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Reproductive coercion (RC), or partner interference in reproductive decisions, limits women's autonomy. Little is known about RC behaviors and measurement in low- and middle-income countries (LMICs). In this mixed-methods study, we examined the transferability of the US-developed RC Scale to the Kenyan context. Through community-based sampling, recent intimate partner violence (IPV) survivors were recruited from Nairobi's informal settlements. We conducted quantitative analyses (n = 327) to assess the transferability of RC measures via exploratory factor analysis and used descriptive statistics to examine prevalence and continuous metrics. We conducted in-depth interviews (IDIs; n = 30) to contextualize results. Psychometric analyses indicated a two-factor solution comprising pregnancy coercion and condom manipulation (alpha = 0.86). Eighty-two percent of IPV survivors reported experiencing RC (pregnancy coercion = 76.6 percent; condom manipulation = 59.5 percent). IDIs highlighted women's multiple, severe RC experiences; experiences described in IDIs were largely consistent with quantitative findings. We found the RC Scale was transferable to this LMIC context, where IPV survivors face prevalent, severe RC and would benefit from linkage to woman-centered support services.

Low grade serous ovarian cancer (LGSOC) accounts for 10% of ovarian cancer cases and is characterised by an early age of onset and an indolent disease course. In contrast to high grade serous ovarian cancer (HGSOC), LGSOC is relatively resistant to cytotoxic chemotherapy and so aggressive surgery is preferred, especially at first presentation. Bevacizumab is effective in advanced ovarian cancer, and several singleinstitution studies have reported activity in patients with recurrent LGSOC. Bevacizumab is contraindicated in patients with extensive malignant bowel involvement due to the risk of perforation, which can be fatal. We present two patients with advanced LGSOC and extensive bowel serosal disease who safely received combination chemotherapy and bevacizumab in the first line setting and demonstrate that surgery was specifically facilitated by the bevacizumab component of this regimen.

Intimate partner violence (IPV) and sexual violence (SV) are drivers of women’s morbidity and mortality yet remain among the most underreported crimes in the United States. Understanding IPV/SV survivors’ justice preferences and justice definitions can strengthen violence prevention and response systems. In-depth interviews were conducted with women who experienced past-year IPV ( n = 26), to explore their justice preferences and recommendations. Primary themes included accountability, safety, and rehabilitation, with examples within and outside the current justice system, and across restorative and retributive justice frameworks. Women sought accountability through a variety of means. Retributive approaches like incarceration offered accountability as well as fleeting safety, but were critically limited in addressing the root causes of violence and, in some cases, were felt to exacerbate the problem. Women’s expressed needs and preferences centered on restorative aspects of justice, including perpetrator’s acknowledgment of harm, achieving physical safety and stability, and perpetrator rehabilitation through counseling. Paradoxically, women’s safety-related justice goals both encouraged and discouraged their engagement in the formal justice system. The discordance between women’s justice preferences and their perceptions and experiences within the current justice system illustrate complex and difficult trade-offs faced by survivors in achieving physical, social, and economic safety. Moreover, they likely contribute to the low levels of IPV/SV reporting to police. Women’s goals were aligned with restorative justice principles, illustrating the value of this approach. In an era of unprecedented dialogue on justice reform, results provide direction for integrating restorative justice practices to strengthen the justice response to violence against women.

Intimate partner violence (IPV) harms women physically, sexually, and psychologically. Safety strategies, or harm reduction techniques implemented by women undergoing recurrent violence, may help mitigate the negative health, economic, and social consequences of IPV. This study aimed to understand recommended and utilized safety strategies among three urban informal settlements in Nairobi, Kenya. Semi-structured key informant discussions (KIDs; n = 18) with community-based service providers and focus group discussions (FGDs; n = 49) with IPV survivors were conducted. All interviews were audio-recorded, transcribed, and translated verbatim from Swahili to English. Inductive thematic analysis was used to structure codes. Convergence matrices were used to analyze emergent strategies by data source (service providers vs. IPV survivors). Women preferred safety strategies that they could implement unassisted as first line of harm reduction. Strategies included removing stressors, proactive communication, avoidance behaviors, sexual and reproductive health (SRH), economic, leaving partner for safety, child safety, and securing personal property. Strategies recommended by service providers and utilized by IPV survivors differed, with clear divergence indicated for leaving the abusive relationship, SRH, and personal property strategies. Innovative strategies emerged from IPV survivors for safeguarding property. Similar to upper-income and other low and middle-income contexts, women experiencing IPV in urban informal settlements of Nairobi actively engage in behaviors to maximize safety and reduce harm to themselves and their families. Integration of strategies known to be helpful to women in these communities into community-based prevention and response is strongly encouraged. Increased synergy between recommended and implemented safety strategies can enhance programming and response efforts.

