult asthmatic outpatients during a 10-year follow-up comparing years 1–5 (1st period) with years 6–10 (2nd period) to assess factors affecting these changes. A total of 100 outpatients performed spirometry every 3 months during a 10-year survey. FEV1/Ht3 slope values of the 2nd period reduced significantly respect to the 1st period (p < 0.0001). FEV1 slopes of years 1–5 and 6–10 were inversely associated with FEV1 at enrolment (p = 0.02, p = 0.01, respectively). Reversibility and variability FEV1 showed a significant effect on the 1st period slopes (p = 0.01 and p < 0.04, respectively). Frequent exacerbators in the 1st year had steeper FEV1/Ht3 slopes in the 1st period (p = 0.01). The number of subjects using higher doses of ICS was significantly lower at the 10th years respect to the 5th and the 1st year (p < 0.001, p = 0.003, respectively). This study shows that FEV1 decline in treated adult asthmatics non-smokers, over 10-year follow-up, is not constant. In particular, it slows down over time, and is influenced by FEV1 at enrolment, reversibility, variability FEV1 and exacerbation score in the 1st year.
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Nerbass, Fabiana B., Louise Moist, William F. Clark, Marcos A. Vieira, and Roberto Pecoits-Filho. "Hydration Status and Kidney Health of Factory Workers Exposed to Heat Stress: A Pilot Feasibility Study." Annals of Nutrition and Metabolism 74, Suppl. 3 (2019): 30–37. http://dx.doi.org/10.1159/000500373.
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Dehydration associated with heat stress increases the risk of workplace injury or illness, decreases productivity, and may contribute to the chronic kidney disease epidemic identified in outdoor workers from hot climates. There is limited research on the effects of chronic occupational heat stress among indoor workers. We aimed to test the feasibility of measuring markers of hydration and kidney function in foundry factory workers in Southern Brazil, exposed and not exposed to heat stress. Factory workers exposed to heat stress (wet bulb globe temperature ≥28.9) and not exposed to heat were identified by management and invited to participate. Clinical and biochemical markers of hydration and kidney function were evaluated before and after a single 8.5 h work shift (lunch time not included). Feasibility outcomes included rates of enrolment, % completion of study protocols, and time to complete data collection. This study was deemed feasible with 80% enrolment and 90% completion of the protocol. Among the preselected workers, the enrolment rate was 91%. All subjects completed the physiological measures and blood collection and 95% completed the urine studies. Mean time to complete data collection pre-shift was 19.1 ± 4.2 min and post-shift: 14.3 ± 4.0 min. Workers exposed to heat stress had a greater decline in estimated glomerular filtration rate compared to controls over the work shift (–13 ± 11 vs. –5 ± 7 mL/min; p < 0.01). We demonstrated the feasibility and challenges of conducting future hydration and kidney function research among indoor factory workers. Further study is needed to determine if exposure to indoor heat contributes to a decline in kidney function.
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SILVA, SIMONE, and DAVID R. HOTCHKISS. "HOW DOES THE SPREAD OF PRIMARY AND SECONDARY SCHOOLING INFLUENCE THE FERTILITY TRANSITION? EVIDENCE FROM RURAL NEPAL." Journal of Biosocial Science 46, no. 1 (February 21, 2013): 16–46. http://dx.doi.org/10.1017/s0021932013000096.
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SummaryFrom 1996 to 2006, Nepal experienced a substantial fertility decline, with the total fertility rate dropping from 4.6 to 3.1 births per woman. This study examines the associations between progress towards universal primary and secondary schooling and fertility decline in rural Nepal. Several hypotheses regarding mechanisms through which education affects current fertility behaviour are tested, including: the school environment during women's childhood; current availability of schools; knowledge of educational costs; and women's own educational attainment. Data for the analysis come from the 2003–04 Nepal Living Standards Survey, a nationally representative random sample of households, which includes detailed data on fertility, household expenditure, educational attainment, demographic characteristics and the use of social services. Census and administrative data are also used to construct district-level gross enrolment ratios for primary and secondary schools during the women's childhood. Discrete dependent variable modelling techniques are used to estimate the effects of the following variables on the probability of women giving birth in a given year: district-level gross enrolment ratios for primary and secondary schools during women's childhood; having had a child previously in school; women's own educational level; current school availability; and other covariates. Separate models are estimated for the overall sample of rural women of reproductive age, and for parity-specific sub-samples. The results suggest that district-level gross enrolment ratios for secondary schools and, in some instances, having had a previous child enrolled in school are significant determinants of fertility in rural areas. These results are highly independent of women's own educational levels. Overall, the results suggest that, in the rural Nepal context, mass schooling influences the fertility transition through both community- and household-level pathways.
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Faisal, Buyinza, Teera Joweria, and Bateganya Fred Henry. "Consequences of HIV Infection on Household Assets and Human Capital Investment in Uganda: Micro Evidence." International Journal of Economics and Finance 9, no. 12 (November 19, 2017): 202. http://dx.doi.org/10.5539/ijef.v9n12p202.
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This paper studies the effect of the HIV and AIDS epidemic on economic decision making using the Uganda National Household Survey (2010). The findings indicate that household’s HIV and AIDS status, education and social-economic factors are important in explaining low household’s asset accumulation and school enrolments of children in Uganda especially at primary school level. Household savings and assets accumulation findings show that household’s HIV and AIDS status and their education levels, marital status and the employment status are consistently associated with lower savings. Major implications of these results is that raising women’s education improves their economic opportunities and the behavioral responses in sexual interaction will lead to decline in HIV infection by reducing the willingness to engage in unprotected sex. In fact, we find that educational performance declines in those HIV infected households in which the father is living with HIV. The paper recognizes the policy challenges surrounding the HIV and AIDS -education linkage and considers some of the strategies that have been implemented to improve the schooling outcomes of children from households of people living with HIV (PLHIV). We find a weak positive effect of HIV infection on savings and a significant positive effect on school enrolment and educational expenses for children. High-perceived infection risk has a positive albeit imprecise influence on school enrollment and educational expenses, but no effect on savings.
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Dutta, Eliza K., Sampath Kumar, Selvaraju Venkatachalam, Laura E. Downey, and Sandra Albert. "An analysis of government-sponsored health insurance enrolment and claims data from Meghalaya: Insights into the provision of health care in North East India." PLOS ONE 17, no. 6 (June 3, 2022): e0268858. http://dx.doi.org/10.1371/journal.pone.0268858.
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Introduction The Megha Health Insurance Scheme (MHIS) was launched in 2013 in the North-East Indian state of Meghalaya to reduce household out-of-pocket expenditure on health and provide access to high-quality essential healthcare. Despite substantial expansion of the MHIS since the scheme’s inception, there is a lack of comprehensive documentation and evaluation of the scheme’s performance against its Universal Health Care (UHC) objectives. Methods We analysed six years of enrolment and claims data (2013–2018) covering three phases of the scheme to understand the pattern of enrolment, utilisation and care provision under the MHIS during this period. De-identified data files included information on age, sex, district of residence, the district of provider hospital, type of hospital, date of admission, status at discharge, claimed category of care, package codes, and amount claimed. Descriptive statistics were generated to investigate key trends in enrolment, service utilisation, and Government health spending under the MHIS. Results Approximately 55% of the eligible population are currently enrolled in MHIS. Enrolment increased consistently from phase I through III and remained broadly stable across districts, gender, age group and occupation categories, with a small decline in males 19–60 years. Claims were disproportionately skewed towards private provision; 57% of all claims accrued to the 18 empanelled private hospitals and 39% to the 159 public sector facilities. The package ‘General Ward Unspecified’ was responsible for the highest volume of claims and highest financial dispensation across all three phases of the scheme. This likely indicates substantial administrative error and is potentially masking both true burden of disease and accurate financial provision for care under the MHIS. Anti-rabies injections for dog/cat bite contributed to 11% of total claims under MHIS III, and 1.6% of all claims under MHIS II. This warrants investigation to better understand the burden of animal bites on the Meghalayan population and inform the implementation of cost-effective strategies to reduce this burden. Conclusions This paper describes the first analysis of health insurance enrolment and claims data in the state of Meghalaya. The analysis has generated an important evidence base to inform future MHIS enrolment and care provision policies as the scheme expands to provide Universal Health Coverage to the state’s entire population.
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Narayana, M. R. "Accounting for Growth Effects of Age Structure Transition through Public Education Expenditure: New Macroeconomic Evidence from India." South Asian Journal of Macroeconomics and Public Finance 7, no. 2 (October 4, 2018): 174–211. http://dx.doi.org/10.1177/2277978718795773.
