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Cruz Reyes, Fray Masias. "Ordenamiento territorial y turismo sostenible Caso: provincia Recuay-Ancash." Investigaciones Sociales 14, no. 25 (June 11, 2014): 63–70. http://dx.doi.org/10.15381/is.v14i25.7294.
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La presente investigación, debido a la dimensión del tema, se enfocó al reconocimiento y evaluación del potencial turístico, su implicancia en la economía y calidad de vida de la población y para ello se utilizó el ordenamiento territorial como instrumento de planificación territorial para lograr el uso adecuado y sostenible de los mismos. La infraestructura turística de la provincia es escasa y precaria, pese a contar con recursos turísticos tangibles e intangibles, cuya puesta en valor incrementarían el empleo e ingresos de la población. Su potencial hídrico hace de esta provincia susceptible de invertir en actividades productivas. La implementación de un Plan de Ordenamiento Territorial a nivel provincial concertará propuestas de la población respecto a las potencialidades y limitaciones del territorio y al uso sostenible de los recursos naturales, buscando la reducción de los desequilibrios en el territorio y asegurando las inversiones.
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Espinoza, Einer, Roosevelt Villalobos, and Victor Martinez. "Evaluación de la calidad del agua de consumo humano de la provincia de Recuay." APORTE SANTIAGUINO 10, no. 1 (December 26, 2017): 65. http://dx.doi.org/10.32911/as.2017.v10.n1.183.
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<p>Evalúa la calidad del agua de consumo humano de la ciudad de Recuay a través de sus parámetros físicos, químicos y microbiológicos, para lo cual se realizó el trabajo de campo con la toma de muestras en cinco puntos diferentes: zona de captación, tanque de almacenamiento, línea matriz parte alta, parte intermedia y parte baja. Las muestras se sometieron a análisis físico-químicos y microbiológicos, usando métodos gravimétricos, volumétricos, colorimétricos e instrumentales para 16 parámetros, con el propósito de determinar las variables de contaminación. De los resultados obtenidos el más crítico es el promedio de 5.34 de pH que indica agua ligeramente ácida, el hierro se encuentra en concentraciones de hasta 0.02 mg/L muy cerca al límite máximo permisible y los coliformes totales están dentro de lo permitido. Las mayores concentraciones de los parámetros están en el Reservorio de Shekpa, debido a la acumulación de lodos no removidos. Se concluye, que el agua de consumo de la ciudad de Recuay es de Clase II, por lo que se considera de baja calidad y deberá procederse a la adecuación según la Ley General de Aguas y la Organización Mundial de la Salud (OMS).</p>
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Roque González, Juan, Edson Yupanqui Torres, Edell Aliaga Zegarra, Jenny Álvarez Bautista, and Olivio Castro Mandujano. "Caracterización química y toxicológica del garbancillo (Astragalus garbancillo Cav.)." APORTE SANTIAGUINO 9, no. 1 (December 26, 2017): 61. http://dx.doi.org/10.32911/as.2016.v9.n1.213.
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<p>El objetivo de la investigación es conocer los componentes químicos y tóxicos del garbancillo <em>(Astrágalus garbancillo Cav.</em>), para determinar los elementos activos tóxicos y adictivos de esta planta que provoca la muerte de los animales que lo consumen en el periodo de estiaje, ocasionando pérdidas económicas en la ganadería andina. Se ubicaron los lugares de toma de muestra considerando su abundancia: Huacacorral, distrito de Chiquián, provincia de Bolognesi; Kallan Punta, distrito de Independencia, provincia de Huaraz; Conococha, distrito de Pampas Chico, provincia de Recuay; distrito de San Marcos, provincia de Huari; todos ubicados en el departamento de Ancash. Los análisis a los que se sometieron las muestras son: análisis fitoquímico, determinación de ácidos grasos y esteroles (Cromatografía de gases), determinación de metales (método de ICP), determinación de selenio (absorción atómica con generación de hidruros), y la toxicidad. Entre los componentes de mayor presencia encontramos, ácidos grasos: palmítico (13,2%) y esteárico (10,6%). Esteroles: brassicasterol (44,03%), β-sitosterol (22,3%); estigmasterol (13,1%). Metales mayoritarios: K (15 g/Kg), Ca (9,65 g/Kg), Mg (2,07 g/Kg), Se (2,2 mg/Kg). Fitoquímico: alcaloides, taninos, fenoles, esteroides y triterpenos (+++) y la toxicidad como DL50 es mayor a 5,0 g de producto/Kg de pc, cantidad equivalente a 0,011 mg Se/Kg de pc. La adicción del ganado a esta planta se debe a los alcaloides y la morbi-mortalidad al selenio, el garbancillo es un acumulador de selenio y su ingesta en cantidades abundantes lo hace tóxico.</p>
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Yupanqui T., Edson, Edell Aliaga Z., Ydania Espinoza B., and Víctor Martínez M. "Evaluación de la harina de Dioscorea amcaschsensis Knuth (runtuy) como fuente nutriente del distrito de Cátac, provincia de Recuay, Ancash-2010." APORTE SANTIAGUINO 4, no. 1 (July 19, 2011): 27. http://dx.doi.org/10.32911/as.2011.v4.n1.525.
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El objetivo de esta investigación fue caracterizar nutricional y toxicológicamente la harina de Runtuy (Dioscorea amcaschsensis Knuth) para conocer el potencial nutritivo y alimenticio de este tubérculo alto andino actualmente olvidado, y así aliviar la desnutrición crónica infantil.<br />Las muestras de Runtuy fueron colectadas del sector de Chacaypampa (3769 msnm), distrito de Cátac, provincia de Recuay — Ancash, de las que se extrajo la harina siguiendo el procedimiento de Pacheco, adaptado al caso, posteriormente se determinó la composición nutrirional, toxicidad y el valor biológico. Los resultados proximales son: proteínas 5,93%, grasas 1,09%, carbohidratos 80,60%, almidón 66,10%, humedad 8,34%, ceniza 4,04%, fibra cruda 2,78%, fibra dietética total 14,15% y fibra soluble 11,37%. Minerales: calcio 900,22 mg,/100 g, potasio 355,93 mg/100 g, fósforo 127,28 mg/100 g, magnesio 105,54 mg/100 g y zinc 11,37 mg/100 g. Energía calórica total 355,93 Kca1/100 g. Valor biológico 26,50%. Análisis toxicológico: DLsomayor a 2000 mg/Kg por peso corporal, además el rendimiento en harina es 24,60%. Se concluye, que la harina de Runtuy es del tipo integral, no tóxica con altos niveles de calcio, potasio, fósforo y magnesio
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Forte, Tonia, Julie Klein-Geltink, Rami Rahal, Gina Lockwood, and Heather E. Bryant. "Use of a Pan-Canadian indicator to measure treatment rates relative to evidence-based guidelines for rectal cancer." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 177. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.177.
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177 Background: As part of the Canadian Partnership Against Cancer’s (CPAC) System Performance initiative, indicators measuring treatment practice patterns across the country are now available, offering the ability to compare against evidence-based guidelines. We report on the percentage of patients with stage II and III rectal cancer receiving pre-operative radiation treatment (RT) based on an analysis of Canadian administrative data. A retrospective chart review was conducted to examine reasons for non-treatment with RT, set performance targets, and inform quality improvements. Methods: Data on the percentage of stage II and III rectal cancer cases receiving preoperative RT were obtained from five provincial cancer registries using a standardized methodology for 2,854 cases diagnosed between 2007 and 2008, with 2009 data soon to be available. A retrospective chart review was conducted in five provinces on a random sample of 383 patients diagnosed in 2008 to examine reasons for non-referral and non-treatment. Results: Based on administrative data, an average of 45% of cases received RT preceding surgical resection for stage II or III rectal cancer, ranging from 36% to 48% across provinces. Preoperative RT rates were similar for men and women, but were lower in older patients. From 2007 to 2008, the percentage of patients receiving pre-operative RT increased in all provinces. Results from the chart review showed that, of those who did not receive preoperative RT, 33% were not referred by a surgeon to an oncologist. The most common documented reasons for non-referral were co-morbidities (26%) and patient choice (7%). Among patients referred to an oncologist, 42% were treated with preoperative RT, 30% were treated with post-operative RT and 28% received no treatment. Among those receiving no treatment, 29% were seen only by a medical oncologist, and 18% were not treated due to patient choice. Conclusions: Findings are being used to develop national targets for treatment rates and, working with national oncologist associations, to develop quality improvement strategies, including patient education efforts to promote informed decisions on treatment options.
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Weinerman, B. H., and K. B. Orr. "Colorectal Cancer: A Total Provincial Experience with Survival Analysis." Canadian Journal of Gastroenterology 3, no. 3 (1989): 126–30. http://dx.doi.org/10.1155/1989/789385.
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A review of 1212 cases of colorectal cancer from the Manitoba Tumour Registry from 1974 through 1976 was done in order to establish survival rates for a total population, to examine the role of tumour differentiation and stage of disease on survival. and to examine the incidence of disease in the rural and urban populations. Stage was the most important factor in determining survival although the difference between stages C1and C2disease was not significant. However, a continuing relapse rate was seen in all patients with any type of infiltrating disease (B1and B2There appeared to be continuing relapse patterns in all those groups to at least 96 months. Histology was also an independent predictor of survival even when controlling for stage of disease. Some patients with well differentiated colorectal cancers with stage D disease (over 10%) were alive at 42 months. Age was not found to be a significant factor in survival except for those individuals over 71-years-old and sex was not an important factor. There was increased incidence of co lo rectal cancer in urban as opposed to rural populations, suggesting that possible differences in lifestyle may play a role in causation.
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Hutapea,, Hotma Martogi Lorensi. "Enterococcus hirae, Unexpected Bacteria Detected in Rectal Swab of A Subject in Nduga District, Papua Province by 16s rDNA Sequencing System." Journal of Medical Science And clinical Research 05, no. 05 (May 28, 2017): 22266–70. http://dx.doi.org/10.18535/jmscr/v5i5.160.
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Tsang, Erica S., Yarrow Jean McConnell, David F. Schaeffer, Caroline Speers, and Hagen F. Kennecke. "Loco-regional outcomes of a population-based cohort of rectal neuroendocrine tumors." Journal of Clinical Oncology 34, no. 4_suppl (February 1, 2016): 668. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.668.
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668 Background: Optimal management of rectal neuroendocrine tumors (NETs) is not well defined. We characterized the clinicopathologic features, loco-regional, and systemic management of a population-based cohort of rectal NETs. Methods: Patients diagnosed with rectal NETs from 1999-2011 were identified from British Columbia provincial databases. NETs were classified as G1 and G2 tumors with a Ki-67 ≤ 20% and/or mitotic count ≤ 20 per high power field. Results: Of 91 rectal NETs, median age was 58 (IQR 48-65) years and 35 (38%) were male. Median tumor size was 6 (IQR 4-8) mm. Median overall survival was 164.7 months, with 3 patients presenting with stage IV disease. Treatment included local excision (n = 79), surgical resection (n = 6), and pelvic radiation (n = 1; T3N1 tumor). Final margin status was positive in 17 (20%) cases. Local relapse occurred in 8 (9%) cases, and one relapse to bone 13 months after T3N1 tumor resection. Univariate analysis demonstrated an association between local relapse and T classification, Ki-67, mitotic count, grade, and perineural invasion (p< 0.01), but not N or M classification, or lymphovascular invasion. Local relapse was not associated with surgical management or margin status. Of 3 patients with metastatic disease, two received systemic management, with capecitabine and temozolomide. Conclusions: Rectal NETs generally presented with small, early tumors and were treated with local excision or surgical resection without pelvic radiation. [Table: see text]
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Estopiñan Rebollar, Ramón, Ramón Estopiñan Cánovas, Rafael Pila Pérez, and Rafael Pila Peláez. "Enfermedad de Hirschsprung en un adulto." Revista Colombiana de Gastroenterología 31, no. 1 (March 30, 2016): 52. http://dx.doi.org/10.22516/25007440.73.
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Objetivo: presentar un caso infrecuente de enfermedad de Hirschsprung en un adulto. Caso clínico: paciente masculino de 32 años de edad, con grave retraso intelectual y mental y con familiares de bajo nivel educacional. Tiene antecedentes de episodios de estreñimiento aliviados con laxantes desde la infancia; fue ingresado en múltiples ocasiones al hospital pediátrico de su provincia por el ya mencionado motivo. Se le diagnostica enfermedad de Hirschsprung mediante colon por enema y manometría rectal; de esta manera, se plantea una intervención quirúrgica como tratamiento pero no se cuenta con el permiso de los familiares. Acude al cuerpo de guardia del hospital refiriendo que llevaba 83 días sin defecar; en el examen físico presentaba abdomen globuloso, asimétrico, se palpaba una tumoración de 30 cm x 15 cm en el hemiabdomen derecho. Tacto rectal: esfínter tónico, ampolla rectal vacía, ruidos hidroaéreos disminuidos. El estudio analítico fue normal. La radiografía de abdomen de pie y acostado mostró radiopacidad compatible con materia fecal. Se practica sigmoidectomía con colostomía tipo Hartman para resolver el cuadro agudo; el resultado quirúrgico demostró un megacolon agangliónico confirmado por histopatología. El paciente se encuentra asintomático en espera para tratamiento quirúrgico definitivo. Conclusiones: la enfermedad de Hirschsprung es rara en el adulto, y en estos casos debe diferenciarse de otras causas de megacolon. Su etiología es desconocida aunque se considera multifactorial; el primer y más importante síntoma es el estreñimiento, su diagnóstico se lleva a cabo con estudios imagenológicos y manometría rectal, y se confirma por histopatología. Su tratamiento siempre es quirúrgico.
