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Abstract Background With more than 15,000 annual deaths from head and neck cancer (HNC), an important aspect of end-of-life care for these patients is place of death. Recent evidence suggests an increasing preference for home/hospice at end of life; however, it is unclear whether there is variation in home/hospice use based on region or urban status. We described differences in the place of death of HNC patients based on their region and urban status. Methods Using the CDC WONDER (Wide-Ranging Online Data for Epidemiologic Research) database for HNC mortality (1999 to 2019), place of death was dichotomized as home/hospice vs. other, by Health and Human Services (HHS) region (Regions 1-10), and by urbanization status. Multivariable logistic regression analyses estimated odds of place of death being home/hospice, and being urban/metro, adjusting for both clinical and nonclinical variables. Results Over the study period, there were 260,630 deaths, 47.4% of which were at home or hospice. Compared to patients in New England/Region 1 (CT, ME, MA, NH, RI, and VT), HNC patients were more likely to die at home/hospice in the Pacific Northwest/Region 10 (AK, ID, OR, WA) (aOR (1.73; 95% CI: 1.64, 1.83) and less likely in the Eastern Section/Region 2 (NJ, NY, PR, VI) (aOR 0.93; 95% CI: 0.89, 0.97). Further, large central metro areas had significantly lower rates of dying at home/hospice than did all other settings. Conclusion Patients in moderately urban areas were reported to have the greatest use of hospice services and at-home death; patients in the HHS Region representing Alaska, Idaho, Oregon, and Washington were also found to have the highest rates of use. These differences in hospice care should be considered when clinicians counsel patients on their end-of-life options.

ObjectiveThe purpose of this study is to examine the efficacy of BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) vs. usual transitional care management among diverse adults with traumatic brain injury (TBI) discharged home from acute hospital care and families.MethodsThis will be a single-site, two-arm, randomized controlled trial (N = 436 people, 218 patient/family dyads, 109 dyads per arm) of BETTER, a culturally- and linguistically-tailored, patient- and family-centered, TBI transitional care intervention for adult patients with TBI and families. Skilled clinical interventionists will follow a manualized protocol to address patient/family needs. The interventionists will co-establish goals with participants; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills for 16 weeks following hospital discharge. English- and Spanish-speaking adult patients with mild-to-severe TBI who are discharged directly home from the hospital without inpatient rehabilitation or transfer to other settings (community discharge) and associated family caregivers are eligible and will be randomized to treatment or usual transitional care management. We will use intention-to-treat analysis to determine if patients receiving BETTER have a higher quality of life (primary outcome, SF-36) at 16-weeks post-hospital discharge than those receiving usual transitional care management. We will conduct a descriptive, qualitative study with 45 dyads randomized to BETTER, using semi-structured interviews, to capture perspectives on barriers and facilitators to participation. Data will be analyzed using conventional content analysis. Finally, we will conduct a cost/budget impact analysis, evaluating differences in intervention costs and healthcare costs by arm.DiscussionFindings will guide our team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to enhance the standard of care for adults with TBI and families. The new knowledge generated will drive advancements in health equity among diverse adults with TBI and families.Trial registrationNCT05929833.

Summary: Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30–64 years participating in the ESTAMPA study. Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0–53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3–96.7). Specificity was 96.5% (95% CI: 96.3–96.7) using cytology and 88.7% (95% CI: 88.3–89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%–100% and 83.6–90.8%, respectively). Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.

Yam is currently an emblematic tuber from Colombian Caribbean Region. Its cultivation and consumption are linked to the arrival of slaves on the Caribbean Coast. Colombia’s yam has stood out worldwide for its technological advances in cultivation and it has been among the countries with the best performance indicators in tons per hectare planted. The 90% of the national production comes from Caribbean Region. However, the high perishability of the yam, and high temperatures, the lack of communication routes and the high transportation costs, increase the losses and limit the profitability of the product. There is an overproduction of yam and other tubers too. The impact has come to significantly impoverish both farmers and consumers, even affecting the presence of yam in local population diet. Under similar circumstances, in many cultures distilled alcoholic beverages have emerged from local foods, such as wheat, malt, potato, sugar cane, grapes, etc. The aim of this article is to show preliminary results about using yam as a raw material in an alternative way. It could contribute to increase yam’s value through developing a vodka-like distilled process. In this case, raw yam flour was hydrolyzed to obtain a worth to be fermented at 20°C with a commercial S. cerevisiae yeast. After fermentation a simple batch distillation in a copper distiller was made. During the process, it was measured temperature, fermentation time, pH, and Brix degree. All transformation process was done in a pilot plant (CE 640 Gunt, Hamburg). A first-order kinetics model was adjusted to sugars consumption, and a Gompertz model was used to ethanol production. It is concluded that an alcoholic beverage based on yam can be an alternative to yam overproduction. Keywords.Yam, fermented beverages, distilled beverages, physicochemical analysis, kin

