Objectives: To determine social, economic, biological and environmental factors critical to malaria control effectiveness in African countries that are with contrasting responses to the malaria control and elimination efforts, and use this information to inform the development of improved malaria control strategies in Africa.

Methods: A systematic analysis was conducted using longitudinally collected data from publically available data sources for the period of 2000 and 2016, for 8 African countries with contrasting malaria incidence dynamics. Single- and multivariable linear regression analyses were performed to determine the impact of various risk factors on malaria incidence. The risk factors included autocorrelation with a one year time lag, study country, and economic status, internal and external malaria control budgets, bednet coverage, indoor residual spray coverage, and insecticide resistance status.

Results: Malaria incidence exhibited highly significant autocorrelation. Per capita government funding for malaria control and insecticide resistance were the two significant factors correlating with malaria incidence.

Conclusions: This study indicates the significance of malaria control investment from African countries themselves and insecticide resistance management in malaria control and elimination in Africa.

Key Words: Malaria incidence, National government funding, Malaria control effectiveness, Insecticide resistance

CT imaging predisposes patients to high levels of radiation. In this study, we retrospectively compared the radiation dose of triple-bolus computed tomography (TBCT) and conventional CT (CCT) urography protocols, analyzed the effects of body mass index (BMI) on radiation dose in each group and assessed image quality.

We retrospectively reviewed the images of patients who underwent CCT or TBCT imaging in the management of renal cortical neoplasms. We used standard volumetric CT dose index (CTDIvol) and dose length product (DLP) to estimate radiation exposure. In addition, 2 urologists rated the quality of 20 CT images from each group using a survey with a 5-point Likert scale. The survey consisted of 10 questions relating to the ability of the scan to identify relevant anatomy.

The study included 120 patients. CTDIvol and DLP were 28.7% and 40.4% lower in the TBCT protocol, respectively (both P<.001). Increased BMI was associated with a higher DLP for the CCT group compared with the TBCT group (P<.001). The effect of BMI on CTDIvol did not differ between the CCT and TBCT groups. There was no difference in the urologists’ assessments of CT image quality.

In patients with renal cortical neoplasms, TBCT provides comparable image quality to CCT, with lower ionizing radiation exposure without compromising image quality. Obese patients may benefit more from TBCT scans.

Objective: The purpose of this study is to analyze the trend of migraine prevalence in the United States (US) adult population in 2010-2015 and possible causes of the racial/ethnic differences.

Methods: Data from the 2010-2015 National Health Interview Survey (NHIS) were analyzed. The yearly trend of age and sex adjusted migraine prevalence was estimated by a linear regression. Chi-squared tests were performed to examine the racial/ethnic differences in migraine prevalence. Multivariable logistic regression models were built to evaluate the associations between candidate variables and racial/ethnic migraine prevalence, as well as to explore the interactions between races/ethnicities and migraine contributing factors.

Results: In 2015, migraine prevalences in non-Hispanic Whites, Hispanic Whites, Blacks, Asians, bi-/multi-racial people, and American Indians and Alaska Natives were 15.38%, 14.36%, 15.67%, 10.68%, 20.91%, and 17.36%, respectively. The overall prevalence dropped from 16.28% to 14.95% during 2010-2015, but no significance was detected. Migraine prevalence was significantly lower in Asians and higher in bi-/multi-racial people. No significant difference was seen among other populations. Strong correlations with racial/ethnic migraine prevalence were found in age, sex, poverty status, problems in paying medical bills, depression/anxiety problems, hypertension, current smoking, pain, and sleep disturbances. Higher education, poverty, depression/anxiety problems, hypertension, smoking, and pain had interactions with certain racial/ethnic subgroups.

Conclusion: Migraine prevalence in the US adults was relatively stable during 2010-2015. A lower proportion of contributing factors in Asians and a higher proportion in bi-/multi-racial people may partly explain the racial differences. Interactions between contributing factors and races/ethnicities indicate race/ethnicity-specific associations with migraines.

Prostate Cancer (PCa) is a non-cutaneous malignancy in men. Considering the severity of the disease, it is essential to consider the early detection and screening of prostate-specific antigen for decreasing the incidence of death due to this disease. Decipher is a genomic test that has gained increasing attention in estimating the risk of developing a recurrence or metastatic PCa disease in patients. Therefore, this study is focused on evaluating the association of Decipher score risk with recurrence of prostate cancer patients based on their medical, genetic predictors, and demographics (e.g., races) by conducting a systematic review. Moreover, the study would also assess whether Decipher score risk can be a good predictor for prostate patients’ metastasis and prostate cancer-specific mortality in men and clinical decision-making regarding Treatment Recommendations for patients. The research study reviewed 120 research articles, and the results of the systematic review have been presented in the form of themes. The studies' review indicated that Decipher acts as a genomic metastasis signature to predict metastatic disease among patients and make better decisions about treating the disease. Moreover, this genomic test can also be used in conjunction with MRI for identifying the lesions that may carry the biological potential for early metastases. Furthermore, the studies also identified that treatment options for PCa might range from ART and SRT to RP; however, the selection of treatment methodology depends upon the GC score and risk stratification. The results further suggested that the occurrence of PCa is two folds greater among AA men than non-AA men. The increasing incidence of PCa among AA and discrimination within AA's health and socio-economic conditions plays a significant role in treating AA. In this scenario, the Decipher score plays an essential role in making treatment decisions. Hence, this research has reviewed the evidence of benefits of the Decipher test, placed the usage into clinical context, made recommendations to help providers and patients know which treatment might be more appropriate based on the GC score, and when they should consider using the Decipher score based on the works of literature. To conclude, further trials are still required for validating the Decipher biomarkers. All treatment options should be managed based on the individual risk profile and sensitivity to particular medical treatment. As a future direction, scientists could enhance decipher score ability to be run on blood samples of a patient instead of tumor tissue, which will help patients to use decipher test as a screening test at the asymptomatic level. In this way, this test can be routinely done for patients with a family history of prostate cancer, and the biopsy will not be required during the screening stage.