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Belanti, María Milena. "Fortaleza ante la vulnerabilidad de personas con discapacidad / Strength in the face of vulnerability of people with disabilities." Revista Derecho y Salud | Universidad Blas Pascal, no. 2 (November 15, 2018): 179–97. http://dx.doi.org/10.37767/2591-3476(2018)15.
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vEn el caso “Tejera, Valeria Fernanda C/ ANSES y otro s/ varios” la Corte Suprema de Justicia de la Nación resuelve a favor de que una mujer pueda percibir una Asignación Universal por Hijo y una pensión provincial para su hijo menor discapacitado, entendiendo que gozar de ambas no es incompatible. A través del presente comentario se intentará hacer una aproximación del razonamiento de la Corte en una ejemplar decisión que recayó sobre una persona de extrema vulnerabilidad: un niño, con discapacidad y en condiciones de carencias económicas.
In the case "Tejera, Valeria Fernanda C / ANSES and other s / several" the Supreme Court of Justice of the Nation resolves in favor of a woman being able to receive a Universal Assignment for Child and a provincial pension for her disabled minor child, understanding that to enjoy both is not incompatible. Through this commentary we will try to approximate the reasoning of the Court in an exemplary decision that fell on a person of extreme vulnerability: a child, with a disability and in conditions of economic deprivation.
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Castonguay, Charles. "La cassure linguistique et identitaire du Canada français." Recherche 46, no. 3 (August 14, 2006): 473–94. http://dx.doi.org/10.7202/012474ar.
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Depuis la dislocation du Canada français dans les années 1960, une divergence se creuse entre ses éléments. Alors que la vitalité du français, langue principale à la maison, se renforce au Québec et au Nouveau-Brunswick, elle s’affaiblit ailleurs au Canada. De même, elle progresse à Montréal, Moncton et Gatineau mais recule à Toronto, Sudbury et Ottawa. Les données inédites du recensement de 2001 touchant les langues secondaires au foyer indiquent en outre que le comportement bilingue est le plus souvent de nature additive parmi les francophones du Québec et du Nouveau-Brunswick, tandis qu’il joue le rôle d’étape transitoire vers l’anglicisation dans les autres provinces. En parallèle avec la cassure en matière de comportement linguistique, il s’est développé une divergence identitaire : au contraire des jeunes de langue maternelle française du Québec et du Nouveau-Brunswick, ceux de l’Ontario et des autres provinces s’identifient comme bilingues plutôt que francophones.
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PHAN, M. Q., W. HENRY, C. B. BUI, D. H. DO, N. V. HOANG, N. T. THU, T. T. NGUYEN, et al. "Detection of HPAI H5N1 viruses in ducks sampled from live bird markets in Vietnam." Epidemiology and Infection 141, no. 3 (June 1, 2012): 601–11. http://dx.doi.org/10.1017/s0950268812001112.
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SUMMARYIn Vietnam, highly pathogenic avian influenza (HPAI) H5N1 infections in poultry often occur without concomitant clinical signs and outbreaks are not consistently reported. Live bird markets represent a convenient site for surveillance that does not rely on farmers' notifications. Two H5N1 surveys were conducted at live bird markets/slaughter points in 39 districts (five provinces) in the Red River, Mekong delta, and central Vietnam during January and May 2011. Oropharyngeal and rectal swab samples from 12 480 ducks were tested for H5N1 by reverse transcription–polymerase chain reaction in pools of five. Traders and stallholders were interviewed using standardized questionnaires; 3·3% of pools tested positive. The highest prevalence (6·6%) corresponded to the Mekong delta, and no H5N1 was detected in the two Red River provinces. The surveys identified key risk behaviours of traders and stallholders. It is recommended that market surveys are implemented over time as a tool to evaluate progress in HPAI control in Vietnam.
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Sewitch, Maida J., Mengzhu Jiang, Lawrence Joseph, Alan N. Barkun, and Alain Bitton. "Rate of Serious Complications of Colonoscopy in Quebec." Canadian Journal of Gastroenterology 26, no. 9 (2012): 611–13. http://dx.doi.org/10.1155/2012/382149.
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BACKGROUND: The rate of serious complications is one marker of the quality of colonoscopy services.OBJECTIVE: To estimate the rate of serious complications of colonoscopy according to colonoscopy indication and polypectomy status.METHODS: A prospective cohort study of patients scheduled for colonoscopy who were recruited from seven endoscopy facilities across Montreal (Quebec) was conducted. Before colonoscopy, patients completed a brief questionnaire and provided their health insurance numbers. Colonoscopy indication was based on patient-reported medical history. Polypectomy status was obtained from provincial physician billing records (Régie de l’assurance maladie du Québec). Diagnoses and procedures associated with hospitalization in the 30 days following colonoscopy were obtained from the provincial hospitalization database (MedEcho).RESULTS: Of the 2134 patients enrolled (mean age 60.9 years, 50.1% male), 33 (1.55% [95% CI 1.06% to 2.16%]) were hospitalized within 30 days. One patient experienced bleeding following a colonoscopy that involved polypectomy and was diagnosed with carcinoma in situ of the rectum. Based on self-reported rectal bleeding in the previous six months, the colonoscopy was nonscreening. The provincial hospitalization data showed no occurrences of perforation, diverticulitis, myocardial infarction/stroke or death; thus, the rate of serious colonoscopy complications was 0.05% (95% CI 0.00% to 0.26%).DISCUSSION: The rate of serious colonoscopy complications requiring hospitalization was low and comparable with what is reported in the literature. The serious complication occurred subsequent to polypectomy and in a nonscreening colonoscopy.CONCLUSION: The findings support the relative safety of screening colonoscopy in persons without large bowel diseases and symptoms. However, future research to determine the rate of serious complications not requiring hospitalization is warranted to reassure decision makers of the safety of colonoscopy for colorectal cancer screening.
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Unchupaico P., Ide, Luis Bazán A., Carlos Quispe E., and Edith Ancco G. "Temperatura ambiental y su efecto sobre parámetros fisiológicos en vacas Nellore y cruces bajo condiciones del trópico peruano." Revista de Investigaciones Veterinarias del Perú 31, no. 1 (March 29, 2020): e17549. http://dx.doi.org/10.15381/rivep.v31i1.17549.
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El objetivo del estudio fue determinar las constantes fisiológicas relacionadas con la termorregulación corporal, así como parámetros hematológicos básicos entre vacas Nellore y sus cruces bajo estrés calórico. El estudio se desarrolló en la provincia de Satipo, región Junín, Perú, a 628 msnm. Se trabajó con 16 vacas cruzadas (Brown Swiss x Nellore) y 16 vacas Nellore. Las constantes fisiológicas (temperatura corporal, frecuencia respiratoria y frecuencia cardiaca) se evaluaron en horas de la mañana (06:00-07:00) y en la tarde (14:00-17:00). Se tomaron muestras de sangre para determinar hemoglobina (g/dl), hematocrito (%), volumen corpuscular medio (VCM, fl), hemoglobina corpuscular media (HCM, pg), concentración de hemoglobina corpuscular media (CHCM, g/dl). Las funciones termorreguladoras (temperatura rectal, frecuencia cardiaca y frecuencia respiratoria) se vieron afectadas en horas de estrés calórico en los dos grupos raciales (p<0.05). Los valores hematológicos se encontraron dentro de los rangos referenciales, excepto el VCM y la HCM.
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Tan, Kang-Lian, Hai-Jun Deng, Zhi-Qiang Chen, Ting-Yu Mou, Hao Liu, Run-Sheng Xie, Xue-Min Liang, Xiao-Hua Fan, and Guo-Xin Li. "Survival outcomes following laparoscopic vs open surgery for non-metastatic rectal cancer: a two-center cohort study with propensity score matching." Gastroenterology Report 8, no. 4 (August 1, 2020): 319–25. http://dx.doi.org/10.1093/gastro/goaa046.
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Abstract Background:?> Laparoscopic surgery for rectal cancer is commonly performed in China. However, compared with open surgery, the effectiveness of laparoscopic surgery, especially the long-term survival, has not been sufficiently proved. Methods:?> Data of eligible patients with non-metastatic rectal cancer at Nanfang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese Medicine between 2012 and 2014 were retrospectively reviewed. Long-term survival outcomes and short-term surgical safety were analysed with propensity score matching between groups. Results Of 430 cases collated from two institutes, 103 matched pairs were analysed after propensity score matching. The estimated blood loss during laparoscopic surgery was significantly less than that during open surgery (P = 0.019) and the operative time and hospital stay were shorter in the laparoscopic group (both P < 0.001). The post-operative complications rate was 9.7% in the laparoscopic group and 10.7% in the open group (P = 0.818). No significant difference was observed between the laparoscopic group and the open group in the 5-year overall survival rate (75.7% vs 80.6%, P = 0.346), 5-year relapse-free survival rate (74.8% vs 76.7%, P = 0.527), or 5-year cancer-specific survival rate (79.6% vs 87.4%, P = 0.219). An elevated carcinoembryonic antigen, <12 harvested lymph nodes, and perineural invasion were independent prognostic factors affecting overall survival and relapse-free survival. Conclusions:?> Our findings suggest that open surgery should still be the priority recommendation, but laparoscopic surgery is also an acceptable treatment for non-metastatic rectal cancer.
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Raissouni, Soundouss, Dawn Elizabeth Armstrong, Julie A. Price Hiller, Jamison Mercer, Erin Diana Powell, Anthony MacLean, Maria Jiang, et al. "Predictors of treatment interruption/dose reduction of neoadjuvant chemotherapy for rectal cancer: A multicenter study." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 580. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.580.
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580 Background: Neoadjuvant chemoradiation (CRT) is the standard of care for patients with locally advanced rectal cancer. Many patients require dose reduction or chemotherapy interruption due to significant toxicities. To assess the predictors of neoadjuvant chemotherapy treatment (tx) adjustments, we performed a retrospective study in four Canadian provinces. Methods: Cancer Registries identified consecutive patients with clinical stage I-III rectal cancer from the Tom Baker Cancer Center, Cross Cancer Institute, BC Cancer Agency, Ottawa Hospital Cancer Centre and the Dr. H. Bliss Murphy Cancer Centre who received CRT and had curative intent surgery (Sx) from 2005 to 2012. Patient, tumor and tx characteristics were correlated with treatment completion. Results: Of the 891 patients included, 886 patients had tx dose adjustments data available. 738 (83.2%) completed the planned neoadjuvant chemotherapy, while 148 (16.7%) failed to complete planned chemotherapy. Patients who required tx interruption/cessation or dose reduction were more likely to be female, elderly, had higher ECOG PS and were treated with fluorouracil (FU) chemotherapy in univariate analysis (see Table). On multivariable analysis, female gender (OR 1.807, 95% CI 1.02-3.2, p=0.042) and tx with FU (vs capecitabine) (OR 2.7, 95% CI 1.52-4.77, p=0.0007) were associated with dose reduction and tx interruption/cessation. Conclusions: Gender and type of chemotherapy are predictors of neoadjuvant chemotherapy interruption or dose reduction in rectal cancer. Careful monitoring of these patients is warranted during neoadjuvant CRT. [Table: see text]
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Sandoval, José, Carlos Santa, and Patricia Paz. "Fístulas vaginales: 173 casos observados en 18 años." Revista Peruana de Ginecología y Obstetricia 44, no. 3 (June 19, 2015): 208–15. http://dx.doi.org/10.31403/rpgo.v44i959.
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OBJETIVOS: Determinar las causas y tipos de fístulas vaginales más frecuentes. Reconocer y comparar el tratamiento y resultado de los casos en estudio. DISEÑO Serie de casos, descriptivo y retrospectivo. LUGAR: Hospital Arzobispo Loayza. RESULTADOS: Se analizó 173 casos de fístulas vaginales ocurridos entre 1980 y 1997, con un promedio de 9,6 casos por año. La mitad de las pacientes proceden de provincia. Las principales causas fueron histerectomía abdominal con 43% y expulsivo, prolongado con 41% de los casos. Los tipos de fístulas más frecuentes fueron la vésico-vaginal (FVV) (57%), vésico-vagino-rectal (FVR) (16,2%) y uretero-vagina (12%). El 70% de las FVV curadas fueron intervenidas entre los 4 y 24 meses y las urótero-vaginales entre los 2 y 6 meses. La tasa de recidiva fue 8%, las FVV amplias son de fácil recidiva. La vía de abordaje de la FVV por vía abdominal ha tenido mayor éxito (80%)frente a la vía transvaginal (53%). CONCLUSIONES: El parto atendido por empíricas sigue siendo una de las causas de fístula vaginal. Se debe mejorar la atención materna en los lugares más apartados del país.
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Oliveira, Carlos Eduardo França de. "O FAROL, O OBSERVADOR E A VOZ: O DEBATE SOBRE A FEDERAÇÃO E A REFORMA CONSTITUCIONAL NA IMPRENSA PAULISTA (1830-1832)." Almanack, no. 20 (September 2018): 132–53. http://dx.doi.org/10.1590/2236-463320182006.