Abstract Background For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions can to be beneficial for patients and partners. However, these studies have been limited by reliance on in-person treatment delivery and have not targeted couples at high risk for poor outcomes. This study tests the efficacy of a Couples Communication Skills Training (CCST) intervention delivered via videoconference for couples reporting high levels of holding back from discussing cancer-related concerns, a variable associated with poorer psychological and relationship functioning. Methods This RCT is designed to evaluate the efficacy of CCST in improving patient and partner relationship functioning (primary outcome). Secondary outcomes include patient and partner psychological functioning and patient symptoms and health care use. We also examine the role of objective and self-reported communication behaviors as mediators of treatment effects. Two hundred thirty patients with advanced lung, gastrointestinal, genitourinary, and breast cancer and their partners will be randomized to CCST or an education control intervention. Participants in both conditions complete self-reported outcome measures at baseline, mid-treatment, post-treatment, and 3 months post-treatment. Objective measures of communication are derived from video-recorded couple conversations collected at baseline and post-treatment. An implementation-related process evaluation (assessing implementation outcomes and potential barriers to/facilitators of implementation) will be conducted to inform future efforts to implement CCST in real-world settings. Discussion This trial can yield important new knowledge about effective ways to improve patient and partner adjustment to advanced cancer. Trial registration This study trial is registered at clinicaltrials.gov (Trial # NCT04590885); registration date: October 19, 2020.

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples’ ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being.

Performing intravital imaging of the colon in mouse models is challenging due to the colon’s anatomic location and motility. Here, the authors develop a murine colonic window for intravital chronic imaging that maximises long-term animal survival and minimises motion artefacts.

BackgroundMedical resident reading and information-seeking behavior is limited by time constraints as well as comfort in accessing and assessing evidence-based resources. Educational technology interventions, as the preferred method for millennial leaners, can reduce these barriers. We implemented an educational web tool, consisting of peer-reviewed articles as well as local and national protocols and policies, built into the daily workflow of a university-based anesthesiology department. We hypothesized that this web tool would increase resource utilization and overall perceptions of the educational environment. ObjectiveThe goal of this study was to demonstrate that an educational web tool designed and built into the daily workflow of an academic anesthesia department for trainees could significantly decrease barriers to resource utilization, improve faculty-trainee teaching interactions, and improve the perceptions of the educational environment. MethodsFollowing Institutional Review Board approval, a longitudinal cohort survey study was conducted to assess trainee resource utilization, faculty evaluation of trainees’ resource utilization, and trainee and faculty perceptions about the educational environment. The survey study was conducted in a pre-post fashion 3 months prior to web tool implementation and 3 months following implementation. Data were deidentified and analyzed unpaired using Student t tests for continuous data and chi-square tests for ordinal data. ResultsSurvey response rates were greater than 50% in all groups: of the 43 trainees, we obtained 27 (63%) preimplementation surveys and 22 (51%) postimplementation surveys; of the 46 faculty members, we obtained 25 (54%) preimplementation surveys and 23 (50%) postimplementation surveys. Trainees showed a significant improvement in utilization of peer-reviewed articles (preimplementation mean 8.67, SD 6.45; postimplementation mean 18.27, SD 12.23; P=.02), national guidelines (preimplementation mean 2.3, SD 2.40; postimplementation mean 6.14, SD 5.01; P

Bioethics is a transcendental discipline applied to medical training for decision making. Teachers and students lack adequate knowledge. A descriptive crosssectional study was proposed. 15 teachers and 231 students were surveyed to assess the degree of bioethical knowledge through a standardized survey. Low levels of knowledge were found in teachers and students at below 70%. Doctors fom Argentina, Mexico and Ecuador were compared in knowledge without significant differences being found. The level of knowledge about bioethics in teachers and students is limited. It is to establish training and education programs about this subject.