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This article quantifies the growth effects of age structure transition through current public education expenditure. Using the National Transfer Accounts’ (NTA) First Demographic Dividend (FDD) model, growth effects are accounted by the impact of current public education expenditure on economic support ratio (ESR) and labour productivity through human capital investments. The results offer new macroeconomic evidence. Age structure transition reduces the education dependency ratio (EDR) by all levels of education but the highest in the elementary education. This impacts on a long-term decline in enrolment in elementary education where the current gross enrolment ratio (GER) is close to 100 per cent and a decline in current public education expenditure. Other things being equal, the resultant potential savings, or the availability of extra budgetary resources, is a new way of financing the investment requirements for secondary and higher education with the aim of increasing national economic growth through human capital investments. In particular, growth effects are shown to be positive, higher and longer up to 2050, if the current public education spending is reallocated more for the secondary and higher education. Surprisingly, growth effects are explained less by the ESR than labour productivity. This justifies a higher human capital investment to enhance labour productivity for attainment of higher economic growth. The afore- mentioned macroeconomic framework, results and implications are of general relevance for other developing countries in South Asia and elsewhere in the world. JEL Classification: E65, H52, J11
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Seelig, Jennifer L. "Battling Declining Enrolment in the Upper Midwestern United States: Rural Schools in a Competitive Society." Australian and International Journal of Rural Education 27, no. 2 (August 18, 2017): 77–92. http://dx.doi.org/10.47381/aijre.v27i2.122.
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This paper examines the effects of declining student enrolment and population loss on one rural school district in the United States, as well as the district’s strategies to mitigate these effects. In the state of Wisconsin, the relationship between student enrolment and school funding destabilises rural school districts experiencing population decline and forces them to depend on local property taxes to make up the difference. In order to achieve community financial and political support, the school district in Forest Lake, Wisconsin, emphasises choice, transparency and new managerial practices. Using data from a year-long ethnographic study, the following analysis explores neoliberal educational policies at the state level that shape local educational policies and practices in Forest Lake. The Forest Lake school district is mired in a paradoxical situation in which being competitive in the educational marketplace equates to disrupting established school-community relations. The findings imply that required participation in an educational marketplace shifts the priorities of a rural school district to a focus on competition and financial security over the well-being of the school community.
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Miele, Catherine H., Matthew R. Grigsby, Trishul Siddharthan, Robert H. Gilman, J. Jaime Miranda, Antonio Bernabe-Ortiz, Robert A. Wise, and William Checkley. "Environmental exposures and systemic hypertension are risk factors for decline in lung function." Thorax 73, no. 12 (July 30, 2018): 1120–27. http://dx.doi.org/10.1136/thoraxjnl-2017-210477.
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BackgroundChronic lung disease is a leading contributor to the global disease burden; however, beyond tobacco smoke, we do not fully understand what risk factors contribute to lung function decline in low-income and middle-income countries.MethodsWe collected sociodemographic and clinical data in a randomly selected, age-stratified, sex-stratified and site-stratified population-based sample of 3048 adults aged ≥35 years from four resource-poor settings in Peru. We assessed baseline and annual pre-bronchodilator and post-bronchodilator lung function over 3 years. We used linear mixed-effects models to assess biological, socioeconomic and environmental risk factors associated with accelerated lung function decline.ResultsMean±SD enrolment age was 55.4±12.5 years, 49.2% were male and mean follow-up time was 2.36 (SD 0.61) years. Mean annual pre-bronchodilator FEV1 decline was 30.3 mL/year (95% CI 28.6 to 32.0) and pre-bronchodilator FVC decline was 32.2 mL/year (30.0 to 34.4). Using multivariable linear mixed-effects regression, we found that urban living, high-altitude dwelling and having hypertension accounted for 25.9% (95% CI 15.7% to 36.1%), 21.3% (11.1% to 31.5%) and 15.7% (3.7% to 26.9%) of the overall mean annual decline in pre-bronchodilator FEV1/height2, respectively. Corresponding estimates for pre-bronchodilator FVC/height2 were 42.1% (95% CI% 29.8% to 54.4%), 36.0% (23.7% to 48.2%) and 15.8% (2.6% to 28.9%) of the overall mean annual decline, respectively.ConclusionUrbanisation, living at high altitude and hypertension were associated with accelerated lung function decline in a population with low daily smoking prevalence.
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Adams, Jennifer, and Emily Hannum. "Children's Social Welfare in China, 1989–1997: Access to Health Insurance and Education." China Quarterly 181 (March 2005): 100–121. http://dx.doi.org/10.1017/s0305741005000068.
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Fundamental changes in China's finance system for social services have decentralized responsibilities for provision to lower levels of government and increased costs to individuals. The more localized, market-oriented approaches to social service provision, together with rising economic inequalities, raise questions about access to social services among China's children. With a multivariate analysis of three waves of the China Health and Nutrition Survey (1989, 1993 and 1997), this article investigates two dimensions of children's social welfare: health care, operationalized as access to health insurance, and education, operationalized as enrolment in and progress through school. Three main results emerge. First, analyses do not suggest an across-the-board decline in access to these child welfare services during the period under consideration. Overall, insurance rates, enrolment rates and grade-for-age attainment improved. Secondly, while results underscore the considerable disadvantages in insurance and education experienced by poorer children in each wave of the survey, there is no evidence that household socio-economic disparities systematically widened. Finally, findings suggest that community resources conditioned the provision of social services, and that dimensions of community level of development and capacity to finance public welfare increasingly mattered for some social services.
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Saraf, Santosh L., Jin Han, Maria Armila Ruiz, Andrew Srisuwananukorn, David Shuey, Faiz Ahmed Hussain, Franklin Njoku, Robert E. Molokie, and Victor R. Gordeuk. "Defining and Predicting Rapid Egfr Decline in Sickle Cell Disease." Blood 138, Supplement 1 (November 5, 2021): 122. http://dx.doi.org/10.1182/blood-2021-147861.
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Abstract Chronic kidney disease is observed in up to 50% of adults with sickle cell disease (SCD) and is a consistent predictor for increased morbidity and early mortality. Progression of kidney disease can be manifested by a rapid decline in estimated glomerular filtration rate (eGFR). In retrospective studies, up to 38% of SCD patients have a rapid decline in kidney function, defined from the non-SCD literature as an eGFR slope < -3.0 mL/min/1.73m 2. Clinical and genetic predictors and the appropriate cutoff for rapid eGFR decline in SCD are unclear, but are paramount for guiding intervention studies in sickle cell nephropathy. We investigated 1) genetic, laboratory, and clinical risk factors for eGFR decline and 2) the rate of eGFR decline that best predicted mortality risk in a longitudinal cohort of SCD patients enrolled in a prospective registry at our institution. Between 10/2009 and 2/2018, 439 SCD patients were recruited. Blood samples, clinical and laboratory data were collected after obtaining consent at the time of enrolment during a clinic visit without the patient being in a vaso-occlusive crisis. 352 SCD patients with > 6 months of outpatient eGFR assessments were included in this analysis. The eGFR slope was calculated for each patient by linear regression of eGFR by time. Genotyping for the APOL1 G1 and G2 kidney risk variants and alpha thalassemia were performed by PCR. High-risk APOL1 status was defined as being either homozygous or compound heterozygous for the G1 and/or G2 variants. The statistical analyses for predictors of eGFR decline were conducted using linear regression, adjusting for age, sex, SCD genotype, hydroxyurea use, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use, and baseline eGFR. Median and interquartile ranges (IQR) are provided. The median age of the cohort was 32 years old (IQR, 24 - 43 years), 60% were female, 76% had Hb SS or Sβ 0-thalassemia genotype, 47% were on hydroxyurea, and 12% were on ACEi or ARB therapy. With a median follow up of 6.7 (IQR, 3.8 - 8.5) years, the median annual eGFR slope was -0.9 (IQR, -3.6 to 1.1) mL/min/1.73m 2. A faster rate of eGFR decline was observed in SCD patients with the Hb SS or Sβ 0-thalassemia genotype, with high-risk APOL1 status, and in those without coinheritance of α-thalassemia (Figure 1A). The urine albumin concentration, based on the average of two consecutive values from the time of enrolment, was significantly associated with a more rapid eGFR decline (β -0.63, P < 0.0001). An albuminuria cutoff of ≥ 100 mg/g creatinine was a stronger predictor for eGFR decline than cutoffs of ≥ 30 or ≥ 300 mg/g (Figure 1B). During the follow up period, we observed 26 deaths (7.4% mortality). An annual eGFR slope of < -6 mL/min/1.73m 2 was independently associated with a greater risk for mortality, after adjusting for age, sex, SCD genotype, hydroxyurea use, ACEi or ARB use, and baseline eGFR (Figure 1C). Using receiver operating curves, this cutoff was also associated with the largest area under the curve for predicting mortality. Our data highlights genetic risk factors and supports albuminuria as an independent predictor of eGFR decline in a longitudinal cohort of SCD patients. We also demonstrate that an annual eGFR slope of < -6 mL/min/1.73m 2 is the strongest predictor for mortality in our cohort. This threshold will need to be validated in other longitudinal SCD cohorts. The association of urine albumin ≥ 100 mg/g creatinine with eGFR decline supports using this cutoff as a clinical biomarker to identify high risk patients for kidney disease progression and for initiating disease modifying and reno-protective therapies. Figure 1 Figure 1. Disclosures Saraf: Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding. Gordeuk: Modus Therapeutics: Consultancy; Novartis: Research Funding; Incyte: Research Funding; Emmaus: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding; CSL Behring: Consultancy.
