Predisposing, Supporting and Driving Factors for Utilization of Adolescent Care Health Services in South Kuta

Background and purpose: Targetted adolescent health services (PKPR) at the South Kuta Health Center havebeen offered since 2007. However, these are rarely accessed (less than 5 visits per month) whereas adolescent healthincidents/concerns such as abortion, HIV/AIDS and drug use are reportedly increasing. This study aimed to determinethe predisposition, supporting and reinforcing factors of PKPR utilization.Methods: Study was qualitative and conducted among 27 students in four sessions of focus group discussions, as wellas in-depth interviews with four key informants. Data collected consisted of knowledge, attitudes and views ofparticipants on PKPR facilities. Thematic analysis was conducted to identify predisposition, supporting and enforcingPKPR utilization factors.Results: The study participants intimated that their knowledge about PKPR was low, although they recognised thebenefits of such a service. They also acknowledged that the quality of facilities/infrastructure were poor, the IECmaterial was interesting but the deliverance unclear and the attitude of providers unfriendly. Funds, inappropriateclinic hours and labor provided were minimal. Schools, health centers and the government health office stronglysupported PKPR activities and the role of peer counselors. School health programs also encouraged students to takeadvantage of PKPR.Conclusion: Local schools, health centers and the government health office were supportive of PKPR activities,however the student's knowledge about PKPR was low because coverage of PKPR was very limited. &nbsp

The Role of Cohabitating Partner and Relationship Characteristics on Physical Activity among Individuals with Osteoarthritis

Background: Most individuals with knee or hip osteoarthritis do not meet recommendations for physical activity. The Social Cognitive Theory suggests that the social environment (e.g., spouses/partners) may influence the physical activity of individuals with osteoarthritis. The purpose of this study was to examine whether the physical activity of insufficiently active, coupled adults with osteoarthritis was associated with received partner support for physical activity, partner’s engagement in physical activity, and relationship satisfaction. Methods: Cross-sectional data from 169 couples were collected. Accelerometers estimated moderate-to-vigorous physical activity and daily steps for participants with osteoarthritis and their partners. Participants with osteoarthritis reported total received partner support for physical activity and relationship satisfaction. Results: Participants with osteoarthritis were on average 65 years old, 65% female, 86% non-Hispanic white, and 47% retired. Receiving total partner support more frequently was associated with more minutes of moderate-to-vigorous physical activity but not with steps. Relationship satisfaction moderated the association of partner’s physical activity on the daily steps of individuals with osteoarthritis such that having a partner who accomplished more daily steps was associated with participants with osteoarthritis accomplishing more daily steps themselves when they reported greater relationship satisfaction. Conclusions: Partners and relationship satisfaction may play an important role in the physical activity of individuals with osteoarthritis. Interventions seeking to increase physical activity in this population may be enhanced by promoting partner support. Additional research is needed to further explain these associations within the context of relationship satisfaction

A Real Space Description of Magnetic Field Induced Melting in the Charge Ordered Manganites: I. The Clean Limit

We study the melting of charge order in the half doped manganites using a model that incorporates double exchange, antiferromagnetic superexchange, and Jahn-Teller coupling between electrons and phonons. We primarily use a real space Monte Carlo technique to study the phase diagram in terms of applied field $(h)$ and temperature $(T)$, exploring the melting of charge order with increasing $h$ and its recovery on decreasing $h$. We observe hysteresis in this response, and discover that the `field melted' high conductance state can be spatially inhomogeneous even without extrinsic disorder. The hysteretic response plays out in the background of field driven equilibrium phase separation. Our results, exploring $h$, $T$, and the electronic parameter space, are backed up by analysis of simpler limiting cases and a Landau framework for the field response. This paper focuses on our results in the `clean' systems, a companion paper studies the effect of cation disorder on the melting phenomena.Comment: 16 pages, pdflatex, 11 png fig

Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study.