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Resumo Ancorado em estudos que apontam para a importância do elemento provincial na construção do Império brasileiro e o papel da imprensa periódica nesse processo, o presente artigo tem como objetivo analisar um aspecto específico da imprensa paulista durante o final do Primeiro Reinado e o início do período regencial, qual seja, o debate travado pelos jornais de São Paulo a respeito da federação e da reforma constitucional. A ideia central é questionar uma suposta homogeneidade presente no pensamento político paulista que não teria abrigado outros posicionamentos além de um liberalismo moderado consensual e hegemônico, ponto de vista que foi forjado pelos próprios agentes históricos da época e que ainda persiste em parte da historiografia sobre São Paulo nos Oitocentos. Busca-se, assim, problematizar o pensamento liberal paulista e indicar seus matizes, avanços e recuos, mostrando como o embate moderados versus exaltados revela não uma dicotomia inflexível, mas sim fissuras dentro do ideário liberal que transcendiam os limites da província e se articulavam à discussão política que envolvia o centro do Império e suas partes.
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Fung-Kee-Fung, Michael, Robin P. Boushey, Chris Morash, James Watters, Robin Morash, Marlene Mackey, and Jennifer Smylie. "Use of a community of practice (CoP) platform as a model in regional quality improvements in cancer surgery: The Ottawa model." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 68. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.68.
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68 Background: The Ottawa CoP model for developing multidisciplinary practitioner networks and integrating them with organizational processes was established in 2007 as a platform improving access to quality cancer surgery in one of the health regions (population 1,276,370) of Ontario, Canada. The three inter-disciplinary CoP collaboratives in breast, colorectal, and prostate cancer involve 230 care providers from 9 hospitals performing over 2,000 cancer surgeries per year. Objectives: 1) to address lack of coordination and standardization of care, 2) develop a regional platform for quality initiatives, and 3) bridge the gap between academic and community hospitals. Methods: Using the model, an academic tertiary care hospital and eight community hospitals partnered to support a regional quality improvement initiative that combines 1) educational outreach with audit and feedback to address variations in practice and 2) a unique platform for knowledge generation and innovation. Regional interdisciplinary teams developed a set of regional quality indicators (18) linked to mutually agreed standards and pathways. Regional registry was established to provide data feedback on performance against both provincial and regional standards. Best practices, innovations, and implementation progress are reviewed through sustained interactions between CoP members. Patient and care provider surveys are conducted. Results: The development and implementation of regional care standards and clinical pathways for three disease sites in 9 hospitals. Regional pathway compliance ranged 65-94%. Other significant improvements include: rectal cancer surgery centralization (80-90% per annum), increase in use of sentinel lymph node biopsies in breast cancer surgery (60-77% per annum) and a decreased positive prostate cancer surgical margin rate form 45% to 22%. Compliance with provincial guidelines for colon cancer surgery improved (20% increase 2006/2007 vs. 2010/2011). Increase in patient access to high-quality cancer surgery closer to home. Conclusions: Participation in the regional CoPs is associated with quality improvements at the system, patient, and professional levels.
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Abba, Agustín M., Guillermo H. Cassini, and Fernando C. Galliari. "Nuevos aportes a la historia natural de la mulita pampeana Dasypus hybridus (Mammalia, Dasypodidae)." Iheringia. Série Zoologia 101, no. 4 (December 2011): 325–35. http://dx.doi.org/10.1590/s0073-47212011000300007.
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En este trabajo se presentan nuevos aportes sobre la historia natural de la mulita pampeana Dasypus hybridus (Desmarest, 1804) (Mammalia, Xenarthra, Dasypodidae). Los estudios de campo fueron llevados a cabo en 100 ha de cuatro establecimientos agropecuarios de la provincia de Buenos Aires, Argentina. Durante tres años se realizó un muestreo estacional de armadillos por captura y liberación. Se obtuvieron datos de hábitos alimentarios, uso del espacio y del tiempo, comportamiento, termorregulación, datos poblacionales y morfológicos. Se realizaron 71 capturas. En la dieta el ítem principal registrado fue material vegetal, seguido por hormigas e insectos coleópteros; no se observó una diferencia estacional en los hábitos alimentarios. La actividad de las mulitas se concentra durante el día, existió una baja en la frecuencia de observación durante las estaciones frías (otoño e invierno). La mulita pampeana prefiere suelos húmicos, terrenos altos y pastizales densos y altos; asimismo seleccionan los montes para refugiarse. Son individuos asociales. La temperatura rectal mostró correlaciones positivas con la temperatura ambiente. La proporción de sexos fue cercana a uno y no se observó dimorfismo sexual. Los resultados obtenidos concuerdan parcialmente con lo observado para otras especies del género, destacando las tendencias observadas en los hábitos alimentarios y en la estrategia termorregulatoria. Este trabajo representa un aporte en varios aspectos de una especie poco estudiada en una zona bajo importantes presiones de uso y modificación de hábitat.
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Liu, Wen-Han, Pei-Jing Yan, Dong-Ping Hu, Peng-Hui Jin, Yao-Chun Lv, Rong Liu, Xiong-Fei Yang, Ke-Hu Yang, and Tian-Kang Guo. "Short-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Cohort Study." American Surgeon 85, no. 3 (March 2019): 294–302. http://dx.doi.org/10.1177/000313481908500336.
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The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus ( P < 0.001), the time to the first postoperative oral fluid intake ( P < 0.001), and the length of hospital stay ( P < 0.01) of the R-TME group were about three days faster than those in the L-TME group. The rate of conversion to open laparotomy ( P = 0.038) and postoperative urinary retention ( P = 0.016) were significantly lower in the R-TME group than in the L-TME group. Intraoperative blood loss of the R-TME group was more than that of the L-TME group ( P < 0.01).The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. The total cost of the R-TME group was higher than that of the L-TME group, but with a lack of statistical significance (85,623.91 ± 13,310.50 vs 67,356.79 ± 17,107.68 CNY, P = 0.084). The R-TME is safe and effective and has better postoperative short-term outcomes and faster intestinal function recovery time, contrasting with the L-TME. The large, multicenter, prospective studies were needed to validate the advantages of robotic surgery system used in rectal cancer.
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Armstrong, Dawn Elizabeth, Soundouss Raissouni, Julie A. Price Hiller, Jamison Mercer, Erin Diana Powell, Anthony MacLean, Maria Jiang, et al. "Predictors of pathologic complete response after neoadjuvant treatment for rectal cancer: A multicenter study." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 397. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.397.
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397 Background: Pathologic complete response (pCR) to neoadjuvant chemoradiation (CRT) for rectal cancer is associated with better long-term outcomes, and is used as an early indicator of response to novel agents. To assess the rate and predictors of pCR, we performed a retrospective population based study in four Canadian provinces. Methods: Cancer Registries identified consecutive patients with clinical stage I-III rectal cancer from the Tom Baker Cancer Center, Cross Cancer Institute, BC Cancer Agency, Ottawa Hospital Cancer Centre and the Dr. H. Bliss Murphy Cancer Centre who received fluoropyrimidine-based CRT and had curative intent surgery (Sx) from 2005 to 2012. Patient, tumor, and therapy characteristics were correlated with response. Results: Of the 891 patients included, 885 patients had pCR data available. 161 (18.2%) had a pCR to CRT, while 724 (81.8%) did not. Patients with a pCR had a lower pre-treatment (tx) CEA, and higher hemoglobin on univariate analysis (see table). On multivariable analysis, statin use at baseline (OR 1.7, 95% CI 1.04-2.89, p=0.044), lower pre-tx CEA (OR 1.03, 95% CI 1.003-1.05 p=0.028) and distance closer to anal verge (OR 1.07, 95% CI 1.004-1.15, p=0.039) were significant predictors of pCR. The 3yr DFS was 86% in those with pCR vs 62.5% in those without a pCR (P<0.0001). Conclusions: Lower pre-tx CEA, distance closer to anal verge and statin use are predictors of pCR. Clinical trials investigating statins combined with neoadjuvant CRT may be warranted. [Table: see text]
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Armstrong, Dawn Elizabeth, Haider Ali, Erin Diana Powell, Julie A. Price Hiller, Patricia Tang, D. Gwyn Bebb, Scot D. Dowden, et al. "Predictors of pathologic complete response (pCR) after neoadjuvant chemoradiation (Neo CRT) for rectal cancer: A multicenter population-based study." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e14073-e14073. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e14073.
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e14073 Background: pCR to Neo CRT for rectal cancer is associated with better outcomes and used as an early indicator of response. To assess the rate and predictors of pCR, as well as access to care, we performed a retrospective study in two Canadian provinces. Methods: Cancer registries identified consecutive patients with clinical stage I-III rectal cancer from the Tom Baker Cancer Center, Cross Cancer Institute, and Dr. H. Bliss Murphy Cancer Centre who received Neo CRT and had curative intent surgery (Sx) from 2005 to 2011. Patient, tumor and therapy characteristics were correlated with response. Results: 301 patients were included of which 59 (19.6%) had a pCR to Neo CRT. At a median follow-up of 17 months, disease free survival was 96.7% for pCR vs 82.3% for non-pCR (p=0.005). 43 (73%) patients with pCR received adjuvant chemotherapy including bolus FU 27 (63%), capecitabine 10 (23%) and oxaliplatin-based 6 (14%). Median time from diagnosis to consult was 4 weeks (wks), from consult to start of Neo CRT 3.3 wks and start of CRT to Sx 13 wks. On multivariate analysis a low pre-op CEA (p=0.0323) was a significant independent predictor of pCR while statin use at initial consult (p=0.077) and higher pre-op hemoglobin (p=0.0974) trended toward significance when adjusted for clinical stage. Conclusions: Rates of pCR in a population based setting are substantial. A lower pre-op CEA is associated with a pCR to Neo CRT. Statin use and pre-op hemoglobin require further investigation. Our access to care data provides a baseline for future comparisons. [Table: see text]
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Bhavanam, Sudha, Stephen Freedman, Bonita Lee, Ran Zhuo, Yuanyuan Qiu, Linda Chui, Jianling Xie, Samina Ali, Otto Vanderkooi, and Xiaoli Pang. "Differences in Illness Severity among Circulating Norovirus Genotypes in a Large Pediatric Cohort with Acute Gastroenteritis." Microorganisms 8, no. 12 (November 26, 2020): 1873. http://dx.doi.org/10.3390/microorganisms8121873.
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Norovirus is a major pathogen identified in children with acute gastroenteritis (AGE), little is known about the strain’s diversity and their clinical severity. Stool and/or rectal swabs were collected from children ≤18 years of age recruited at emergency departments (ED), and a provincial nursing advice phone line due to AGE symptoms in the province of Alberta, Canada between December 2014 and August 2018. Specimens were tested using a reverse transcription real time PCR and genotyped by Sanger sequencing. The Modified Vesikari Scale score (MVS) was used to evaluate the disease severity. The objectives are to identify the Genogroup and Genotype distribution and to compare illness severity between the GI and GII genogroups and to complete further analyses comparing the GII genotypes identified. GII.4 was the genotype most commonly identified. Children with GII.4 had higher MVS scores (12.0 (10.0, 14.0; p = 0.002)) and more prolonged diarrheal (5 days (3.0, 7.8)) and vomiting (3.2 days (1.7, 5.3; p < 0.001)) durations compared to other non GII.4 strains. The predominant strain varied by year with GII.4 Sydney[P31] predominant in 2014/15, GII.4 Sydney[P16] in 2015/16 and 2017/18, and GII.3[P12] in 2016/17. Genogroup II norovirus strains predominated in children with AGE with variance between years; clinical severity associated with different strains varied with episodes being most severe among GII.4 infected children.
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DENIS, Wilfrid B. "L’État et les minorités; de la domination à l’autonomie." Sociologie et sociétés 26, no. 1 (September 30, 2002): 133–53. http://dx.doi.org/10.7202/001178ar.
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Résumé L'État occupe plusieurs fonctions dans les sociétés capitalistes avancées. Sa structure même, et plus encore ses divers programmes, est l'enjeu de tensions entre les fractions de la bourgeoisie dans un premier temps, et des luttes entre la bourgeoisie et les groupes dominés dans un deuxième. La ligne de démarcation et de confrontation entre ces groupes progresse et recule au fil des ans. Les minorités francophones du Canada ne font pas exception à cette articulation à l'État. Il est donc très utile d'analyser la situation des francophones de la Saskatchewan, qui, malgré une situation linguistique des plus précaire, obtiennent en 1988 deux ententes formelles avec le gouvernement fédéral. Suite à l'une de ces ententes, la communauté fransaskoise se dotait d'une stratégie provinciale de développement. Cet article analyse les répercussions de cette stratégie et de l'entente sur les rapports entre les Fransaskois, en tant que groupe dominé, et l'État. Nous concluons que les contradictions inhérentes à une telle entente permettent au groupe dominé une autonomie et une prise de contrôle de sa situation accrues tout en risquant de l'imbriquer davantage dans les structures et les rouages de l'État.
