Promoting indigenous vegetables in urban agriculture & livelihoods : policy lessons from Sub-Saharan Africa

[From Introduction] Globally, the growth of urbanised areas continues at an exponential rate, and most spectacularly in the developing world. The global urban population will increase from 2.9 billion in 2000 to 5.0 billion by 2030. The mean rate of urban growth in non-OECD countries between 2000 and 2005 was just under 3% per annum, compared to 0.5 % for rural regions of the same countries (UN-Habitat 2006). Although the proportion of Africans currently living in urban areas is the lowest in the world (+ 40%), because of this low base it is not unsurprising that the rates of urbanisation are among the highest at approximately 4.3% per annum. Projections vary, but sometime in the mid- 2020s over 50% of Africa's population will be living in urban areas, as compared to just 15% in 1950 and 34% in 1994. As urbanisation takes place another important trend is revealed, namely the locus of poverty in Africa is slowly shifting from rural to urban areas. For example, it is estimated that more than 56% of the world's absolute or chronic poor will be concentrated in urban areas (WRI 1996). Since as much as 60-80% of the income of the urban poor is spent on the purchase of food (Maxwell et al. 2000), the issue of food supply, both its quantity and quality, is increasingly a central issue in poverty reduction debates and strategies. In rural areas, a common strategy to alleviate poverty is to call for measures to boost small-holder food production. Surprisingly, this is less common in urban poverty alleviation programmes, despite the widespread promise of urban and household agriculture in contributing to improved food security

Anisotropic flow in sqrt(s)=2.76 TeV Pb+Pb collisions at the LHC

The results on elliptic flow in sqrt(s)=2.76 TeV Pb+Pb collisions at the Large Hadron Collider (LHC) reported by the ALICE collaboration are remarkably similar to those for sqrt(s)=200 GeV gold-gold collisions at the Relativistic Heavy Ion Collider (RHIC). This result is surprising, given the expected longer lifetime of the system at the higher collision energies. We show that it is nevertheless consistent with 3+1 dimensional viscous event-by-event hydrodynamic calculations, and demonstrate that elliptic flow at both RHIC and LHC is built up mostly within the first 5 fm/c of the evolution. We conclude that an "almost perfect liquid" is produced in heavy-ion collisions at the LHC. Furthermore, we present predictions for triangular flow as a function of transverse momentum for different centralities.Comment: 5 pages, 9 figures, one figure replaced; includes event-by-event computations with increased statistics and resolution and more accurate matching to experimental spectra; comments on different v_2 measurement methods added; calculation of the integrated v_2 adde

Policy brief, number 11, 2014

[From Introduction] Urbanisation in sub-Saharan Africa: changing the locus of poverty. Urbanisation is a global phenomenon that is changing the face of the Earth, as well as how people earn a living and secure their livelihoods. In 2006 the number of urban people in the world surpassed the number of rural people, and this gap will continue to grow. In only 16 years (by 2030) just under two-thirds of the world's people will be urban dwellers. Whilst most of the developed world and large parts of Latin America already have more than threequarters of their populations living in cities and towns, most countries in Asia and sub-Saharan Africa are still catching up. This means that they are experiencing massive migrations from rural to urban areas as rural people wish to swap the insecurities of rural living for the allure of secure employment and better services for health, education, sanitation and transport in towns and cities. Sub-Saharan Africa (SSA) is the most rapidly urbanising region of the globe. According to UN-Habitat, in 1990, only 28 % of the region's inhabitants lived in towns and cities; that increased to approximately 32 % in 2001 and 41 % in 2010. The size of the urban population is likely to surpass the rural one around 2025. Contrary to popular belief, most urban residents in SSA (and globally) live in small towns rather than massive megacities; with just over half living in towns of less than 200,000 people and 78 % living in towns of less than 500,000 residents. Only 14 % of urban dwellers live in cities of more than one million people. Many new urban households maintain strong links to relatives and clans in rural areas, with circular migration patterns emerging as the urban transition takes place over several decades. The implications of this extremely rapid urbanisation in SSA countries for livelihoods and poverty are widely debated. UN-Habitat highlights a relatively unique aspect of urbanisation in SSA as being the accompanying high rate of growth in informal settlements or slums. In other words, not all rural migrants to towns and cities find secure incomes or shelter. Some slum areas have become permanent features where inter-generational poverty is reproduced. Although urban areas are producing an increasing share of national wealth in SSA countries, some argue that slowly the nexus of poverty is shifting towards urban areas. Rates of poverty are high in rural areas of SSA, but migration and internal population growth means that in some countries the number of urban poor almost matches the number of rural poor, and it is likely to grow. The informal economy contributes an average of 40 – 45 % of total urban GDP, which is higher than any other region of the world

