Gotowa bibliografia na temat „Parental case-control studies”

Introduction: Cow’s milk protein allergy requires changes in family habits to maintain children’s health. Objective: This study evaluated the effects of cow’s milk protein allergy on the health of children, the quality of life of parents and children, and the adopted parental styles. Methods: Control case study. The case group consisted of children with cow’s milk protein allergy, from eight months to five years old, and those guardians, and the Control Group, for healthy children of the same age group, and their parents. The quality of life of the child (TNO-AZL Preschool Children Quality of Life) and the caregiver (SF-36) were evaluated; parental style (Parental Beliefs and Care Practices Scale); and socioeconomic and health data of the child. The Mann-Whitney test was used to compare the groups (p <0.05). Results: 76 dyads from the case group and 44 from the control group participated. Children with cow’s milk protein allergy had a lower quality of life in the health dimension, worse nutritional status, followed up with a larger number of health professionals. Those in charge of the case group offered less body stimulation to the children. Those in the control group had a lower quality of emotional life. Conclusions: Cow’s milk protein allergy had an impact on the health and nutritional status of children, on the corporal stimulation received by the children, and on the quality of emotional life of those guardians.

BackgroundProspective, longitudinal studies of risk factors for anorexia nervosa (AN) are lacking and existing cross-sectional studies are generally narrow in focus and lack methodological rigor. Building on two studies that used the Oxford Risk Factor Interview (RFI) to establish time precedence and comprehensively assess potential risk correlates for AN, the present study advances this line of research and represents the first case-control study of risk factors for AN in the USA.MethodThe RFI was used for retrospective assessment of a broad range of risk factors, while establishing time precedence. Using a case-control design, 50 women who met DSM-IV criteria for AN were compared to those with non-eating disorder DSM-IV psychiatric disorders (n=50) and those with no psychiatric disorder (n=50).ResultsWomen with psychiatric disorders reported higher rates of negative affectivity, maternal and paternal parenting problems, family discord, parental mood and substance disorder, and physical and sexual abuse than women with no psychiatric disorder. Women with AN specifically reported greater severity and significantly higher rates of negative affectivity, perfectionism and family discord, and higher parental demands than women with other psychiatric disorders. The role of weight and shape concerns was most salient in the year preceding onset of AN.ConclusionsConvergent data identifying common risk factors as well as those more severe in the development of AN are emerging to inform longitudinal risk factor and prevention studies for this disorder.

It is commonly believed that patients with agoraphobia have suffered more frequently from aberrant family experiences in childhood. Some authors have described an excess of parental deprivation and others have incriminated parental overprotectiveness. Recent studies have failed to confirm these impressions but, instead, find that agoraphobic patients recall deficits in parental warmth and care during their early years. This report of a Sydney case-control study adds support to the view that parental overprotectiveness in isolation is unlikely to place the child at greater risk of developing agoraphobia in the future. Only when the child experiences a sense of parental neglect and lack of care, either alone or in combination with overprotection, does the risk of agoraphobia in adulthood appear to be increased.

There are considered results of studies on the association between parental age at conception and risk of various childhood and adult-onset cancers in progeny. In spite of inconsistency of data available it is possible to affirm that advanced parental age is a risk factor of cancer in progeny as well as of other adverse health effects. Paternal age seems to be more significant then maternal age due to particularity of gametogenesis in men lasted during whole life (as opposed to women). In a result sperm accumulates much more potential carcenogenic injuries (mutations, epigenetic alterations, particularity of telomeres) transmitted to progeny. The standard designs of studies are described (case-control, population cohort) as well as sources of personal information (Cancer Registers, Registers of Births, interview), parameters of assessment of parental age effect (mean age of parents in case and control groups, odds ratio - OR, relative risk - RR). The causes of discrepancy of results are discussed. Some unusual results are described (association between parental age and hematological cancer, in adult offspring limited to participants without siblings in childhood, protective effect of older ages of parents for some kinds of malignancies in children) which need further investigations.

