Time to presentation and diagnosis of esophageal cancer in patients seen at the Kenyatta National Hospital

Background: Esophageal Cancer (EC) is one of the leading causes of cancer death in Kenya. Majority of the patients with esophageal cancer at Kenyatta National Hospital (KNH) present at an advanced stage limiting their treatment options. Objective: To determine diagnostic time lines and factors associated with delayed health care service delivery among patients with established histological diagnosis of EC at KNH. Design and Setting: A retrospective diagnostic cohort study was carried out at the Cardiothoracic, endoscopy and radiotherapy units at KNH.Results: Eighty-five participants with established histological diagnosis of EC consented and were enrolled into the study. Majority (89.4%) were diagnosed in stage III and IV of the disease. The median time to  histological diagnosis of EC was 90 days. The time to first presentation was more than 30 days among 78.8% of subjects. The median time from first consultation to referral to a diagnostic-capable facility was 30 days, with 76.5% of the participants taking more than 30 days to reach KNH. Those who could not afford transport and consultation were more likely to report delay to first presentation (OR 3.6 95% CI 1.2-11.3, p=0.022). Referral delay was associated with residence, with those living in the rural areas less likely to delay (OR 0.2, 95% CI 0.0-0.8, p=0.019). Conclusion: Overall this study found that there was significant delay in the diagnostic process of EC patients. Over 75% of the patients delayed in presenting for the first consultation, being referred to higher level facilities, getting an endoscopy done and receiving histological diagnosis.  Consequently, about 90% of the patients were diagnosed at an advanced stage of the disease

Music Therapist Experiences of a Randomized Controlled Trial as Clinician Researchers

Music therapy clinicians bring an important perspective to the design and conduct of clinically meaningful studies. Unfortunately, there continue to be roadblocks that hinder clinician involvement in research and the development of successful partnerships between academic researchers and practicing clinicians. To help grow clinician involvement, it is important that research teams share their experiences. As such, the purpose of this qualitative study was to share music therapists' perspectives about their experience of working as a research clinician on a large multisite randomized controlled trial. 10 board-certified music therapists provided written responses to 6 data-generating questions about: (a) reasons for participating, (b) perceived challenges and benefits, (c) experiences of quality assurance monitoring, (d) professional growth, (e) value of research, and (f) advice for clinicians considering research involvement. Using thematic content analysis, we identified primary themes and subthemes for each question (20 themes; 30 subthemes). Qualitative analysis revealed not only common challenges, such as reconciling clinical and research responsibilities, but also benefits, including continued professional growth, greater understanding of research processes, and research participation as a way to advocate and advance the profession. Finally, for clinicians interested in becoming involved in research, therapists noted the importance of having workplace support from a mentor, supervisor, and/or administrator; seeking out available resources; and knowing roles and responsibilities before initiating research involvement. Findings offer important insight and recommendations to support the involvement of clinicians in research and support further exploration of clinician involvement in dissemination efforts to improve translation and uptake of research into practice

LEAD ZIRCONATE TITANATE ON BASE METAL FOILS: AN APPROACH FOR EMBEDDED HIGH-K PASSIVE COMPONENTS* m Government retains for itself. and others Lead Zirconate Titanate thin films on base-metal foils: An approach for embedded high-K passive components

d acting on its behalf, a paid-up, non exclusive, irrevomble worldwide license in works, dmnbute mpm to the pbhc. and pa-form publicly and display publicly,by or -. This paper was submitted to the US-Japan Seminar on Dielectric and Piezoelectric Ceramics, Okinawa, Japan, held on November 3-5, 1999. ABSTRACT An approach for embedding high-K dielectric thin films into polymer packages has been developed. Pb0.g5L%.ls(fiOszTb.M)0.gsOs thin films were prepared by chemical solution deposition on 50 pm thick Ni-coated Cu foils. Sputter deposited Ni top electrodes completed the all base-metal capacitor stack. After high temperature N2 crystallization anneals, the PLZT composition showed reduction resistance while the base-metal foils remained flexible. Capacitance density and Loss tangent values range between 300 and 400 nF/cm2 and 0.01 and 0.02 from 1 to 1000 kHz respectively. These properties represent a 2 to 3 order of magnitude improvement over available embedded capacitor technologies for polymeric packages.l INTRODUCTION Embedding thin film high-permittivity dielectrics into low temperature processed polymer packages offers advantages in electronics miniaturization and manufacturing cost reduction. Miniaturization potential stems from replacement of surface mount components and the subsequent reduction of the required wiring board real estate. Cost reductions are associated with the ability to produce packaging substrates with capacitiveJayers pre-embedded. Such layers remove the need for pick-and-place assembly operations which can comprise an appreciable fraction of the manufacturing cost.1 Photolithographic methods coupled with etching and metallization steps can conceivably be used synthesize the necessary combinations of capacitive elements and interconnects rapidly and in large quantity. We present here a strategy to produce high permittivity capacitive layers compatible with low temperature processed polymer packages. To avoid traditional temperature limitations, all high temperature processing steps required by the oxide dielectric would be performed prior to the embedding process. This goal was achieved throug

Assays for insulin and insulin-like activity based on adipocytes.

Data from the metabolic assays (and signaling assays; see below) are calculated as stimulation factor above basal activity (absence of insulin/compound/drug candidate) for processes stimulated (e.g., lipogenesis, glucose transport, and GLUT4 translocation) or as difference between the basal and insulin/compound/drug candidate-induced values for processes downregulated (e.g., lipolysis). In each case, these data, which reflect the responsiveness of the metabolic effector system studied toward the respective stimulus (insulin/compound/drug candidate), are normalized to the basal (set at 0 %) and maximal insulin action (set at 100 %; elicited by maximally effective concentration of insulin). For characterization of the sensitivity of the metabolic effector system toward the respective stimulus, effective concentrations for the induction of 150 % (or higher) of the basal activity (set at 100 %) can be given. These so-called EC150-values facilitate the insulin-independent comparison of the relative potency of the insulin-like activity between compounds/drug candidates, in general, and in particular for those frequently observed stimuli, which do not elicit the same maximal response in % stimulation or inhibition and/or fail to approach the maximal insulin response