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Liu, Shiru Lucy, Pierre O'Brien, Yizhou Zhao, Wilma M. Hopman, Nathan William Dana Lamond, and Ravi Ramjeesingh. "Impact of adjuvant treatment in elderly patients with locally advanced rectal cancer: A population-based retrospective study." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 3613. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.3613.
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3613 Background: Little is known about the benefit and use of adjuvant chemotherapy (ADJ) in the elderly population (age ≥ 65) with locally advanced rectal cancer (LARC). We undertook a provincial review of LARC patients to evaluate the potential benefits, including survival and time to relapse (TTR), of ADJ in elderly patients. Methods: We performed a retrospective analysis of 286 LARC patients (stage 2 and 3) diagnosed between January 2010 and December 2013 from Nova Scotia, Canada, who underwent curative-intent surgery. Baseline patient, tumor and treatment characteristics were collected. Survival and TTR analysis were performed using Kaplan-Meier and Cox-regression statistics. Results: 152 patients were age ≥65, and 92 age ≥70. Median follow-up was 46 months. 178 patients (62%) received neoadjuvant chemo-radiation (NEOADJ). While 109 patients (81%) age < 65 received ADJ, only 68 patients (45%) age ≥ 65 received ADJ. Kaplan-Meier analysis revealed a significant survival and TTR advantage for ADJ irrespective of age (table). In cox-regression multivariate analysis, ECOG status, T stage, and ADJ were significant predictors of survival (p < 0.04), while age was not. Similarly, N stage, NEOADJ, and ADJ were significant predictors of TTR (p < 0.007). Poor ECOG status was the most common cause of ADJ omission. There was a significantly higher amount of grade≥ 1 chemotherapy-related toxicity experienced by patients age ≥ 65 treated with ADJ compared to no ADJ (77% vs 32%, p < 0.0001), which consisted mostly of diarrhea and mucositis. Toxicity was the main reason for non-completion of ADJ in the elderly. Conclusions: Elderly patients with LARC have significantly improved overall survival with ADJ, but the use of ADJ is lower than in patients age < 65. However, elderly patients experience more chemotherapy-related toxicities, leading to higher rates of early treatment discontinuation. [Table: see text]
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Gotfrit, Joanna, Tharshika Thangarasa, Horia Marginean, Shaan Dudani, Rachel Anne Goodwin, Patricia A. Tang, Jose Gerard Monzon, Kristopher Dennis, Winson Y. Cheung, and Michael M. Vickers. "The impact of socioeconomic factors on outcomes of patients with locally advanced rectal cancer (LARC)." Journal of Clinical Oncology 37, no. 4_suppl (February 1, 2019): 612. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.612.
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612 Background: Patients with rectal cancer may experience disparities in outcomes due to various socioeconomic (SES) factors. We assessed the impact of SES factors on outcomes in patients with LARC who received neoadjuvant chemoradiation (nCRT) and surgery (Sx) in three Canadian provinces. Methods: Associations between clinical variables, demographics, community characteristics (2015 Canadian Census data), distance and time to the nearest cancer center (mapping software), and outcomes were evaluated. Results: 1,098 patients were included (Table 1). Median follow-up time was 67.8 months. The 5-year survival rate was 0.80 (95% CI 0.77-0.82). Factors predictive of disease-free survival in univariate analysis (UVA) included age, worse performance status (PS), driving time > 1 hour, median community income, and driving distance > 100 km. Factors that remained significant in multivariate analysis (MVA) included age (HR 1.01; 95% CI 1.00-1.02; p = 0.01), worse PS (HR 1.30; 95% CI 1.01-1.68; p = 0.04) and driving time > 1 hour (HR 1.31; 95% CI 1.01-1.71; p = 0.04). Factors predictive of overall survival in UVA included age, worse PS, driving time to the cancer centre > 1 hour, median community income, and community proportion with post-secondary education. Factors that remained significant in MVA included age (HR 1.03; 95% CI 1.02-1.04; p < 0.001), worse PS (HR 1.41; 95% CI 1.03-1.94; p = 0.03), and median community income (HR 1.00; 95% CI 1.00-1.00; p = 0.05). Conclusions: Outcomes of patients with LARC undergoing nCRT are significantly associated with driving time to the nearest cancer centre and community household income. Further efforts to understand and reduce these socioeconomic disparities are warranted. [Table: see text]
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Lacroix, Audrey, Placide Mbala Kingebeni, Simon Pierre Ndimbo Kumugo, Guy Lempu, Christelle Butel, Laetitia Serrano, Nicole Vidal, et al. "Investigating the Circulation of Ebola Viruses in Bats during the Ebola Virus Disease Outbreaks in the Equateur and North Kivu Provinces of the Democratic Republic of Congo from 2018." Pathogens 10, no. 5 (May 4, 2021): 557. http://dx.doi.org/10.3390/pathogens10050557.
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With 12 of the 31 outbreaks, the Democratic Republic of Congo (DRC) is highly affected by Ebolavirus disease (EVD). To better understand the role of bats in the ecology of Ebola viruses, we conducted surveys in bats during two recent EVD outbreaks and in two areas with previous outbreaks. Dried blood spots were tested for antibodies to ebolaviruses and oral and rectal swabs were screened for the presence of filovirus using a broadly reactive semi-nested RT-PCR. Between 2018 and 2020, 892 (88.6%) frugivorous and 115 (11.4%) insectivorous bats were collected. Overall, 11/925 (1.2%) to 100/925 (10.8%) bats showed antibodies to at least one Ebolavirus antigen depending on the positivity criteria. Antibodies were detected in fruit bats from the four sites and from species previously documented to harbor Ebola antibodies or RNA. We tested for the first time a large number of bats during ongoing EVD outbreaks in DRC, but no viral RNA was detected in the 676 sampled bats. Our study illustrates the difficulty to document the role of bats as a source of Ebolaviruses as they might clear quickly the virus. Given the increasing frequency of EVD outbreaks, more studies on the animal reservoir are urgently needed.
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Shack, Lorraine, Shuang Lu, Lee-Anne Weeks, Peter S. Craighead, and Marc Kerba. "Determining the need and utilization of radiotherapy in cancers of the breast, cervix, lung, prostate, and rectum in Alberta, Canada." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 116. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.116.
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116 Background: Determining the appropriate rate of RT is important for health care planning and resource allocation. Establishing RT shortfalls (difference between observed and estimates of RT need) could provide an estimate of the capacity expansion that would be required to address them. Our primary objective was to determine the utilization of RT for cancers of the breast, cervix, lung, prostate and rectum in Alberta (AB), Canada. To determine the burden of RT shortfalls in AB, the secondary objective was to compare the observed AB RT rates to estimates of need derived from criterion-based benchmarking (CBB) and evidence-based estimates (EBEST). Methods: All incident cases of breast (B), cervix (C), lung (L), prostate (P) and rectal (R) cancers diagnosed in 2004-8 in AB were identified from the provincial cancer registry (ACR). Ethics board approval was obtained. Patients receiving RT within one year (RT-1y) of diagnosis were identified and grouped by cancer site. The proportion of cases receiving RT-1y was then calculated. Rates were compared using a Z statistic of the normal approximation for a difference in proportions. Estimates of the appropriate RT rate were derived from CBB and EBEST methods described in the literature. Results: A total of 68,164 cancer cases of interest were identified from the ACR. RT-1y rates for AB (95%CI) were: B: 50.5%(49.5-51.4), C: 45.7%(42.2-49.3), L: 36.5%(35.5-37.3), P:26.4%(25.6-27.3) and R:38.8%(37.1-40.6). Observed rates of RT in AB were lower than estimates derived using CBB and EBEST of RT-1y for B: 60.7%(59.3-62.1) and 57.1%(52.6-62.0), C: 48.6%(39.1-58.1) and 63.4%(61.1-65.7), L: 41.3%(39.9-42.7) and 44.6%(41.0-48.2), P: 37.2%(35.8-38.7) and 32.0%(28.4-36.0), and R: 43.4%(39.1-47.6) and 69.6%(68.7-70.5). Shortfalls varied across cancer sites according to whether CBB or EBEST estimates were referenced, ranging from 4.8% in lung cancer to 30.8% in rectal cancer. Conclusions: Important shortfalls exist in the utilization of RT in Alberta, Canada despite centralized cancer care and a publically funded health care system. The magnitude of the shortfall varied according to whether a CBB or EBEST estimate of RT was applied.
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Liang, Jun, Irene Dankwa-Mullan, Yan-ping Ren, Alan Chen, Van Willis, Gretchen Jackson, Nathan Levitan, Kyu Rhee, and Tian-le Li. "Employing an oncology decision-support system to quantify treatment variation." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18067-e18067. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18067.
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e18067 Background: Factors affecting cancer treatment may include evidence for effectiveness, cost, and preference. These influences can lead to treatment variation across institutions and populations. Decision-support systems have been proposed as tools to reduce variation. This study quantified concordance between treatment provided by oncologists in China and therapeutic options presented by a decision-support tool. Methods: We identified and analyzed concordance studies in nine unique institutions located in seven provinces in China, published in 2017-2018 using Watson for Oncology (WFO), a clinical decision-support tool. Published rates of concordance were compared by cancer type and institution. Results: Concordance of all combined cases was 59% (2012/3388). Concordance rates varied by cancer type and institution (Table). Concordance rates were highest for ovarian (96%), rectal (94%) and breast (89%) cancers but lowest in gastric (12%), ovarian (43%) and breast (55%) cancers. Conclusions: Concordance between treatments and therapeutic options from an oncology decision-support tool varied significantly across cancer types and institutions in China, suggesting significant practice variation. Without established guidelines for treatment, clinical decisions may be influenced by preferences and local factors. Future studies are needed to identify reasons for variation and improve adherence to regional evidence-based guidelines. [Table: see text]
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Gong, Jiansen, Jinqiu Zhang, Ming Xu, Chunhong Zhu, Yan Yu, Xuexian Liu, Patrick Kelly, Bu Xu, and Chengming Wang. "Prevalence and Fimbrial Genotype Distribution of Poultry Salmonella Isolates in China (2006 to 2012)." Applied and Environmental Microbiology 80, no. 2 (November 15, 2013): 687–93. http://dx.doi.org/10.1128/aem.03223-13.
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ABSTRACTIn this study, a total of 323Salmonella entericastrains were isolated from 3,566 rectal swab samples of 51 poultry farms in seven regions of 12 provinces of China between 2006 and 2012. The prevalences ofSalmonellasp. carriage were 12.4% in geese (66 positive/533 samples), 10.4% in turkeys (32/309), 9.8% in chickens (167/1,706), 6.8% in ducks (41/601), and 4.1% in pigeons (17/417), respectively. These isolates belonged to 20 serovars, in which the most frequent serovars wereS. entericaserovar Gallinarum biovar Pullorum (herein,S. Pullorum) (55 isolates, 17.0%),S. entericaserovar Typhimurium (50 isolates, 15.5%), andS. entericaserovar Enteritidis (39 isolates, 12.1%). Overall,S. Typhimurium was the most commonly detected serovar; among the individual species,S. Pullorum was most commonly isolated from chickens,S. Enteritidis was most common in ducks,S. Typhimurium was most common in geese and pigeons, andS. entericaserovar Saintpaul was most common in turkeys. PCR determination of 20 fimbrial genes demonstrated the presence ofbcfD,csgA,fimA,stdB, andsthEgenes and the absence ofstaAandstgAgenes in these isolates, and other loci were variably distributed, with frequency values ranging from 11.8 to 99.1%. These 323Salmonellaisolates were subdivided into 41 different fimbrial genotypes, and of these isolate, 285 strains (88.2%) had 12 to 14 fimbrial genes. Our findings indicated that theSalmonellaisolates from different poultry species were phenotypically and genetically diverse and that some fimbrial genes are more frequently associated with serovars or serogroups.
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Liang, Jun, Tianle Li, Shan-shan Zhang, Cheng Chen, Courtney VanHouten, Anita Preininger, Irene Dankwa-Mullan, and Gretchen Purcell Jackson. "Reasons for discordance in treatment approaches between oncology practice and clinical decision support in China." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6555. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6555.
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6555 Background: Therapeutic clinical decision-support systems (CDSS) are often evaluated by comparisons between CDSS options and actual practice decisions or expert opinions. Few such studies have carefully examined reasons for discordance. Methods: We reviewed 11 concordance studies from different hospitals across 8 provinces in China, published between 2017 and 2018. The studies compared IBM Watson for Oncology (WfO) therapeutic options to treatments selected by oncologists or a tumor board involved in review of cases for lung, colon, rectal, breast, gastric, and gynecological cancers. We identified given reasons for discordance and summarized themes across studies. Results: Of the 11 studies, 9 provided 1 or more reasons for discordance which could be analyzed. We found three major themes related to discordance: formulary restrictions, treatment-protocol differences, and physician or patient preferences (Table). Formulary differences between WfO and regional practices included off-label drug uses or unavailable therapies. Treatment-protocol differences included variations in regimens, such as simultaneous versus sequential treatments. Physician or patient preferences included factors such as the cost of treatment and logistics associated with various treatments. Conclusions: This study identified multiple reasons for discordance between an oncology CDSS option and oncologists’ treatment choices in China. Treatment differences arose from local formulary or protocol differences as well as provider and patient preferences. Future studies of CDSS should include reasons for discordance when assessing system performance in this manner. [Table: see text]
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Lee, Bonita, Xiao-Li Pang, Ran Zhuo, Brendon Parsons, Linda Chui, Jianling Xie, Karen Lowerison, Lara Osterreicher, Samina Ali, and Stephen Freedman. "Identifying Enteropathogens in Children with Acute Gastroenteritis Presenting with Isolated Vomiting–Appetite Study." Open Forum Infectious Diseases 4, suppl_1 (2017): S360—S361. http://dx.doi.org/10.1093/ofid/ofx163.876.