BackgroundPrior studies suggest parental and perinatal risk factors are associated with later offending. It remains uncertain, however, if such risk factors are similarly related to sexual offending.MethodWe linked socio-demographic, family relations, and perinatal (obtained at birth) data from the nationwide Swedish registers from 1973 to 2009 with information on criminal convictions of cases and control subjects. Male sex offenders (n = 13 773) were matched 1:5 on birth year and county of birth in Sweden to male controls without sexual or non-sexual violent convictions. To examine risk-factor specificity for sexual offending, we also compared male violent, non-sexual offenders (n = 135 953) to controls without sexual or non-sexual violent convictions. Predictors included parental (young maternal or paternal age at son's birth, educational attainment, violent crime, psychiatric disorder, substance misuse, suicide attempt) and perinatal (number of older brothers, low Apgar score, low birth weight, being small for gestational age, congenital malformations, small head size) variables.ResultsConditional logistic regression models found consistent patterns of statistically significant, small to moderate independent associations of parental risk factors with sons’ sexual offending and non-sexual violent offending. For perinatal risk factors, patterns varied more; small for gestational age and small head size exhibited similar risk effects for both offence types whereas a higher number of older biological brothers and any congenital malformation were small, independent risk factors only for non-sexual violence.ConclusionsThis nationwide study suggests substantial commonalities in parental and perinatal risk factors for the onset of sexual and non-sexual violent offending.

THE ROLE OF PARENTAL BEHAVIOUR AND SELF-ESTEEM OF FATHER AND MOTHER ON SELF-ESTEEM AND SELFCONTROL OF BOYS AND GIRLS The aim of the research was to analyse the connection between parental behaviours and self-esteem of the parents on the self-esteem and self-control of the children. The pupils of the seventh and eighth grade of six primary schools in the area of the city of Zagreb and the city of Split and their parents participated in the research. The children filled out the Coopersmith Self-Esteem Inventory, the Brief Self-Control Scale and the Perception of Parental Behaviour Scale, while the parents filled out the Rosenberg Self-Esteem Scale. Regression analysis was used and it has determined that the parental control is the best predictor for the child’s self-esteem. Self-esteem of boys is better predicted by the sets of parental predictors and it is somewhat more connected with the father’s self-control, while self-esteem of girls is more connected with the mother’s self-control. Self-control of girls is best predicted by the mother’s acceptance and control, so that the sets of parental variables, more specifically the mother’s variables, are significant only for predicting self-control of girls. The assumption about the greater role of the mother in the development of self-esteem and self-control of children was confirmed, while the assumptions about the gender differentiation in upbringing were confirmed only in the case of the child’s self-control, but not in the case of their self-esteem, which shows that there are differences in the direction of transition towards more modern upbringing practices. The results, as well as the existing studies and theoretical assumptions, point out the importance of the parental role as the model for the development of the child’s self-esteem and self-control, and the different approaches in the upbringing of boys and girls can be addressed specifically.

