International health: what is the role of fourth year pharmacy students and a pharmacist on an interdisciplinary medical brigade in Guatemala?

Background: Timmy Global Health (TGH) is a non-profit organization that expands international access to healthcare and empowers both students and volunteers to confront challenging global health issues. A pharmacist’s knowledge of drug products, therapeutic substitution, patient counseling, drug dosing and calculations, pharmacy organization and workflow, and dispensing efficiency make them a valuable asset to a brigade team. Objective: To evaluate the roles and impact of fourth year pharmacy students and a pharmacist integrated into an interdisciplinary team on a medical brigade in the surrounding area of Quetzaltenango, Guatemala. Methods: A retrospective analysis of a single interdisciplinary medical brigade in Guatemala during August 16-24,2014 was conducted. An electronic survey was administered to all team members upon completion of travel. Medical brigade members included: Boston College pre-medical students (including 2014 graduates), college students (including non-healthcare majors), medical doctors, and TGH employees and volunteers. Project was designated as exempt by the authors’ Institutional Review Board. Results: The survey was distributed to 36 members of which 13 responded (36% response rate). 69% of respondents were female and the majority between 21-30 years old (54%). Respondents role on the brigade was 77% pre-medical students, medical doctor (17%) and TGH employee (8%). One-third had never worked with pharmacy personnel before the brigade and 100% of respondents viewed the role of a pharmacist more positively after the brigade. Respondents ranked knowledge of drug products as most useful pharmacy service (38%) followed by therapeutic substitution (23%). After the brigade respondents had a higher appreciation for the importance of teamwork, felt better prepared to work on a team, had a higher agreement that pharmacists are an important part of the medical team, and were more likely to refer a drug-related question to a pharmacy representative in the future. Conclusion: Incorporation of pharmacy students and a pharmacist as part of an international, interdisciplinary medical brigade improved attitudes and opinions towards the pharmacy profession, working as part of a medical team, and likelihood of referring questions to pharmacists in the future. Preliminary results of this project provide evidence of the potential roles and opportunities for pharmacists in global health initiatives

Revisiting Exclusion of Prior Cancer in Clinical Trials of Male Breast Cancer

Background: Eligibility criteria for cancer clinical trials present challenges to enrollment. Many trials exclude patients with a prior cancer. This common practice may be especially detrimental to trials of rare cancers, such as male breast cancer, that struggle to accrue adequate numbers of participants. Objectives: to estimate prevalence of prior cancer among men newly diagnosed with breast cancer and describe characteristics of men with prior cancer compared to those without. Methods: We identified men diagnosed with breast cancer between 2011-2015 using population-based data from National Cancer Institute\u27s Surveillance, Epidemiology, and End Results program of cancer registries. We used sequence number and diagnosis year to identify cancers diagnosed prior to breast cancer (inclusive of prior breast, different, and unknown types of cancer). We compared sociodemographic, tumor, and treatment characteristics of men with and without prior cancer using chi-square tests. Results: Among 2317 men, nearly one quarter (24.3%) had any prior cancer, and the majority (58.7%) of these were of a different cancer type. A higher proportion of men with a prior cancer of a different type were older, had smaller (≤ 2 cm) breast tumors, were diagnosed with stage 0-1 breast cancer, and did not receive surgery compared to men without any prior cancer; there were no statistically significant differences by race and ethnicity, county median income, hormone receptor status, or surgery type. Conclusion: Given prevalence of prior cancer in this rare and understudied population of men diagnosed with breast cancer, including men with prior cancer in clinical trials may improve accrual

Trustworthy IoT: An evidence collection approach based on smart contracts

Today, Internet of Things (IoT) implements an ecosystem where a panoply of interconnected devices collect data from physical environments and supply them to processing services, on top of which cloud-based applications are built and provided to mobile end users. The undebatable advantages of smart IoT systems clash with the need of a secure and trustworthy environment. In this paper, we propose a service-based methodology based on blockchain and smart contracts for trustworthy evidence collection at the basis of a trustworthy IoT assurance evaluation. The methodology balances the provided level of trustworthiness and its performance, and is experimentally evaluated using Hyperledger fabric blockchain

Potential Impact of Revised Nci Eligibility Criteria Guidance: Prior Malignancy Exclusion in Breast Cancer Clinical Trials

BACKGROUND: Many individuals with cancer have survived a prior cancer and for this reason may have been excluded from clinical trials. Recent NCI guidance recommends including these individuals, especially when the risk of the prior malignancy interfering with either safety or efficacy endpoints is very low. Using breast cancer as an example, we determined the potential effect this policy change may have on clinical trial accrual. PATIENTS AND METHODS: We reviewed protocols of NCI-sponsored breast cancer clinical trials activated in 1991 through 2016. We quantified prevalence of prior cancer-related exclusion criteria and assessed the association with trial characteristics using Fisher\u27s exact tests. Using SEER data, we estimated the prevalence and timing of prior primary (nonbreast) cancer diagnoses among patients with breast cancer. RESULTS: Among 87 clinical trials (total target enrollment, 137,253 patients), 77% excluded individuals with prior cancer, most commonly (79%) within the preceding 5 years. Among trials with radiographic response or toxicity endpoints, 69% excluded prior cancer. In SEER data, the prevalence of a prior (nonbreast) cancer diagnosis ranged from 5.7% to 7.7%, depending on breast cancer stage, of which 39% occurred within 5 years of the incident breast cancer. For trials excluding prior cancer, the estimated proportion of patients excluded for this reason ranged from 1.3% to 5.8%, with the estimated number of excluded patients ranging from 1 to 288. CONCLUSIONS: More than three-fourths of NCI-sponsored breast cancer clinical trials exclude patients with prior cancer, including almost 70% of trials with response or toxicity endpoints. Given that \u3e5% of patients with breast cancer have a history of prior cancer, in large phase III trials this practice may exclude hundreds of patients. Following recent NCI eligibility guidance, the inclusion of patients with prior cancer on breast cancer trials may have a meaningful impact on accrual

