Assessment of the face validity of two pain scales in Kenya: a validation study using cognitive interviewing

Background: Patients in sub-Saharan Africa commonly experience pain, which often is un-assessed and undertreated. One hindrance to routine pain assessment in these settings is the lack of a single-item pain rating scale validated for the particular context. The goal of this study was to examine the face validity and cultural acceptability of two single-item pain scales, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), in a population of patients on the medical, surgical, and pediatric wards of Moi Teaching and Referral Hospital in Kenya. Methods: Swahili versions of the NRS and FPS-R were developed by standard translation and back-translation. Cognitive interviews were performed with 15 patients at Moi Teaching and Referral Hospital in Eldoret, Kenya. Interview transcripts were analyzed on a question-by-question basis to identify major themes revealed through the cognitive interviewing process and to uncover any significant problems participants encountered with understanding and using the pain scales. Results: Cognitive interview analysis demonstrated that participants had good comprehension of both the NRS and the FPS-R and showed rational decision-making processes in choosing their responses. Participants felt that both scales were easy to use. The FPS-R was preferred almost unanimously to the NRS. Conclusions: The face validity and acceptability of the Swahili versions of the NRS and FPS-R has been demonstrated for use in Kenyan patients. The broader application of these scales should be evaluated and may benefit patients who currently suffer from pain

A new quantitative approach to identify reworking in Eocene to Miocene pollen records from offshore Antarctica using red fluorescence and digital imaging

Antarctic palaeoclimate evolution and vegetation history after the formation of a continent-scale cryosphere at the Eocene–Oligocene boundary, 33.9 million years ago, has remained a matter of controversy. In particular, the reconstruction of terrestrial climate and vegetation has been strongly hampered by uncertainties in unambiguously identifying non-reworked as opposed to reworked sporomorphs that have been transported into Antarctic marine sedimentary records by waxing and waning ice sheets. Whereas reworked sporomorph grains over longer non-successive geological timescales are easily identifiable within younger sporomorph assemblages (e.g. Permian sporomorphs in Pliocene sediments), distinguishing non-reworked from reworked material in palynological assemblages over successive geological time periods (e.g. Eocene sporomorphs in Oligocene sediments) has remained problematic. This study presents a new quantitative approach to identifying non-reworked pollen assemblages in marine sediment cores from circum-Antarctic waters. We measured the fluorescence colour signature, including red, green, and blue fluorescence; brightness; intensity; and saturation values of selected pollen and spore taxa from Eocene, Oligocene, and Miocene sediments from the Wilkes Land margin Site U1356 (East Antarctica) recovered during Integrated Ocean Drilling Program (IODP) Expedition 318. Our study identified statistically significant differences in red-fluorescence values of non-reworked sporomorph taxa against age. We conclude that red fluorescence is a reliable parameter for identifying the presence of non-reworked pollen and spores in Antarctic marine sediment records from the circum-Antarctic realm that are influenced by glaciation and extensive reworking. Our study provides a new tool to accurately reconstruct Cenozoic terrestrial climate change on Antarctica using fossil pollen and spores

Efficient execution in an automated reasoning environment

We describe a method that permits the user of a mechanized mathematical logic to write elegant logical definitions while allowing sound and efficient execution. In particular, the features supporting this method allow the user to install, in a logically sound way, alternative executable counterparts for logically defined functions. These alternatives are often much more efficient than the logically equivalent terms they replace. These features have been implemented in the ACL2 theorem prover, and we discuss several applications of the features in ACL2.Ministerio de Educación y Ciencia TIN2004–0388

Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

Background Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service. Objectives, methods and outcomes Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to a resource-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme. Conclusion Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment

Phase I, Pharmacogenomic, Drug Interaction Study of Sorafenib and Bevacizumab in Combination with Paclitaxel in Patients with Advanced Refractory Solid Tumors

VEGF blockade does not uniformly result in clinical benefit. We evaluated safety, dose-limiting toxicities (DLT), recommended phase II dose (RP2D), antitumor efficacy, and exploratory biomarkers including pharmacogenomics and pharmacokinetics with sorafenib, bevacizumab, and paclitaxel in patients with refractory cancers. The study had a “3 + 3” design, using paclitaxel 80 mg/m2 every week for 3 weeks, in every 4 week cycles, bevacizumab 5 mg/kg every 2 weeks, and sorafenib 200 or 400 mg twice a day, 5 or 7 days/week (5/7, 7/7). The MTD cohort was expanded. Twenty-seven patients enrolled in 3 cohorts: sorafenib 200 mg twice a day 5/7, 200 mg twice a day 7/7, and 400 mg twice a day 5/7. DLTs were grade 3 neutropenia >7 days (cohort 1, 1), grade 3 hypertension (cohort 2, 1), grade 3 hand–foot skin reaction (HFSR; cohort 3, 2). MTD was sorafenib 200 mg twice a day 7/7. Six DLTs occurred in cohort 2 expansion: grade 3 HFSR (2), grade 2 HFSR with sorafenib delay >7 days (2), grade 4 cerebrovascular accident (1), grade 3 neutropenia >7 days (1). RP2D was sorafenib 200 mg twice a day 5/7. Most patients (62%) dose reduced sorafenib to 200 mg daily 5/7 after a median 3 (range, 2–17) cycles. Response rates were 48% overall (27) and 64% for ovarian cancers (14). VEGF-A-1154AA and -7TT recessive homozygous genotypes conferred worse overall survival versus alternative genotypes (7 vs. 22 months). Intermittent, low-dose sorafenib (200 mg twice a day 5/7) combined with bevacizumab and paclitaxel was tolerable and had high antitumor efficacy in patients with refractory cancer (NCT00572078)