La lèpre, maladie infectieuse chronique causée par Mycobacterium leprae, affecte principalement la peau, les nerfs et les yeux avec des séquelles majeures en l’absence de traitement. Avec 200 000 nouveaux cas diagnostiqués chaque année (1 toutes les 2 minutes), il s’agit de la mycobactériose la plus commune après la tuberculose et requalifiée « maladie tropicale négligée » en 2017 par l’Organisation Mondiale de la Santé (OMS). Si la contribution génétique de l’hôte dans l’histoire naturelle de la maladie est maintenant bien établie, son architecture reste lacunaire. Dans cette continuité et afin de la préciser, nous avons, pour la première fois, utilisé une approche de génétique épidémiologique familiale. Plus précisément, nous avons réalisé la première étude d’association pangénomique (Genome-Wide Association Study, GWAS) familiale sur la lèpre. Ainsi, au cours des 20 dernières années, un échantillon de 481 familles nucléaires, parents et enfants, sélectionnées à partir d’un enfant atteint, a été constitué au Vietnam. Sur cet échantillon primaire de 1749 individus incluant 622 enfants atteints, nous avons testé l’association de près de 6 millions de variants bi-alléliques (Single Nucleotide Polymorphism, SNP), génotypés ou imputés, avec la lèpre. Dans un second temps, nous avons testé les signaux les plus prometteurs dans un échantillon de réplication, c’est-à-dire, indépendant et issu de la même population, constitué de 1 181 cas et 668 contrôles. Les résultats les plus significatifs ont été observés au sein de la région HLA et l’analyse multivariée a permis d’identifier trois signaux indépendants. Deux dans la région HLA classe I : rs1265048 [Odds-ratio (OR) = 0,69 ; p-val = 5,5.10⁻¹¹] et rs114598080 [OR = 1,47 ; p-val = 8,8.10⁻¹³] ; Et un dans la région HLA classe II : rs3187964 [OR = 1,67 ; p-val = 8,4.10⁻¹⁶]. Nous avons également identifié deux signaux hors HLA : un variant faux-sens dans le gène LACC1 (rs3764147 : OR = 1,52 ; p-val = 5,1.10⁻¹⁴), et un variant à proximité du gène IL12B (rs6871626 : OR = 0,73 ; p-val = 6.4.10⁻⁸). Les contraintes de coûts des études pangénomiques imposent une réduction majeure du nombre de SNPs à tester dans d’autres échantillons. Dans les études familiales, les parents sont de fait génotypés et pourraient permettre une réplication immédiate sans coûts ajoutés. Au moyen d’une large étude de simulation, nous avons montré que cette approche était pertinente. Une étude cas-contrôle chez les parents de l’échantillon primaire est une réplication valide, statistiquement indépendante de l’étude d’association familiale. C’est un argument fort en faveur des approches familiales pour l’exploration pangénomique de la contribution génétique de l’hôte dans les phénotypes complexes. La compréhension de la physiopathologie de l'infection à M. leprae est cruciale pour optimiser les approches préventives selon les profils génétiques à plus haut risque, et ouvrir de nouvelles pistes thérapeutiques en précisant les cascades fonctionnelles pertinentes. En ce sens, la dissection du contrôle génétique de l'infection par l'hôte est indispensable. Enfin, remettre la famille au cœur de la quête génétique, c’est remettre la génétique dans son milieu naturel
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It primarily affects the skin and peripheral nerves, and can cause an irreversible impairment of nerve function, often leading to severe disabilities and social stigma if left untreated. The disease, re-qualified by WHO (World Health Organization) as a “Neglected Tropical Disease” in 2017, remains a major public health problem in regions of endemic countries, with over 200,000 new cases per year (one every two minutes). It is ranked second as the most common mycobacterial infectious disease, right after tuberculosis. While it has been well established that there is a genetic contribution to this disease, the underlying genetic causes remains unknown. In our study, we sought to reveal the host´s genetic architecture of leprosy by taking of a familial epidemiological approach. We conducted the first Family-Based Genome-Wide Association Study (GWAS) of leprosy in 481 Vietnamese nuclear families (parents and children) selected based on one affected child and collected over the past 20 years. Using this sample of 1,749 individuals, including 622 affected offspring, we performed association tests between six million biallelic genetic variants (Single-Nucleotide Polymorphism, genotyped or imputed) and the binary phenotype of disease status. Following this first analysis, we conducted a replication analysis of the most promising results in an independent sample of the same ethnic origin, accounting for 1,181 cases and 668 controls. The most significant results were observed within the HLA (Human Leukocyte Antigen) region, in which 3 independent SNPs displayed genome-wide significant associations. Among these, two were for the HLA class I region and one for the HLA class II (rs1265048 [OR = 0.69; p-value = 5.5x10⁻¹¹], rs114598080 [OR = 1.47; p-value = 8.8x10⁻¹³] and rs3187964 [OR = 1.67; p-value = 8.4x10⁻¹⁶] respectively). We also identified a missense variant in the LACC1 gene (rs3764147: OR = 1.52; p-value = 5.1x10⁻¹⁴) and an intergenic variant located close to the IL12B gene (rs6871626: OR = 0.73; p-value = 6.4x10⁻⁸). LACC1 encodes a central regulator of the metabolic function and bioenergetic state of macrophages and IL12B encodes IL-12p40, which is common to two interleukins, IL-12 and IL-23. Large GWAS are expensive, strongly limiting the number of variants to test in a replication set. Here, we took advantage of the available parental phenotypic and genotypic information to perform a classical case-control study among the parents of the family-based sample. Indeed, using of extensive computer simulations, we demonstrated that this population-based parental study is a valid, powerful and costless replication strategy to confirm family-based associations. Overall, our observations add to the attractiveness of family-based designs and should provide valuable help for investigators planning to perform GWA studies. Understanding leprosy pathophysiology infection is crucial to optimize preventive approaches based on genetic profiles. Dissection of the genetic control of the infection by M. leprae by its human host, therefore, constitutes an indispensable step. Finally, repositioning the family at the heart of the genetic quest means repositioning genetics into its natural environment