Comparison of the pattern of metastatic spread of squamous cell cancer and adenocarcinoma of the uterine cervix

Retrospective review of medical records and autopsy findings in patients dying of squamous cell cancer or adenocarcinoma of the uterine cervix was undertaken to evaluate for possible differences in biologic behavior between these tumor types. Twenty-one patients with each tumor type were evaluated. Patients with adenocarcinoma were found to have a higher incidence of tumor involvement of the paraaortic lymph nodes (13/21 vs 6/20, P P P P P < 0.05) was also significantly more frequent in patients with adenocarcinoma. These findings suggest that this tumor may behave differently in regard to pattern of metastatic spread or response to therapy. The therapeutic implications of these findings deserve further study.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27919/1/0000342.pd

Perceptual Context in Cognitive Hierarchies

Cognition does not only depend on bottom-up sensor feature abstraction, but also relies on contextual information being passed top-down. Context is higher level information that helps to predict belief states at lower levels. The main contribution of this paper is to provide a formalisation of perceptual context and its integration into a new process model for cognitive hierarchies. Several simple instantiations of a cognitive hierarchy are used to illustrate the role of context. Notably, we demonstrate the use context in a novel approach to visually track the pose of rigid objects with just a 2D camera

Malignant placental site trophoblastic tumor associated with placental abruption, fetal distress, and elevated CA-125

The second pregnancy of 27-year-old woman, gravida 2, para 2 was complicated by a low [alpha]-fetoprotein and symptoms of chronic placental abruption. She delivered by cesarean section at 35 weeks for fetal distress at which time a biopsy of the uterus revealed a placental site trophoblastic tumor (PSTT). She rapidly developed intraabdominal spread of the neoplasm which did not respond to chemotherapy and she died 10 weeks later. Her CA-125 was elevated to 5360 u/ml and this decreased after hysterectomy. This patient is reported to highlight a very malignant course of PSTT that was associated with a live-born male infant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29752/1/0000090.pd

Patterns of genomic testing for epithelial ovarian cancer across a large community-based health care network- a real world experience

Background: NCCN guidelines recommend germline and somatic tumor testing for all women with invasive epithelial ovarian cancer (EOC). Despite this recommendation, testing rates remain low and an optimal strategy to achieve the recommended testing has not been defined. Purpose: We elected to review the patterns of germline and somatic tumor testing for patients with EOC across a large health care network to identify barriers to testing. Methods: Clinical, pathologic, demographic and genomic testing (GT) information including involvement of a genetic counselor, specific test(s) ordered, test vendor, test turn-around time, and test results were obtained from the diverse dataset within the Providence St. Joseph Health (PSJH) Electronic Medical Records and the system-wide cancer registry data mart. PSJH is the third largest non-profit health care system in the US and treats roughly 43,000 cancer patients annually across a 7 state region. Patients with a diagnosis of EOC (ICD C56.x) who had at least a single in-person visit to a PSJH oncology department or a PSJH oncologist for EOC during the period between January 2015 and January 2020 were identified. GT data was manually abstracted, where structured data was un-available; data were analyzed in aggregate and to evaluate for trends over time in patterns of testing. Results: Within this EOC cohort (n=3,007), 1,1027 (34%) had GT results available in the EMR.  Germline testing (GMT) was the initial testing approach in 728 (71%) of women tested, and 210 (29%) of the 728 women who had GMT first went on to have tumor tissue testing (TTT). Of the 300 patients who had TTT first, 79 (26%) went on to have GMT. A BRCA1/2 mutation was identified in 153 (14.9%) patients on GMT and/or TTT. Mutation results were discordant in 7 of 289 (2.4%) who had both GMT and TTT. GT rates increased over time but remained low (46% in 2019). Involvement of a genetic counselor (GC) increased uptake of GT, however, only 62% of patients completed recommended GC referral. GT was ordered from 17 different vendors (12 GMT; 11 TTT). Median time from initial diagnosis to GT order date decreased over time and was 8 weeks and 12 weeks in 2019 for GMT and TTT, respectively. The median time interval between GMT and TTT in patients who had both tests decreased from 130 weeks in 2015 to 6 weeks in 2019. Despite improvement in median time to testing, multiple outliers were observed. Conclusion: The uptake of GT for EOC patients has increased over time but remains low. There is substantial heterogeneity in testing approach including the timing, sequencing, and ordering of tests. Genetic counseling for patients with EOC increases uptake of testing. Significance: These findings highlight the challenges of developing a standardized testing approach across a diverse health care system. There is a need to develop a comprehensive network wide testing strategy that can be effective in multiple settings