BACKGROUND: Whole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer.METHODS: The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer. Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or polyp cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs), and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN43958015, and is complete.FINDINGS: Between March 26, 2013, and Aug 19, 2016, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial; 68 (23%) had metastasis at baseline. Pathway sensitivity was 67% (95% CI 56 to 78) for WB-MRI and 63% (51 to 74) for standard pathways, a difference in sensitivity of 4% (-5 to 13, p=0·51). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (95% [95% CI 92-97]) and standard pathways (93% [90-96], p=0·48). Agreement with the multidisciplinary team's final treatment decision was 96% for WB-MRI and 95% for the standard pathway. Time to complete staging was shorter for WB-MRI (median, 8 days [IQR 6-9]) than for the standard pathway (13 days [11-15]); a 5-day (3-7) difference. WB-MRI required fewer tests (median, one [95% CI 1 to 1]) than did standard pathways (two [2 to 2]), a difference of one (1 to 1). Mean per-patient staging costs were £216 (95% CI 211-221) for WB-MRI and £285 (260-310) for standard pathways.INTERPRETATION: WB-MRI staging pathways have similar accuracy to standard pathways and reduce the number of tests needed, staging time, and cost.FUNDING: UK National Institute for Health Research.

Spot cooling is the process of directing a stream of cool air into a designated equipment or a group of people. Using Air as a natural refrigerant in the Spot cooling application brings in fresh air into the building and cools the area. The method of cooling are many, but sustainability is the biggest concern of this industry. The available refrigerants in the market are either effecting ODP (Ozone Depletion Potential) or GWP (Global Warming Potential). The only way out is to introduce sustainable and natural refrigerants. The Hypothesis which is brought into this research is to study the different types of spot cooling techniques available in the industry and challenge it with natural Air as a refrigerant. Sustainability is a paramount importance of our existence. This paper brings in the aspect of using natural refrigerants in comparison with currently used Freon’s. This paper tries to introduce spot cooling comparison for basic industrial application and warehouse. Usually in the industry machinist and some times even the machine is not cooled for different reasons. If the cooling is provided both the machinist and machine will have better productivity and performance output. The paper puts light on different ways of spot cooling and the parameters important of the application. Best Worst Method has been applied using industrial expert opinion was taken into consideration. The results were a well-defined application for industrial use for cooling machine is established. Which can act as reference for other researchers to follow. All industrial facilities, warehouses and areas where production work takes place can apply the result of this research paper.

Face identification is the most active area of research in computer vision and biometric authentication. Various face identification methods are developed over the time, still, numerous facial appearances are needed to cope with such as facial expression, pose, and illumination variation. Moreover, faces captured in unrestrained situations also impose immense concern in designing effective face identification methods. It is desirable to extract robust local descriptive features to effectively characterize such facial variations both in unrestrained and restrained situations. This chapter discusses such a face identification method that incorporate a popular local descriptor such as local binary patterns (LBP) based on the improved directional wavelet transform (IDW) method to extract facial features. This designed method is applied to complex face databases such as CASIA-WebFace and LFW which consists of a large number of face images collected under an unrestrained environment with extreme facial variations in expression, pose, and illumination. Experiments and comparison with various methods which include not only the local descriptive methods but also local descriptive-based multiresolution analysis (MRA) based methods demonstrate the efficacy of the LBP-based IDW method.

Subcutaneous metastases at presentation in cervical cancer are rare and they are associated with ominous prognosis. In this literature review, we present a case of skin metastasis and systematically review the current literature with the aim to discuss trends, treatment and survival of the reported cases.