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Holdaway, Edward A., Wendy M. Bryan, and Wilfred H. Allan. "International University Students in Canada: Obtaining the Information Needed for Policy Making." Canadian Journal of Higher Education 18, no. 3 (December 31, 1988): 13–29. http://dx.doi.org/10.47678/cjhe.v18i3.183043.
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International university students represent sources of goodwill and benefits for their host countries. Unfortunately, Canada, although still one of the major receiving countries, has seen a substantial decline in international enrolment during the 1980s. Reasons proposed for this decline include differential fees, insufficient financial support, quotas, and employment restrictions. The problems most frequently encountered by international students in Canada involve immigration procedures, accommodation, language, loneliness, and funding. The formulation of policies concerning these problems and other matters relevant to international university students occurs at the federal, provincial, and institutional levels. Even though the main forces driving such policies are cultural, financial, and political, the policies should take into account information about the needs, desires, and experiences of international students. A comprehensive 1986-87 University of Alberta survey of international students served as a case study to demonstrate how research can better inform policy making in this area. Respondents suggested that they would be helped by being allowed to work in Canada while studying and after graduation, which is a federal policy area, and by having more scholarships available to them and differential fees removed, both of which are provincial and institutional policy areas.
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Ogawa, Miku. "The Role of Low-cost Private Secondary Schools in Rural Kenya Under the ‘Free Secondary Education Policy’." Journal of International and Comparative Education 10, no. 2 (2021): 97–115. http://dx.doi.org/10.14425/jice.2021.10.2.1205.
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This study aims to understand the role of private secondary schools in rural Kenya under the Free Secondary Education Policy. Data were collected from four private schools over two months in 2018 and 2019. All the schools had experienced instability due to low enrolment, particularly after the policy was implemented in 2018. The decline in the schools’ income also affected the quality of education. However, the results suggest that some students prefer to complete their education at private schools as low-expense-boarders or as beneficiaries of fee discounts. Other students choose private schools to avoid overcrowded classrooms and travel far, especially when excluded from public schools. This study argues that despite limited learning resources, private secondary schools in rural Kenya have an important place in the public education system outside of the academic pyramid of public schools.
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Stager, David A. A. "Returns to Investment in Ontario University Education, 1960-1990, and Implications for Tuition Fee Policy." Canadian Journal of Higher Education 26, no. 2 (August 31, 1996): 1–21. http://dx.doi.org/10.47678/cjhe.v26i2.183235.
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Because students' university enrolment decisions are influenced by expected returns to their educational investment, policy decisions should be informed by calculations of such returns. Private rates of return, by field of study, for Ontario university graduates in 1990 ranged from 7% (humanities) to 21% (medicine). Returns were generally higher for women than for men. The 1990 results were virtually unchanged from 1985 when there was a sharp reversal of the long-run decline in rates of return that occurred from 1960 to 1980. Alternative assumptions about tuition fee levels show that doubling tuition fees from 1990 levels, or abolishing fees, would change the rates of return by only about two percentage points in either direction. Doubling fees in the major professional faculties would leave rates of return still in excess of returns to arts and science at current fee levels.
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Gruijters, Rob J., Tak Wing Chan, and John Ermisch. "Trends in educational mobility: How does China compare to Europe and the United States?" Chinese Journal of Sociology 5, no. 2 (March 19, 2019): 214–40. http://dx.doi.org/10.1177/2057150x19835145.
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Despite an impressive rise in school enrolment rates over the past few decades, there are concerns about growing inequality of educational opportunity in China. In this article, we examine the level and trend of educational mobility in China, and compare them to the situation in Germany, the Netherlands, the UK and the USA. Educational mobility is defined as the association between parents’ and children’s educational attainment. We show that China’s economic boom has been accompanied by a large decline in relative educational mobility chances, as measured by odds ratios. To elaborate, relative rates of educational mobility in China were, by international standards, quite high for those who grew up under state socialism. For the most recent cohorts, however, educational mobility rates have dropped to levels that are comparable to those of European countries, although they are still higher than the US level.
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Rajaram, Nadia, Beverley Yap, Mikael Eriksson, Shivaani Mariapun, Lee Mei Tan, Hamizah Sa’at, Evelyn Lai Ming Ho, et al. "A Randomized Controlled Trial of Soy Isoflavone Intake on Mammographic Density among Malaysian Women." Nutrients 15, no. 2 (January 6, 2023): 299. http://dx.doi.org/10.3390/nu15020299.
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Soy intake is associated with lower breast cancer risk in observational studies concerning Asian women, however, no randomized controlled trials (RCT) have been conducted among Asian women living in Asia. This three-armed RCT assessed the effects of one-year soy isoflavone (ISF) intervention on mammographic density (MD) change among healthy peri- and postmenopausal Malaysian women. This study was registered at ClinicalTrials.gov (NCT03686098). Participants were randomized into the 100 mg/day ISF Supplement, 50 mg/day ISF Diet, or control arm, and assessed for change in absolute and relative dense area from digital mammograms conducted at enrolment and after 12 months, compared over time across study arms using Kruskal-Wallis tests. Out of 118 women enrolled, 91 women completed the intervention, while 27 women (23%) were lost in follow up. The ISF supplement arm participants observed a larger decline in dense area (−1.3 cm2), compared to the ISF diet (−0.5 cm2) and control arm (−0.8 cm2), though it was not statistically significant (p = 0.48). Notably, among women enrolled within 5 years of menopause; dense area declined by 6 cm2 in the ISF supplement arm, compared to <1.0 cm2 in the control arm (p = 0.13). This RCT demonstrates a possible causal association between soy ISF intake and MD, a biomarker of breast cancer risk, among Asian women around the time of menopause, but these findings require confirmation in a larger trial.
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Zaharin, Nur Lisa, Sabariah Sharif, Soon Singh Bikar Singh, Rosy Talin, Muralindran Mariappan, Navin Mohanaraj, Yusmail Jusup, and Panthmanathan Suppiah. "Promoting Students’ Interest, Attitude and Intrinsic Motivation Towards Learning STEM Through Minimalist Robot Education Programme." International Journal of Service Management and Sustainability 4, no. 1 (March 2, 2020): 41. http://dx.doi.org/10.24191/ijsms.v4i1.8054.
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Intrinsic motivation is one of the main driving forces for students’ interest and attitude towards learning STEM subjects such as Science, Technology, Engineering and Mathematics (STEM). Unfortunately, students’ interestand attitude towards STEM subjects are on the decline. A continued decline, if unchecked, will affect the number of students’ enrolment into the STEM fields. This study was conducted to investigate the students’ interest, attitude and intrinsic motivation towards learning STEM subjects by appraising the pro educational modules that include assembling and dismantling the minimalist robots and by providing software training to the students. The results of hypothesis testing of P-value generated via Statistical Packages of Social Sciences (SPSS) v2.5 indicate the effectiveness of Minimalist Robot Education Programme. The students’ interest, attitude and intrinsic motivation show a significant difference towards the learning of STEM. The findings also show that all the alternative hypotheses: (1) students’ interest towards learning STEM is increased as a result of participating in the Minimalist Robotic Education Programme; (2); students’ attitude towards learning STEM increased as a result of participating in the Minimalist Robotic Education Programme and (3) students’ intrinsic motivation towards learning STEM increased as a result of participating in the Minimalist Robotic Education Programme set for this study.These favorable findings can be a platform for advocating the application of robotics in the Malaysian curricula.
