Responding to a Community's Concern: A Comparison of Breast Cancer Characteristics and Initial Treatment in Three Selected North Carolina Counties

BACKGROUND A 2007 national report identified North Carolina's Edgecombe County as having among the highest breast cancer incidence and mortality rates nationally, motivating the initiation of a task force and other local efforts to address the problem. The goal of this study is to examine county breast cancer characteristics before and after the report, including whether geographic variation may mask racial disparities in this majority African American community. METHOD With guidance from community partners, breast cancer cases from 2000 to 2012 in Edgecombe, Nash, and Orange Counties (N = 2,641) were obtained from the North Carolina Central Cancer Registry. Bivariate and trend analyses of tumor and treatment characteristics were examined by county and race. RESULTS Women in Edgecombe and Nash Counties were diagnosed with more advanced stage, higher grade tumors. African Americans in Edgecombe and Nash Counties were diagnosed with advanced disease more often than African Americans in Orange County. Average time-to-treatment was well within guideline recommendations. Incidence and mortality rates appear to have declined, with variation in measures of racial differences over time. LIMITATIONS Changes in coding standards across the observation period required reliance on coarse measures that may partially mute useful findings. CONCLUSIONS Racial disparities remain a concern in North Carolina; however, they appear to be less profound than in the 2007 national report. The portentous statistics in the report represent an all-time high, after which some, but not all, measures reflect positive change amidst ongoing local efforts to improve breast cancer knowledge and care

Management and treatment of children, young people and adults with systemic lupus erythematosus: British Society for Rheumatology guideline scope

The objective of this guideline is to provide up-to-date, evidence-based recommendations for the management of SLE that builds upon the existing treatment guideline for adults living with SLE published in 2017. This will incorporate advances in the assessment, diagnosis, monitoring, non-pharmacological and pharmacological management of SLE. General approaches to management as well as organ-specific treatment, including lupus nephritis and cutaneous lupus, will be covered. This will be the first guideline in SLE using a whole life course approach from childhood through adolescence and adulthood. The guideline will be developed with people with SLE as an important target audience in addition to healthcare professionals. It will include guidance related to emerging approved therapies and account for National Institute for Health and Care Excellence Technology Appraisals, National Health Service England clinical commissioning policies and national guidance relevant to SLE. The guideline will be developed using the methods and rigorous processes outlined in ‘Creating Clinical Guidelines: Our Protocol’ by the British Society for Rheumatology

Scaling up tests on virulence of the cassava green mite fungal pathogen Neozygites tanajoae (Entomophthorales: Neozygitaceae) under controlled conditions: first observations at the population level

Virulence of entomopathogens is often measured at the individual level using a single host individual or a group of host individuals. To what extent these virulence assessments reflect the impact of an entomopathogen on their host in the field remains largely untested, however. A methodology was developed to induce epizootics of the cassava green mite fungal pathogen Neozygites tanajoae under controlled conditions to evaluate population-level virulence of two (one Beninese and one Brazilian) isolates of the entomopathogen-which had shown similar individual-level virulence but different field impacts. In unrepeated separate experiments we inoculated mite-infested potted cassava plants with either 50 or 25 live mites (high and low inoculum) previously exposed to spores of N. tanajoae and monitored the development of fungal infections for each isolate under the same conditions. Both isolates caused mite infections and an associated decline in host mite populations relative to the control (without fungus) in all experiments, but prevalence of the fungus varied with isolate and increased with inoculum density. Peak infection levels were 90% for the Beninese isolate and 36% for the Brazilian isolate at high inoculum density, and respectively 17% and 25% at low inoculum density. We also measured dispersal from inoculated plants and found that spore dispersal increased with host infection levels, independent of host densities, whereas mite dispersal varied between isolates. These results demonstrate that epizootiology of N. tanajoae can be studied under controlled conditions and suggest that virulence tests at the population level may help to better predict performance of fungal isolates than individual-level tests