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado
Background: There are no internationally validated questionnaires to investigate the prevalence of infant wheezing. This study was undertaken to validate a questionnaire for the International Study on the Prevalence of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). Material and Methods: Construct and criterion validity were tested for the question 'Has your baby had wheezing or whistling in the chest during his/her first 12 months of life?'. Construct validity (i.e. the ability of parents and doctors to refer to the same symptoms with the same words) was tested in a sample of 50 wheezing and 50 non-wheezy infants 12-15 months of age in each of 10 centres from 6 different Spanish- or Portuguese-speaking countries. Criterion validity (i.e. the ability of parents to correctly detect the symptom in the general population) was evaluated in 2 samples (Santiago, Chile and Cartagena, Spain) of 50 wheezing and 50 non-wheezing infants (according to parents) of the same age, randomly selected from the general population, who were later blindly diagnosed by a paediatric pulmonologist. Results: Construct validity was very high (κ test: 0.98-1) in all centres. According to Youden's index, criterion validity was good both in Cartagena (75.5%) and in Santiago (67.0%). Adding questions about asthma medication did not improve diagnosis accuracy. Conclusions: The EISL questionnaire significantly distinguished wheezy infants from healthy ones. This questionnaire has a strong validity and can be employed in large international multicentre studies on wheezing during infancy.
Revisión por pares

碩士
國立臺灣大學
流行病學研究所
87
Epidemiologists often examine the relation between susceptible gene and disease with case-control study design. Due to different allele frequencies among the races, drawing unsuitable controls may result in selection bias. Calculating the relative risks under the 'case-parental control study' design will circumvent this problem of selection bias. The 'genotype relative risks' (GRRs) can be estimated by iterative or non-iterative methods. There are three non-iterative methods proposed in the recent literatures, which have similar formula apart from the weighting constants. Here we propose a new non-iterative method, which has the 'optimal weighting constants'. Monte-Carlo simulation shows that the variances of the new estimators are smallest among the non-iterative methods.

Text in English
An increasingly recognised prevention approach for substance use entails reduction in risk factors and enhancement of promotive or protective factors in individuals and the environment surrounding them during their growth and development. However, in order to enhance the effectiveness of this approach, continuous study of risk aspects targeting different cultures, social groups and mixture of society has been recommended. This study evaluated the impact of potential risk and protective factors associated with family management and relations on adolescent substance abuse in South Africa. Exploratory analysis and cumulative odds ordinal logistic regression modelling was performed on the data while controlling for demographic and socio-economic characteristics on adolescent substance use. The most intensely used substances were tobacco, cannabis, cocaine, heroin and alcohol in decreasing order of use intensity. The specific protective or risk impact of family management or relations factors varied from substance to substance. Risk factors associated with demographic and socio-economic factors included being male, younger age, being in lower education grades, coloured ethnicity, adolescents from divorced parents and unemployed or fully employed mothers. Significant family relations risk and protective factors against substance use were classified as either family functioning and conflict or family bonding and support. Several family management factors, categorised as parental monitoring, discipline, behavioural control and rewards, demonstrated either risk or protective effect on adolescent substance use. Some factors had either interactive risk or protective impact on substance use or lost significance when analysed jointly with other factors such as controlled variables. Interaction amongst risk or protective factors as well as the type of substance should be considered when further considering interventions based on these risk or protective factors. Studies in other geographical regions, institutions and with better gender balance are recommended to improve upon the representativeness of the results. Several other considerations to be made when formulating interventions, the shortcomings of this study and possible improvements as well as future studies are also suggested.
Psychology
M. A. (Psychology)