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Yeasmin, Sabina, and Md Dulal Mahmud. "Acquiring Scientific and Technological Proficiency: State of Science Education in Bangladesh." Asian Journal of Humanity, Art and Literature 6, no. 2 (December 31, 2019): 179–94. http://dx.doi.org/10.18034/ajhal.v6i2.363.
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Developing scientific values in students’ mind is the goal of science teaching. Bangladesh, of late, has adopted various strategies to educate the people and mainly the children. There are still many challenges for the country to attain an acceptable standard of education. Science education here in Bangladesh is in a state of crisis. The enrolment for science studies in the country shows a sharp decline over the past few years. This discipline, what once used to be the most sought after subject at secondary, higher secondary and tertiary levels in the country, is losing its appeal in an alarming shift of choice. Indeed it is important know what the obstacles are and how they are removed within a stipulated short period. This paper aims to present the current situation of Bangladesh in terms of science and technological development in the education sector. There is no alternative of a scientifically and technologically literate workforce as the future economy will also be science i.e. ICT based.
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Stelle, Isabella, Mamadou Bah, Sergio A. Silverio, Hans Verhoef, Ebrima Comma, Andrew M. Prentice, Sophie E. Moore, and Carla Cerami. "Iron supplementation of breastfed Gambian infants from 6 weeks to 6 months of age: protocol for a randomised controlled trial." Wellcome Open Research 7 (January 18, 2022): 16. http://dx.doi.org/10.12688/wellcomeopenres.17507.1.
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Background: A recent analysis showed that plasma iron concentrations decline rapidly from birth in Gambian infants, irrespective of sex or birthweight, to concentrations well below normal expected values for iron-replete children older than two months of age (typically >10 μmol/L). The development and function of neural and immune cells may thus be compromised before the minimum age at which children should receive iron supplementation as per World Health Organisation recommendations. Methods: This study is a two-arm, double-blind, placebo-controlled, randomised superiority trial. Infants will be randomised to receive iron drops (7.5mg/day of iron as ferrous sulphate) or placebo daily for 98 days, to test the impact on serum iron concentrations in healthy, breastfed infants (n = 100) aged 6-10 weeks at enrolment. Participants will be visited daily and supplemented by the field team. Daily health and weekly breastfeeding questionnaires will be administered. Anthropometry, and venous blood and faecal samples will be collected at enrolment and after 98 days of supplementation with serum iron as the primary endpoint. Low birthweight (less than 2.5kg at birth) and infants born prematurely (< 37 weeks) will not be excluded. Formula-fed and infants with any illness will be excluded. An additional study exploring maternal stakeholder perspectives of the intervention will be conducted by means of maternal interviews and four focus group discussions with local stakeholders. Discussion: Most breast-fed Gambian infants have very low circulating iron levels by five months of age. This study will introduce iron supplements much earlier in infancy than has previously been attempted in a low-income setting with the primary aim of increasing serum iron concentration. Trial registration: Clincaltrials.gov (NCT04751994); 12th February 2021
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Heerspink, Hiddo J. L., Bergur V. Stefansson, Glenn M. Chertow, Ricardo Correa-Rotter, Tom Greene, Fan-Fan Hou, Magnus Lindberg, et al. "Rationale and protocol of the Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) randomized controlled trial." Nephrology Dialysis Transplantation 35, no. 2 (February 1, 2020): 274–82. http://dx.doi.org/10.1093/ndt/gfz290.
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Abstract Background Recent cardiovascular outcome trials have shown that sodium–glucose co-transporter 2 (SGLT2) inhibitors slow the progression of chronic kidney disease (CKD) in patients with type 2 diabetes at high cardiovascular risk. Whether these benefits extend to CKD patients without type 2 diabetes or cardiovascular disease is unknown. The Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) trial (NCT03036150) will assess the effect of the SGLT2 inhibitor dapagliflozin on renal and cardiovascular events in a broad range of patients with CKD with and without diabetes. Methods DAPA-CKD is a randomized, double-blind, placebo-controlled, trial in which ∼4300 patients with CKD Stages 2–4 and elevated urinary albumin excretion will be enrolled. The vast majority will be receiving a maximum tolerated dose of a renin–angiotensin system inhibitor at enrolment. Results After a screening assessment, eligible patients with a urinary albumin:creatinine ratio ≥200 mg/g and estimated glomerular filtration rate (eGFR) between 25 and 75 mL/min/1.73 m2 are randomly assigned to placebo or dapagliflozin 10 mg/day. Enrolment is monitored to ensure that at least 30% of patients do not have diabetes and that no more than 10% have an eGFR >60 mL/min/1.73 m2. The primary endpoint is a composite of a sustained decline in eGFR of ≥50%, end-stage renal disease, renal death or cardiovascular death. The trial will conclude when 681 primary renal events have occurred, providing 90% power to detect a 22% relative risk reduction (α level of 0.05). Conclusion DAPA-CKD will determine whether the SGLT2 inhibitor dapagliflozin, added to guideline-recommended therapies, safely reduces the rate of renal and cardiovascular events in patients across multiple CKD stages with and without diabetes.
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Ehrlich, Simeon D. "The Health of the Classics Job Market during the Pandemic: A Long-Term Perspective." Mouseion 17, no. 3 (July 1, 2021): 561–82. http://dx.doi.org/10.3138/mous.17.3.008.
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The pressures of the COVID-19 pandemic have led to a 60% decline in the scale of the academic job market in classics in Canada and the United States. Review of online job posting data stretching back to the mid-1990s shows that the health of this market correlates closely with that of the economy at large. While minor year-to-year economic fluctuations have a minimal impact on the job market in the long term, recessions fundamentally alter its character, with the market remaining depressed for years after the economy itself has recovered. Compounding this problem is the oversupply of PhDs flooding the market at present, a consequence of the long training period of graduate school, which keeps PhD output high for many years after a wave of undergraduate enrolment peaks. A third factor is the trend in academia to short-term positions with high teaching loads, which leads to fewer openings for permanent jobs and a diminished need for faculty. Taken together, current trends bode ill for the future of our discipline and pose an existential threat for many smaller programs.
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Banusing, Rita O., and Joel M. Bual. "The Quality of Catholic Education of Diocesan Schools in the Province of Antique." Philippine Social Science Journal 3, no. 2 (November 12, 2020): 35–36. http://dx.doi.org/10.52006/main.v3i2.150.
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The mission of Catholic schools is linked to the evangelizing thrust of the Church in proclaiming Christ to the world to transform society. However, most Catholic institutions nowadays are confronted with issues on the deterioration of values, migration of qualified teachers to public schools, and decline in enrolment, posing threats to the Catholic identity and mission, operational sustainability, and quality of teaching and learning. To address these problems, the Catholic Educational Association of the Philippines (CEAP) developed the Philippine Catholic Schools Standards (PCSS) to help these schools in the country revisit and re-examine their institutional practices according to the identity and mission of the Catholic Church. Hence, this paper assessed the quality of Catholic education of diocesan schools in the Province of Antique in the light of Catholic identity and mission, leadership and governance, learner development, learning environment, and operational vitality domains of PCSS. Also, it sought to find out whether a significant relationship exists between the age, sex, length of service, and designation of assessors and their quality assessment on Catholic education.
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Banusing, Rita O., and Joel M. Bual. "Appraising the Quality of Diocesan Catholic Education in accordance with Philippine Catholic Schools Standards." Philippine Social Science Journal 4, no. 2 (June 17, 2021): 80–89. http://dx.doi.org/10.52006/main.v4i2.344.
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Catholic education is linked to the Church's evangelical mission. However, Catholic schools are confronted with the deterioration of values, teacher turnover, and decline in enrolment, posing threats to their mission and operation (Catholic Educational Association of the Philippines [CEAP], 2016). Hence, this assessed the quality of Catholic education of Antique diocesan schools using the Philippine Catholic Schools Standards (PCSS). Further, it identified areas for continuous improvement in the Catholic school operation. It also correlated the respondents’ age, sex, length of service, and designation with the quality assessment. With the descriptive-correlational design, the 120 school personnel responded through a standardized PCSS questionnaire. Generally, the assessment was rated “fully meets benchmark” with Catholic identity and mission as the highest and operational vitality as the lowest. The correlation showed no relationship between the age, sex, and length of service with the quality assessment while little if any relationship with the designation. Accordingly, the quality of Catholic education is attained through continuous adherence to the standards. With this, stakeholders’ collaboration is necessary.
