110 research outputs found
Prostate Specific Antigen (PSA) Growth Curves: A Method to Improve Prostate Cancer Screening
No full textProstate cancer (PrCA) screening aimed at detecting aggressive disease represents a significant public health issue. Development of biomarkers to predict PrCA that is likely to kill if left untreated is a major challenge. This dissertation focused on analyzing existing repeated measures of prostatic specific antigen (PSA) to develop and validate a tool to improve both sensitivity and specificity of the PSA-based screening test to detect high-risk PrCA. We used the Prostate Lung Colorectal and Ovarian trial data (PLCO) for PSA growth model building. Using 6 years of annual PSA measurements we established the PSA growth curves for four groups of men; those who developed high-risk PrCA, those who developed low-risk PrCA, those who developed benign prostatic hyperplasia (BPH) and those who were not diagnosed with either PrCA or BPH. We used these curves to estimate PSA annual rate of change at defined time points; one and two years before diagnosis for each individual in the cohort. We then examined the area under the curve (AUC) to estimate the specificity and the sensitivity of PSA annual rate thresholds. We validated our work by replicating the PSA growth models in a cohort of screened men in The Department of Veterans Affairs. Our results show that PSA annual change rates varied significantly by cancer status in both cohorts. The difference between the means of PSA rate values across the four groups of men was high and robust. Annual individual PSA rates showed substantial variability; however, a distinct range and significantly higher values were observed among men who developed high-risk PrCA. This resulted in high AUC (0.97) in the logistic regression model. A threshold of 0.37ng/ml/year had the best combination of sensitivity and specificity; i.e., of 97.2%, and 97.3% respectively. In the VA validation cohort, the same pattern was observed. However, men in the low-risk PrCA group had higher annual PSA rates as compared to the same group in the PLCO cohort. This resulted in a lower AUC of 93.3 (92.86-93.71) and the threshold of 0.37ng/ml/year predicted high-risk PrCA with a sensitivity and specificity of 95.5% and 86.2 % retrospectively
Abstract C66: Screening via multiple PSA measures to detect virulent prostate cancer could provide a way to address fundamental issues in African-American men's health
No full textAbstract
The dilemma facing individuals wishing to make decisions regarding prostate cancer (PrCA) screening pivots on two opposing outcomes: over-diagnosing indolent cancer and under-diagnosing virulent cancer. In conjunction with limited data on which to draw conclusions, this dilemma formed the basis on which the US Preventive Services Task Force made its decision to not recommend PSA screening. Data driving that decision-making process was derived nearly entirely from European and European-American men, even though African Americans are much more likely to be diagnosed with later-stage, more aggressive disease at younger ages. The discrepancy that we see between the US' highest-world-quintile incidence rates and second-lowest-world-quintile mortality rates may be explained entirely by the presence of high-virulence disease among African Americans.
Clearly, detecting aggressive disease represents a significant public health issue and unmet clinical need. Development and discovery of biomarkers to predict PrCA that is likely to kill if left untreated is the major challenge in PrCA prevention and control. With this background in mind we sought to interrogate a large data set with multiple PSAs measured at regular (i.e., annual) intervals to see if we could predict high-virulence PrCA. Using the PLCO data we showed that with ≥three measures we were able to improve sensitivity and specificity of the PSA test to >97% overall and >99% among African-American men for detecting virulent, clinically relevant high-risk prostate cancer (PSA level ≥ 20ng/ml, cancer that invades prostate capsule, PrCA that involves more than one lobe, or Gleason score >7).
At this juncture, we have begun to address the question of what can be done to distinguish aggressive PrCA in African-American men. We propose creating a cohort of 48,000 individuals who are willing to undergo annual PSA screening with the intention of validating/refining the algorithm that the University of South Carolina team developed using PLCO trial data that combines three or more PSA measures to detect virulent, high-risk PrCA. This cohort also would serve another important purpose. There currently exists no other cohort with a sufficient number of African-American men to address other important cancer-related health issues. So, if designed correctly, this cohort could serve numerous other purposes.
This would be a simple follow-up study design with extensive baseline data collection and follow-up data collected at regular (i.e., annual) intervals. This would require strong community buy-in, commitment to providing information needed for informed decision-making, formulating rules for referring men out for diagnostic workup, and putting procedures in place for data linkage (e.g., to the cancer registries). Twelve institutions in 10 states across the US have expressed interest in being involved.
Currently, there are two, non-mutually exclusive, options for recruitment.
