Cervical cancer screening cascade for women living with HIV: a cohort study from Zimbabwe

Countries with high HIV prevalence, predominantly in sub-Sahahran Africa, have the highest cervical cancer rates globally. HIV care cascades successfully facilitated the scale-up of antiretroviral therapy. A cascade approach could similarly succeed to scale-up cervical cancer screening, supporting WHO's goal to eliminate cervical cancer. We defined a Cervical Cancer Screening Cascade for women living with HIV (WLHIV), evaluating the continuum of cervical cancer screening integrated into an HIV clinic in Zimbabwe. We included WLHIV aged ≥18 years enrolled at Newlands Clinic in Harare from June 2012-2017 and followed them until June 2018. We used a cascade approach to evaluate the full continuum of secondary prevention from screening to treatment of pre-cancer and follow-up. We report percentages, median time to reach cascade stages, and cumulative incidence at two years with 95% confidence intervals (CI). We used univariable Cox proportional hazard regressions to calculate cause-specific hazard ratios with 95% CIs for factors associated with completing the cascade stages. We included 1624 WLHIV in the study. The cumulative incidence of cervical screening was 85.4% (95% CI 83.5-87.1) at two years. Among the 396 WLHIV who received screen-positive tests in the study, the cumulative incidence of treatment after a positive screening test was 79.5% (95% CI 75.1-83.2) at two years. The cumulative incidence of testing negative at re-screening after treatment was 36.1% (95% CI 31.2-40.7) at two years. Using a cascade approach to evaluate the full continuum of cervical cancer screening, we found less-than 80% of WLHIV received treatment after screen-positive tests and less-than 40% were screen-negative at follow-up. Interventions to improve linkage to treatment for screen-positive WLHIV and studies to understand the clinical significance of screen-positive tests at follow-up among WLHIV are needed. These gaps in the continuum of care must be addressed in order to prevent cervical cancer

Identifying critically important vascular access outcomes for trials in haemodialysis : an international survey with patients, caregivers and health professionals

BACKGROUND: Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes. METHOD: Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7-9 being critically important). The relative importance was determined by a best-worst scale using multinomial logistic regression. Open text responses were analysed thematically. RESULTS: The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best-worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best-worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle. CONCLUSIONS: Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD

Secondary fast magnetoacoustic waves trapped in randomly structured plasmas

Fast magnetoacoustic wave is an important tool for inferring solar atmospheric parameters. We numerically simulate the propagation of fast wave pulses in randomly structured plasmas mimicking the highly inhomogeneous solar corona. A network of secondary waves is formed by a series of partial reflections and transmissions. These secondary waves exhibit quasi-periodicities in both time and space. Since the temporal and spatial periods are related simply through the fast wave speed, we quantify the properties of secondary waves by examining the dependence of the average temporal period ($\bar{p}$) on the initial pulse width ($w_0$) as well as the density contrast ($\delta_\rho$) and correlation length ($L_c$) that characterize the randomness of the equilibrium density profiles. For small-amplitude pulses, $\delta_\rho$ does not alter $\bar{p}$ significantly. Large-amplitude pulses, on the other hand, enhance the density contrast when $\delta_\rho$ is small but have a smoothing effect when $\delta_\rho$ is sufficiently large. We found that $\bar{p}$ scales linearly with $L_c$ and that the scaling factor is larger for a narrower pulse. However, in terms of the absolute values of $\bar{p}$, broader pulses generate secondary waves with longer periods, and this effect is stronger in random plasmas with shorter correlation lengths. Secondary waves carry the signatures of both the leading wave pulse and background plasma, our study may find applications in MHD seismology by exploiting the secondary waves detected in the dimming regions after CMEs or EUV waves

Excitation of standing kink oscillations in coronal loops

In this work we review the efforts that have been done to study the excitation of the standing fast kink body mode in coronal loops. We mainly focus on the time-dependent problem, which is appropriate to describe flare or CME induced kink oscillations. The analytical and numerical studies in slab and cylindrical loop geometries are reviewed. We discuss the results from very simple one-dimensional models to more realistic (but still simple) loop configurations. We emphasise how the results of the initial value problem complement the eigenmode calculations. The possible damping mechanisms of the kink oscillations are also discussed