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Abstract Background As diarrheal stool samples are the recommended specimen for testing in acute gastroenteritis (AGE), etiological investigations are rarely performed in children presenting with isolated vomiting. This study identifies enteropathogens in children with AGE presenting with isolated vomiting. Methods Children <18 years old with ≥3 episodes of vomiting/diarrhea in 24 hours and <7 days of symptoms were recruited in 2 pediatric emergency departments, a public health clinic and via Health Link, a provincial nurse advice phone line. Rectal swabs and stool samples were collected and tested using the Luminex xTAG GPP, an in-house 5-virus RT-qPCR panel and enteric bacterial culture. Vomiting and diarrhea data were collected at enrollment (day 0) and at day 14. Results Between Dec 9, 2014 and Apr 14, 2016, 2,184 children were enrolled and tested: 784 (36%) presented with isolated vomiting, 250 (11%) with isolated diarrhea (ID), 1,138 (52%) with both vomiting and diarrhea (V&D), 12 had missing data. The detection of enteropathogens was 56% when presenting with isolated vomiting, 55% with ID and 83% with V&D. Of the 784 children with isolated vomiting, 54% (n = 424) had one or more viruses: the most common was norovirus (NoV) (n = 244, 50%), followed by adenovirus (Adv) (91, 19%), rotavirus (Rota) (57, 12%), sapovirus (84, 17%) and astrovirus (10, 2%). Fifty-eight cases had >1 virus; co-infection with NoV and Adv was the most common (n = 23). Ten of these 424 patients also had enteric bacteria (2 Aeromonas, 2 ETEC, 2 Salmonella, 2 Yersinia, 1 Campylobacter, 1 E coli O157) and 8/9 (89%) of these patients reported development of diarrhea at day 14. In comparison, 212/383 (55%) of patients with virus only reported diarrhea at follow up. Enteric bacteria with no virus was detected in 11 patients (3 Aeromonas, 3 Salmonella, 3 STEC, 1 Campylobacter, 1 E coli O157) and 3/10 of these patients reported diarrhea. Conclusion Over 50% of AGE presented with isolated vomiting had enteric virus identified in stool or rectal swabs, representing a significant pathogen-based disease burden not previously included in healthcare planning (e.g., Rota vaccine). NoV was the predominant agent followed by Adv and Rota. Finding enteric bacteria in these cases is novel and requires further study. Disclosures All authors: No reported disclosures.
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Dudani, Shaan, Horia Marginean, Joanna Gotfrit, Patricia A. Tang, Jose Gerard Monzon, Kristopher Dennis, Hagen F. Kennecke, et al. "The impact of chronic kidney disease in locally advanced rectal cancer patients treated with neoadjuvant chemoradiation." Journal of Clinical Oncology 36, no. 4_suppl (February 1, 2018): 794. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.794.
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794 Background: Chronic kidney disease (CKD) and cancer are common with advancing age. CKD may influence drug tolerance/efficacy and is an independent prognostic factor in some cancers. The impact of CKD on outcomes in patients (pts) with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiation (nCRT) has not been previously studied. Methods: We reviewed pts with LARC undergoing nCRT prior to surgery with curative intent from 2005-2013 across 4 Canadian provinces. Data regarding demographics, staging, baseline renal function, treatments and outcome were collected. CKD was defined as having an estimated glomerular filtration rate (eGFR) (Cockroft-Gault) < 60 ml/min. Primary endpoints were neoadjuvant treatment completion rate, disease-free survival (DFS), and overall survival (OS). Logistic regression and Cox proportional hazard models were used to assess for an association between renal function and outcomes. Results: 1122 (71%) of 1580 pts were included for analysis. Median age was 61 (IQR 54-69), 70% male, 84% performance status 0-1. 28% and 68% had clinical stage II and III disease, respectively. Median eGFR was 93 ml/min (IQR 74-114), with 11% < 60 ml/min (n = 120). 97% of all pts received ≥ 44 Gy (median 50 Gy [range 20-80]). 53% received 5-fluorouracil and 44% received capecitabine as neoadjuvant chemotherapy (nCT). 84% completed nCT, 95% completed neoadjuvant radiotherapy (nRT), and 76% received adjuvant chemotherapy (aCT). Pts with CKD were less likely to receive aCT (62% vs 78%; p < 0.01). There was no significant difference in completion rate of nCT (80% vs 85%; p = 0.15) or nRT (93% vs 95%; p = 0.20) based on renal function. After a median follow up time of 62 months, 8% developed local recurrence, 21% developed distant recurrence and 21% have died. 5-year OS and DFS were 78% and 73%, respectively. Pts with CKD had decreased OS on univariate analysis (HR 1.59, 95% CI 1.11-2.28; p = 0.01), but not on multivariate analysis. DFS was not significantly different based on renal function (HR 1.27, 95% CI 0.89-1.81; p = 0.18). Conclusions: In LARC pts undergoing nCRT, CKD was associated with less use of aCT but did not have any independent association with nCT and nRT completion rate, DFS or OS.
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Haley, Nicholas J., Chris Siepker, W. David Walter, Bruce V. Thomsen, Justin J. Greenlee, Aaron D. Lehmkuhl, and Jürgen A. Richt. "Antemortem Detection of Chronic Wasting Disease Prions in Nasal Brush Collections and Rectal Biopsy Specimens from White-Tailed Deer by Real-Time Quaking-Induced Conversion." Journal of Clinical Microbiology 54, no. 4 (February 10, 2016): 1108–16. http://dx.doi.org/10.1128/jcm.02699-15.
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Chronic wasting disease (CWD), a transmissible spongiform encephalopathy of cervids, was first documented nearly 50 years ago in Colorado and Wyoming and has since spread to cervids in 23 states, two Canadian provinces, and the Republic of Korea. The expansion of this disease makes the development of sensitive diagnostic assays and antemortem sampling techniques crucial for the mitigation of its spread; this is especially true in cases of relocation/reintroduction of farmed or free-ranging deer and elk or surveillance studies of private or protected herds, where depopulation is contraindicated. This study sought to evaluate the sensitivity of the real-time quaking-induced conversion (RT-QuIC) assay by using recto-anal mucosa-associated lymphoid tissue (RAMALT) biopsy specimens and nasal brush samples collected antemortem from farmed white-tailed deer (n= 409). Antemortem findings were then compared to results from ante- and postmortem samples (RAMALT, brainstem, and medial retropharyngeal lymph nodes) evaluated by using the current gold standardin vitroassay, immunohistochemistry (IHC) analysis. We hypothesized that the sensitivity of RT-QuIC would be comparable to IHC analysis in antemortem tissues and would correlate with both the genotype and the stage of clinical disease. Our results showed that RAMALT testing by RT-QuIC assay had the highest sensitivity (69.8%) compared to that of postmortem testing, with a specificity of >93.9%. These data suggest that RT-QuIC, like IHC analysis, is an effective assay for detection of PrPCWDin rectal biopsy specimens and other antemortem samples and, with further research to identify more sensitive tissues, bodily fluids, or experimental conditions, has potential for large-scale and rapid automated testing for CWD diagnosis.
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Lu, Jiayue, Ning Dong, Congcong Liu, Yu Zeng, Qiaoling Sun, Hongwei Zhou, Yanyan Hu, Sheng Chen, Zhangqi Shen, and Rong Zhang. "Prevalence and molecular epidemiology of mcr-1-positive Klebsiella pneumoniae in healthy adults from China." Journal of Antimicrobial Chemotherapy 75, no. 9 (June 9, 2020): 2485–94. http://dx.doi.org/10.1093/jac/dkaa210.
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Abstract Objectives To investigate the nationwide prevalence of mcr-1-positive Klebsiella pneumoniae (MCRPKP) strains among healthy adults in China and identify their phenotypic and genomic characterizations. Methods A total of 7401 rectal swab samples were collected from healthy individuals in 30 hospitals located in 30 provinces and municipalities of mainland China in 2016. Colistin-resistant bacteria were enriched in colistin-supplemented lysogeny broth. MCRPKP strains were isolated and characterized with MALDI-TOF MS, PCR analysis and antimicrobial susceptibility testing. The genomic characteristics of MCRPKP strains were determined by WGS and bioinformatics analysis. Results Seven MCRPKP strains and one mcr-1-positive Klebsiella variicola strain were selectively isolated from six locales (three from Henan and one from each of Tianjin, Jiangxi, Yunnan, Gansu and Tibet). Antimicrobial susceptibility testing results indicated that all mcr-1-positive strains were susceptible to meropenem, aztreonam and ceftazidime/avibactam. WGS analysis suggested these strains belonged to seven distinct STs: ST15, ST1425, ST1462, ST273, ST307, ST391 and ST37-SLV. mcr-1 genes were carried by diverse plasmids, including IncHI2 (n = 3), IncX4 (n = 2), IncHI2/IncN (n = 1), IncFIB (n = 1) and one other plasmid type. Two ST15 strains harboured both mcr-1 and mcr-8 genes, which has not been reported before. Conclusions Our data indicated a low prevalence of mcr-1-positive Klebsiella strains (0.11%, 8/7401) in healthy individuals in mainland China and most of these strains remained susceptible to clinically important antibiotics. The prevalence and coexistence of mcr-1 and mcr-8 in K. pneumoniae may further threaten public health through either the food chain or environmental routes.
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Dudani, Shaan, Horia Marginean, Patricia A. Tang, Jose Gerard Monzon, Soundouss Raissouni, Timothy R. Asmis, Rachel Anne Goodwin, Joanna Gotfrit, Winson Y. Cheung, and Michael M. Vickers. "Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictive and prognostic markers in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation." Journal of Clinical Oncology 35, no. 4_suppl (February 1, 2017): 758. http://dx.doi.org/10.1200/jco.2017.35.4_suppl.758.
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758 Background: A standard therapy for locally advanced rectal cancer (LARC) includes fluoropyrimidine (FP)-based neoadjuvant chemoradiation (nCRT). Previous studies have inconsistently demonstrated that baseline neutrophil- and platelet-to-lymphocyte ratios (NLR and PLR) are predictive of response to nCRT or prognostic of outcomes in LARC. Methods: We performed a review of patients with LARC undergoing nCRT followed by surgery with curative intent from 2005-2013 in 3 academic cancer centers from 2 Canadian provinces. Data regarding demographics, staging, baseline hematologic variables (<4 weeks prior/up to 2 weeks after initiating nCRT) and treatment details were collected. Outcome measures of interest were pathological complete response (pCR), disease-free survival (DFS) and overall survival (OS). Logistic regression and Cox proportional hazard models were used to assess for an association between baseline hematologic variables and outcomes. Results: Of 1081 identified patients, 845 were included in the DFS/OS analysis. Median age was 61 (range 23-87), 70% male, 85% performance status (PS) 0-1. 31% and 67% had clinical stage II and III disease, respectively. 25% had elevated NLR (≥ 4), and 64% had elevated PLR (≥ 150). 98% of patients received FP-based nCRT, with 96% receiving ≥ 44 Gy (median 50 Gy [range 20-74]). 80% completed neoadjuvant chemotherapy and 94% completed neoadjuvant radiotherapy, with a pCR rate of 23%. After a median follow up time of 64 months, 6% developed local recurrence, 20% developed distant recurrence and 19% have died. 5-year OS and DFS were 78% (95% CI 74-81%) and 76% (95% CI 73-79%), respectively. In multivariate analyses, elevated baseline NLR and PLR were not prognostic for OS or DFS. Elevated NLR was a negative predictor of pCR (OR 0.61, p=0.037, 95% CI 0.38-0.97); there was no association with elevated PLR. Conclusions: Elevated NLR was a negative predictor of pCR, but not prognostic for DFS and OS. PLR was neither predictive nor prognostic.
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Sisler, Jeffrey James, Zoann Nugent, Tara Carpenter-Kellett, and Joel Roger Gingerich. "Comparative study of the perceptions of continuity of care of CRC survivors transitioned to primary care." Journal of Clinical Oncology 35, no. 5_suppl (February 10, 2017): 96. http://dx.doi.org/10.1200/jco.2017.35.5_suppl.96.