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Chi, Kim N., Sebastien J. Hotte, Susan Ellard, Joel Roger Gingerich, Anthony Michael Joshua, Christian K. Kollmannsberger, Evan Y. Yu, and Martin Edwin Gleave. "A randomized phase II study of OGX-427 plus prednisone versus prednisone alone in patients with chemotherapy-naive metastatic castration-resistant prostate cancer." Journal of Clinical Oncology 30, no. 5_suppl (February 10, 2012): 121. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.121.
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121 Background: Heat Shock Protein 27 (Hsp27) is a stress-activated, multi-functional chaperone protein highly expressed in cancer that regulates cell signaling and survival pathways implicated in cancer progression. In prostate cancer models, Hsp27 complexes with androgen receptor (AR) and enhances transactivation of AR-regulated genes. OGX-427 is a 2nd generation antisense that inhibits Hsp27 expression with in vitro and in vivo efficacy. Phase I studies have demonstrated tolerability and single agent activity. Methods: Patients (pts) with CRPC, no/minimal symptoms and any prior treatment other than chemotherapy were randomized 1:1 to receive prednisone (P) 5 mg PO BID or P with OGX-427 600 mg IV x 3 loading doses followed by 1000 mg IV weekly. Primary endpoint was the proportion of pts progression free (PSAWG 2 criteria) at 12 weeks. A 2-stage MinMax design (H0 = 5%, HA >20%, α=0.1, β=0.1) will enrol 32 pts total per arm and provide 70% power to detect the difference at a 0.10 1-sided significance. Secondary endpoints include PSA decline, measurable disease response, and circulating tumour cell (CTC) enumeration. Results: In the first 22 pts randomized (11 to OGX-427+P, 11 to P), baseline median age was 71 years (53-86), ECOG PS 0 or 1 in 64% and 36% of pts, median PSA 89 (6-606), metastases in bone/lymph nodes/liver or lung in 77%/64%/10%, 23% had prior treatment with P, and 91% had ≥5 CTC/7.5 ml (median 18/7.5 ml). Thus far, 82% of pts randomized to OGX-427+P have had a PSA decline (55% with ≥30% decline) and 18% a PSA increase; 40% of pts treated with P have had a PSA decline (20% with ≥30% decline), 10% no change and 50% with PSA increase. CTC conversion from ≥5 to <5/7.5 ml has occurred in 60% of pts randomized to OGX-427+P and 20% of pts treated with P alone. Grade 1-2 infusion reactions (e.g., chills, diarrhea, flushing) have occurred in 45% of pts receiving OGX-427+P and 1 pt developed hemolytic uremic syndrome after week 7 probably related to OGX. Conclusions: Preliminary data provide clinical support for the role of Hsp27 in AR signalling and as a therapeutic target for prostate cancer. Enrolment on this study continues. Funded by a grant from the Terry Fox Research Institute.
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Malik, Dr Mohd Azhar Ud Din, and Dr Hasina Jabeen. "Higher Education in India: Women Employment, Why So Few Among So Many?" International Journal of Business and Management Research 6, no. 3 (September 30, 2018): 79–84. http://dx.doi.org/10.37391/ijbmr.060301.
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Progress of a country weather social or economical is largely resolute by the active contribution and participation of its labor force. Both men and women create the labor force; but it has been noted that since past decade, India has been seen a steady decline in Female Labor Force Participation (FLFP) from 37% in 2005 to an all-time low of 23 percent in 2016. On the other hand, percentage of women participation in the higher education increase. The enrolment ratio of women in higher education increased from 22% in 2012 to 26% in 2016 as per study of AISHE. The objective of this paper is to know reason behind decline in labour participation of women, as their ratio in higher education increase. The study was totally based on secondary data. This work examines the reason of women labor force participation, as against the backdrop of India having one of the lower most participation rates for female among peer countries. The research work has revealed that in modern world women are much more creative and innovative than men. Women by nature are economical and not cause undue wastage of resources and needless expenses. If they are on condition that with the right entree backed by the right governmental strategies, they can also influence the well–being of the environment and public health at national level. The main finding is that a number of program initiatives can help in boosting female in social and economic participation in India, including labor market flexibility, speculation in infrastructure, and improved social outlay.
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Cresswell, Fiona V., Ananta S. Bangdiwala, Nathan C. Bahr, Emily Trautner, Edwin Nuwagira, Jayne P. Ellis, Radha Rajasingham, et al. "Tuberculous meningitis diagnosis and outcomes during the Xpert MTB/Rif era: a 6.5-year cohort study in Uganda." Wellcome Open Research 3 (July 3, 2018): 64. http://dx.doi.org/10.12688/wellcomeopenres.14610.2.
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Background: Tuberculous meningitis (TBM), a leading cause of meningitis in sub-Saharan Africa, is notoriously difficult to diagnose. In our Ugandan setting TB diagnostics have evolved rapidly in recent years, with introduction of Xpert MTB/Rif (Xpert) in 2011 and culture in 2013. We aim to describe the impact of improved TBM diagnostics at two Ugandan hospitals between 2010 and 2017. Methods: Adults presenting with meningitis (headache and objective meningism) were assessed for eligibility for enrolment in two consecutive trials investigating cryptococcal meningitis. Cohort one received cerebrospinal fluid (CSF) smear microscopy only (2010-2013). Cohort two received smear microscopy and Xpert on 1ml unprocessed CSF at physician discretion (2011-2013). Cohort three received smear microscopy, routine liquid-media culture and Xpert on large volume CSF (2013-2017) for all meningitis suspects with a negative CSF cryptococcal antigen (crAg). In a post-hoc analysis of three prospective cohorts, we compare rates of microbiologically confirmed TBM and hospital outcomes over time. Results: 1672 predominantly HIV-infected adults underwent lumbar puncture, of which 33% (558/1672) had negative CSF crAg and 12% (195/1672) were treated for TBM. Over the study period, microbiological confirmation of TBM increased from 3% to 41% (P<0.01) and there was a decline in in-hospital mortality from 57% to 41% (P=0.27). Adjusting for definite TBM and antiretroviral therapy, and using imputed data, the odds of dying were nearly twice as high in cohort one (adjusted odds ratio 1.7, 95% CI 0.7 to 4.4) compared to cohort three. Sensitivity of Xpert was 63% (38/60) and culture was 65% (39/60) against a composite reference standard. Conclusions: Since 2010, as TBM diagnostics have evolved, microbiologically-confirmed TBM diagnoses have increased significantly. There has been a non-significant decline in TBM in-hospital mortality but due to multiple possible confounding factors it is not possible to conclude what has driven this decline in mortality.
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Ison, Michael G., John W. Gnann, Stephanie Nagy-Agren, John Treanor, Carlos Paya, Roy Steigbigel, Michael Elliott, Heidi L. Weiss, and Frederick G. Hayden. "Safety and Efficacy of Nebulized Zanamivir in Hospitalized Patients with Serious Influenza." Antiviral Therapy 8, no. 3 (April 1, 2002): 183–90. http://dx.doi.org/10.1177/135965350300800301.
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Influenza is an important cause of hospitalization due to lower respiratory tract involvement for which there is no specific antiviral treatment with proven efficacy. We conducted a double-blind, randomized, placebo-controlled trial to assess the tolerability and efficacy of nebulized zanamivir (16 mg four times a day) in combination with rimantadine compared to rimantadine with nebulized saline for treating influenza in adults hospitalized with influenza. Twenty patients tolerated the inhaled zanamivir (ZNV) plus rimantadine without decline in peak expiratory flow rates compared to the 21 who received inhaled saline. The study was terminated early because the approval of ZNV made further enrolment untenable. No significant differences were observed in the proportion of patients shedding virus by treatment day 3 (57% ZNV plus rimantadine, 67% placebo plus rimantadine), or in the durations of hospitalization and supplemental oxygen use. More ZNV plus rimantadine recipients exhibited no or mild cough on day 3 of treatment (94 vs 55%, P=0.01). Two rimantadine-resistant viruses emerged during rimantadine monotherapy; no ZNV resistance was observed. Nebulized ZNV appears to be well tolerated in this hospitalized population but further studies are needed to assess its efficacy.
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Brett, Benjamin L., Zachary Y. Kerr, Samuel R. Walton, Avinash Chandran, J. D. Defreese, Rebekah Mannix, Ruben J. Echemendia, William P. Meehan, Kevin M. Guskiewicz, and Michael McCrea. "Longitudinal trajectory of depression symptom severity and the influence of concussion history and physical function over a 19-year period among former National Football League (NFL) players: an NFL-LONG Study." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 3 (October 18, 2021): 272–79. http://dx.doi.org/10.1136/jnnp-2021-326602.
