Larssonabbott4632
Racial disparities in care and outcome have been demonstrated for several cancers, but it is not clear that a similar discrepancy exists for pancreatic cancer. Furthermore, there are limited data describing the pancreatic cancer experience of Pacific Islanders. The primary objective of this study was to analyze the clinical characteristics, treatment, and outcomes of Pacific Islander patients with pancreatic cancer.
We obtained data for a consecutive sample of pancreatic adenocarcinoma patients who presented to the largest hospital in Hawaii from 1 January 2000, through 31 December 2019. Analyses were performed for the entire population and separately for patients who had their cancer resected. Overall survival was calculated by the Kaplan-Meier method. Cox proportional hazards regression models were constructed to determine the prognostic capacity of clinical and pathologic factors.
A total of 1040 patients were included in the final analysis. Pacific islanders presented at a significantly younger age compared to Whites or Asians and had the highest Medicaid rate. There were no statistically significant racial differences in stage at presentation or treatments. We did not demonstrate an association between race and survival on univariate analysis, nor after adjusting for demographic and tumor factors. Age, stage, and treatment were significantly associated with survival for both univariate and multivariate analyses.
We did not demonstrate disparate outcomes among Pacific Islanders with pancreatic cancer. This is likely due in part to the absence of a screening test and the notable poor prognosis of pancreatic adenocarcinoma. Furthermore, equity in treatment may have contributed to racial parity in survival.
We did not demonstrate disparate outcomes among Pacific Islanders with pancreatic cancer. This is likely due in part to the absence of a screening test and the notable poor prognosis of pancreatic adenocarcinoma. Furthermore, equity in treatment may have contributed to racial parity in survival.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. NAFLD is associated with dyslipidemia, and cardiovascular mortality remains the leading cause of death. While statins are the first-line therapy in hyperlipidemia, their utilization has been suboptimal. Hence, we examined the use of statins in NAFLD and mortality.
Analysis was performed with the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. Longitudinal outcomes were assessed with survival analysis.
Of 12,538 NAFLD patients, 6,452 were indicated for hyperlipidemia treatment. Statin usage was highest among high-risk individuals (44.28%) and lowest among low-risk individuals (8.48%). The risk of overall (HR 0.87, CI 0.76 to 0.99,
=0.04) and cancer-related (SHR 0.73, CI 0.54 to 0.99,
=0.04) mortality was significantly lower in NAFLD patients with statins. There was no significant decrease in cardiovascular-related mortality.
Over concerns of hepatotoxicity and lack of evidence in reducing mortality events, statins remain underutilized in NAFLD. However, statin use was associated with a significant reduction in overall and cancer-related mortality. The lack of reduction in cardiovascular disease mortality is likely a selection bias of patients, where individuals with higher risk are more likely to receive treatment.
Over concerns of hepatotoxicity and lack of evidence in reducing mortality events, statins remain underutilized in NAFLD. However, statin use was associated with a significant reduction in overall and cancer-related mortality. The lack of reduction in cardiovascular disease mortality is likely a selection bias of patients, where individuals with higher risk are more likely to receive treatment.
This paper proposes a novel, trauma-informed, conceptual model of care for Post-Acute Sequelae of COVID-19 illness (PASC).
This paper describes essential elements, linkages and dimensions of the model that affect PASC patient experiences and the potential impact of trauma-informed care on outcomes.
PASC is a consequence of the global pandemic, and a new disease of which little is known. Our model was derived from the limited available studies, expert clinical experience specific to PASC survivors and publicly available social media narratives authored by PASC survivors.
The model provides a critical and novel framework for the understanding and care of persons affected by PASC. This model is aimed at the provision of nursing care, with the intention of reducing the traumatic impacts of the uncertain course of this disease, a lack of defined treatment options and difficulties in seeking care. The use of a trauma-informed care approach to PASC patients can enhance nurses' ability to remediate and amelioof health. The model particularly seeks to suggest means of supporting patients who have already experienced a life-threatening illness and are now coping with its long-term impact. Since the scope of this impact is not yet defined, trauma-informed care for PASC patients is likely to reduce the overall health and systems burdens of this complex condition.This study aims to evaluate the perception of safety and security in informal transport in Tunisia. This research employs a questionnaire-based survey of passengers and drivers of informal transport in Tunisia. Interviews were conducted with 215 informal transport Tunisian drivers and 255 Tunisian passengers, all above 18 years of age. Analyses have been made by employing several multivariate statistical analyses. Results showed that personal attributes of informal transport drivers influence their decision to violate traffic laws and to display risky driving behaviors. It was also found that driver skills, personality, education, experience, quality of the car, and information about the road congestion are the main factors influencing safety and security in informal transport. Non-compliance with the law by informal drivers leads to aberrant habits and behaviors as well as to a driving style beyond recognized standards. Informal drivers, police and local authorities are the parties involved in the low safety and security aspects of informal transport. It can be concluded that this study underlines that improving safety and security in informal transport cannot be achieved without improving awareness of the role of traffic laws and the need for their enforcement.