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96 Background: Colorectal cancer (CRC) patients are increasingly being discharged to a primary care provider (PCP) for follow-up care. This study used a pre-post design to evaluate the impact of the Moving Forward After Cancer(MFAC) program at CancerCare Manitoba on patient perceptions of continuity of care. Methods: The MFAC program was introduced in 2010 to support transfer of care to primary care and includes transitional appointments (TAs) and survivorship care plans. The pre-implementation (PRE) group was a random sample of patients on the provincial cancer registry diagnosed in 2008/09 with Stage II / III CRC. The post-implementation (POST) group was recruited in oncology clinics after their TA over four years starting in 2010. Both groups completed the same mailed survey. Respondents were asked to identify the main provider(s) of their follow-up care. Those indicating a PCP completed the Patient Continuity of Care Questionnaire (PCCQ) which assesses continuity upon discharge with scoring between 5 and 25. Quality of life, disease, treatment, and demographic data were collected. Results: There were 246 responses in the PRE group (rate of 68.3%) and 83 (66%) in the POST. The POST group was significantly younger, more urban and further from diagnosis. It included more Stage III and rectal cancer patients who received more treatment. Comparing the subset of both groups (106 vs 65) who described a PCP as a main provider, the POST group demonstrated higher scores on the PCCQ (24.0 v 22.8, p=0.0065) and on two of its subscales. This finding persisted when tested for the impact of differences between the two groups in stage, site, age and treatment. The most common pattern of provider involvement in follow-up was the “FP alone,” which rose from 19% in the PRE group to 54% in the POST (p<0.0001). The proportion of participants who felt “adequately prepared” for their transfer of care was significantly increased (71 vs 91%, p=0.003). Conclusions: A formal information sharing process with CRC patients at time of transition to primary care follow-up improved their evaluation of continuity of care. Significant shifts were seen in the locus of care from oncology to primary care settings consistent with the intent of the MFAC program.
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Nuangmek, Aniroot, Suvichai Rojanasthien, Suwit Chotinun, Panuwat Yamsakul, Pakpoom Tadee, Visanu Thamlikitkul, Nattasit Tansakul, and Prapas Patchanee. "Antimicrobial Resistance in ESBL-Producing Escherichia coli Isolated from Layer and Pig Farms in Thailand." Acta Scientiae Veterinariae 46, no. 1 (May 16, 2018): 8. http://dx.doi.org/10.22456/1679-9216.81823.
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Background: Study of drug resistance of commensal bacteria in both humans and animals can determine the scale of the drug resistance problem. Usage of antimicrobials to treat infections in humans and animals has generated extensive antimicrobial pressure not only on targeted pathogens but also on commensal bacteria. Commensal Escherichia coli appears to be the major reservoir for resistant genes implicated in the transmission of genetic traits from one bacterium to another. Antimicrobial resistance in Enterobacteriaceae has increased dramatically worldwide in the last decade. An increasing number of community-onset extended-spectrum beta-lactamase (ESBL)-producing bacterial infections, especially those caused by ESBL-producing E. coli, have been reported in many countries, including Thailand. Moreover, ESBL-producing E. coli have been widely detected in food-producing animals and the environment. The increased use of ESBLs in food animals is a serious public health problem. The objective of the study was to determine the prevalence and antimicrobial resistance pattern of ESBL-producing E. coli isolated from pigs, layers, farm workers and stagnant water, in order to increase awareness about antimicrobial usage on farms and to minimize the expansion of the antimicrobial resistance phenomenon in farm settings.Materials, Methods & Results: A total of 588 samples were collected from 107 pig farms and 89 layer farms in Chiang Mai–Lamphun and Chon Buri provinces during May 2015-April 2016. Double-disk diffusion method according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) guidelines was used for detection. The results demonstrated that 36.7% (216/588) of samples were ESBL-producing E. coli-positive, including rectal swabs 74.8% (80/107), pig farm worker stool swabs 57.0% (61/107), stagnant water on pig farms 21.5% (23/107), healthy layer rectal swabs 6.7% (6/89) and layer farm worker stool swabs 51.7% (46/89). Most of the isolates were resistant against ampicillin (99.5%), followed by erythromycin (98.6%) and ceftriaxone (96.3%). All of them were classified as multidrug-resistant strains. Moreover, AMP-CRO-E-TE-C-SXT-CN was the most frequent phenotype pattern detected in animals, humans and the environment, followed by AMP-CRO-E-TE-C-SXT-NA-CN.Discussion: The present study offers clear evidence that the prevalence of ESBL-producing E. coli in healthy pigs is higher than in layers. One possible explanation is that a large amount and variety of antimicrobials are used on pig farms, resulting in a common and significant source of drug-resistant ESBL-producing E. coli. The lower incidence of ESBL-producing E. coli in samples from a pig farm environment than in samples of animal origin indicate that pigs are a reservoir of a reservoir for resistant bacteria and a source of environmental contamination. Antimicrobial resistance patterns of ESBLproducing E. coli detected in all sample types and study locations were quite similar. In almost all ESBL-producing E. coli isolates, resistance was shown against ampicillin, erythromycin, ceftriaxone, tetracycline and chloramphenicol. Moreover, multidrug resistance was found in all isolates of ESBL-producing E. coli. The differences in antimicrobial agent resistance patterns can be used to differentiate sources by employing analytical tools such as discriminant function analysis. A molecular typing protocol is recommended for use in a discriminant function analysis for pattern determination of pathogen spreading. However, genetic fingerprinting techniques for microbial source tracking are more expensive, and facilities with appropriate equipment and expertise are required.
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Fadelu, Temidayo, Fidel Sebahungu, Kevin Diasti, Cam Nguyen, Tiffany Yeh, Cyprien Shyirambere, Eugene Nkusi, et al. "Patient characteristics and outcomes of colorectal cancer (CRC) at Butaro Cancer Center of Excellence (BCCOE): Results from a retrospective cohort." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e16081-e16081. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e16081.
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e16081 Background: There are few studies on CRC in sub-Saharan Africa. BCCOE in Rwanda provides patients with CRC access to chemotherapy, surgery and radiotherapy referrals. Here, we describe patient characteristics, treatments delivered and outcomes. Methods: This retrospective observational study included 136 patients with CRC who presented between July 2012 and June 2018. We abstracted patient characteristics, diagnostic and treatment data, and outcomes from electronic and paper records. We compared baseline and treatment characteristics for colon cancer (CC) versus (vs.) rectal cancer (RC) patients. For patients treated with curative intent, we plotted Kaplan Meier estimation of disease free survival (DFS), defined as time from presentation to cancer recurrence, progression or death. Log-rank test was used to examine subgroup differences. Results: The mean age was 52.5, and 71 (52.2%) were female. 101 (74.2%) patients had RC. Compared to CC, patients with RC were older 54.5 vs. 46.9 (p = 0.0084), and more likely female 59.4 vs. 31.4 (p = 0.0043). All provinces in Rwanda were represented including 14 (10.3%) from outside Rwanda; 79 (58.1%) patients lived in rural areas. Median duration of symptoms prior to presentation was 12 months, and 57 (41.9%) had used traditional medicine prior to presentation. 72 (52.9%) patients were non-metastatic, 46 (33.8%) de novo metastatic, 4 (2.9%) recurrent, and 14 (10.2%) had indeterminate stage. Of the patients treated with curative intent, 54 (65.1%) had neoadjuvant and/or adjuvant chemotherapy, while only 34 (41.0%) had curative surgery. 40 (48.2%) patients received a permanent colostomy. 18 (27.7%) patients with RC received concurrent chemoradiation. Over the follow up period, 49 (36%) patients died or were referred for end of life care, 13 (9.3%) remain in surveillance, while 65 (47.8%) were lost to follow up. Median DFS for patients with non-metastatic disease was 22.2 months. On exploratory analyses, there were no statistically significant differences in DFS by cancer type, gender, or performance status, though these analyses were underpowered and follow-up short. Conclusions: CRC treatment requires multidisciplinary care, which is a challenge in low-resource settings. Our results highlight gaps in CRC care delivery and suboptimal patient outcomes; most striking gaps were the low rates of surgery and radiation, and high loss to follow up rates. Rigorous research is needed to understand the underlying causes, and to develop interventions to address these gaps.
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Flower, Richard. "TAMQVAM FIGMENTVM HOMINIS: AMMIANUS, CONSTANTIUS II AND THE PORTRAYAL OF IMPERIAL RITUAL." Classical Quarterly 65, no. 2 (September 2, 2015): 822–35. http://dx.doi.org/10.1017/s000983881500035x.
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Constantius, as though the Temple of Janus had been closed and all enemies had been laid low, was longing to visit Rome and, following the death of Magnentius, to hold a triumph, without a victory title and after shedding Roman blood. For he did not himself defeat any belligerent nation or learn that any had been defeated through the courage of his commanders, nor did he add anything to the empire, and in dangerous circumstances he was never seen to lead from the front, nor even to be among the front ranks. But he wanted to display an exaggeratedly long procession, standards stiff with gold and the beauty of his attendants, to a population who were living more peacefully, neither anticipating nor wishing to see this or anything like it. For perhaps he was unaware that some earlier emperors had been content with lictors in peacetime, but when the heat of battle could not allow inactivity, one of them had entrusted himself to a small fishing boat, blasted by raging gales, another had followed the example of the Decii and offered up his life in a vow for the state, and another had himself explored the enemy camp alongside the regular soldiers; that, in short, various of them had won renown for magnificent deeds, and so committed their glories to the distinguished memory of posterity. …When he was approaching the city, observing with a serene expression the respectful attendance of the Senate, and the venerable likenesses of the patrician families, he thought, not like Cineas, the legate of Pyrrhus, that a multitude of kings had been assembled together, but rather that this was the refuge of the whole world [cumque urbi propinquaret, senatus officia, reuerendasque patriciae stirpis effigies, ore sereno contemplans, non ut Cineas ille Pyrrhi legatus, in unum coactam multitudinem regum, sed asylum mundi totius adesse existimabat]. Next, when he turned his gaze to the general populace, he was astonished at the speed with which every type of men from everywhere had flowed into Rome. As though he were trying to terrify the Euphrates or the Rhine with the sight of arms, with the standards in front of him on each side, he sat alone in a golden chariot, glittering with the shimmer of many different precious stones, whose flashes seemed to produce a flickering light. After many others had preceded him, he was surrounded by dragons, woven from purple cloth and affixed to the golden, bejewelled tips of spears, open to the wind with their broad mouths and so hissing as though roused with anger, trailing the coils of their tails in the wind [eumque post antegressos multiplices alios, purpureis subtegminibus texti, circumdedere dracones, hastarum aureis gemmatisque summitatibus illigati, hiatu uasto perflabiles, et ideo uelut ira perciti sibilantes, caudarumque uolumina relinquentes in uentum]. Then there came a twin column of armed men, with shields and plumed helmets, shining with glittering light, clothed in gleaming cuirasses, with armoured horsemen, whom they call clibanarii, arranged among them, masked and protected by breastplates, encircled with iron bands, so that you might have thought them to be statues finished by the hand of Praxiteles, not men [sparsique catafracti equites, quos clibanarios dictitant, personati thoracum muniti tegminibus, et limbis ferreis cincti, ut Praxitelis manu polita crederes simulacra, non uiros]. Slender rings of metal plates, fitted to the curves of the body, clothed them, spread across all their limbs, so that, in whatever direction necessity moved their joints, their clothing moved likewise, since the joins had been made to fit so well.When he was hailed as Augustus with favourable cries, [Constantius] did not shudder at the din that thundered from hills and shores, but showed himself unmoved, as he appeared in his provinces. For, when passing through high gates, he stooped his short body, and, keeping his gaze straight, as though his neck were fixed, he turned his head neither right nor left, as though an image of a man, and he was never seen to nod when the wheel shook, or to spit or wipe or rub his face or nose, or to move his hand [nam et corpus perhumile curuabat portas ingrediens celsas, et uelut collo munito, rectam aciem luminum tendens, nec dextra uultum nec laeua flectebat, tamquam figmentum hominis, nec, cum rota concuteret, nutans, nec spuens, aut os aut nasum tergens uel fricans, manumue agitans uisus est umquam]. Although this behaviour was an affectation, it, and other aspects of his more private life, were however indications of extraordinary endurance, granted to him alone, as it was given to be supposed. This passage, which describes the aduentus of Constantius II into Rome in 357, is one of the best-known episodes in the Res Gestae of Ammianus Marcellinus. This historical work was completed by the retired military officer in around 390, with the surviving books covering the period from 353 to the aftermath of the Battle of Adrianople in 378. Unsurprisingly, this passage is also one of the most debated. Throughout his work, Ammianus regularly criticized Constantius as a weak, vicious ruler, influenced by women and, in particular, eunuchs, and so contrasted him with his cousin and successor Julian, the emperor who receives the most favourable treatment within this text. The degree and nature of criticism within this particular passage has, however, been the subject of a variety of wildly differing interpretations. It is clear that, at the outset, Ammianus is inveighing against the notion of holding a triumph for victory in a civil war, but there has been debate over whether Constantius was actually celebrating a triumph or merely the anniversary of his accession. Similarly, the description of the Senate as ‘the refuge of the whole world’ has been read in contrasting ways, being regarded as derogatory by Johannes Straub, as neutral, or even positive, by Pierre Dufraigne, and as respectful by R.C. Blockley. While this passage as a whole is generally read as an attack on Constantius for his pretentions to ill-deserved military glory, it also raises the question of whether Ammianus was also criticizing Constantius for the way in which he performed his aduentus, emphasizing his pompous and autocratic behaviour in order to contrast him with Julian, who preferred to behave more like a ciuilis princeps in public. Of course, such a reading almost inevitably produces a portrait of Ammianus as an impractically nostalgic figure, harking back to a style of rule which was anachronistic in the post-Diocletianic Later Roman Empire. In addition, Ammianus also presented Julian as performing an aduentus into Constantinople in 361, employing some phrases that were similar to those used to describe Constantius’ procession in 357. Furthermore, as John Matthews has illustrated, Ammianus’ presentations of the occasions when Julian eschewed late-antique imperial protocol are not without tinges of criticism, and his judgement on the propriety of different modes of imperial behaviour varied dependent on the context.