Levantamento de características epidemiológicas do sarampo em São José do Rio Prêto (Brasil) - 1973 Appraisal of the epidemiological characteristics of measles in São José do Rio Prêto (Brazil) - 1973

Considerando-se o sarampo como infecção com grande importância médico-sanitária atual, estudou-se sua incidência numa cohorte de 5 anos (entre 2 -<FONT FACE=Symbol>&frac12;</FONT>7 anos atuais) em região urbana de São José do Rio Prêto (Brasil) evidenciando-se a elevação da incidência progressivamente em idades mais jovens. Utilizando-se de método de investigação acessível em noso meio - entrevistas - determinou-se a ação profilática da vacina específica (96%) e a demanda hospitalar devido ao sarampo (758 leitos/dia) na área estudada nos últimos 5 anos.<br>In this country measles is considered a very important infection from the sanitary point of view. Its incidence was studied in a cohort of 5 years (between 2 and 7 years old at present) in the urban area of São José do Rio Prêto. The progressive increase of incidence in the lower age patients, was showed. The prophylactie value of specific vaccination (96%) and the hospital demand due to measles (758 beds/day) were evaluated by means of the most accessible mean of investigation in this area - i.e., personnal interviews

Efeito da restrição alimentar qualitativa sobre o ganho compensatório em frangos de corte Effects of qualitative feed restriction on compensatory growth in the broiler chicken

No presente estudo, aplicou-se a diluição qualitativa da dieta com o objetivo de determinar os efeitos das diferentes diluições (25% e 50%) das rações no desempenho de frangos de corte criados até 42 dias de idade. Utilizou-se, para a diluição, casca de soja na dieta inicial (21,5% de PB e 3.050 kcal/kg de EM), e os tratamentos experimentais foram baseados nessas dietas e distribuídos de forma contínua, durante sete dias, ou de forma intercalada, com a ração não diluída. Os tratamentos aplicados foram: T1: ração inicial (testemunha); T2 e T3: ração inicial diluída com 25% e 50% de casca de soja, respectivamente, fornecida durante sete dias; T4 e T5: ração inicial diluída com 25% e 50% de casca de soja, respectivamente, fornecida nos dias 7, 9, 11 e 13, intercalada com a ração testemunha nos dias 8,10 e 12. As aves sob restrição alimentar mostraram pesos corporais menores (P<0,05) em comparação com as aves do tratamento-testemunha. Não houve diferenças quanto a conversão alimentar acumulada (0-42 dias) entre os tratamentos da restrição. O oferecimento de forma intercalada das rações diluídas conferiu menores perdas no ganho de peso e no peso corporal. Não houve diferença quanto a mortalidades entre os tratamentos. As aves não apresentaram crescimento compensatório, o que parece estar associado ao padrão de curva de crescimento apresentada pela linhagem.<br>An experiment was conducted to determine the effects of the diet dilution on performance of broiler chickens until 42 days of age. Nutrient restriction was achieved by feeding a starter diet (CP 21.5% and ME 3,050 kcal/kg) in which the major ingredients were replaced with 25% or 50% of soybean hulls. Four treatments involved feeding the diluted diets for seven days (7-14 days of age), either continuous or split into periods with the undiluted diet (control). The treatments were: T1: control diet; T2 and T3: diluted diet (25% and 50% of soybean hulls, respectively) 7-14 days; T4 and T5: diluted diet (25% and 50% of soybean hulls, respectively) on days 7, 9, 11 and 13 alternating with T1 (on days 8, 10 and 12). The birds fed with diluted diets exhibited lower mean body weights (P<0.05) than controls. Feed conversion ratios from 0-42 days of age for restricted broilers were not different. Varying the period of nutrient restriction did not affect adversely body weight and body weight gain. There was no statistical difference in the overall mortality through 0-42 days among the dietary treatments. Compensatory growth was not observed, and this result could be associated with the pattern of growth curve exhibited by the hybrids used in this experiment