The Veterans Administration (VA) system could be ideal setting for this because: 1. They already have the screening infrastructure in place; 2. There isn't the financial incentive to over-diagnose and over-treat; 3. There is an excellent system of medical records; 4. There are many African-American veterans in the VA system; and 5. The medical home (for subsequent care) already is in place.
The NCI's community oncology research program (NCORP) appears to understand the CBPR imperative. As such, they have good access to local, interested communities and in some regions of the country this includes large AA populations. They have excellent community relations and local “connectivity” that could help to ensure a competent, caring ‘medical home' that would be essential for program viability (i.e., recruitment and follow-up). Depending on geographical particulars, there could be good overlap with the VA. NCORPS could add an important element of academic medicine/ NCI imprimatur to the mix.
Citation Format: James R. Hebert, Abraham Turner, Johnny Payne, Azza Shoaibi. Screening via multiple PSA measures to detect virulent prostate cancer could provide a way to address fundamental issues in African-American men's health. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C66.</jats:p
A Look at the Condition of Women in Malentendues by Azza Filali
No full textA Look at the Female Condition in Malentendues by Azza Filali
This article analyzes the female condition through the central character of Malentendus by Azza Filali. It explores the tensions between social injunctions and individual aspirations, highlighting how the author constructs a female figure striving for emancipation in a Tunisian context marked by deep contradictions. The study examines the narrative and discursive strategies that reveal the obstacles, resistances, and ambiguities shaping the character’s journey. Adopting a literary and socio-critical approach, this article investigates the representation of power dynamics and identity issues in the novelCe travail propose une analyse de la condition féminine à travers le personnage central de Malentendues d’Azza Filali. Il s’agit d’explorer les tensions entre injonctions sociales et aspirations individuelles, mettant en avant la manière dont la romancière présente une figure féminine en quête d’émancipation dans un contexte tunisien marqué par des contradictions majeures. L’article examine les stratégies narratives et discursives qui révèlent les obstacles, les résistances et les ambiguïtés du parcours de ce personnage. En adoptant une approche sociocritique, ce travail interroge la représentation des rapports de pouvoir et des dynamiques identitaires à l’œuvre dans le roman
Roles and responsibilities of family home caregivers for elderly people in Qatar: Experiences and challenges
No full textAssessment of services for diabetes mellitus in clinics in Ramallah, West Bank, occupied Palestinian territory: an evaluation study
No full textAzza,Shoaibi:University of South Carolina
Rana,Khatib:Community and Public Health
Abdullatif,Husseini:Community and Public HealthBackground Diabetes mellitus is a leading cause of morbidity and mortality worldwide. Few reliable data about its
management and complication rates have been reported in the occupied Palestinian territory (oPt). Services are offered
to patients with diabetes by four main providers: Ministry of Health (MoH), UN Relief and Works Agency for Palestine
Refugees in the Near East (UNRWA), non-governmental organisations (NGOs), and the private sector. However, the
main components of their services have not been assessed systematically in the reports. Our objective therefore was to
assess the provision of services for disease management (including infrastructure and related equipment), training
needs of health-care personnel, adherence to guidelines for disease management by the clinics of the MoH, UNRWA,
and NGOs in Ramallah, West Bank, oPt, for patients with diabetes.
Methods We assessed 11 clinics in Ramallah between Jan 27 and Feb 24, 2009. Four were clinics of the MoH, three
UNRWA, one NGO, and three joint clinics of MoH and NGOs. We assessed the clinics through semistructured
interviews with the doctors, nurses, pharmacists, and laboratory technicians managing patients with diabetes;
examination of the infrastructure of the clinics, measurement of crowding, and review of one to three patients’
consultations per clinic with doctors and nurses; and review of three to five sample records per clinic to ascertain their
completeness. Consent was obtained from the various stakeholders to assess their clinics, and health professionals
working at the clinics to interview them and review the records of their patients. The aim of reviewing the records was
to assess their completeness and we did not use the names of the patients or the actual data on the record.
Findings The management guidelines and provision of services for patients with diabetes differed between providers.