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Iqbal, Basit Kareem. "Religion as Critique: Islamic Critical Thinking from Mecca to the Marketplace." American Journal of Islamic Social Sciences 35, no. 3 (July 1, 2018): 93–98. http://dx.doi.org/10.35632/ajiss.v35i3.488.
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Christianity was the religion of spirit (and freedom), and critiqued Islam as a religion of flesh (and slavery); later, Christianity was the religion of reason, and critiqued Islam as the religion of fideism; later still, Christianity was the religion of the critique of religion, and critiqued Islam as the most atavistic of religions. Even now, when the West has critiqued its own Chris- tianity enough to be properly secular (because free, rational, and critical), it continues to critique Islam for being not secular enough. In contrast to Christianity or post-Christian secularism, then, and despite their best ef- forts, Islam does not know (has not learned from) critique. This sentiment is articulated at multiple registers, academic and popular and governmen- tal: Muslims are fanatical about their repressive law; they interpret things too literally; Muslims do not read their own revelation critically, let alone literature or cartoons; their sartorial practices are unreasonable; the gates of ijtihād closed in 900CE; Ghazali killed free inquiry in Islam… Such claims are ubiquitous enough to be unremarkable, and have political traction among liberals and conservatives alike. “The equation of Islam with the ab- sence of critique has a longer genealogy in Western thought,” Irfan Ahmad writes in this book, “which runs almost concurrently with Europe’s colonial expansion” (8). Luther and Renan figure in that history, as more recently do Huntington and Gellner and Rushdie and Manji.Meanwhile in the last decade an interdisciplinary conversation about the stakes, limits, complicities, and possibilities of critique has developed in the anglophone academy, a conversation of which touchstones include the polemical exchange between Saba Mahmood and Stathis Gourgouris (2008); the co-authored volume Is Critique Secular? (2009), by Talal Asad, Wendy Brown, Judith Butler, and Mahmood; journal special issues dedi- cated to the question (e.g. boundary 2 40, no. 1 [2013]); and Gourgouris’s Lessons in Secular Criticism (2013), among others. At the same time, the discipline of religious studies remains trapped in an argument over the lim- its of normative analysis and the possibility of critical knowledge.Religion as Critique: Islamic Critical Thinking from Mecca to the Mar- ketplace seeks to turn these debates on their head. Is critique secular? Decidedly not—but understanding why that is, for Ahmad, requires revising our understanding of critique itself. Instead of the object of critique, reli- gion here emerges as an agent of critique. By this account, God himself is the source of critique, and the prophets and their heirs are “critics par ex- cellence” (xiv). The book is divided into two parts bookended by a prologue and epilogue. “Formulation” comprises three chapters levying the shape of the argument. “Illustration” comprises three chapters taking up the case study of the South Asian reformer Abul-A‘la Maududi and his critics (es- pecially regarding his views on the state and on women) as well as a fourth chapter that seeks to locate critique in the space of the everyday. There are four theses to Ahmad’s argument, none of them radically original on their own but newly assembled. As spelled out in the first chap- ter (“Introduction”), the first thesis holds that the Enlightenment reconfig- uration of Christianity was in fact an ethnic project by which “Europe/the West constituted its identity in the name of reason and universalism against a series of others,” among them Islam (14). The second thesis is that no crit- ic judges by reason alone. Rather, critique is always situated, directed, and formed: it requires presuppositions and a given mode to be effective (17). The third thesis is that the Islamic tradition of critique stipulates the com- plementarity of intellect (‘aql, dimāgh) and heart (qalb, dil); this is a holistic anthropology, not a dualistic one. The fourth thesis is that critique should not be understood as the exclusive purview of intellectuals (especially when arguing about literature) or as simply a theoretical exercise. Instead, cri- tique should be approached as part of life, practiced by the literate and the illiterate alike (18).The second chapter, “Critique: Western and/or Islamic,” focuses on the first of these theses. The Enlightenment immunized the West from critique while subjecting the Rest to critique. An “anthropology of philosophy” approach can treat Kant’s transcendental idealism as a social practice and in doing so discover that philosophy is “not entirely independent” from ethnicity (37). The certainty offered by the Enlightenment project can thus be read as “a project of security with boundaries.” Ahmad briefly consid- ers the place of Islam across certain of Kant’s writings and the work of the French philosophes; he reads their efforts to “secure knowledge of humani- ty” to foreclose the possibility of “knowledge from humanity” (42), namely Europe’s others. Meanwhile, ethnographic approaches to Muslim debates shy away from according them the status of critique, but in so doing they only maintain the opposition between Western reason and Islamic unrea- son. In contrast to this view (from Kant through Foucault), Ahmad would rather locate the point of critical rupture with the past in the axial age (800-200BCE), which would include the line of prophets who reformed (critiqued) their societies for having fallen into corruption and paganism. This alternative account demonstrates that “critical inquiry presupposes a tradition,” that is, that effective critique is always immanent (58). The third chapter, “The Modes: Another Genealogy of Critique,” con- tests the reigning historiography of “critique” (tanqīd/naqd) in South Asia that restricts it to secular literary criticism. Critique (like philosophy and democracy) was not simply founded in Grecian antiquity and inherited by Europe: Ahmad “liberates” critique from its Western pedigree and so allows for his alternative genealogy, as constructed for instance through readings of Ghalib. The remainder of the chapter draws on the work of Maududi and his critics to present the mission of the prophets as critiquing to reform (iṣlāḥ) their societies. This mandate remains effective today, and Maududi and his critics articulate a typology of acceptable (tanqīd) and unacceptable (ta‘īb, tanqīṣ, tazhīk, takfīr, etc.) critiques in which the style of critique must be considered alongside its object and telos. Religion as Critique oscillates between sweeping literature reviews and close readings. Readers may find the former dizzying, especially when they lose in depth what they gain in breadth (for example, ten pages at hand from chapter 2 cite 44 different authors, some of whom are summarizing or contesting the work of a dozen other figures named but not cited di- rectly). Likewise there are moments when Ahmad’s own dogged critiques may read as tendentious. The political purchase of this book should not be understated, though the fact that Muslims criticize themselves and others should come as no surprise. Yet it is chapters 4–6 (on Maududi and his critics) which substantiate the analytic ambition of the book. They are the most developed chapters of the book and detail a set of emerging debates with a fine-grained approach sometimes found wanting elsewhere (espe- cially in the final chapter). They show how Islam as a discursive tradition is constituted through critique, and perhaps always has been: for against the disciplinary proclivities of anthropologists (who tend to emphasize discon- tinuity and rupture, allowing them to discover the modern invention of traditions), Ahmad insists on an epistemic connection among precolonial and postcolonial Islam. This connection is evident in how the theme of rupture/continuity is itself a historical topos of “Islamic critical thinking.” Chapter 4 (“The Message: A Critical Enterprise”) approaches Maududi (d. 1979) as a substantial political thinker, not simply the fundamentalist ideologue he is often considered to be. Reading across Maududi’s oeuvre, Ahmad gleans a political-economic critique of colonial-capitalist exploita- tion (95), a keen awareness of the limits of majoritarian democracy, and a warning about the dispossessive effects of minoritization. Maududi’s Isla- mism (“theodemocracy”), then, has to be understood within his broader project of the revival of religion to which tanqīd (“critique”), tajdīd (“re- newal”), and ijtihād (“understanding Islam’s universal principles to de- termine change”) were central (103). He found partial historical models for such renewal in ‘Umar b. ‘Abd al-‘Aziz, Ghazali, Ibn Taymiyya, Ahmad Sirhindi, and Shah Wali Ullah. A key element of this critique is that it does not aim to usher in a different future. Instead it inhabits a more complicated temporality: it clarifies what is already the case, as rooted in the primordial nature of humans (fiṭra), and in so doing aligns the human with the order of creation. This project entails the critique and rejection of false gods, in- cluding communism, fascism, national socialism, and capitalism (117). Chapter 5 (“The State: (In)dispensible, Desirable, Revisable?”) weaves together ethnographic and textual accounts of Maududi’s critics and de- fenders on the question of the state (the famous argument for “divine sov- ereignty”). In doing so the chapter demonstrates how the work of critique is undertaken in this Islamic tradition, where, Ahmad writes, “critique is connected to a form of life the full meaning of which is inseparable from death” (122). (This also means that at stake in critique is also the style and principles of critique.) The critics surveyed in this chapter include Manzur Nomani, Vahiduddin Khan, Abul Hasan Ali Nadvi, Amir Usmani, Sadrud- din Islahi, Akram Zurti, Rahmat Bedar, Naqi Rahman, Ijaz Akbar, and others, figures of varying renown but all of whom closely engaged, defend- ed, and contested Maududi’s work and legacy in the state politics of his Jamaat-e Islami. Chapter 6 (“The Difference: Women and In/equality”) shows how Maududi’s followers critique the “neopatriarchate” he proposes. Through such critique, Ahmad also seeks to affirm the legitimacy of a “nonpatri- archal reading of Islam” (156). If Maududi himself regarded the ḥarem as “the mightiest fortress of Islamic culture” (159)—a position which Ahmad notes is “enmeshed in the logic of colonial hegemony”—he also desired that women “form their own associations and unbiasedly critique the govern- ment” (163). Maududi’s work and legacy is thus both “disabling” and “en- abling” for women at the same time, as is borne out by tracing the critiques it subsequently faced (including by those sympathetic to his broader proj- ect). The (male) critics surveyed here include Akram Zurti, Sultan Ahmad Islahi, Abdurrahman Alkaf, and Mohammad Akram Nadwi, who seriously engaged the Quran and hadith to question Maududi’s “neopatriarchate.” They critiqued his views (e.g. that women were naturally inferior to men, or that they were unfit for political office) through alternative readings of Islamic history and theology. Chapter 7 (“The Mundane: Critique as Social-Cultural Practice”) seeks to locate critique at “the center of life for everyone, including ordinary sub- jects with no educational degrees” (179). Ahmad writes at length about Khan Abdul Ghaffar Khan (d. 1988), the anticolonial activist who led a massive movement against colonial domination, and whose following faced British brutality with nonviolence. The Khudai Khidmatgār movement he built was “a movement of critique” (195), Ahmad writes, composed of or- dinary men and women, peasants and the unlettered. The brief remainder of the chapter suggests that the proverbs which punctuate everyday life (for example, in the trope of the greedy mullah) also act as critiques. By the end of Religion as Critique it is difficult not to see critique na- scent in every declaration or action. This deflates the analytic power of the term—but perhaps that is one unstated aim of the project, to reveal critique as simply a part of life. Certainly the book displaces the exceptional West- ern claim to critique. Yet this trope of exposure—anthropology as cultural critique, the ethnographer’s gaze turned inward—also raises questions of its own. In this case, the paradigmatic account of critique (Western, sec- ular) has been exposed as actually being provincial. But the means of this exposure have not come from the alternative tradition of critique Ahmad elaborates. That is, Ahmad is not himself articulating an Islamic critique of Western critique. (Maududi serves as an “illustration” of Ahmad’s ar- gument; Maududi does not provide the argument itself.) In the first chap- ters (“Formulation”) he cites a wide literature that practices historicism, genealogy, archeology, and deconstruction in order to temper the universal claims of Western supremacists. The status of these latter critical practices however is not explored, as to whether they are in themselves sufficient to provincialize or at least de-weaponize Western critique. Put more directly: is there is a third language (of political anthropology, for example) by which Ahmad analytically mediates the encounter between rival traditions of cri- tique? And if there is such a language, and if it is historically, structurally, and institutionally related to one of the critical traditions it is mediating, then what is the status of the non-Western “illustration”? The aim of this revision of critique, Ahmad writes, is “genuinely dem- ocratic dialogue with different traditions” (xii). As much is signalled in its citational practices, which (for example) reference Talal Asad and Viveiros de Castro together in calling for “robust comparison” (14) between West- ern and Islamic notions of critique, and reference Maududi and Koselleck together in interpreting critique to be about judgment (203). No matter that Asad and de Castro or Maududi and Koselleck mean different things when using the same words; these citations express Ahmad’s commitment to a dialogic (rather than dialectical) mode in engaging differences. Yet because Ahmad does not himself explore what is variously entailed by “comparison” or “judgment” in these moments, such citations remain as- sertions gesturing to a dialogue to come. In this sense Religion as Critique is a thoroughly optimistic book. Whether such optimism is warranted might call for a third part to follow “Formulation” and “Illustration”: “Reckoning.”
Basit Kareem IqbalPhD candidate, Department of Anthropologyand Program in Critical TheoryUniversity of California, Berkeley
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Arias Torre, Ana. "Toponimia de Ticapampa." Boletín de la Academia Peruana de la Lengua, June 30, 2009, 81–108. http://dx.doi.org/10.46744/200901.004.