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ObjectiveThis study investigated the longitudinal course of depressive symptom severity over 19 years in former American football players and the influence of concussion history, contact sport participation and physical function on observed trajectories.MethodsFormer American football players completed a general health questionnaire involving demographic information, medical/psychiatric history, concussion/football history and validated measures of depression and physical function at three time points (2001, 2010 and 2019). Parallel process latent growth curve modelling tested associations between concussion history, years of football participation, and overall and change in physical function on the overall level and trajectory of depressive symptoms.ResultsAmong the 333 participants (mean(SD) age, 48.95 (9.37) at enrolment), there was a statistically significant, but small increase in depressive symptom severity from 2001 (48.34 (7.75)) to 2019 (49.77 (9.52)), slope=0.079 (SE=0.11), p=0.007. Those with greater concussion history endorsed greater overall depressive symptom severity, B=1.38 (SE=0.33), p<0.001. Concussion history, B<0.001 (SE=0.02), p=0.997 and years of participation, B<0.001 (SE=0.01), p=0.980, were not associated with rate of change (slope factor) over 19 years. Greater decline in physical function, B=−0.71 (SE=0.16), p<0.001, was predictive of a faster growth rate (ie, steeper increase) of depression symptom endorsement over time.ConclusionsConcussion history, not years of participation, was associated with greater depressive symptom severity. Neither factor was predictive of changes over a 19-year period. Decline in physical function was a significant predictor of a steeper trajectory of increased depressive symptoms, independent of concussion effects. This represents one viable target for preventative intervention to mitigate long-term neuropsychiatric difficulties associated with concussion across subsequent decades of life.
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DE JAGER, C. A., E. MILWAIN, and M. BUDGE. "Early detection of isolated memory deficits in the elderly: the need for more sensitive neuropsychological tests." Psychological Medicine 32, no. 3 (April 2002): 483–91. http://dx.doi.org/10.1017/s003329170200524x.
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Background. Early detection of cognitive decline in the elderly is important because this may precede progression to Alzheimer's disease. The aim of this study was to see whether sensitive neuropsychological tests could identify pre-clinical cognitive deficits and to characterize the cognitive profile of a subgroup with poor memory.Methods. A neuropsychological test battery was administered to a community-dwelling sample of 155 elderly volunteers who were screened with CAMCOG at enrolment (mean age 74·7 years). The battery included tests of episodic memory, semantic and working memory, language and processing speed.Results. Episodic memory test z scores below 1 S.D. from the cohort mean identified 25 subjects with ‘non-robust’ memory performance. This group was compared to the remaining ‘robust memory’ group with a General Linear Model controlling for age, IQ, education and gender. Test performance was significantly different in all tests for episodic and semantic memory, but not in tests for working memory, processing speed and language. CANTAB paired associates learning and spatial recognition tests identified the highest percentages of those in the ‘non-robust memory’ group. Processing speed partialled out the age effect on memory performance for the whole cohort, but the ‘non-robust memory’ group's performance was not associated with age or processing speed.Conclusions. Sensitive neuropsychological tests can detect performance below the norm in elderly people whose performance on MMSE and CAMCOG tests is well within the normal range. Age-related decline in memory performance in a cohort of the elderly may be largely due to inclusion within the cohort of individuals with undetected pre-clinical Alzheimer's disease or isolated memory impairment.
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Fern, Lorna Anne, Clare Rowntree, Rachael E. Hough, Ajay J. Vora, Adele Fielding, Chris Mitchell, Nicholas Goulden, et al. "Barriers To Clinical Trial Enrolment For Teenagers and Young Adults With Acute Lymphoblastic Leukaemia: The Impact of Age Eligibility Criteria." Blood 122, no. 21 (November 15, 2013): 1401. http://dx.doi.org/10.1182/blood.v122.21.1401.1401.
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Abstract Background Overall survival (OS) for teenagers and young adults (TYA) aged 15-24 years (yrs) with acute lymphoblastic leukaemia (ALL) is inferior to OS for children. In the UK, five-year OS for children up to 14 years with ALL is 89%, falling to 69% for 15-19 yr olds and 52% for 20-24 yr olds (O'Hara et al, National Cancer Intelligence Network, 2013). Both disease biology and choice of protocol are likely to be important in explaining these differences. However, lower rates of inclusion into clinical trials with increasing age may also be a significant factor. In the UK 3 national paediatric and adult ALL trials were open to recruitment between 1997-2006 (table 1). In 2006 the upper age eligibility criteria for UKALL2003 was increased from 18 to 24 yrs and the lower age limit of UKALL XII was correspondingly increased to reflect emerging evidence that TYA have improved outcomes when treated on paediatric protocols. Aims 1. To examine trial accrual rates (AR) by age over a ten year period (1997-2006) to three UK national ALL trials. 2. To determine the influence of amending the age eligibility criteria for UKALL2003 on TYA accrual Methods ALL incidence figures for patients aged 1-39 yrs during the study period of 1997-2006 were obtained from a national cancer registry. Incidence data was classified according to the morphology-based coding specifically for TYA (Birch et al, BJC, 2002). Accrual rates (AR) were expressed as the ratio of patients entered onto trials during the same time period compared to incidence cases. Descriptive statistics were applied for an observational dataset where sample size or incidence cases cannot be controlled (Fern et al. BJC, 2008). We obtained a further incidence data set for cases diagnosed in 2007 and 2008 to examine the impact of age eligibility amendments in 2006 and 2008 to UKALL2003. Results ALL was diagnosed in 4,579 patients aged 1-39 yrs between 1997-2006, 2,767 were under 10 yrs. The figure shows the proportion of newly diagnosed ALL patients entering trials 1997-2006. Red arrows show age eligibility criteria of the trials. 65% of all patients were enrolled onto one of the 3 trials. AR were highest for under 10's (71.5%), declining to 55.2% for 15-16 yr olds, 43.4% for 17-18 yr olds and 40% for those aged 21-24 yrs. The amendments to age inclusion criteria for UKALL2003 and UKALL XII improved AR for 17-18 yr olds to a level equivalent to AR for 15-16 yr olds. AR for 19-20 yr olds also improved to 62.5%. However, recruitment of 21-24 year olds did not change. During 1997-2006 three quarters of 17-18 yr olds recruited to trials were enrolled onto UKALLXII. After protocol amendments, three quarters of 17-18 yrs were recruited to the paediatric trial. Conclusions We have shown a decline in trial accrual with increasing age for teenagers and young adults with ALL despite the availability of national trials spanning the age range being available during the time period studied. Due to close cooperation between adult and paediatric trial management groups, major changes were made to age eligibility criteria for both paediatric and adult trials, following increasing evidence that TYA have better outcomes when treated on paediatric protocols. We have shown an increased accrual of older teenagers to ALL trials in the UK following these changes. No improvements were observed for 21-24 year olds. However, this age group were only eligible for UKALL 2003 during the last year of our analysis. This approach to trial eligibility design may serve as a model for future trials, both in ALL and other cancers. Disclosures: No relevant conflicts of interest to declare.
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Wang, Jiayi, and Gerard A. Postiglione. "China’s minorities without written scripts." Journal of Asian Pacific Communication 18, no. 2 (July 31, 2008): 166–90. http://dx.doi.org/10.1075/japc.18.2.04pos.
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The Chinese state sees language as an essential determinant in ethnic minority schooling. The use of minority language as a medium of instruction is viewed as a way to increase attendance rates and strengthen socialization into a national ideology. However, the policies differ for those ethnic miorities with or without a commonly used written script. Among the minorities without a script are the 300,000 strong Dongxiang, an ethnic group with the lowest level of literacy and school access in China. There is virtually no systematic research on the role of language in school access for Chinese minority groups without a written script. In particular, there is a lack of analysis of the Dongxiang (and similar groups without a written script) learning and school discontinuation. This research aimed to identity the major difficulties in school based learning for the Dongxiang speaking children. Specifically, it explores local perspectives on how language and other factors are related to school enrolment and achievement. In order to accomplish this, the research combined a variety of data gathering methods, including survey questionnaires, open ended interviews, in-depth interviews, field visits, observations, and case studies to analyze the difficulties of language transition faced by Dongxiang ethnic minority children. The results reveal that although native language does not directly cause schoolchildren to discontinue their studies, it has an important indirect influence, especially on the girls. The research results also show that Dongxiang ethnic minority schoolchildren in the early years of schooling generally cannot understand their teachers’ Chinese teaching, which results in poor school performances, a decline of interest in learning, a frustrated sense of achievement, and a decline in self-respect. Many students drop out as part of a vicious cycle that sees a reproduction of poor conditions for learning.