Frequency of homologous recombination deficiency in a large community-based cohort of epithelial ovarian cancer cases

Purpose/Background: Homologous recombination deficiency (HRD) is a useful predictor of treatment response in patients with epithelial ovarian cancer (EOC). Reported data on the frequency of HRD in EOC is largely based on analysis of patients treated at academic medical centers or who participated in clinical trials. We sought to characterize the frequency of HRD based on mutations in homologous recombination repair (HRR) genes, genomic instability (GI) and loss of heterozygosity (LOH) scores in a large community-based cohort of EOC patients who received genomic testing in the context of routine clinical care. Methods: Information including patient demographic, tumor stage and histology data, and results from ovarian cancer tumor tissue sequencing tests was obtained from the diverse dataset within the Providence St. Joseph Health (PSJH) Electronic Medical Record (EMR) and the system-wide cancer registry data. Patients with an EOC diagnosis (ICD C56.x) during the time interval between January 2015 and January 2020 were included. Structured genomic data was sourced from laboratory information systems and manual abstraction of molecular sequencing reports. Alterations in the following HRR genes were analyzed, along with LOH and GI scores: ATM, BARD1, BRCA1, BRCA2, BRIP1, CDK12, CHEK1, CHEK2, FANCL, PALB2, PPP2R2A, RAD51B, RAD51C, RAD51D, RAD54L. Results: Within this EOC cohort of 3007 patients, 510 (17%) had tumor tissue sequencing (TTS) ordered in the context of clinical care. TTS increased over time (p\u3c0.0001) and was more frequent in patients with advanced stage disease (33/392 vs 149/659 for Stage I-II vs Stage III-IV, X2=34.6, p \u3c 0.00001) or who had a tissue biopsy at a PSJH facility (214/1,151 vs 139/998 for biopsy vs no biopsy, X2=8.5, p=0.004). Eight patients (1.5%) had an insufficient tissue sample despite multiple attempts. Pathogenic mutations in HRR genes were identified in 97 (19%) patients including BRCA1 (n=54), BRCA 2 (n=25), ATM (n=9), CHEK2 (n=6), PALB2 (n=2) and BRIP1 (n=1). LOH and GI scores reflective of HRD were noted in 34/115 (30%) and 9/40 (23%) of patients tested, respectively. HRR gene mutations and/or GI/LOH were identified in tumors of all stages. Treatment data was available for a subset of patients. Patients with mutations or GI/LOH were far more likely to receive PARPi maintenance therapy than patients without these findings. Conclusion: In this large, community based cohort of EOC cases, commercial TTS identified evidence of HRD in 151 of 510 (27%) patients tested. Molecular alterations were identified in tumors of all stages, suggesting that broad based TTS may be of value. Significance: A large fraction of patients with HRD may not be receiving indicated PARPi therapy. This data suggests there is a need to establish a systemized approach to genetic testing for EOC within the PSJH system. Presenting Author: Nicole Kretzer, MD, PhD, Obstetrics and Gynecology, First Hill Campus, [email protected]

Factors impacting genomic testing rates among epithelial ovarian cancer patients across a large community-based healthcare system