Full textAbstract:
Este trabajo es un estudio sincrónico de un corpus toponímico de más de cien entradas, que tiene como finalidad principal describir los procesos lingüísticos en la formación de nombres de lugar. Los topónimos como fuente de información léxica directa son testigos del cambio lingüístico de una lengua. El corpus de trabajo se ha extraído del pueblo de Ticapampa, ubicado al sur de la provincia de Recuay en el departamento de Ancash. En la estructura de los topónimos se encuentran operando procesos fonológicos, de asimilación, debilitamiento y monoptongación; procesos morfológicos, de nominalización verbal y derivación nominal; y en el ámbito de la frase, procesos de lexicalización. Aquí sólo revisaremos estos últimos y algunos aspectos semánticos debido a que son los puntos más pertinentes para tocar en este artículo.
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Arias Torre, Ana. "Toponimia de Ticapampa." Boletín de la Academia Peruana de la Lengua, June 30, 2009, 81–108. http://dx.doi.org/10.46744/bapl.200901.004.
Full textAbstract:
Este trabajo es un estudio sincrónico de un corpus toponímico de más de cien entradas, que tiene como finalidad principal describir los procesos lingüísticos en la formación de nombres de lugar. Los topónimos como fuente de información léxica directa son testigos del cambio lingüístico de una lengua. El corpus de trabajo se ha extraído del pueblo de Ticapampa, ubicado al sur de la provincia de Recuay en el departamento de Ancash. En la estructura de los topónimos se encuentran operando procesos fonológicos, de asimilación, debilitamiento y monoptongación; procesos morfológicos, de nominalización verbal y derivación nominal; y en el ámbito de la frase, procesos de lexicalización. Aquí sólo revisaremos estos últimos y algunos aspectos semánticos debido a que son los puntos más pertinentes para tocar en este artículo.
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Santiago Martel, Alexzander, Edwin Loarte Cadenas, and Ricardo Villanueva Ramírez. "Monitoreo de la dinámica del glaciar Pastoruri empleando tecnología RPA." Revista de Glaciares y Ecosistemas de Montaña, no. 2 (June 2017). http://dx.doi.org/10.36580/rgem.i2.23-30.
Full textAbstract:
En el estudio de investigación se empleó la tecnología RPA (remotely piloted aircraft), realizando dos campañas de vuelo, para obtener fotografías de un área puntual de la superficie del glaciar Pastoruri, ubicado en la Cordillera Blanca, Distrito de Cátac, Provincia de Recuay, Departamento de Ancash. En este proceso se capturaron 753 fotografías para el mes de julio y 892 para agosto de 2016. Para mejorar el nivel de posicionamiento de la información, se colectaron seis puntos de control empleando GPS sub-métrico. En base a procesamiento en gabinete se obtuvieron productos de ortofotos y modelo digital de superficie con una resolución espacial de 0.05 m. Para obtener los productos mencionados, se empleó softwares de fotogrametría, SIG y teledetección. De los resultados obtenidos, podemos apreciar variaciones drásticas en cuanto al retroceso de los frentes y pérdida del área glaciar. Para el análisis se tomaron tres sectores del frente glaciar: Zona 1 ubicada al oeste, Zona 2 en el este y Zona 3 en la parte central, la cual será dividida en tres sectores (oeste, central y este) para el mejor análisis. Todas las zonas se encuentran adyacentes a la laguna en formación, a la que denominaremos Pastoruri. En el análisis de los frentes, la mayor variación se presentó en la Zona 1 con un máximo retroceso de 10 m, y el menor retroceso en la zona 2 con un retroceso máximo de 2.2 m. La mayor formación de grietas se aprecia en el segundo mes de análisis, encontrándose una grieta con un ancho máximo de 22 m y una longitud máxima de 59 m.
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Le, Quynh, Lorraine Shack, Adam Elwi, Francesca Coutinho, Ryan Rochon, Todd Mcmullen, and Donald Buie. "Data Linkage for Optimizing Rectal Cancer Care in Alberta." International Journal of Population Data Science 3, no. 4 (August 23, 2018). http://dx.doi.org/10.23889/ijpds.v3i4.657.
Full textAbstract:
IntroductionDespite good overall care in Alberta Health Services the local recurrence rates are higher than what is accepted as standard of care for rectal cancer treatment. There are variations in pre-operative staging, application of best surgical techniques and pathological grading, use of neoadjuvant and adjuvant therapies, and in clinical reporting.
Objectives and ApproachWe aimed at reducing the variations through the design and implementation of a provincial clinical pathway for rectal cancer by 2018. Our approaches included: 1) multidisciplinary tumor board consultation together with physician education sessions in reviewing standards of care and quality metrics; 2) data linkage and analysis based on chart reviews and extraction of data from Alberta Cancer Registry; and 3) production of provincial reports and individual feedbacks to physicians. CancerControl Alberta and Cancer Strategic Clinical Network collaborated in the linkage and analysis of data as well as mobilization oncology physicians to the initiative.
ResultsA review of a set of metrics for producing individual and provincial feedback reports to rectal cancer physicians. The set has 24 key quality metrics includes five, four, eight, and six metrics for radiologists, pathologists, oncologists, and surgeons respectively. Thirty-two surgeons have received individual physician feedback reports. Feedback reports for radiologist, pathologist and oncologist are being finalized with input from key opinion leaders in each physician group. Key impacts to the quality of rectal cancer diagnosis, treatment, and care between 2013 and 2015 include increases in use of rectal cancer pre-operative MRIs for curative resections (+23%), completeness of synoptic MRI reports for pre-operative MRIs (+21%), grade 3 TME of curative resections (+4%), and pathologic reporting of TME assessments (+2%).
Conclusion/ImplicationsPhysician feedback report system will enable the Alberta rectal cancer community to sustain the results and address strategies to continuously enhance the quality of rectal cancer care and survival. We recommend ongoing annual dissemination of feedback reports to support continuous improvement of rectal cancer care.
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Moya, María E., Alberto A. Galussi, Luciano J. Casermeiro, and María S. Fontana. "Anatomía foliar y caulinar de Chascolytrum subaristatum (Poaceae, Pooideae, Poeae)." Lilloa, December 7, 2019, 47–58. http://dx.doi.org/10.30550/j.lil/2019.56.2/4.
Full textAbstract:
El objetivo del presente estudio fue describir la anatomía foliar y caulinar de Chascolytrum subaristatum (Poaceae) presente en áreas naturales de la provincia de Entre Ríos. Se realizaron transcortes y preparados epidérmicos de la parte media de hojas de innovaciones estériles y transcortes de tallo de innovaciones reproductivas. Las observaciones realizadas a nivel epidérmico manifestaron que Chascolytrum subaristatum es de tipo festucoide presentando cuerpos silícicos costales redondeados o alargados con paredes levemente onduladas, células epidérmicas más largas que anchas, con paredes anticlinales sinuosas y rectas, estomas de forma ovoide, células subsidiarias oblongas, tricomas tipo gancho. En transcorte la estructura anatómica foliar presenta un patrón anatómico de gramíneas C 3 , sin embargo, Chascolytrum presenta células de parénquima incoloro en el mesofilo, no descriptas para el tipo festucoideo.Las paredes periclinales externas de las células epidérmicas de las cara adaxial y abaxial se encuentran impregnadas de lignina. Los tallos presentaron sección circular. Se observó una epidermis uniestratificada, sin pelos y con cutícula gruesa y un anillo esclerenquimático subepidérmico. Los haces vasculares colaterales cerrados se disponen en 3-4 anillos concéntricos, con médula parenquimática o médula hueca.
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Mvumbi, Patrick M., Jeanine Musau, Ousmane Faye, Hyppolite Situakibanza, and Emile Okitolonda. "Adherence to the referral advice after introduction of rectal artesunate for pre-referral treatment of severe malaria at the community level: a noninferiority trial in the Democratic Republic of the Congo." Malaria Journal 18, no. 1 (December 2019). http://dx.doi.org/10.1186/s12936-019-3074-6.
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Abstract Background The Democratic Republic of the Congo adopted the strategy of using, at the community level, a dose of rectal artesunate as a pre-referral treatment for severe malaria amongst children under 5 years who could not quickly reach a health care facility and take oral medication. However, the adherence to referral advice after the integration of this strategy and the acceptability of the strategy were unknown. Methods To assess adherence by the mothers/caretakers of children under 5 years to referral advice provided by the community health workers after pre-referral treatment of severe malaria with rectal artesunate, the authors conducted a noninferiority community trial with a pre- and post-intervention design in 63 (pre-intervention) and 51 (post-intervention) community care sites in 4 provinces (Kasaï-Oriental, Kasaï-Central, Lomami, Lualaba) from August 2014 through June 2016. The pre- and post-intervention surveys targets 387 mothers of children under 5 years and 63 community health workers and 346 mothers and 41 community health workers, respectively. A 15% margin was considered for noninferiority analyses due to the expected decrease in adherence to referral advice after the introduction of the new intervention. Results The mothers acknowledged that the rectal route was often used (60.7%), and medicines given rectally were considered more effective (63.6%) and easy to administer (69.7%). The acceptability of pre-referral rectal artesunate was relatively high: 79.4% (95% CI 75.4–83.3) among mothers, 90.3% (95% CI 82.3–96.8) among community health workers, and 97.8% (95% CI 93.3–100) among nurses. Adherence to referral advice at post-intervention [84.3% (95% CI 80.6–88.1)] was non-inferior to pre-intervention adherence [94.1% (95% CI 91.7–96.4)]. Conclusions The integration of pre-referral rectal artesunate for severe malaria into the community care site in the DR Congo is feasible and acceptable. It positively affected adherence to referral advice. However, more health education is needed for parents of children under 5 years and community health workers.
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Tuat, C. V., P. T. Hue, N. T. P. Loan, N. T. Thuy, L. T. Hue, V. N. Giang, Vera I. Erickson, and Pawin Padungtod. "Antimicrobial Resistance Pilot Surveillance of Pigs and Chickens in Vietnam, 2017–2019." Frontiers in Veterinary Science 8 (July 8, 2021). http://dx.doi.org/10.3389/fvets.2021.618497.
Full textAbstract:
Antimicrobial use (AMU) and antimicrobial resistance (AMR) are a growing public health and economic threat in Vietnam. We conducted a pilot surveillance programme in five provinces of Vietnam, two in the south and three in the north, to identify antimicrobial resistance (AMR) in rectal swab samples from pigs and fecal samples from chickens at slaughter points during three different points in time from 2017 to 2019. Escherichia coli (E. coli) and non-typhoidal Salmonella (NTS) isolates were tested for antimicrobial susceptibility using disk diffusion assay for 19 antimicrobial agents belonging to nine antimicrobial classes and Etest for colistin (polymyxin). Almost all E. coli (99%; 1029/1042) and NTS (96%; 208/216) isolates were resistant to at least one antimicrobial agent; 94% (981/1042) of E. coli and 89% (193/216) of NTS isolates were multidrug-resistant (MDR). Higher proportions of E. coli and NTS isolated from chickens were resistant to all antimicrobial classes than those isolates from pigs. There was a significantly higher proportion of MDR NTS isolates from the southern provinces of Ho Chi Minh City and Long An (p = 0.008). Although there were increasing trends of NTS in proportion of resistance to fluoroquinolone over the three surveillance rounds, there was a significant decreasing trend of NTS in proportion of resistance to polymyxin (p = 0.002). It is important to establish an annual AMR surveillance program for livestock in Vietnam to assess the impact of interventions, observe trends and drive decision making that ultimately contributes to reducing AMR public health threat.
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Hosseinvand, M., A. Eskandari, S. Ganjkhanloo, R. Ghaderi, P. Castillo, and J. E. Palomares-Rius. "Taxonomical considerations and molecular phylogeny of the closely related genera Bitylenchus, Sauertylenchus and Tylenchorhynchus (Nematoda: Telotylenchinae), with one new and four known species from Iran." Journal of Helminthology 94 (2020). http://dx.doi.org/10.1017/s0022149x20000784.
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Abstract During several nematological surveys in cultivated and natural habitats in Khuzestan and Zanjan provinces of Iran, a new species, Bitylenchus parvulus n. sp., two new records for Iran – namely, Tylenchorhynchus agri and Tylenchorhynchus graciliformis – and a population of Bitylenchus parvus and one of Sauertylenchus maximus were recovered and characterized based upon morphological and molecular approaches. The new species is characterized by lip region with five to seven annuli, stylet 17.7 (17.0–18.5) μm long, sub-cylindrical tail narrowing abruptly near terminus giving a bluntly digitate shape to the tail tip, cuticle near anterior part of vulva wrinkled and post-rectal sac occupies whole of tail cavity. The phylogenetic analyses were carried out using molecular data from D2–D3 expansion segments of large ribosomal subunit (28S rRNA) for all studied species and the partial small ribosomal subunit (18S rRNA) for the new species. The representatives of Bitylenchus and Sauertylenchus formed distinct clades from Tylenchorhynchus members, supporting the hypothesis in which Bitylenchus and Sauertylenchus could be considered as valid genera, but rejecting the ‘large-genus’ concept for Tylenchorhynchus. Also, Sauertylenchus ibericus was proposed as a junior synonym of S. maximus based on the results from morphological and phylogenetic analysis. Furthermore, an identification key for all known species included in the three genera Bitylenchus, Tylenchorhynchus and Sauertylenchus is presented herein. The number of transverse annuli on the lip region and presence/absence of post-rectal sac were considered as the main diagnostic characters for classifying the species into seven groups, and other morphological and morphometric characters were subsequently used for distinguishing species in each group.