碩士
國立臺灣大學
流行病學研究所
89
ABSTRACT Purpose: This research proposes a novel form of confounding effect, the 'gene-gene confounding '. The author discusses the criteria for such a confounding effect and quantifies its magnitude in case-control and case-parents studies. Method: The author assumes two genetic loci, A and B, conferring susceptibility to a disease. When B gene is ignored in the case-control or case-parents study, the confounding biases in the estimation of genotype relative risks for A gene are calculated. This study examines the situations of homogeneous, stratified, and admixed populations, respectively. Result: It is shown that the confounder gene could incur biases through short-distance confounding or population structure confounding. These two form of confounding effects act intricately under different study designs and population structures. It can happen in case-control as well as in case-parents studies. The degree of bias resulting from gene-gene confounding can be quite substantial in actual practice. The conditions for a genetic confounder are much more complex than the usual confounders in conventional epidemiology. Conclusion: As epidemiology is fast moving into a post-genomic era, the concept put forth in this study should have important implications for future studies aiming at identification and quantification of disease-susceptibility genes. KEY WORDS: case-control study, case-parents study, confounding, epidemiologic methods, genetic epidemilogy.

In the 1980s, sudden infant death syndrome (also known as SIDS or cot death) was one of the most common post-neonatal causes of death in the UK. The dramatic 80% fall in these deaths over the last three decades is a testament to evidence-based research using the observational case–control study and even more impressive given the difficulties in funding studies without a randomized controlled trial design. This chapter will describe the initial breakthrough in the early 1990s, the characteristic profile of SIDS, the associated factors identified, the potential causal mechanisms, and the current risk reduction messages. Most of the risk reduction messages are non-controversial and have been readily accepted by health professionals and parents alike. The divergence of opinion regarding how we give preventative advice surrounding infant bed sharing and the strategies employed is addressed in more detail.

Critically ill patients and patients undergoing major surgery usually develop stress hyperglycaemia, which is associated with an increased morbidity and mortality risk. Randomized controlled trials interfering with elevated blood glucose during intensive care and the perioperative period have yielded mixed results, however. The optimal blood glucose target may depend on the context. Tight glucose control was shown to be effective and safe when performed with accurate glucose measurement tools and a reliable insulin infusion protocol in patients receiving early parenteral nutrition. Whether tight glucose control is beneficial in the absence of early parenteral nutrition, remains to be studied. In any case, hypoglycaemia and severe hyperglycaemia should be avoided. In patients with poorly controlled diabetes, the ideal blood glucose target may be higher than in non-diabetics.

Some of the world’s most overcrowded, violent and anarchic prisons are in Latin America. In many of them prisoners have untrammelled control of their own areas and staff only entered the interior of the prisons in large numbers and suitably armed. This chapter provides case studies of prisons in Venezuela and Colombia where lawlessness in the prisons is an extreme reflection of the dangers and difficulties which face many sections of the community in their daily lives. In El Salvador and Guatemala the overarching problem in prisons is the presence of warring gangs which had their genesis in Los Angeles and New York before members were deported back to the country of their or their parents’ birth. The reaction of some governments has been to meet violence with violence, what is commonly known as the mano dura, the ‘iron fist’, confining prisoners in appalling and dangerous conditions. As an alternative, the Dominican Republic offers a strong ray of hope for a more positive approach with what it calls its New Model of imprisonment.