Background: Epithelial ovarian cancer (EOC) accounts for the highest mortality of all gynecological cancers. NCCN guidelines recommend germline and somatic testing for all women with invasive EOC. Despite this recommendation, there is a large diversity in the types of testing patients receive even within a single healthcare system. Reported data of genetic testing for epithelial ovarian cancer (EOC) patients is largely based on patients treated at academic medical centers or patients who participate in clinical trials. Purpose: This study sought to determine the rates of germline and somatic testing for epithelial ovarian cancer patients and identify factors that impact testing rates across a large community-based healthcare system over 5 states: WA, OR, CA, AK, and MT. The system is comprised of over 100,000 caregivers, 51 hospitals and 829 physician clinics. The aim was to identify barriers to testing such as region, hospital type, insurance status, racial/ethnic disparities, and stage of diagnosis. Methods: Clinical, pathologic, demographic and genomic testing information was obtained from the diverse dataset within the Providence St. Joseph Health Electronic Medical Records and the system-wide cancer registry for all patients with an EOC diagnosis (ICD C56.x) between January 2015 and January 2020. Structured genomic data was sourced from laboratory information systems and manual abstraction of molecular sequencing reports. This dataset encompasses patient population data among diverse hospital settings and urban/rural environments. Institution types were broken down into academic setting which contain a residency program (Academic), Commission on Cancer (CoC) accredited programs, or smaller community sites (Community) without CoC accreditation. Descriptive statistics and logical regression are utilized to summarize key findings. Results: Within this EOC cohort (3,007 patients), 34% (n=1,027 patients) completed some type of genomic testing (GT). The percentage of patients tested increased from 31% in 2015 to 46% in 2019, reflecting uptake of testing guidelines. The increase in GT rates was largely attributable to an increase in somatic tumor testing (14-39%); while germline testing rates were stable across the interval (25-33%). Patients were more likely to receive testing if they received care at an academic or CoC institution vs community institution (p=0.0001). Logistic regression analysis demonstrated the following factors impacted tested rates: institution type, insurance, and stage at diagnosis (p=0.001, p= 0.0019 and p \u3c 0.0001, respectively). Race/ethnicity did not contribute significantly to the model but did have a significant effect when analyzed independently. Conclusion: This study is the first to analyze practice patterns in GT for EOC across a broad community-based healthcare system servicing 5 states. The data highlight discrepancies in GT heavily influenced by practice setting, insurance status, and stage of diagnosis (likely reflecting payer coverage/ increased need for information in advanced stage disease). Significance: There is a need for a universally defined approach to testing to provide equitable access to evidence based cancer care. Presenting Author: Nicole Kretzer, MD, PhD, Obstetrics and Gynecology, First Hill Campus, [email protected]

Effects of personal characteristics on serum CA125, mesothelin, and HE4 levels in healthy postmenopausal women at high-risk for ovarian cancer.

OBJECTIVE: To evaluate if serum levels of candidate ovarian cancer biomarkers vary with individual characteristics of healthy women who are likely candidates for an ovarian cancer screening program. METHODS: We analyzed serum CA125, mesothelin, and HE4 levels in a sample of 155 healthy postmenopausal women at increased risk for developing ovarian cancer based on personal and family cancer history. Information on reproductive, family and medical histories, lifestyle factors, and anthropometry was collected by self-report. Twenty-two factors were examined using univariate and multiple linear regression models for the three biomarker levels. RESULTS: In the multivariate models, CA125 levels were significantly higher in women who had used talcum powder (P = 0.02) and were lower in women who were parous (P = 0.05). Mesothelin levels were significantly higher in older women (P = 0.01) and lower in heavier women (P = 0.03). HE4 levels were higher in older women (P = 0.001) and in women who began menstruating at an older age (P = 0.03). CONCLUSIONS: CA125, mesothelin, and HE4 levels in healthy, postmenopausal women at increased risk for ovarian cancer are significantly associated with a few ovarian cancer risk factors. Since the effects of these personal characteristics on these serum markers are not large, their incorporation in screening algorithms may be unnecessary. This is true especially if a longitudinal algorithm is used because the marker level at the previous screen reflects personal characteristics such as age, body mass index, and age of menarche. Understanding the influence of personal factors on levels of novel early detection markers in healthy, unaffected women may have clinical utility in interpreting biomarker levels