Among 2,186 U.S. adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials. SIGNIFICANCE: Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically significant 30-day all-cause mortality benefit with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefit. Treatment receipt reflects clinical decision-making and suggests disparities in medication access.This article is highlighted in the In This Issue feature, p. 1426

Analysis of thermal and hydraulic performance of V-shape corrugated carbon foam

A study of the hydraulic and thermal characteristics of V-shape corrugated carbon foams in air flow is presented. The hydraulic performance is assessed by the pressure drop across the foam while thermal performance is evaluated by the overall heat transfer coefficient. Numerical solution, using Finite Element Method (FEM), is established and validated with experimental data. Foam geometries under study are further analyzed to better understand the transport process within the porous matrix. Four different V-shape corrugated carbon foam geometries are selected based on design considerations and availability. Foam geometries under study have varying lengths and heights. The foam length is chosen to be 25.4, 38.1 or 52.1 mm while the height is 6.8 or 11.7 mm. The wall thickness for all geometries is 2.5 mm. The effects of the foam length and height on thermal and hydraulic performance are presented and discussed. For laminar flow of air with an average inlet velocity of 0.71-4 m/s, the pressure drop ranges from 53 to 531 Pa and the heat transfer coefficient ranges from 186 to 1602 W/m2 K. A key finding from the present analysis is that the heat transfer efficiency of the foam approaches unity within a distance of 1.2 mm (or about 3 pore size) upon air penetrating into the foam, which means there is no significant heat transfer occurring after this distance. This establishes the foundation for the design of corrugated foam to maximize the thermal performance while minimizing the pressure drop. © 2014 Elsevier Ltd. All rights reserved

Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study.

Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness. In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing. Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57-76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53-2·21), male sex (1·63, 1·07-2·48), smoking status (former smoker vs never smoked: 1·60, 1·03-2·47), number of comorbidities (two vs none: 4·50, 1·33-15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11-7·18), active cancer (progressing vs remission: 5·20, 2·77-9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79-4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07-0·84) or the US-Midwest (0·50, 0·28-0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality. Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments. American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research

The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19.

Hospitalized patients with COVID-19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well-known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID-19 is lacking. To assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID-19. Among patients with cancer in the COVID-19 and Cancer Consortium registry (CCC19) cohort study, we assessed the incidence of VTE and ATE within 90 days of COVID-19-associated hospitalization. A multivariable logistic regression model specifically for VTE was built using a priori determined clinical risk factors. A simplified RAM was derived and internally validated using bootstrap. From March 17, 2020 to November 30, 2020, 2804 hospitalized patients were analyzed. The incidence of VTE and ATE was 7.6% and 3.9%, respectively. The incidence of VTE, but not ATE, was higher in patients receiving recent anti-cancer therapy. A simplified RAM for VTE was derived and named CoVID-TE (Cancer subtype high to very-high risk by original Khorana score +1, VTE history +2, ICU admission +2, D-dimer elevation +1, recent systemic anti-cancer Therapy +1, and non-Hispanic Ethnicity +1). The RAM stratified patients into two cohorts (low-risk, 0-2 points, n = 1423 vs. high-risk, 3+ points, n = 1034) where VTE occurred in 4.1% low-risk and 11.3% high-risk patients (c statistic 0.67, 95% confidence interval 0.63-0.71). The RAM performed similarly well in subgroups of patients not on anticoagulant prior to admission and moderately ill patients not requiring direct ICU admission. Hospitalized patients with cancer and COVID-19 have elevated thrombotic risks. The CoVID-TE RAM for VTE prediction may help real-time data-driven decisions in this vulnerable population

COVID-19 vaccination and breakthrough infections in patients with cancer

Vaccination is an important preventive health measure to protect against symptomatic and severe COVID-19. Impaired immunity secondary to an underlying malignancy or recent receipt of antineoplastic systemic therapies can result in less robust antibody titers following vaccination and possible risk of breakthrough infection. As clinical trials evaluating COVID-19 vaccines largely excluded patients with a history of cancer and those on active immunosuppression (including chemotherapy), limited evidence is available to inform the clinical efficacy of COVID-19 vaccination across the spectrum of patients with cancer. We describe the clinical features of patients with cancer who developed symptomatic COVID-19 following vaccination and compare weighted outcomes with those of contemporary unvaccinated patients, after adjustment for confounders, using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19). Patients with cancer who develop COVID-19 following vaccination have substantial comorbidities and can present with severe and even lethal infection. Patients harboring hematologic malignancies are over-represented among vaccinated patients with cancer who develop symptomatic COVID-19. Vaccination against COVID-19 remains an essential strategy in protecting vulnerable populations, including patients with cancer. Patients with cancer who develop breakthrough infection despite full vaccination, however, remain at risk of severe outcomes. A multilayered public health mitigation approach that includes vaccination of close contacts, boosters, social distancing, and mask-wearing should be continued for the foreseeable future. •Patients with cancer who develop breakthrough COVID-19 following full vaccination remain susceptible to severe outcomes.•Hematologic malignancies are over-represented among vaccinated patients with cancer who develop breakthrough COVID-19.•Vaccination of close contacts, masking, boosters, and social distancing are needed to protect patients with cancer