[This Proceedings paper was revised and published in the 2019 issue of the Interdisciplinary Journal of E-Skills and Lifelong Learning, Volume 15.] Aim/Purpose: Following the widespread use of social networking applications (SNAs) by children, adolescents, and young adults, this paper sought to examine the usage habits, sharing, and dangers involved from the perspective of the children, adolescents, and young adults. The research question was: What are the usage habits, sharing, drawbacks, and dangers of using SNAs from the perspective of children, adolescents, and young adults? Background: Safety has become a major issue and relates to a range of activities including online privacy, cyberbullying, exposure to violent content, exposure to content that foments exclusion and hatred, contact with strangers online, and coarse language. The present study examined the use of social networking applications (SNAs) by children, adolescents, and young adults, from their point of view. Methodology: This is a mixed-method study; 551participants from Israel completed questionnaires, and 110 respondents were also interviewed. Contribution: The study sought to examine from their point of view (a) characteristics of SNA usage; (b) the e-safety of SNA; (c) gender differences between age groups; (d) habits of use; (e) hazards and solutions; and (f) sharing with parents and parental control. Findings: Most respondents stated that cyberbullying (such as shaming) happens mainly between members of the group and it is not carried out by strangers. The study found that children’s awareness of the connection between failures of communication in the SNAs and quarrels and disputes was lower than that of adolescents and young adults. It was found that more children than adolescents and young adults believe that monitoring and external control can prevent the dangers inherent in SNAs, and that the awareness of personal responsibility increases with age. The SNAs have intensified the phenomenon of shaming, but the phenomenon is accurately documented in SNAs, unlike in face-to-face communication. Therefore, today more than ever, it is possible and necessary to deal with shaming, both in face-to-face and in SNA communication. Recommendations for Practitioners: Efforts should be made to resolve the issue of shaming among members of the group and to explain the importance of preserving human dignity and privacy. The Internet in general and SNAs in particular are an integral part of children’s and adolescents’ life environment, so it can be said that the SNAs are part of the problem because they augment shaming. But they can also be part of the solution, because interactions are accurately documented, unlike in face-to-face communication, where it is more difficult to examine events, to remember exactly what has been said, to point out cause and effect, etc. Therefore, more than ever before, today it is possible and necessary to deal with shaming both in face-to-face and in the SNA communication, because from the point of view of youngsters, this is their natural environment, which includes smart phones, SNAs, etc. Recommendations for Researchers: The study recommends incorporating in future studies individual case studies and allowing participants to express how they perceive complex e-Safety situa-tions in the use of social networking apps. Impact on Society: Today more than ever, it is possible and necessary to deal with shaming, both in face-to-face and in SNA communication. Future Research: The study was unable to find significant differences between age groups. Fur-ther research may shed light on the subject.

Aim: We aim to estimate the global prevalence of consanguinity among the ASD families and compare that among different populations. Methods: Meta-analysis of observational studies reporting prevalence of consanguinity among ASD families was searched systematically in important databases including EMBASE, PubMed and Academic Search Complete. Individual studies were screened by two reviewers independently, extracted data and assessed the risk of bias using a risk of bias tool (Hoy’s tool). Random Effect model was used to calculate pooled weighted estimates due to considerable heterogeneity. Subgroups analysis was also calculated. Results: 10 publications were identified based on our inclusion criteria from 8 different countries, 4 of them were from the Gulf Cooperation Council (GCC) and the rest were from: Lebanon (2 studies), Egypt, Jordan, Iran, and Israel). Studies varied in ASD cases numbers as it ranged between 49 -500, and the total ASD individuals in all studies were 1581. All studies address consanguinity among the ASD families despite the variation in the methods. The pooled estimate of consanguinity among ASD families was 24% Subgroup analysis by the study country led to a higher pooled estimate of consanguinity of 38% in the GCC countries compared to other than GCC countries with a pooled estimate of 16%. In addition, the overall odd ratio calculated from the case-control studies included in our meta-analysis was 1.5. Discussion: To our knowledge, this is the first meta-analysis that studied the prevalence of consanguinity among ASD families worldwide. Children born to consanguineous parents have been reported to have lower social behavior and cognitive ability, which are the main problems with ASD children. Our study qualitatively reviewed the prevalence of consanguinity among ASD families throughout the world and 10 eligible studies from eight countries were identified. We quantitatively synthesized the results and the key findings of this study showed a 24% overall pooled estimate of consanguinity among ASD families. GCC countries showed a high estimated pooled prevalence of consanguinity among ASD families as 38% compared to countries other than GCC 16%, which was higher than our overall pooled prevalence. This high estimate among GCC countries can be related to the high rates of consanguineous marriage in the GCC countries compared to the worldwide rates (20%). In Qatar, the rate of consanguineous marriage reported as 54%. This high rates among GCC countries may be due to factors like rooted cultural beliefs, social life and customs in addition to, economic benefits of keeping wealth within the families. Conclusion: The globally estimated pooled consanguinity prevalence among ASD patients was 24%, GCC countries showed a higher pooled prevalence (38%)