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Schreiner, Camilla, and Svein Sjøberg. "Et meningsfullt naturfag for dagens ungdom?" Nordic Studies in Science Education 1, no. 2 (December 7, 2012): 18–35. http://dx.doi.org/10.5617/nordina.480.
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Can school science become more attractive, interesting and meaningful for young people of today? The point of departure for raising this question is the decline in enrolment in studies in science and technology (S&T) that is apparent in many OECD countries. We draw on perspectives from literature on late modernity and identity construction and we use data from the international comparative project ROSE (the Relevance of Science Education) to shed light on how young people perceive S&Tand some of their criteria for their educational choices. Our focus is on the Nordic situation, but we also provide comparisons with other cultures. We show that young people in all kinds of countries share a positive view on the importance S&T for society and the future development. We note, however, some remarkable differences when it comes to the willingness to engage in S&T-related studies and careers. We use Norwegian data to illustrate the values and concerns that are important for the choice of future jobs for young people. We suggest that there is a mismatch between these values and the values that young people meet in science at school. We argue that science curricula must change to accommodate some of the values of the young generation.
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Puri, Sapna, and Manisha Kohli. "The role of trans obturator tape as a surgical procedure for female stress urinary incontinence and its impact on quality of life in Jammu region." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 12 (November 26, 2019): 4975. http://dx.doi.org/10.18203/2320-1770.ijrcog20195355.
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Background: Stress incontinence is one of the most common but debilitating health issue among women. It has a detrimental effect on overall health and quality of life of women. Trans obturator tape (TOT) has emerged as a promising treatment modality. The aim of present study was to assess the usefulness of TOT in terms of change in quality of life of stress incontinence patients.Methods: The study was performed at Department of Obstetrics and Gynecology, Acharya Shri Chandler of Medical Sciences (ASCOMS), Jammu. A total of 50 symptomatic women were enrolled in the study and underwent TOT procedure using outside-in technique. The quality of life of women was assessed at enrolment and 12 months after the procedure using King’s Health Questionnaire (KHQ). Change in QOL was assessed using paired ‘t’-test.Results: After 12 months follow-up, a total of 27 (54%) patients were entirely symptom free. As compared to pre-treatment QOL assessment on KHQ for general health/incontinence impact, quality of life and symptom scores a % decline of 73.2%, 79.8% and 78.4% was observed. For all the three parts, the change in scores was significant statistically. No other complications and side effects were reported.Conclusions: TOT is a useful procedure which provided symptomatic relief as well as QOL enhancement.
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Belmont, Anne-Sophie, Christophe Sajous, Amandine Bruyas, Sara Calattini, Stéphanie Cartalat, Marion Chauvenet, Marc Colombel, et al. "Impact of the First Wave of the COVID-19 Pandemic on the Lyon University Hospital Cancer Institute (IC-HCL)." Cancers 14, no. 1 (December 22, 2021): 29. http://dx.doi.org/10.3390/cancers14010029.
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This article presents the protective measures put in place at the “Institut de Cancérologie des Hospices de Lyon” (IC-HCL) during the first wave of the COVID-19 pandemic in France (spring 2020) and how they impacted IC-HCL clinical activity. Spring 2020 activities were compared to winter 2019–2020. Results showed a decrease of activity of 9% for treatment dispensations, 17% for multidisciplinary team meetings, 20% for head and neck and thoracic surgeries, and 58% for new patient enrolment in clinical trials. Characteristics of patients treated for solid cancer and hospitalized for COVID-19 during spring 2020 were collected in a retrospective study. Mortality was attributed to COVID-19 for half of the cases, 82% being patients above 70 and 73% being stage IV. This is in concordance with current findings concluding that the risk of developing severe or critical symptoms of COVID-19 is correlated with factors co-occurring in cancer patients and not to the cancer condition per se. While a number of routines and treatment regimens were changed, there was no major decline in numbers of treatments conducted at the IC-HCL during the first wave of the COVID-19 pandemic that hit France between March and May 2020, except for clinical trials and some surgery activities.
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Nkiko, Mojisola O. "Interrogating the Teaching and Learning of Chemistry in Nigerian Private Universities: Matters Arising." Journal of Education and Learning 10, no. 3 (May 14, 2021): 132. http://dx.doi.org/10.5539/jel.v10n3p132.
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The indispensability and vast career possibilities associated with Chemistry notwithstanding, there is a palpable growing decline enrollment in Chemistry in Nigerian universities, particularly the private universities. The paper interrogated the teaching and learning of Chemistry in Nigerian private universities with a view to re-awakening the students’ interest for effective mastery of the subject. It relied on secondary sources and critical analysis and found out that major inhibiting factors include: Students’ faulty foundation in Chemistry, syndrome of area of concentration, absence of competitiveness in the admission process, poor attitude of students and lecturers as well as the ambience for effective scholarship. The paper concluded that the current downturn in the students enrolment in Chemistry and the seemingly poor interest in the subject portend sufficient threat to the future of Chemistry, chemical-related industries and the replacement of ageing Chemistry lecturers in Nigeria. It recommended the following strategies to mitigate the vicious cycle: targeted tutorial system, adoption of digital modes of teaching and learning, problem-based learning, capacity building initiatives for Chemistry lecturers, quality assurance mechanism, overhauling science education at the primary and secondary school levels, need-based assessment and provision of quality materials as well as adequate funding.
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Mayeda, Elizabeth Rose, Teresa J. Filshtein, Yorghos Tripodis, M. Maria Glymour, and Alden L. Gross. "Does selective survival before study enrolment attenuate estimated effects of education on rate of cognitive decline in older adults? A simulation approach for quantifying survival bias in life course epidemiology." International Journal of Epidemiology 47, no. 5 (July 13, 2018): 1507–17. http://dx.doi.org/10.1093/ije/dyy124.
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Lemale, Julie, Jean-Luc Decline, Catherine Dive-Pouletty, Chantal Touboul, Nadège Pichon, and Christophe Dupont. "Managing Cow’s Milk Protein Allergy with an Extensively Hydrolyzed Formula: Results from a Prospective, Non-Interventional Study in France (EVA Study)." Nutrients 14, no. 6 (March 12, 2022): 1203. http://dx.doi.org/10.3390/nu14061203.
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Symptoms related cow’s milk proteins allergy (CMPA) usually improve between two to four weeks following an elimination diet, firstly with extensively hydrolyzed formulas (eHF). The aim of the EVA study was to observe the evolution of CMPA-related symptoms in real life after initiation of a whey-based extensively hydrolyzed formula (w-eHF, Althéra®, Nestlé Health Science, Switzerland). This cross-sectional prospective non-interventional study was carried out alongside paediatricians in private practice in France between June 2019 and June 2020. Infants aged 0–3 years presenting with confirmed diagnosis or clinical symptoms suggesting CMPA were enrolled. Data were collected at enrolment (baseline visit) and three to five weeks later (follow-up visit). Symptoms were assessed using the Cow’s Milk-related Symptom Score (CoMiSS®). The per protocol population included 135 infants. The average number of symptoms per infant significantly decreased under the study formula (from 2.81 to 1.36, p < 0.001) and the proportions of infants with any CMPA related symptoms decreased. Daily crying and regurgitation showed the largest decline, respectively −44.4% and −31.85% (p < 0.001). These results describe the early management of symptoms suspected to be related to CMPA in routine practice that was rarely described in the literature. The number and severity of symptoms decreased most of the cases after commencing the study formula.
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Bier, Nathalie, Sébastien Grenier, Catherine Brodeur, Serge Gauthier, Brigitte Gilbert, Carol Hudon, Émilie Lepage, Marie-Christine Ouellet, Chantal Viscogliosi, and Sylvie Belleville. "Measuring the impact of cognitive and psychosocial interventions in persons with mild cognitive impairment with a randomized single-blind controlled trial: rationale and design of the MEMO+ study." International Psychogeriatrics 27, no. 3 (September 30, 2014): 511–25. http://dx.doi.org/10.1017/s1041610214001902.