Services were most centralised at MoH clinics. Insulin was provided at two clinics of MoH, one joint clinic of MoH
and NGO, and all clinics of UNRWA. All health-care personnel at the clinics of UNRWA and NGO and the joint
clinics of MoH and NGOs were trained according to their respective provider’s guidelines compared with none of
those at the clinics of MoH. Weight and height were measured and body-mass index was calculated at one clinic of
MoH, clinic of the NGO, two joint clinics of MoH and NGO, and all clinics of UNRWA. Blood pressure was measured
at three clinics of MoH, two joint clinics of MoH and NGO, clinic of NGO, and all clinics of UNRWA. Equipment for
the assessment of diabetic complications was available in some clinics but rarely used. For example, ophthalmoscopes
were available at three clinics of MoH, three joint clinics of MoH and NGO, one clinic of UNRWA, but used in one
joint clinic; visual acuity charts were available at one clinic of MoH, one joint clinic of MoH and NGO, and two clinics
of UNRWA; electrocardiogram machines were available at three clinics of MoH, three joint clinics of MoH and NGO,
two clinics of UNRWA, and clinic of the NGO, but used in one joint clinic of MoH and NGO, two clinics of UNRWA,
and clinic of the NGO; tuning forks were available in two joint clinics of MoH and NGO and two clinics of UNRWA.
Monofilament was not available in any of the clinics. Foot-care equipment was available at one UNRWA clinic but
was not used. The glycated haemoglobin A1c test was available at the clinic of the NGO and the three joint clinics of
MoH and NGO. Microalbumin test was not available at any of the clinics. A nutritionist was available at the clinic of
the NGO and one joint clinic of MoH and NGO. The consultation time with doctors and nurses at the clinics of the
MoH and UNRWA was short (3–10 min) and consultations were not individualised or recorded. Records at the clinics
of UNRWA, clinic of the NGO, and the joint clinics were better organised and more complete than were those of the
MoH clinics. These clinics had special records with complete information for patients with diabetes whereas the
clinics of MoH had different types of records with incomplete information. Monitoring of patients was more
systematic at the clinics of UNRWA and NGO and the joint clinics of MoH and NGO than at the MoH clinics. In the
clinics of UNRWA and NGO and the joint clinics of NGO and MoH, patients were given appointments and were
monitored according to the protocols in these clinics (for laboratory tests and physical examination), whereas at the
clinics of MoH an appointment system and protocols for monitoring were not used
J Hypertens
No full textIntroductionAngiotensin receptor blockers (ARBs) are commonly used antihypertensive medication with several other additional proven benefits. Recent controversy on association of lung cancer and other solid malignancy with the use of ARBs is concerning, although the follow-up studies have shown no such association.MethodsWe used data from the Department of Veterans Affairs electronic medical record system and registries to conduct a retrospective cohort study that compared first-time ARB users with nonusers in 1:15 ratio, after balancing for many baseline differences using inverse probability of treatment weights. We conducted time-to-event survival analyses on the weighted cohort.ResultsOf the 1 229 902 patients in the analytic cohort, 346 (0.44%) of the 78 075 treated individuals had a newly incident lung cancer and 6577 (0.57%) of 1 151 826 nontreated individuals were diagnosed with lung cancer. On double robust regression, the weighted hazard ratio was 0.74 (0.67\u20130.83, P<0.0001), suggesting a lung cancer reduction effect with ARB use. There was no difference in rates by ARB subtype.ConclusionIn this large nationwide cohort of United States Veterans, we found no evidence to support any concern of increased risk of lung cancer among new users of ARBs compared with nonusers. Our findings were consistent with a protective effect of ARBs.K05 CA136975/CA/NCI NIH HHS/United StatesU48 DP001936/DP/NCCDPHP CDC HHS/United StatesU54 CA153461/CA/NCI NIH HHS/United StatesU54CA153461/CA/NCI NIH HHS/United State
A Comparative Study of the Self-Assembly of Achiral and Chiral Hairy Nanoparticles with Polystyrene Cores and Poly (2- hydroxyethylmethacrylate) Hairs
No full textHairy nanoparticles with polystyrene cores (PS cores) and poly(2 hydroxyethylmethacrylate) (PHEMA) shells were synthesized by combining living anionic polymerization and atom transfer radical polymerization (ATRP). The structural characterization was carried out by FT-IR and NMR spectroscopy (1H NMR, 13C NMR, APT 13C NMR and 1H 13C HMQC). The thermal stability of the PS cores was not a?ected by grafting PHEMA on their surfaces. A di?erential scanning calorimetry (DSC) thermogram of the HNPs showed two distinct transition temperatures indicating microphase separation. Chiral HNPs were prepared by inducing chirality in the achiral HNPs by complexation with R- or S-mandelic acid. The circular dichroism (CD) spectroscopy of complexes of the HNPs/R- or S-mandelic acid indicated the formation of enantiomeric chiral structures. The self-assembled structures formed from the achiral HNPs show di?erent surface morphologies, porous and zigzag, dependent on the solvents used. Blends of polystyrene functionalized with hydroxyl groups and PHEMA show di?erent morphology and thermal properties compared with the core shell HNP system. The chiral HNPs self-assembled into donut like structures or toroids with sizes in the range between 200 to 5000 nm. The study suggests that chirality can be utilized to develop interesting self-assembled structures