Abstract Modelling airflow in the conducting airways of the human lungs is important to predict particle deposition of both contaminants and pharmaceuticals. In order to achieve good predictions of deposition the airflow has to be modelled correctly. Because of the complexity of the bronchial tree structure, the using of the small airways and highly asymmetric of the structure, in vivo studies are difficult for obtaining the global airways effects and the detail of small airways downstream. While the experimental studies are crucial to obtain a somewhat satisfied detail by utilising physiologically scaled up model to study airflow in the lungs. However, those experimental studies are limited up to the 3rd generations of bifurcation and the smaller airways deep within the lungs are inaccessible to most experimental technique even in the scaled up model. CFD studies through the solutions of Navier-Stoke equations seem to be a better way to access the smaller airways and easy to show a large number of data in three dimensional physiologically realistic airway geometries. In both experimental and CFD simulations the control and choice of boundary conditions are essential. A particular problem is the control of boundary conditions, since the complete lung models cannot be modelled and the experiment in vivo data are not available. The only data available is the flow rate at the mouth as a function of time. Because of the complexity of the airway geometries and the limitation of the present day computer power a truncated lung model has to be used to study in airflow dynamics in the lungs at the first stage. This results in a need to control the flow rates in each airway which causes a problem in the numerical boundary condition. Thus in the current investigation aims to carry out the appropriate numerical boundary condition for controlling the flow rates in each airway. A two dimensional CFD model of an asymmetric single bifurcation has been used as a test case. This numerical airway model is an anatomic approximation based on Horsfield’s data [Horsfield et al., 1971]. The radii of curvature in the transition zone from the parent branch to daughter branches and a curved shape of carinal ridge have been taken into account on this model. Different flow boundary conditions have been used for respiratory flow. The most realistic result has been obtained by using numerical pistons attached into the end of most downstream airways. Each piston has been enlarged/contracted to generate the required oscillatory flow rate of air through the single bifurcation of the system. The two dimensional CFD model of the airways with numerical pistons along with finite-element mesh model has been shown in figure 1. These results are compared with the published CFD results using standard boundary conditions [Wilquem & Degrez, 1997].