Intrinsic and extrinsic resistive switching in a planar diode based on silver oxide nanoparticles

Resistive switching is investigated in thin-film planar diodes using silver oxide nanoparticles capped in a polymer. The conduction channel is directly exposed to the ambient atmosphere. Two types of switching are observed. In air, the hysteresis loop in the current–voltage characteristics is S-shaped. The high conductance state is volatile and unreliable. The switching is mediated by moisture and electrochemistry. In vacuum, the hysteresis loops are symmetric, N-shaped and exhibit a negative differential resistance region. The conductance states are non-volatile with good data retention, programming cycling endurance and large current modulation ratio. The switching is attributed to electroforming of silver oxide clusters

Opto-electronic characterization of electron traps upon forming polymer oxide memory diodes

Metal-insulator-polymer diodes where the insulator is a thin oxide (Al2O3) layer are electroformed by applying a high bias. The initial stage is reversible and involves trapping of electrons near the oxide/polymer interface. The rate of charge trapping is limited by electron transport through the polymer. Detrapping of charge stored can be accomplished by illuminating with light under short-circuit conditions. The amount of stored charge is determined from the optically induced discharging current transient as a function of applied voltage and oxide thickness. When the charge density exceeds 8 1017/m2, an irreversible soft breakdown transition occurs to a non-volatile memory diode

The role of internal structure in the anomalous switching dynamics of metal-oxide/polymer resistive random access memories

The dynamic response of a non-volatile, bistable resistive memory fabricated in the form of Al2O3/polymer diodes has been probed in both the off- and on-state using triangular and step voltage profiles. The results provide insight into the wide spread in switching times reported in the literature and explain an apparently anomalous behaviour of the on-state, namely the disappearance of the negative differential resistance region at high voltage scan rates which is commonly attributed to a “dead time” phenomenon. The off-state response follows closely the predictions based on a classical, two-layer capacitor description of the device. As voltage scan rates increase, the model predicts that the fraction of the applied voltage, Vox , appearing across the oxide decreases. Device responses to step voltages in both the off- and on-state show that switching events are characterized by a delay time. Coupling such delays to the lower values of Vox attained during fast scan rates, the anomalous observation in the on-state that, device currents decrease with increasing voltage scan rate, is readily explained. Assuming that a critical current is required to turn off a conducting channel in the oxide, a tentative model is suggested to explain the shift in the onset of negative differential resistance to lower voltages as the voltage scan rate increases. The findings also suggest that the fundamental limitations on the speed of operation of a bilayer resistive memory are the time- and voltage-dependences of the switch-on mechanism and not the switch-off process

Planar non-volatile memory based on metal nanoparticles

Resistive switching properties of silver nanoparticles hosted in an insulating polymer matrix (poly(N-vinyl-2-pyrrolidone) are reported. Planar devices structures using interdigitated gold electrodes were fabricated. These devices have on/off resistance ratio as high as 103 , retention times reaching to months and good endurance cycles. Temperature-dependent measurements show that the charge transport is weakly thermal activated (73 meV) for both states suggesting that nanoparticles will not aggregate into a metallic filament

What explains ethnic organizational violence? Evidence from Eastern Europe and Russia

Why do some ethnopolitical organizations use violence? Research on substate violence often uses the state level of analysis, or only analyzes groups that are already violent. Using a resource mobilization framework drawn from a broad literature, we test hypotheses with new data on hundreds of violent and non-violent ethnopolitical organizations in Eastern Europe and Russia. Our study finds interorganizational competition, state repression and strong group leadership associated with organizational violence. Lack of popularity and holding territory are also associated with violence. We do not find social service provision positively related to violence, which contrasts with research on the Middle East

Alcoholic beverages and risk of renal cell cancer

Using a mailed questionnaire, we investigated the risk of renal cell cancer in relation to different types of alcoholic beverages, and to total ethanol in a large population-based case–control study among Swedish adults, including 855 cases and 1204 controls. Compared to non-drinkers, a total ethanol intake of >620 g month−1 was significantly related to a decreased risk of renal cell cancer (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4–0.9; P-value for trend=0.03). The risk decreased 30–40% with drinking more than two glasses per week of red wine (OR 0.6, 95% CI 0.4–0.9), white wine (OR 0.7, 95% CI 0.4–1.0), or strong beer (OR 0.6, 95% CI 0.4–1.0); there was a clear linear trend of decreasing risk with increasing consumption of these beverages (P-values for trends <0.05)