Research reported prevalence of post-traumatic stress disorder (PTSD) among prisoners varies between countries, with most studies based on Western samples. The trajectory of symptoms has also been controversial. Trauma can affect prisoners' emotions and their emotional regulation tends to be maladaptive.
To examine changes in PTSD and psychiatric comorbidity among prisoners in China over time and to determine whether anger and self-concealment predicts later distress.
In a longitudinal, prospective study, sentenced men in one prison in China were asked to complete a demographic page and several self-rating scales the Post-traumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the Clinical Anger Scale and the Self-Concealment Scale at baseline and at 6 and 12months after the initial assessment.
More than half of the 496 participating men were diagnosed with PTSD. For those completing the scales at each evaluation, PTSD-DS scores were significantly lower at baseline than at the 6-month yles is likely to help predict disorder trajectory and inform interventions. Early signs of anger were indicative of the chronic severity of trauma reactions, while the intention to hide distress was related to other later mental health problems.Entropy is the measure of the amount of energy in any physical system that is not accessible for the useful work, which causes a decrease in a system's thermodynamic efficiency. The idea of entropy generation analysis plays a vital role in characterizing the evolution of thermal processes and minimizing the impending loss of available mechanical power in thermo-fluid systems from an analytical perspective. It has a wide range of applications in biological, information, and engineering systems, such as transportation, telecommunication, and rate processes. The analysis of the entropy generation of axisymmetric magnetohydrodynamic hybrid nanofluid (SiO2-MoS2)/water flow induced by rotating and stretching cylinder in the presence of heat radiation, ohmic heating, and the magnetic field is focus of this study. Thermal energy transport of hybrid nanofluids is performed by applying the Maxwell model. Heat transport is carried out by using convective boundary condition. The dimensionless ordinary differential equations are acquired by similarity transformations. The numerical solution for these differential equations is obtained by the bvp4c program in MATLAB. ND646 A comparison between nanofluid and hybrid nanofluid is made for flow field, temperature, and entropy generation. Comparison of nanofluid flow with hybrid nanofluid flow exhibits a higher rate of heat transmission, while entropy generation exhibits the opposite behavior. It is observed that the flow and heat distribution increase as the solid volume fraction's value grows. An increase in entropy is indicated by augmentation in the Brinkman number and temperature ratio parameter, but the Bejan number shows a declining trend. Furthermore, outcomes of the Nusselt number for hybrid nanofluid and nanofluid are calculated for various parameters. It is noticed that the Nusselt number is reduced for enlarging the magnetic field and Eckert number. The axial and azimuthal wall stress parameters are declined by augmenting the Reynolds number.
Electrochemotherapy (ECT) is an established treatment for primary and secondary cutaneous tumours. The method combines chemotherapy with electroporation, thus increasing the cytotoxic effect of the chemotherapeutic drug. Bleomycin is the drug of choice for ECT, as it is already well established as a treatment for several cancer types and has the largest increase in efficacy after electroporation, enhancing the cytotoxic effect several hundred fold. The response rates of ECT have over the past 30 years been high and consistent. Case based reports point out that the efficacy possibly can be maintained even when the dose of bleomycin is reduced. Consequently in 2018, studies began investigating reducing the bleomycin dose.
The purpose of this review is to summarise all data published using intravenous bleomycin for cutaneous malignancies and is to our knowledge the first review to examine the use of a reduced bleomycin dose in ECT.
This study is a systematic review. Fifty-five clinical studies investigating ECT with intravenous bleomycin for patients with cutaneous malignancies were included.
Studies published from 1993 to 2021 investigating the effect of ECT include 3729 patients and indicate a consistent and high response with a mean objective response rate (ORR) of 81.5%. Interestingly, studies using lower doses of bleomycin observe a similar ORR (85.5%), opening the possibility that a lower dose may not be inferior.
This study gives an overview of published studies on ECT with intravenous bleomycin for patients with cutaneous malignancies, including the use of a reduced bleomycin dose, as preparation for a randomised study.
This study gives an overview of published studies on ECT with intravenous bleomycin for patients with cutaneous malignancies, including the use of a reduced bleomycin dose, as preparation for a randomised study.