Analysis of residential energy consumption characteristics: A comparative study between two cities in China and the U.S
No full textThe author has granted permission for their work to be available to the general public.This study compares and analyzes residential energy use patterns in the two dominant housing typologies in two cities with similar climates in the U.S. and China (Houston, TX and Xiamen, China). The study included developing four residential models representing a single-family-house and a multi-family-house in both Houston and Xiamen using the building performance simulation tool, eQuest. Inputs for the models were based on existing building codes, census data, government surveys, validated previous studies, and a household survey conducted in Xiamen, China. The models were used to study the impact of building physical characteristics and occupant behavior on residential energy consumption patterns in both cities. The results of the simulation were then analyzed and the outcomes of the analysis were used to identify opportunities for reducing Chinese residential energy use. The research outcomes indicate that the low energy efficiency of building envelopes and systems in Chinese houses are a major issue in Chinese residential buildings. Avoiding the potential increase in energy use in the Chinese residential sector requires taking steps to improve the efficiency of building envelopes, systems, and appliances. The research provides specific recommendations for Chinese energy conservation policy-makers as well as developers and companies working in the Chinese residential sector. The research also provides the foundation for future studies aiming to improve the energy efficiency of Chinese houses.Architectur
Optimal Rehabilitation of Urban Drainage Systems: Application of single-objective optimisation for the implementation of Green-Blue-Grey Infrastructures in changing climate
No full textUrban Drainage Systems (UDS) are one of the most vital yet, complex infrastructures that support people's livelihood in urban areas. However, due to their mainly underground infrastructure and complexity, the planning and management of UDS are usually associated with high investment, which stakeholders sometimes overlook. As long-lived infrastructures, UDS’s limited capability is being put under constantly increasing pressures. Amongst the pressures, the global effects of climate change on rainfall extremes is the most important. As climate change affects the rainfall extremes and the overall hourly and daily rainfall events, urban flooding issues are becoming more costly to manage. Several rehabilitation efforts have been made to address this issue with minimum cost and optimal performance in flood reduction by increasing the resiliency of UDS in order to minimise the duration and magnitude of urban flooding. Rehabilitation of UDS can be done in several ways, including implementing Green-Blue-Grey Infrastructures (G-B-G measures). The combination of G-B-G measures can increase the resiliency of the UDS to withstand higher intensity rainfall by reducing both the peak flow and enlarging the capacity of the UDS system. Therefore, this thesis aims to develop a method to find the optimal way to rehabilitate an existing UDS to reduce the risk of flooding under the climate change rainfall scenarios. The method developed coupled a hydrodynamic model, Storm Water Management Model (SWMM), and Genetic Algorithm (GA) to find the optimal solution to rehabilitate UDS. The effect of climate change was incorporated by simulating the solutions using composite design storms that represent the increase in hourly and daily rainfall extremes for 2030, 2050, and 2085. The objective function of this optimisation problem becomes the minimisation of the total cost to implement the measures for the rehabilitation of UDS, under the constraint that no flooding can happen on the system when tested against the climate change rainfall scenarios. Therefore, the decision variables of this optimisation are the size and location for each implemented measure, while the penalty cost is associated with the cost of each m3 of flooding. Based on the analysis of the case study, the most appropriate Green-Blue measures to be implemented is Rain Barrels, Infiltration Trenches, and Pervious Pavements. Meanwhile, for grey measures, it is best to consider pipe and pump replacements and increasing the CSOs’ weirs. The optimisation was done using the developed formal method and manual trial-and-error. The results of the formal optimisation have been confirmed to outperform the result from manual optimisation using the traditional trial-and-error method. The optimal solutions proved that a combination of both grey and G-B measures produced the lowest cost to reduce flooding. Although the solutions can be adapted over time from 2030 until 2085, the results show that adaptive solutions might not be needed when the solution for 2085 is better implemented from the year 2030. Overall, it can be projected that in the future, the combination of G-B-G measures can produce an economically optimal solution to be implemented in order to achieve zero floodings in the case study location.Water Managemen
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