Emotional distress in cancer patients: the Edinburgh Cancer Centre symptom study

To: (1) estimate the prevalence of clinically significant emotional distress in patients attending a cancer outpatient department and (2) determine the associations between distress and demographic and clinical variables, we conducted a survey of outpatients attending selected clinics of a regional cancer centre in Edinburgh, UK. Patients completed the Hospital Anxiety and Depression Scale (HADS) on touch-screen computers and the scores were linked to clinical variables on the hospital database. Nearly one quarter of the cancer outpatients 674 out of 3071 (22%; 95% confidence interval (CI) 20–23%) met our criterion for clinically significant emotional distress (total HADS score 15 or more). Univariate analysis identified the following statistically significant associations: age <65, female gender, cancer type and extent of disease. Multivariate analysis indicated that age <65 (odds ratio 1.41; 95% CI 1.18–1.69), female gender (odds ratio 1.58; 95% CI 1.31–1.92) and active disease (odds ratio 1.72; 95% CI 1.43–2.05) but not cancer diagnosis, were the independent predictors of clinically significant emotional distress. Services to treat distress in cancer patients should be organised to target patients by characteristics other than their cancer diagnosis

The PERMA well-being model and music facilitation practice: Preliminary documentation for well-being through music provision in Australian schools

The aim of this study was to consider how we can invest in music-making to promote well-being in school contexts. Web-based data collection was conducted where researchers identified 17 case studies that describe successful music programs in schools in Australia. The researchers aligned content from these case studies into the five categories of the PERMA well-being model: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment, in order to understand how each well-being element was realised through the music programs. The results indicate that the element of the PERMA well-being model that relates to relationships was described most often. Collaboration and partnership between students, teachers, and staff in schools, and local people in the community such as parents, local entrepreneurs, and musicians were repeatedly identified as a highly significant contributing factor in the success of the music program. The school leaders? roles in providing opportunities for students to experience musical participation and related activities (engagement) and valuing these experiences (meaning) were also crucial in the facilitation of the music programs. The findings of this study indicate that tailored music and relationship-centred music programs in schools not only increase skills and abilities of the students, but also improve the psychosocial well-being of the students and the community

You Say Bully, I Say Bullied: School Culture and Definitions of Bullying in Two Elementary Schools

Purpose This chapter examines the definitions of bullying used by students and adults in elementary schools and the effects that these definitions had within the broader school culture. Design/methodology/approach I combine interviews with 53 students and 10 adults and over 430 hours of participant observation with fifth grade students at two rural elementary schools. Findings Definitions of bullying held by those in these schools typically differed from those used by researchers. Even when individuals held definitions that were in line with those used by researchers, however, a focus on identifying bullies rather than on behaviors that fit definitions of bullying contributed to a school culture in which negative interactions were normalized and student reports of these behaviors were discouraged. Research limitations/implications This study is limited to two elementary schools in the rural Midwest and cannot be seen as representative of all schools. Support for my findings from other research combined with similar definitions and school cultures in both schools, however, suggest that these definitions and practices are part of a broader cultural context of bullying in the United States. Practical implications These findings suggest that schools might be better served by focusing less on labels like bully and more on particular behaviors that are to be taken seriously by students, teachers, staff members, and principals. Originality/value Although other researchers have studied definitions of bullying, none have combined these definitions with observational data on the broader school contexts in which those definitions are created and used

Linear enamel hypoplasia and historical change in a central Australian community

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Background: The current study extends the use of linear enamel hypoplasia (LEH) to examine the historical changes in living conditions encountered by Aboriginal people at Yuendumu who were born between 1890 and 1960. LEH provides health information beyond written records and gives insight into the relationship between individual health and living conditions during initial and ongoing contact with Europeans. Materials and Methods: The dental casts of 446 people, collected as part of the University of Adelaide longitudinal study of growth and development, were recorded for the presence of hypoplastic defects. Defects were recorded according to the Development Defects of the Enamel (DDE) standards and assigned to developmental units based on their crown position. Results: The frequency of LEH on the permanent dentitions increased five-fold from the 1890-1929 birth cohort to the 1955-1960 cohort. LEH also affected earlier developing enamel units. Deciduous defects did not show a strong temporal trend but overall prevalence was comparable to other disadvantaged groups. Conclusion: The changes in permanent LEH frequency and age distribution correspond to altered living conditions with the worst hypoplasia recorded after settlement of Aboriginal people at Yuendumu. Prior to that period LEH was comparable to precontact Australian populations indicating that resettlement had a dramatic impact on childhood morbidity.J Littleton and GC Townsen