41 research outputs found
Clinical Utility of the AJCC 8th Edition pT1 Subclassification and Impact on Practice Patterns in Stage I Seminoma
No full textThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.BACKGROUND: The American Joint Committee on Cancer 8th edition staging guidelines for testicular cancer established a 3 cm cutoff to subclassify stage T1 seminomas (<3 cm = pT1a and ≥3 cm = pT1b). The efficacy of this cutoff in predicting metastatic disease and impact on treatment patterns have not been studied.
METHODS: We retrospectively reviewed patients with pT1 testicular seminoma in the National Cancer Database from 2004-2016. Receiver operating curves (ROC) were used to determine the efficacy of the 3 cm tumor cutoff in identifying metastatic disease, and multivariable regression was used to compute the effect of tumor size on the rate of adjuvant therapy among Stage I patients.
RESULTS: 10,134 patients with pT1 seminoma were evaluated. The current size cutoff of 3 cm for subclassification did not exhibit high discrimination in identifying metastatic disease (area under ROC: 0.546). Surveillance has grown as the preferred treatment after orchiectomy - 32.1% in 2004 to 81.2% in 2015. However, the rate of adjuvant therapy for pT1, Stage I seminomas associated positively with tumor size even with adjustment for year of diagnosis. For tumors above 3 cm, the odds ratio stabilized around 1.9. By using the 3cm cutoff to guide adjuvant therapy, up to 85% of T1b patients may be overtreated.
CONCLUSION: The 3 cm cutoff for subclassification of Stage I seminoma does not predict metastatic recurrence but is associated with increased receipt of adjuvant therapy. A 3 cm cutoff and the pT1a/b classification may therefore contribute to overtreatment in many young patients with a long life expectancy for whom minimizing adverse effects should be prioritized
Unlocking the potentials of community ecotourism: a promising agent of post war reintegration and sustainable development for Ethiopia and Eritrea
No full textThe article was presented in a launching seminar of ‘Centre for Peace and Reconciliation in Mekelle University, focused on ‘Restoring Ethio-Eritrean Relations from Bottom-up: People-to-People Reconciliation and its Contribution to Social Cohesion, Economic and Infrastructure Development’. The paper attempts to explore potentials and roles of community ecotourism in improving the livelihood of border communities and influences post-war re-integration of the society in both countries. The design of the research was qualitative approach. Data sources for this research were aligned to primary and secondary aspects. The primary sources were gathered through interviews with individuals, office holders and experts in the industry and visitors from both countries, and documents. Observations were experienced in the tourist destination sites in Tigrai, Ethiopia. Secondary sources were assessed to address the literature-based discussions. Therefore, findings revealed, the availability of high potentials for community ecotourism engagements in both countries. There are encouraging transport accesses, religious pilgrimages. The availability of variety foods, suitability of ecotourism eco-lodges, seashore in Eritrea; and the UNESCO registered sites and carnivals. There are excellent practices for sustainable ecotourism development linked to the environmental protection and land management. During the observations, Ethio-Eritreans appeared harmoniously enjoying the religious and non-religious carnivals. Therefore, sustainable ecotourism contributes to reconciliation, healing and peace building. The author recommends the participation of all stakeholders in the sustainable development of the community-based ecotourism. In this regard, the sector needs comprehensive socio-economic baseline survey to support the development initiatives
Hypertensive Urgency: The Role of Clinical Pharmacist in Identifying and Managing Drug Therapy Problems: The Case of Ambo Hospital Medical Ward, Ethiopia
No full textInternational audienceHistory of present illness: Mrs.T. T isa previously healthy 56 years old patient presented to female medical ward on 16/03/2014 with dry cough of two days duration. The cough was associated with chest pain. She has high grade fever and shortness of breath
Primary surplus dynamics and fiscal sustainability in sub-saharan African countries
No full textThe study analyzes the Bohn (2007) sustainability test, allowing for a quadratic fiscal reaction function to public debt levels over the period 2000–2019 for 40 countries in sub-Saharan Africa (SSA), employing a dynamic panel threshold model and other alternative estimation methods to investigate the reaction of fiscal policy and Dumitrescu–Hurlin Granger causality to identify potential causality linkages between government spending and revenue. Fiscal policy is found to follow a debt-stabilizing rule at a low to moderate level; however, fiscal responsiveness weakens when public debt to GDP ratio exceeds 55%, indicating that the use of primary surplus as an instrument to contain debt is insufficient when debt goes above the threshold, therefore jeopardizing the efficacy of fiscal retrenchments as an instrument to achieve sustainable debt reduction in SSA countries. The Dumitrescu–Hurlin result suggests a unidirectional flow from expenditure to revenue in SSA countries, implying that an increase in government spending has a substantial impact on widening fiscal imbalances and escalating debt levels within the SSA countries. Hence, governments in SSA countries should guarantee that public debt management strategies are in line with the public debt threshold to enhance fiscal sustainability. Considering these findings, this study highlights the importance of prudent fiscal management incorporating measures such as structural reforms, targeted investments, and prudent debt management strategies in SSA countries. © The Author(s) 2024
Macroeconomic effects of fiscal consolidation on economic activity in SSA countries
No full textThis paper studies the effects of fiscal measures in 40 sub-Saharan countries on economic output, unemployment, consumption, private investment, REER, and current account balance. The study estimates impulse response functions with local projections, based on a yearly dataset covering 40 countries over 2000–2019. The key variable in the dataset is a measure of fiscal stance computed following Blanchard (1993), with a threshold of 1.5%. The study finds that in the short run, fiscal consolidation reduces real GDP and private demand. In addition, the current account balance responds positively to a shock in fiscal consolidation, whereas the real effective exchange rate responds negatively. Moreover, compared with revenue-based consolidations, spending-based consolidations lead to smaller losses in output. Our finding also reveals that fiscal consolidations also depend on economic cycles, with a lower output loss during an economic boom. Finally, this study suggests that fiscal consolidations should be carried out based on spending-based consolidations and have to be preceded by an economic boom. © 2023 The Author