El articulo presente resultados de estudio orientado a identificar la actitud religiosa y su relación con las distorsiones cognitivas en una muestra de personas que pertenecen a un culto religioso de origen protestante. Investigación de enfoque cuantitativo, nivel descriptivo y corte trasversal, empleo el Inventario de pensamientos automáticos de Ruiz y Lujan (1991) y la escala de Actitud religiosa de Orozco Domínguez (2914) en la muestra intencional de 50 persona pertenecientes a una congregación religiosa de Testigos de Jehová de área metropolitana de Medellín, Colombia. Los resultados indican una alta actitud religiosa en la muestra del estudio, sin presentarse una correlación significativa estadísticamente con las distorsiones cognitivas evaluadas. Sin embargo, aunque no de forma concluyente, los resultados indican la presencia de algunos aspectos importantes como una tendencia hacia mayores puntajes en pensamiento polarizado, sobregeneralización, visión catastrófica, personalización, razonamiento emocional, falacia de razón y falacia de recompensa divina en el grupo con más alta actitud religiosa; al igual como una baja correlación de la actitud religiosa con la culpabilidad, indicando lo anterior, la importancia y la necesidad de continuar con estudios en esta línea con el fin de aproximarse a la comprensión del fenómeno de religiosidad y su relación con aspectos cognitivos del ser humano.

Se evaluó el potencial fitorremediador de Typha dominguensis (Td) y Canna generalis (Cg) en la remoción de plomo de aguas residuales, utilizando humedales construidos a escala de laboratorio. El agua residual se preparó a concentraciones de 5, 10 y 15 mg.L Pb. Se establecieron 9 tratamientos (3 controles sin plantas, 3 plantados con Td y 3 plantados con Cg) para las diferentes concentraciones de plomo a evaluar. El tiempo de retención hidráulico fue de 4 días; se monitoreó diariamente el pH y la alcalinidad. La remoción de Pb en los tratamientos plantados no presentó diferencia significativa con respecto a los tratamientos control, predominando en las primeras 2h de tratamiento los mecanismos fisicoquímicos de precipitación y absorción del metal al material en suspensión y la correspondiente deposición en el suelo, para acentuarse luego a las 24h debido a procesos biológicos (absorción del metal por las plantas). Cg logró absorber mayor concentración de plomo -1 en la raíz que en las hojas, comportamiento totalmente opuesto al de Td que presentó mayor capacidad de translocación del metal, capacidad que se vio disminuida con el aumento de la concentración de Pb en el agua, quedando demostrado el rol de estas macrófitas como bioacumuladoras de Pb

BACKGROUND Ovarian failure has been reported to occur in female cancer survivors who had received spinal radiation as children. We aimed to determine whether laparoscopic unilateral oophoropexy prior to radiotherapy effectively preserves ovarian function. METHODS In a retrospective analysis, the study group comprised girls, aged 18 and younger, who received spinal irradiation for a brain tumor. Ovarian dysfunction, the primary endpoint, was defined as an elevated follicle-stimulating hormone level or persistent amenorrhea. RESULTS After applying exclusion criteria, 15 patients comprised the group that had undergone laparoscopic oophoropexy, and 11 patients comprised the comparison group that did not have oophoropexy. Mean age at diagnosis, length of follow-up, proportion of high-risk tumors and doses and duration of chemotherapy and radiation were not different between the two groups. Two of 15 patients (13%, 95% CI 0.2–40%) with oophoropexy had ovarian dysfunction compared with five of 11 (45%, 95% CI 17–77%) in the comparison group (P = 0.09). CONCLUSIONS Oophoropexy may protect against radiation-induced ovarian failure in girls receiving spinal radiation. A high risk of ovarian dysfunction was seen in patients who did not undergo oophoropexy. In girls who underwent oophoropexy, a lower rate of ovarian dysfunction was seen. [ABSTRACT FROM AUTHOR]