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ABSTRACTBackground:Several studies have suggested that cognitive training is a potentially effective way to improve cognition and postpone cognitive decline in older adults with mild cognitive impairment (MCI). The MEMO+ study is a randomized, controlled, single-blind trial designed to test the efficacy, specificity, and long-term effect of a cognitive training intervention and a psychosocial intervention in persons with MCI.Methods:One hundred and sixty-two participants with MCI will be recruited. They will be randomized into three groups: cognitive training, psychosocial intervention, and no-contact. Each intervention will last for eight weeks (one session per week) and a booster training session will be provided three months after the end of the intervention. Various proximal and distal outcomes will be measured at pre-intervention as well as at one week, three months, and six months post-training. Proximal outcomes include memory and psychological health measures. Distal outcomes focus on self-rated functioning in complex daily activities and strategies used in daily life to enhance function. Socio-demographic factors (age, gender, and education), general cognition, personality traits, engagement in activities, and self-efficacy will be used as moderators. Enrolment began in April 2012 and will be completed by December 2014.Conclusions:This study is likely to have a significant impact on the well-being of persons with MCI by contributing to the development of adapted and scientifically supported cognitive and psychosocial interventions.
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Tey, Nai-Peng, Siow-Li Lai, and Sor-Tho Ng. "AGE AT MENARCHE AND SEXUAL DEBUT AMONG YOUNG FILIPINO WOMEN." Journal of Biosocial Science 51, no. 1 (January 21, 2018): 77–94. http://dx.doi.org/10.1017/s0021932017000682.
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SummaryThere has been a secular decline in age at menarche since the 19th century. Early-maturing women are more likely to have their sexual debut at a younger age, which in turn gives rise to a host of reproductive health and social problems. This study used data from five waves of National Demographic and Health Surveys conducted in the Philippines between 1993 and 2013 to examine the trends and socioeconomic differentials in age at menarche and sexual debut. The changing trend in age at menarche and sexual debut was examined across birth cohorts, and logistic regressions were used to identify the determinants of early sexual debut. In the Philippines, the mean and median ages at menarche declined from 13.2 years and 12.6 years, respectively, among young women born in 1973–1977, to 12.9 years and 12.3 years, respectively, among those born in 1993–1997. The proportion who had their sexual debut by age 20 increased from 41.2% for the 1968–1972 birth cohort to 53.4% for the 1988–1992 birth cohort. Filipino women with low education, from poor families and living in rural areas were more likely to have earlier sexual debut despite attaining menarche at a later age as compared with their higher educated counterparts, and those from wealthier families and urban areas. Logistic regression analysis showed that, besides marital status, women’s education and age at menarche were important determinants of early sexual debut. However, ethnicity, place of residence and family wealth had no significant effects on age at menarche. An increasing proportion of young women were found to be having unprotected sexual debut and at a younger age, with health and social ramifications. Hence, apart from increasing the enrolment of girls in schools and discouraging teenage marriage, there is a need for social and health agencies to implement appropriate adolescent sexual and reproductive health programmes such as counselling and educational campaigns, as well as support services, to address sexual problems among the youth.
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Giannini, Olivier, Eling D. de Bruin, Pierluigi Quadri, Mauro Tettamanti, and Damiano D. Zemp. "Influence of Hemodialysis on the Physical Activity and Motor Capacity of Patients with Chronic Renal Disease, Stage 4-5 (K/DOQI): Study Synopsis." Nephrology @ Point of Care 3, no. 1 (January 2017): napoc.5000211. http://dx.doi.org/10.5301/napoc.5000211.
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Purpose Elderly patients who undergo hemodialysis are more fragile than older persons not on dialysis. However, it is not clear if this frailty exists before hemodialysis or if it becomes evident or more acute at the time of beginning a dialysis therapy program. The purpose of this study is to analyze if changes at both the motor and cognitive levels go hand in hand with the beginning of dialysis, and, if this is the case, to identify possible risk factors associated with the functional decline in these patients. Methods A multicentric prospective pilot observational study was conducted in an ambulatory population with the primary objective to represent the evolution of functional gait capacity in patients before and during hemodialysis treatment, to show gait insecurity during treatment follow-up, if it is present. The secondary objectives are to identify risk factors in the development of gait insecurity, and to measure the prevalence of falls during the follow-up period. Results The enrolment of patients began in January 2015 and the duration of the data collection will be at least 36 months. In the first 24 months, 19 patients have been included in the study. Preliminary data analysis is not expected before July 2018. Conclusions The identification of frailty predictors is of major importance in order to identify and target patients at the highest risk of frailty who may be likely to benefit from preventive intervention.
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Hofman, Michael, John A. Violet, Rodney J. Hicks, Justin Ferdinandus, Sue Ping Thang, Amir Iravani, Grace Kong, et al. "Results of a 50 patient single-center phase II prospective trial of Lutetium-177 PSMA-617 theranostics in metastatic castrate-resistant prostate cancer." Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 228. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.228.
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228 Background: Lutetium-177 (177Lu)-PSMA-617 (LuPSMA) is a radiolabelled small molecule that binds with high affinity to prostate specific membrane antigen (PSMA) enabling targeted delivery of beta-radiation. We have previously reported favourable activity with low toxicity in a 30 patient study in men with metastatic castrate-resistant prostate cancer (mCRPC) and now report updated results including a twenty patient extension cohort. Methods: In this phase II trial, 50 pts with PSMA-avid mCRPC who had progressed after standard therapies received up to 4 cycles of LuPSMA every 6 weeks. The primary endpoints were PSA response (PCWG2) and toxicity (CTCAE v4). Other endpoints included imaging response, PSA PFS and OS. Cut-off for analysis 5 Oct 2018. Results: 76 men were screened to identify 50 patients eligible for treatment. Median PSA doubling time was 2.6 months. The majority of patients had received prior docetaxel (84%), cabazitaxel (48%), and abiraterone and/or enzalutamide (90%). The mean administered radioactivity was 7.5 GBq/cycle. PSA decline ≥ 50% was achieved in 32 of 50 patients (64%, 95% CI 50-77%), including 22 patients (44%, 95% CI 30-59%) with a PSA decline ≥ 80%. 27 patients had measurable soft tissue at baseline and 56% of these patients had a partial or complete response by RECIST 1.1. The most common toxicities attributed to LuPSMA were transient G1-2 dry mouth in 68%, G1-2 nausea in 48%, and G1-2 fatigue in 36%. G3-4 toxicities attributed to LuPSMA were infrequent with thrombocytopenia in 10% and anaemia in 10%. Median PSA PFS was 6.9 months (95% CI 6.0-8.7) and median OS was 13.3 months (95% CI 10.5-18.0). Upon subsequent progression, further LuPSMA was administered to 14 patients (median 2 cycles commencing 359 days from enrolment); PSA ≥ 50% response occurred in 9 patients (64%). Conclusions: This expanded 50 patient cohort confirms high response rates and low toxicity with LuPSMA in men who had progressed after standard therapies. In patients who subsequently progressed and were administered further LuPSMA, high response rates were also observed. These results have provided the basis for randomised controlled trials currently underway. Clinical trial information: ACTRN12615000912583.
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von Samson-Himmelstjerna, Friedrich Alexander, Grit Esser, Kevin Schulte, Benedikt Kolbrink, Markus Krautter, Vedat Schwenger, Julia Weinmann-Menke, et al. "Study protocol: the TRAnsplant BIOpsies (TRABIO) study – a prospective, observational, multicentre cohort study to assess the treatment of kidney graft rejections." BMJ Open 12, no. 4 (April 2022): e048122. http://dx.doi.org/10.1136/bmjopen-2020-048122.
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IntroductionDespite continued efforts, long-term outcomes of kidney transplantation remain unsatisfactory. Kidney graft rejections are independent risk factors for graft failure. At the participating centres of the TRAnsplant BIOpsies study group, a common therapeutic standard has previously been defined for the treatment of graft rejections. The outcomes of this strategy will be assessed in a prospective, observational cohort study.Methods and analysisA total of 800 kidney transplantation patients will be enrolled who undergo a graft biopsy because of deteriorating kidney function. Patients will be stratified according to the Banff classification, and the influence of the treatment strategy on end points will be assessed using regression analysis. Primary end points will be all-cause mortality and graft survival. Secondary end points will be worsening of kidney function (≥30% decline of estimated Glomerular Filtration Rate [eGFR] or new-onset large proteinuria), recurrence of graft rejection and treatment response. Baseline data and detailed histopathology data will be entered into an electronic database on enrolment. During a first follow-up period (within 14 days) and subsequent yearly follow-ups (for 5 years), treatment strategies and clinical course will be recorded. Recruitment at the four participating centres started in September 2016. As of August 2020, 495 patients have been included.Ethics and disseminationEthical approval for the study has been obtained from the ethics committee of Kiel (AZ B 278/16) and was confirmed by the committees of Munich, Mainz and Stuttgart. The results will be reported in a peer-reviewed journal, according to the Strengthening the Reporting of Observational Studies in Epidemiology criteria.Trial registration numberISRCTN78772632; Pre-results.