Mixed teff (Eragrostis tef, Poaceae) cultivation and consumption among smallholder farmers in South Wollo Zone, Ethiopia
No full textBackground: Indigenous cropping systems were often developed with a focus on resilience. For example, farmers in many parts of the world have traditionally grown crop varietal mixtures to mitigate risks of crop failure due to drought, pests, and disease. However, crop varietal mixtures are threatened by policies encouraging farmers to plant homogenous, single-variety cropping systems, which are more vulnerable to increasing climate variability. Teff is one of the indigenous staple crops of Ethiopian origin cultivated throughout the country for multiple purposes. Farmers continue to cultivate diverse varieties of teff, as well as a varietal mixture known as sergegna teff. We assessed farmers’ knowledge and practices related to sergegna teff in the northern highlands of Ethiopia to understand its advantages as well as threats to its continued use. Methods: Research was conducted in six kebeles (sub-districts) of Kalu and Tehuledere districts of South Wollo Zone, Ethiopia, situated in warm moist lowlands and tepid and cool mid-highlands. Data were collected through structured surveys with 304 randomly sampled interviewees, semi-structured interviews with 36 purposively sampled key informants, six focus group discussions, guided field tours and market surveys. Varieties of teff in standing crop fields were assessed within 5 m × 5 m random plots at the seed-setting stage. Data analysis included cross-tabulation of survey and interview data, descriptive statistics, and hierarchical clustering. Results: Teff dominates the farm fields in the six study kebeles. Altogether, 13 distinct varieties, including farmers’ varieties (landraces) and breeders’ varieties, were recorded. Fifty-three percent of survey respondents reported active cultivation of sergegna teff variety mixtures. The same proportion asserted preference for varietal mixtures over pure brown or white varieties on account of nutritional benefits and non-food domestic functions. The varietal mixture was also top-ranked by key informants for drought and disease resistance, resilience, and ecological elasticity. Households reported utilizing the varietal mixture in various types of food and selling at local markets. Most respondents (53% of those who reported cultivating sergegna teff in 2023) indicated using sergegna teff to prepare leavened and unleavened foods, including injera, dimeso, kita, anebabero, serebat, porridge and gruel. Conclusion: Farmers express that the ongoing cultivation and use of sergegna teff boost production and enhance resilience and economic returns. These perspectives should be considered in initiatives promoting single breeder’s varieties, which risk supplanting traditional crop varietal mixtures. Further study, alongside proactive conservation, and scaled-up efforts of institutions concerned with food security, biodiversity conservation, and inclusion of ILK are needed. © The Author(s) 2025
HRM, organizational capacity for change, and performance: a global perspective
No full textThis special issue brings together a variety of articles, each one enriching understanding about whether and how human resource management (HRM) influences organizational performance (however defined) against a backdrop of complex change. We present a preliminary framework that enables us to integrate the diverse themes explored in the special issue, proposing a mediating role for organizational change capacity (OCC). OCC represents a particular subset within the resource- based literature labeled as “dynamic capabilities.” Although not well researched, there is evidence that OCC is positively associated with firm performance and that this relationship is stronger given conditions of high uncertainty. Our framework reflects on external and internal parameters, which we suggest moderate the relationship between human resource management (HRM), OCC, and organizational performance. Our intention is to provide compelling insight for both practitioners and researchers, especially those whose remit extends beyond national boundaries, with reference to areas of the globe as disparate as Greece, Ireland, Pakistan, Switzerland, and the United Kingdom
Child and Adolescent Depression Intervention Overview: What Works, for Whom and How Well?
No full textIn this review, the authors provide a summary of the currently available research evidence on interventions in pediatric depression. The use of SSRIs as an effective intervention in the treatment of depression in childhood and adolescence is supported by numerous large clinical trials including TADS and TORDIA. There is also evidence that the combination of medication and CBT is superior to medication alone for accelerating the pace of treatment response and remission, despite some negative studies. For mild to moderate depression, CBT and IPT are reasonable options, although the rate of improvement is much slower with psychotherapy (CBT) alone. Response rates after acute treatment remain modest at best, with significant residual symptoms, and remission rates over long-term follow-ups are not more promising. 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Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy : a systematic analysis for the Global Burden of Disease Study 2021
No full textBackground: Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. Methods: We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990–2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. Findings: We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5–14 years, 6·29% (5·05 to 7·70) in those aged 15–49 years, 5·72% (4·02 to 7·39) in those aged 50–69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5–14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15–49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50–69 years, and a 3·29% (–5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis fo 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (–713 to 2180) fewer deaths. Interpretation: Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Biswajit Banik and Muhammad Aziz Rahman” are provided in this record*
