Advances in Prostate Cancer Diagnosis: Triggers for Prostate Biopsy

In the early years of screening for prostate cancer with serum PSA, absolute cutoffs were typically utilized such as greater than 4.0 ng/mL or even 2.5 ng/mL. A biopsy of the prostate would commonly be recommended in a man with greater than 10-year life expectancy who had a confirmed elevation above such a threshold or in the presence of an abnormal digital rectal examination. The unmet need, however, is to be more selective in recommending a prostate biopsy, due to the risk of complications and the high rate of false-positive PSAs. More recently, various clinical nomograms can be used to refine selection. In addition, clinicians can now utilize various advanced serum biomarkers that have enhanced specificity—especially for the patient with a rising PSA with prior negative biopsy. In this chapter, we will focus on the biomarkers PCA3, Prostate Health Index, and 4 K score to illustrate key concepts in biomarker development and clinical utility

Investigation of Pipeline Vandalism and Its Implications on Business Activities in Nigeria

The recent pipeline vandalism by the Niger Delta Avengers and other militants groups have attracted both national and international condemnations due to its implication on not only business activities in Nigeria but the Nigerian economy as a whole.  The consequences of their actions had affected most businesses which paralyzed business activities as a result of power failure and rising cost of production through the provision of alternative power source which have significant impact on both the organizations and the country’s economy in general. It is for this reason that the study was conducted with the main objective of investigating pipeline vandalism and its implications on business activities in Nigeria. The study employs the use of both primary and secondary sources of data from managers and customers of business organizations in the Nigeria’s power sector. A Simple Linear Regression was used to analyze the data obtained from the formulated hypotheses. Findings based on the analysis reveals that, pipeline vandalism in Nigeria significantly affects business activities in Nigeria as it’s resulted to destruction of critical pipeline installations and constant power failure which affects the smooth operations of business organizations and subsequently, retard economic development. The study recommended that Federal Government of Nigeria should through the NNPC collaborate with the nation’s military and other security agencies to ensure adequate policing and protection of critical pipeline infrastructure throughout the country so as to checkmate the activities of pipeline vandals which is having a devastating effects on the economy. The study concludes that the actions of the militant groups is a serious economic sabotage which if allowed to go unchecked will continue to be having a devastating effect on the country’s economy. Keywords: Business Activities, Pipeline Vandalism, Power Generation, Revenue Generatio

Public Participation in Los Angeles Water Resources Management

Public participation is essential to the efficient management of resources. However, there are significant problems with water resources management and water importation practices in Southern California due to lack of public awareness and input. Little is known regarding specific participants’ perceptions that could help in addressing the challenges of Los Angeles water resources management. Grounded in the advocacy coalition framework, this qualitative study was conducted with the purpose of narrowing this knowledge gap. The study explored the role of public participation in Los Angeles water resources management from the perspectives of key actors, resident stakeholders, nonprofit organizations, water agency administrators, and policymakers, who could contribute to an improved understanding of imported water challenges. Purposeful sampling was used to recruit nineteen participants. Data were collected from seven participants through online interviews and twelve participants through online focus group discussions. Coding and thematic data analysis were conducted to identify the following emerging themes: roles of the public, effectiveness of public participation, and outcomes of public engagement in Los Angeles water resources management. The data analysis results indicated general participant consensus that public participation has played important roles and produced effective outcomes that have moved Los Angeles from expansive extraction to retraction and refinement of imported water. The positive social change implications of this study are that results may inform the future direction of Los Angeles water resources management, and promote improved public engagement, awareness, understanding, and quality of life for all parties concerned

A Theoretical Model to Explain the Overrepresentation of College Men among Campus Judicial Offenders: Implications for Campus Administrators

As is the case in most K-12 schools, male students, in comparison to their female counterparts, disproportionately violate policies and are sanctioned more often for violence and disruptive behaviors on college and university campuses across the country. A theoretical model to explain this phenomenon is proposed in this article. Specifically, a synthesis of existing literature and theories from sociology, psychology, men’s studies, and education resulted in the identification of six acute variables that explain male overrepresentation among campus judicial offenders. While each component of the model is thoroughly explained, insight into interactions among the six variables is also offered. Practical implications for campus administrators who are interested in minimizing violence and disruptive behaviors among college men conclude the article

A call to action for evidence‐based safer conception interventions for HIV‐affected couples desiring children in Sub‐Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135487/1/ijgo73.pd

Achieving Pregnancy Safely in HIV-Affected Individuals and Couples: An Important Strategy to Eliminate HIV Transmission From Mother-To-Child and Between Sexual Partners

