Compliance with childhood leukemia treatment in Indonesia : Influence of socio-economic status on treatment refusal or abandonment

Veerman, A.J.P. [Promotor]Sutaryo, A. [Promotor

Belasting 2A

Exam paper for second semeste

Is Brain Gym an Effective Educational Intervention?

Brain Gym® (BG) (BGI, 2008) is a popular commercial program sold by Brain Gym® International (BGI). Making extravagant claims for improved intellectual and physical development, it used in more than 80 countries. While BGI’s claims are persuasive, to date there is little empirical evidence validating the approach. We examine some theoretical assumptions from which BGI was developed, review the efficacy literature, and provide suggestions for making informed decisions about the judiciousness of investing time and resources in this program

Diagnostic applications of cell-free and circulating tumor cell-associated miRNAs in cancer patients

Summary: Circulating tumor cells (CTCs) have rapidly developed as important cancer biomarkers after their enumeration proved to be prognostic in metastatic breast, colorectal and prostate cancer, and their rise or decline after the first cycle of therapy showed to predict therapy response. Besides mere counting, CTCs can be isolated and subsequently analyzed using various molecular applications, including miRNA expression analysis. Recently, miRNA expression profiling in primary tumors has yielded promising results. However, establishing miRNA expression in the circulation likely has advantages over determination in primary tumor tissue, further augmenting the potential applications of miRNA determination in oncology. Additionally to CTC-associated miRNAs, free circulating miRNAs have been identified in whole blood, plasma and serum. Since determination of miRNAs in peripheral blood, either cell-free or CTC-associated, is expected to become important in oncology, especially when linked to and interpreted together with epithelial CTCs, this review focuses on measuring miRNAs in the circulation of cancer patients

A High-Efficiency 4x45W Car Audio Power Amplifier using Load Current Sharing

A 4x45W (EIAJ) monolithic car audio power amplifier is presented that achieves a power dissipation decrease of nearly 2x over standard class AB operation by sharing load currents between loudspeakers. Output signals are conditioned using a common-mode control loop to allow switch placement between loads with minimal THD increase. A prototype is realized in a SOI bipolar-CMOS-DMOS process with 0.5μm feature size. Die area is 7.5x4.6mm2. THD+N @(1kHz,10W) is 0.05%

Cohomogeneity one manifolds and selfmaps of nontrivial degree

We construct natural selfmaps of compact cohomgeneity one manifolds with finite Weyl group and compute their degrees and Lefschetz numbers. On manifolds with simple cohomology rings this yields in certain cases relations between the order of the Weyl group and the Euler characteristic of a principal orbit. We apply our construction to the compact Lie group SU(3) where we extend identity and transposition to an infinite family of selfmaps of every odd degree. The compositions of these selfmaps with the power maps realize all possible degrees of selfmaps of SU(3).Comment: v2, v3: minor improvement

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment. Study participants were parents of childhood cancer patients diagnosed between August 2013 and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9–1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days; P < .001). Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media

Regularity of Cauchy horizons in S2xS1 Gowdy spacetimes

We study general S2xS1 Gowdy models with a regular past Cauchy horizon and prove that a second (future) Cauchy horizon exists, provided that a particular conserved quantity $J$ is not zero. We derive an explicit expression for the metric form on the future Cauchy horizon in terms of the initial data on the past horizon and conclude the universal relation A\p A\f=(8\pi J)^2 where A\p and A\f are the areas of past and future Cauchy horizon respectively.Comment: 17 pages, 1 figur

Socio-economic Status Plays Important Roles in Childhood Cancer Treatment Outcome in Indonesia

Background: The influence of parental socio-economic status on childhood cancer treatment outcome in low-income countries has not been sufficiently investigated. Our study examined this influence and explored parental experiences during cancer treatment of their children in an Indonesian academic hospital. Materials and Methods: Medical charts of 145 children diagnosed with cancer between 1999 and 2009 were reviewed retrospectively. From October 2011 until January 2012, 40 caretakers were interviewed using semi-structured questionnaires. Results: Of all patients, 48% abandoned treatment, 34% experienced death, 9% had progressive/relapsed disease, and 9% overall event-free survival. Prosperous patients had better treatment outcome than poor patients (P<0.0001). Odds-ratio for treatment abandonment was 3.3 (95%CI: 1.4-8.1, p=0.006) for poor versus prosperous patients. Parents often believed that their child's health was beyond doctor control and determined by luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or God's punishment (23%). Alternative treatment could (18%) or might (50%) cure cancer. Most parents (95%) would like more information about cancer and treatment. More contact with doctors was desired (98%). Income decreased during treatment (55%). Parents lost employment (48% fathers, 10% mothers), most of whom stated this loss was caused by their child's cancer (84% fathers, 100% mothers). Loss of income led to financial difficulties (63%) and debts (55%). Conclusions: Treatment abandonment was most important reason for treatment failure. Treatment outcome was determined by parental socio-economic status. Childhood cancer survival could improve if financial constraints and provision of information and guidance are better addressed

Impact Evaluation of Wet-Weather Events on Influent Flow and Loadings of a Water Resource Recovery Facility

Since the introduction of environmental legislation anddirectives in Europe, the impact of combined sewer overflows (CSO) on receiving waterbodies has become a priority concern in water and wastewater treatment industry. Timeconsumingand expensive local sampling and monitoring campaigns have been carried outto estimate the characteristic flow and pollutant concentrations of CSO water. This studyfocused on estimating the frequency and duration of wet-weather events and their impactson influent flow and wastewater characteristics of the largest Italian water resource recoveryfacility (WRRF) in Castiglione Torinese. Eight years (viz. 2009-2016) of routinely collectedinfluent data in addition to the arithmetic mean daily precipitation rates (PI) of the plantcatchment area, were elaborated. Relationships between PI and volumetric influent flow rate(Qin), chemical oxygen demand (COD), ammonium concentration (N-NH4) and totalsuspended solids (TSS) are investigated. Time series data mining (TSDM) method isimplemented for segmentation of time series by use of sliding window algorithm to partitionthe available records associated with wet and dry weather events based on the dailyvariation of PI time series. Appling the methodology in conjunction with results obtained fromdata reduction techniques, a wet-weather definition is proposed for the plant. The resultsconfirm that applied methodology on routinely collected plant data can be considered as agood substitute for time-consuming and expensive sampling campaigns and plantmonitoring programs usually conducted for accurate emergency response and long-termpreparedness for extreme climate conditions