Introduction: Breast cancer is the most common malignancy in women and represents a major obstacle to public health worldwide. The molecular diagnosis of this type of cancer is one of the main contemporary challenges in oncology, since it is hampered by a complex inheritance pattern, characterized by both genetic and environmental factors. Only a minority of breast cancers are explained by the presence of high penetrance gene mutations, such as those in the BRCA1 and BRCA2 genes, which together with mutations in intermediate penetrance genes explain only up to 25% of the risk. In fact, much of the genetic influence is elucidated by low penetrance variants. Mutations in the germline BRCA1 and BRCA2 are the most common alterations in cases of early onset or of family history of breast cancer. It is also important to acknowledge that BRCA2 mutations can increase the risk of developing other cancers. Some studies show a relation between BRCA2 mutations and the development of leukemia, especially acute myeloid leukemia (AML). Also, some of these mutations, when inherited from both parents, cause a rare form of Fanconi anemia, a syndrome associated with the development of AML. In addition, there are studies evaluating a higher risk of pancreatic and esophageal cancer in carriers of BRCA2 mutations. The risk of colorectal cancer is also increased in patients with BRCA1 mutations. However, there are also some authors who defend that BRCA2 mutations could also be related. The specific statistics are not well defined because of the lack of data focusing on the relationship with the aforecited types of cancers, demonstrating the need for further analysis. This study aims to report the case of a woman with breast cancer at an early age. Such malignancy is associated and was somehow induced by the rich family history, represented by the high prevalence of cancer in the ancestry. We report a 34-year-old woman with an extensive history of carcinoma in the family, who was diagnosed with breast cancer in July 2016. In order to confirm the diagnosis, it was required an ultrasound, which resulted in a 2.2×1.5 cm node on the right breast’s left superior quadrant, classified as BIRADS 4A. It also performed an ultrasound-guided biopsy that showed a tubular carcinoma on the right breast with the following characteristics: positive for estrogen and progesterone receptor, positive for KI 67 (5%), and negative for HER2, with staging of T1cN0M0. During anamnesis, the patient mentioned menarche at 12 years old, history of birth control pills use for 10 years, no pregnancy, and no breastfeeding. When it comes to family history, a great number of relatives were previously diagnosed with some type of cancer. Her paternal grandfather had rectum cancer at 42 years old and breast cancer at 62 years old. The paternal grandmother passed away because of a fast-progression leukemia at the age of 68. It is important to mention that her progenitors were first cousins. Furthermore, the patient’s dad was diagnosed with breast cancer at 62 years, alongside his three brothers who were also diagnosed with cancer: one with prostatic cancer at the age of 64 years and the other two with intestinal cancer at the ages of 64 and 68 years old. Considering such a family history, a genetic panel was performed, analyzing the genes related to hereditary cancer risk, and it identified mutations in the patient’s BRCA2 gene. Then, firstly, she performed a bilateral mastectomy in January 2017 with sentinel lymph node investigation, which was negative for neoplastic cells in the lymph nodes. Later, considering the BRCA2 mutation, in August 2017, the patient had to undergo prophylactic surgery: oophorectomy with salpingectomy.

Establishing School-Based Management Committees (SBMCs) is one of the most widely adopted and widely studied interventions aimed at addressing the learning crisis faced in many developing countries: giving parents and communities a certain degree of control over aspects of school management is assumed to increase school accountability and contribute to improvements in learning. Examining the case of Nigeria, which in 2005 adopted a national policy to establish SBMCs in state schools, this paper reviews the evidence available on SBMCs’ ability to mobilise communities, and the potential for this increased community participation to translate into improved learning. The paper shows that while local community participation can help improve school performance, the donor and state supported SBMCs struggle to stay active and have positive impact on school performance. Yet for ministries of education in many developing countries establishing SBMCs remains a priority intervention among the many initiatives aimed at improving education quality. The paper thus asks what makes the establishment of SBMCs a priority intervention for the Nigerian government. By presenting an analysis of the SBMC-related policy documents in Nigeria, the paper demonstrates that an intervention aimed at involving local communities and developing bottom-up approaches to identifying and designing education policies is itself entirely a product of top-down policy making, envisioned, developed, and funded almost entirely by the international development community. The entire process is reflective of isomorphic mimicry—a process whereby organisations attempt to mimic good behaviour to gain legitimacy, instead of fixing real challenges. Adopting the policy to establish SBMCs, which is heavily promoted by the international development community and does not require actual reform of the underlying political-economy challenges hindering investment in education, enables education ministries to mimic commitment to education reforms and attain the endorsement of the international community without addressing the real challenges. Like all cases of isomorphic mimicry, such policy adoption and implementation has costs: national ministries, as well as state- and district-level education authorities, end up devoting time, resources, and energy to planning, designing, and implementing an intervention for which neither the need nor the evidence of success is established. Additionally, such top-down measures prevent state agencies from identifying local opportunities for delivering the same goals more effectively and perhaps at a lower cost. The paper illustrates this with the case of the state of Kano: there is a rich indigenous culture of supporting community schools, yet, rather than learning why local communities support certain kinds of school but not state schools, and trying to replicate the lessons in state schools, the SBMC model introduced is designed by development agencies at the national level and is administratively complicated and resource-intensive. The opportunity for local learning has not been realised; instead, both the agenda and the implementation framework have been entirely shaped by international aid agencies. The paper thus demonstrates how apparently positive policy interventions resulting from pressure exerted by the international community could be having unintended consequences, given the national-level political-economy dynamics.