Prostate Cancer Screening, Detection and Treatment Practices, Among Sub-Saharan African Urologists

Introduction: Prostate cancer is reported to be the leading cancer in men in Sub-Saharan Africa (SSA) and the number of prostate cancer deaths is expected to double in the next 20 years. Despite the importance of this public health issue in SSA, there remains relatively limited information about practices related to prostate cancer treatment in this population. Objective: We conducted a survey of 28 urology practices in SSA to evaluate the scope of available screening, detection and treatment. Materials and Methods: Screening was more commonly reported as a part of general medical care in South Africa (SA) compared with East or West (EW) Africa. However, use of digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA) were used at similar rates for screening in all locations. Screening is primarily focused in men over age 50 and those with symptoms. Routine screening was the primary reason for screening use in SA, while symptoms were the primary reason for screening use in EW. Financial and cultural barriers to screening were more commonly reported in EW than SA. Similar detection approaches were used in all regions, with free PSA and PSA velocity being more commonly used in SA than EW. Six core biopsies were more commonly used in EW and 12 core biopsies were more common in SA. Trans urethral ultrasounds and bone scans were more commonly used in SA than EW. Treatment options were similar in all regions, with brachytherapy less likely to be used in EW than SA. Results: The descriptive data suggest that differences in patterns of screening, detection and treatment exist across Africa. Differences by geography may also reflect differences in SES and racial composition of the populations in each region.Key Words: Prostate cancer, Screening and Detection, Practice guidelines, Sub-Saharan Afric

Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq

Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Methods: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50–74%, and low dosing as <50% of the target dose. Results: 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days). In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively. Conclusions: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team

SURF1 knockout cloned pigs: early onset of a severe lethal phenotype

Leigh syndrome (LS) associated with cytochrome c oxidase (COX) deficiency is an early onset, fatal mitochondrial encephalopathy, leading to multiple neurological failure and eventually death, usually in the first decade of life. Mutations in SURF1, a nuclear gene encoding a mitochondrial protein involved in COX assembly, are among the most common causes of LS. LSSURF1 patients display severe, isolated COX deficiency in all tissues, including cultured fibroblasts and skeletal muscle. Recombinant, constitutive SURF1−/− mice show diffuse COX deficiency, but fail to recapitulate the severity of the human clinical phenotype. Pigs are an attractive alternative model for human diseases, because of their size, as well as metabolic, physiological and genetic similarity to humans. Here, we determined the complete sequence of the swine SURF1 gene, disrupted it in pig primary fibroblast cell lines using both TALENs and CRISPR/Cas9 genome editing systems, before finally generating SURF1−/− and SURF1−/+ pigs by Somatic Cell Nuclear Transfer (SCNT). SURF1−/− pigs were characterized by failure to thrive, muscle weakness and highly reduced life span with elevated perinatal mortality, compared to heterozygous SURF1−/+ and wild type littermates. Surprisingly, no obvious COX deficiency was detected in SURF1−/− tissues, although histochemical analysis revealed the presence of COX deficiency in jejunum villi and total mRNA sequencing (RNAseq) showed that several COX subunit-encoding genes were significantly down-regulated in SURF1−/− skeletal muscles. In addition, neuropathological findings, indicated a delay in central nervous system development of newborn SURF1−/− piglets. Our results suggest a broader role of sSURF1 in mitochondrial bioenergetics

Tariffs

Northern Indiana Public Service Co. (NIPSCO) is collaborating with a group of municipalities to initiate a program to replace all fixtures in its service territory with LED fixtures. In this presentation we discuss this program and its timing, results, and tariff impacts

The effect of time constraint on anticipation, decision making, and option generation in complex and dynamic environments

Researchers interested in performance in complex and dynamic situations have focused on how individuals predict their opponent(s) potential courses of action (i.e., during assessment) and generate potential options about how to respond (i.e., during intervention). When generating predictive options, previous research supports the use of cognitive mechanisms that are consistent with long-term working memory (LTWM) theory (Ericsson and Kintsch in Phychol Rev 102(2):211–245, 1995; Ward et al. in J Cogn Eng Decis Mak 7:231–254, 2013). However, when generating options about how to respond, the extant research supports the use of the take-the-first (TTF) heuristic (Johnson and Raab in Organ Behav Hum Decis Process 91:215–229, 2003). While these models provide possible explanations about how options are generated in situ, often under time pressure, few researchers have tested the claims of these models experimentally by explicitly manipulating time pressure. The current research investigates the effect of time constraint on option-generation behavior during the assessment and intervention phases of decision making by employing a modified version of an established option-generation task in soccer. The results provide additional support for the use of LTWM mechanisms during assessment across both time conditions. During the intervention phase, option-generation behavior appeared consistent with TTF, but only in the non-time-constrained condition. Counter to our expectations, the implementation of time constraint resulted in a shift toward the use of LTWM-type mechanisms during the intervention phase. Modifications to the cognitive-process level descriptions of decision making during intervention are proposed, and implications for training during both phases of decision making are discussed

Equality of Participation Online Versus Face to Face: Condensed Analysis of the Community Forum Deliberative Methods Demonstration

Online deliberation may provide a more cost-effective and/or less inhibiting environment for public participation than face to face (F2F). But do online methods bias participation toward certain individuals or groups? We compare F2F versus online participation in an experiment affording within-participants and cross-modal comparisons. For English speakers required to have Internet access as a condition of participation, we find no negative effects of online modes on equality of participation (EoP) related to gender, age, or educational level. Asynchronous online discussion appears to improve EoP for gender relative to F2F. Data suggest a dampening effect of online environments on black participants, as well as amplification for whites. Synchronous online voice communication EoP is on par with F2F across individuals. But individual-level EoP is much lower in the online forum, and greater online forum participation predicts greater F2F participation for individuals. Measured rates of participation are compared to self-reported experiences, and other findings are discussed.Comment: 14 pages, 10 tables, to appear in Efthimios Tambouris, Panos Panagiotopoulos, {\O}ystein S{\ae}b{\o}, Konstantinos Tarabanis, Michela Milano, Theresa Pardo, and Maria Wimmer (Editors), Electronic Participation: Proceedings of the 7th IFIP WG 8.5 International Conference, ePart 2015 (Thessaloniki, August 30-September 2), Springer LNCS Vol. 9249, 201

Inspiratory muscle warm-up does not improve cycling time-trial performance

Purpose: This study examined the effects of an active cycling warm-up, with and without the addition of an inspiratory muscle warm-up (IMW), on 10-km cycling time-trial performance

A BRiTE Journey: 2013–2019

Resilience is widely acknowledged as important for teacher success, yet how to assist pre-service teachers build the skills and strategies for professional resilience is a question often asked by teacher educators. This chapter overviews the design, development and features of a series of five online learning modules designed to support pre-service teacher resilience. The BRiTE modules were informed by an analysis of the literature and content created to address the key themes. Five modules were developed: Building resilience, Relationships, Wellbeing, Taking initiative and Emotions. Each module was designed to be interactive and personalised, enabling users to build their personal toolkit to support their resilience. Since their launch in 2015, the modules have been widely used by pre-service teachers, teachers and a range of stakeholders with over 14,000 registered users at the beginning of 2020. Potential for future use in supporting teacher resilience is discussed