HIV-infected individuals are living longer, more productive lives. HIV-affected individuals and couples experience personal and social desires to reproduce for all the same reasons as uninfected individuals and couples,1 and thus require safe reproductive options. HIV prevention interventions often do not consider the childbearing desires of HIV-affected individuals or couples, especially in low- and middle-income countries (LMICs). Failure to assist women with desired fertility can contribute to continued HIV transmission and must be addressed within national elimination of mother-to-child transmission (eMTCT) strategies. A human rights perspective suggests that HIV-affected couples* should have the same ability to choose if and when to have children as HIV-unaffected couples, including access to pre-pregnancy counseling, contraceptives, and, when needed, abortion services. This holistic view includes assistance in mitigating HIV transmission risk when children are desired. In high-income countries, HIV-affected individuals and couples have access to an array of options: (1) treatment of the HIV-infected partner as prevention of transmission to the uninfected partner in conjunction with timed condomless intercourse2**; (2) preexposure prophylaxis (PrEP) for the uninfected partner3; (3) assisted reproductive services, including timed vaginal insemination and sperm washing with intrauterine insemination or in-vitro fertilization4,5 4,5; (4) sperm donation; and (5) adoption.1,6 1,6 In contrast, access to methods of becoming pregnant in LMICs are limited by cost, availability, and sometimes a lack of appreciation by policymakers of the desires and rights of HIV-affected individuals/couples to have children safely. Simple fertility methods may not be discussed as a component of routine HIV care and treatment counseling due to a lack of awareness or knowledge about their safety, affordability, or efficacy.7 To enhance the armamentarium of HIV prevention and reproductive services to achieve zero perinatal and sexual transmission, “safer conception”, and fertility services should be integrated into existing PMTCT strategies. The existing four-pronged prevention of mother-to-child transmission (PMTCT) strategy, developed by the World Health Organization (WHO), includes (1) prevention of HIV in women of reproductive age; (2) prevention of unintended pregnancy in women with HIV; (3) prevention of HIV transmission from mother to child; and (4) the provision of ongoing care and support to mothers, their children, and their families.8 All four prongs are rooted in prevention of sexual and perinatal HIV transmission, HIV testing, use of ART for mothers and infants, exclusive breastfeeding, and access to contraceptive services. The continuum of care services are included within the third WHO prong, including antenatal, intrapartum, and postpartum/postnatal health care services (Fig. 1). However, provision of education and clinical services for achieving pregnancy safely is not uniquely addressed in the current WHO eMTCT strategy,8 and we believe that they should be included within the continuum of care services of the third prong of the strategy that addresses: “prevention of HIV transmission from mother to child.

Empowering HIV-infected women in lowresource settings: A pilot study evaluating a patient-centered HIV prevention strategy for reproduction in Kisumu, Kenya

Background: Female positive/male negative HIV-serodiscordant couples express a desire for children and may engage in condomless sex to become pregnant. Current guidelines recommend antiretroviral treatment in HIV-serodiscordant couples, yet HIV RNA viral suppression may not be routinely assessed or guaranteed and pre-exposure prophylaxis may not be readily available. Therefore, options for becoming pregnant while limiting HIV transmission should be offered and accessible to HIV-affected couples desiring children. Methods: A prospective pilot study of female positive/male negative HIV-serodiscordant couples desiring children was conducted to evaluate the acceptability, feasibility, and effectiveness of timed vaginal insemination. Eligible women were 18-34 years with regular menses. Prior to timed vaginal insemination, couples were observed for two months, and tested and treated for sexually transmitted infections. Timed vaginal insemination was performed for up to six menstrual cycles. A fertility evaluation and HIV RNA viral load assessment was offered to couples who did not become pregnant. Findings: Forty female positive/male negative HIV-serodiscordant couples were enrolled; 17 (42.5%) exited prior to timed vaginal insemination. Twenty-three couples (57.5%) were introduced to timed vaginal insemination; eight (34.8%) achieved pregnancy, and six live births resulted without a case of HIV transmission. Seven couples completed a fertility evaluation. Four women had no demonstrable tubal patency bilaterally; one male partner had decreased sperm motility. Five women had unilateral/bilateral tubal patency; and seven women had an HIV RNA viral load (≥ 400 copies/mL). Conclusion: Timed vaginal insemination is an acceptable, feasible, and effective method for attempting pregnancy. Given the desire for children and inadequate viral suppression, interventions to support safely becoming pregnant should be integrated into HIV prevention programs

An effectiveness-implementation trial protocol to evaluate PrEP initiation among U.S. cisgender women using eHealth tools vs. standard care

BackgroundThe United States' (U.S.) initiative to End the HIV Epidemic aims to reduce new HIV infections in areas of high HIV prevalence. Despite national efforts to reduce HIV incidence, cisgender women continue to represent approximately one out of every five new HIV diagnoses in the U.S. Taking pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy; however, PrEP initiation among cisgender women is suboptimal, with only 10% of eligible women receiving PrEP prescriptions in 2019.MethodsWe designed a trial to test the effectiveness of interventions to increase PrEP initiation, while evaluating the implementation strategy (hybrid type II trial) in seven obstetrics and gynecology (OB/GYN) clinics (two federally qualified health centers, three community-based, and two academic) in Baltimore, Maryland. A total of 42 OB/GYN providers will be enrolled and randomized (1:1:1) into one of three clinical trial arms (standard of care, patient-level intervention, or multi-level intervention). Eligible patients of enrolled providers will receive a sexual health questionnaire before their appointment through the electronic health record’s (EHR) patient portal. The questionnaire will be scored in three tiers (low, moderate, and high) to assess HIV risk. Patients at low risk will be offered an HIV test only, while those who score medium or high risk will be included in the clinical trial and assigned to the clinical trial arm associated with their provider. Differences in PrEP initiation, our primary outcome, across the three arms will be analyzed using generalized linear mixed-effect models with logistic regression. We will adjust results for demographic differences observed between arms and examine PrEP initiation stratified by patient’s and provider’s race and ethnicity.Additionally, a comprehensive economic analysis for each intervention will be conducted.DiscussionWe hypothesize that gathering information on sensitive sexual behaviors electronically, communicating HIV risk in an understandable and relatable format to patients and OB/GYN providers, and deploying EHR alerts will increase PrEP initiation and HIV testing.Trial RegistrationThe trial is registered with ClinicalTrials.gov (NCT05412433) on 09 June 2022. https://clinicaltrials.gov/ct2/show/NCT05412433?term=NCT05412433&draw=2&rank=1