Media internalization and conformity to traditional masculine norms in relation to body image concerns among men

Previous studies have separately examined conformity to masculine norms and internalization of body ideals in the media in relation to the drive for muscularity (DM). This study was designed to examine these factors together in relation to DM, and further examine how they may differ in relation to drive for thinness (DT) and drive for leanness (DL). Participants were 284 Australian males between ages 18 to 42. They completed validated measures that assessed DM, DT, DL, male gender role norms, and internalization of body ideals. The findings showed that internalization of body ideals mediated the relationship between masculine role norms and body image in the case of both DM and DL. However, masculine norms and internalization were independent predictors of DT. Our findings contribute to further understanding of the roles that the media and masculine norms have in shaping men’s drive for muscularity, leanness, and thinness. Longitudinal research is needed to confirm the nature and direction of these relationships

AI-based dimensional neuroimaging system for characterizing heterogeneity in brain structure and function in major depressive disorder:COORDINATE-MDD consortium design and rationale

BACKGROUND: Efforts to develop neuroimaging-based biomarkers in major depressive disorder (MDD), at the individual level, have been limited to date. As diagnostic criteria are currently symptom-based, MDD is conceptualized as a disorder rather than a disease with a known etiology; further, neural measures are often confounded by medication status and heterogeneous symptom states. METHODS: We describe a consortium to quantify neuroanatomical and neurofunctional heterogeneity via the dimensions of novel multivariate coordinate system (COORDINATE-MDD). Utilizing imaging harmonization and machine learning methods in a large cohort of medication-free, deeply phenotyped MDD participants, patterns of brain alteration are defined in replicable and neurobiologically-based dimensions and offer the potential to predict treatment response at the individual level. International datasets are being shared from multi-ethnic community populations, first episode and recurrent MDD, which are medication-free, in a current depressive episode with prospective longitudinal treatment outcomes and in remission. Neuroimaging data consist of de-identified, individual, structural MRI and resting-state functional MRI with additional positron emission tomography (PET) data at specific sites. State-of-the-art analytic methods include automated image processing for extraction of anatomical and functional imaging variables, statistical harmonization of imaging variables to account for site and scanner variations, and semi-supervised machine learning methods that identify dominant patterns associated with MDD from neural structure and function in healthy participants. RESULTS: We are applying an iterative process by defining the neural dimensions that characterise deeply phenotyped samples and then testing the dimensions in novel samples to assess specificity and reliability. Crucially, we aim to use machine learning methods to identify novel predictors of treatment response based on prospective longitudinal treatment outcome data, and we can externally validate the dimensions in fully independent sites. CONCLUSION: We describe the consortium, imaging protocols and analytics using preliminary results. Our findings thus far demonstrate how datasets across many sites can be harmonized and constructively pooled to enable execution of this large-scale project

Hydrodynamic analysis of the offshore floating nuclear power plant

Thesis: Nav. E., Massachusetts Institute of Technology, Department of Mechanical Engineering, 2015.Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, 2015.Cataloged from PDF version of thesis.Includes bibliographical references (pages 85-86).Hydrodynamic analysis of two models of the Offshore Floating Nuclear Plant [91 was conducted. The OFNP-300 and the OFNP-1100 were both exposed to computer simulated sea states in the computer program OrcaFlex: first to sets of monochromatic waves, each consisting of a single frequency and waveheight, and then to Bretschneider and JONSWAP spectra simulating 100-year storms in, respectively, the Gulf of Mexico and the North Sea. Hydrodynamic coefficients for these simulations were obtained using a separate computer program, WAMIT. Both models exhibited satisfactory performance in both heave and pitch. An alternative design of the OFNP-300 was developed and similarly analyzed in attempt to further improve hydrodynamic performance. A catenary mooring system was designed and analyzed for both plant models. The number of chains and the length of each were selected to ensure the mooring systems would withstand, with sufficient margins of safety, the maximum tension produced in a 100-year storm. This analysis was conducted both with all the designed mooring lines intact, and with the worst-case line broken. A lifecycle cost analysis of various mooring systems was conducted in order to minimize the cost of the mooring system while maintaining adequate performance.by Matthew Brian Strother.Nav. E.S.M. in Engineering and Managemen