Primary malignant tumours of the adrenal gland are rare and present a diagnostic challenge. The adrenal glands are small paired endocrine organs consisting of a medial and lateral limb, body, and apex which lie in the suprarenal space. In adults, 90% of the gland is composed of an outer cortex derived from the mesoderm, and the remainder comprises an inner medulla derived from the neural crest ectoderm. The cortex and medulla are structurally and functionally very different and give rise to different primary malignant tumours. The majority of adrenocortical tumours are benign and non-functioning (1). Adrenocortical carcinomas (ACCs) arise from the cortex whilst malignant pheochromocytomas, ganglioneuroblastomas, neuroblastomas, and other neuroendocrine malignancies arise from the medulla. Other exceptionally rare malignancies include primary adrenal lymphoma, de-differentiated liposarcoma, epithelioid angiosarcoma, and leiomyosarcoma (2).

IntroductionIntimate partner violence (IPV) threatens women’s health and safety globally, yet services remain underdeveloped and inaccessible. Technology-based resources exist, however, few have been adapted and tested in low-resource settings. We evaluate the efficacy of a community-partnered technology solution: culturally and linguistically adapted version of the myPlan app, a tailored safety decision-making and planning intervention, administrated by trained lay professionals.MethodsThis randomised, controlled, participant-blinded superiority trial compares safety-related outcomes at baseline, immediate post intervention and 3-month follow-up among women at risk of and experiencing IPV in Nairobi, Kenya. Women were randomised (1:1 ratio) to: (1) myPlan Kenya (intervention); or (2) standard IPV referrals (control). Primary outcomes were safety preparedness, safety behaviour and IPV; secondary outcomes include resilience, mental health, service utilisation and self-blame.ResultsBetween April 2018 and October 2018, 352 participants (n=177 intervention, n=175 control) were enrolled and randomly assigned; 312 (88.6%, n=157 intervention, n=155 control) were retained at 3 months. Intervention participants demonstrated immediate postintervention improvement in safety preparedness relative to control participants (p=0.001). At 3 months, intervention participants reported increased helpfulness of safety strategies used relative to control participants (p=0.004); IPV reduced in both groups. Among women reporting the highest level of IPV severity, intervention participants had significant increase in resilience (pConclusionsFacilitated delivery of a technology-based safety intervention appropriately adapted to the context demonstrates promise in improving women’s IPV-related health and safety in a low-resource, urban setting.Trial registration numberPan African Clinical Trial Registry (PACTR201804003321122).

BackgroundIntimate partner violence (IPV) is a leading threat to women’s health and safety globally. Women in abusive relationships make critical decisions about safety and harm reduction while weighing multiple competing priorities, such as safety of children, housing and employment. In many low- and middle-income countries (LMIC), IPV prevention and response services are limited and women lack access to safety planning resources. In high-resource settings, an interactive safety decision aid app (myPlan) has been found valuable in reducing decisional conflict and empowering women to take action in accordance with their safety priorities. This paper describes 1) the community-participatory formative process used to adapt the myPlan app content, interface, and implementation for the Kenya context, and 2) the randomized clinical trial study protocol for efficacy evaluation of myPlan Kenya.MethodsA community-participatory formative process engaged service providers and stakeholders, as well as IPV survivors for adaptation, followed by an in-depth pilot and final refinements. A randomized clinical trial design will then be used to determine efficacy of the myPlan Kenya app compared to standard care among women reporting IPV or fear of partner and living in an urban settlement. myPlan Kenya app provides and solicits information on a) relationship health; b) safety priorities; and c) severity of relationship violence. Based on the woman’s inputs, the evidence-based algorithm developed for myPlan Kenya generates a tailored safety plan. Outcome measures are assessed at baseline, immediate post-intervention, and 3-month post-baseline. Difference-in-differences analysis compares primary (e.g. safety preparedness, safety behavior, IPV), and secondary outcomes (e.g. resilience, mental health, service utilization, self-blame) across timepoints by group.DiscussionFormative phase revealed high feasibility and acceptability of a technology-based intervention for safety planning in this LMIC setting. This phase generated essential refinements to myPlan Kenya app readability, content and implementation, including increased visualization of messaging, and implementation via community health volunteers (CHVs). The resulting trial will be the first to evaluate efficacy of a community-partnered technology-based IPV intervention in a LMIC. Our adaptation process and trial results will inform researchers and interventionists to integrate multiple data sources to adapt IPV intervention content and interface in settings where technology-based interventions for IPV are novel and literacy is limited.Trial registrationPan African Clinical Trial Registry approval received 25 April 2018 (PACTR201804003321122); retrospectively registered.