Fiction Fix 09

https://digitalcommons.unf.edu/fiction_fix/1003/thumbnail.jp

Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia.

Introduction The WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first to implement an integrated approach and evaluate its impact. Methods A retrospective study of three of five CM-NTD-endemic counties that implemented the integrated approach was compared with cluster-matched counties with non-integrated CM-NTD. We compared trends in CM-NTD integrated versus non-integrated county clusters. We conducted a pre-post comparison of WHO high-level outcomes using data collected during intervention years compared with baseline in control counties. Changes in health outcomes, effect sizes for different diseases and rate ratios with statistically significant differences were determined. Complementary qualitative research explored CM-NTD stakeholders' perceptions, analysed through the framework approach, which is a transparent, multistage approach for qualitative thematic interdisciplinary data analysis. Results The detection rates for all diseases combined improved significantly in the intervention compared with the control clusters. Besides leprosy, detection rates improved with large effects, over fourfold increase with statistically significant effects for individual diseases. Conclusions Integrating CM-NTDs improves case detection, accessibility and availability of CM-NTD services, promoting universal health coverage. Early case detection and the quality of care need further strengthening

Colorectal cancer incidences in Lynch syndrome: a comparison of results from the prospective lynch syndrome database and the international mismatch repair consortium

Objective To compare colorectal cancer (CRC) incidences in carriers of pathogenic variants of the MMR genes in the PLSD and IMRC cohorts, of which only the former included mandatory colonoscopy surveillance for all participants. Methods CRC incidences were calculated in an intervention group comprising a cohort of confirmed carriers of pathogenic or likely pathogenic variants in mismatch repair genes (path_MMR) followed prospectively by the Prospective Lynch Syndrome Database (PLSD). All had colonoscopy surveillance, with polypectomy when polyps were identified. Comparison was made with a retrospective cohort reported by the International Mismatch Repair Consortium (IMRC). This comprised confirmed and inferred path_MMR carriers who were first- or second-degree relatives of Lynch syndrome probands. Results In the PLSD, 8,153 subjects had follow-up colonoscopy surveillance for a total of 67,604 years and 578 carriers had CRC diagnosed. Average cumulative incidences of CRC in path_MLH1 carriers at 70 years of age were 52% in males and 41% in females; for path_MSH2 50% and 39%; for path_MSH6 13% and 17% and for path_PMS2 11% and 8%. In contrast, in the IMRC cohort, corresponding cumulative incidences were 40% and 27%; 34% and 23%; 16% and 8% and 7% and 6%. Comparing just the European carriers in the two series gave similar findings. Numbers in the PLSD series did not allow comparisons of carriers from other continents separately. Cumulative incidences at 25 years were < 1% in all retrospective groups. Conclusions Prospectively observed CRC incidences (PLSD) in path_MLH1 and path_MSH2 carriers undergoing colonoscopy surveillance and polypectomy were higher than in the retrospective (IMRC) series, and were not reduced in path_MSH6 carriers. These findings were the opposite to those expected. CRC point incidence before 50 years of age was reduced in path_PMS2 carriers subjected to colonoscopy, but not significantly so

The Use of Irony and Contrast in Yukio Mishima’s Confessions of a Mask and After the Banquet: A Study of Translated Literature

A consistent use of the techniques of irony and contrast exists in Yukio Mishima's Confessions of a Mask and After the Banquet. The examination of these techniques reveals the theme of each novel. This paper is based upon the English translations of Mishima's novels. There is an increasing need for original, perhaps even basic, English criticism of translated literature. Translated literature is not identical to the original--the translator may misinterpret the author’s intent, and cultural nuances are often lost or altered when a language is translated (I have attempted to identify these problems in an Appendix, which compares a chapter in one of the translations to the original Japanese). Thus knowledgeable commentary by someone familiar with both languages will be useful to those who wish to study work in translation. Very little knowledgeable comment is currently available in English. I believe that this analysis is a step toward such criticism. My knowledge of Japanese language and culture is, however, somewhat limited. I have been unable to read the critical materials existent in Japanese and have been forced to rely almost completely upon the translations as source material. I believe my experience with Japanese--the equivalent of four years of language study, independent reading in the language, having visited Japan for a number of months and the acquaintance of a number of Japanese citizens--permits a certain degree of critical accuracy, but the paper necessarily lacks the benefit of thorough research. Although the personality of Mishima is not the subject of this thesis, I have found it necessary to mention relationships between Mishima's life and writing which I consider artistically significant. Understanding Mishima the man is vital in understanding his art. Mishima is an important writer. I intend to demonstrate important ways in which his work can be ordered and understood