The attitudes and behaviors of healthcare service providers can influence both provider and patient satisfaction. Groups of individuals that communicate effectively, delegate tasks, share responsibility, and work towards a common goal are indicative of a collaborative clinical culture. Using a new survey instrument, we were able to assess the level of collaborative clinical culture in the Department of Anesthesiology and Perioperative Care at the University of California, Irvine. Positive team function was found to be associated with high levels of morale, and team problems were associated with increased job stress. The survey instrument was shown to have excellent internal consistency, and is suitable for measuring collaborative clinical culture in this type of hospital setting. This exploratory analysis with a new instrument provides a baseline from which additional research in multiple departments and with multiple patient outcomes can be performed.

Biochemical recurrence (BCR) has been a cause of concern for patients and medical professionals. Although several studies have reported that only half of the patients with BCR eventually progress to metastatic disease at 10 years, there is a substantial need for developing a predictive pattern or algorithm to efficiently identify and categorize prostate cancer patients based on their risk of recurrence. Currently non-Hispanic African American adults experience the highest incidence and mortality rates for cancers, with prostate cancer being one of the most prevalent. These statistics could be significantly reduced by introducing an appropriate predictive mechanism by which patients with higher risk of recurrence and tumor progression could be identified and recommended for more aggressive treatments during initial diagnosis, preventing possible progression to metastasis. Recurrence and oncologic outcomes may be dependent on sociodemographic factors and certain other factors contributing to comorbidities. We selected the patients from Veterans Affairs medical facilities for a comparison group, primarily due to reports suggesting that VA patients provide a diverse group of individuals with different socioeconomic, educational, and medical backgrounds. VA patients are generally expected to present with clinically worse comorbidities. Ultimately, the aim was to demonstrate a significant association between higher SES and lowered risk of BCR in African American prostate cancer patients, adjusted for the site of care. We used ‘complexity’, Gleason, and Decipher scores to compare the differences in African American and White patients adjusting for site of care. Our results suggest that African American patients have higher complexity scores, which we defined as a dynamic state in which the personal, social, and clinical aspects of the patient's experience operate as complicating factors. African American patients also had higher Decipher scores regardless of site of care, suggesting a higher risk of BCR. Our findings indicate that complexity scores and Decipher scores can be simultaneously employed to assist in identifying patients with high risk of BCR, allowing for recommendations for intensive treatments.

Abstract

Interest has grown in understanding the connection between the state of mind of an individual and its effect on the body at the molecular level. Studies suggest that mental stress can alter the biochemical functions of the body (Juster, 2010). Depression is an example of a condition associated with mental stress. Exposure to environmental stresses is essential to the development of major depression, which in turn has been shown to affect the body systems in several ways. These effects are exerted at three main levels: genetic, molecular and neural. (Kupfer, 2016). Evidence is beginning to emerge that depression can lead to epigenetic changes in the human genome. Studies have also shown that epigenetic changes are critical to the development of many human malignancies including prostate cancer. It is therefore possible that these two processes may be linked, and that the presence of depression could predispose the individual to the development of cancers. Epigenetic mechanisms include DNA methylation, histone acetylation or methylation and post-translational effects of non-coding RNAs.

The Decipher genomic classifier (GC) uses coding and noncoding RNA to predict men with prostate cancer who are at risk for aggressive disease or disease progression. Using the Decipher genomic classifier as a surrogate for coding and noncoding RNA, we seek to demonstrate a possible association between depression and a tendency for developing aggressive prostate cancer. A multivariable logistic regression comparing Decipher scores in depressed subjects will first be done using depression as a continuous variable adjusting for age, SES and total illness burden index and again after dichotomizing subjects into depressed vs. non-depressed with the same adjustments. We will also seek to demonstrate that high levels of resilience attenuate this association.

A limitation of this study is that a correlation is not proof of direct causation. However, a positive association between depression and the 22 RNA components of the Decipher GC may suggest that at least one of these RNAs may be of interest in the epigenetic mechanisms connecting depression and prostate cancer which could be basis for further studies in the future.

OBJECTIVE: The aim of my study was: to assess the maternal and neonatal outcomes of pre-viable PPROM pregnancies and to describe the predictors for better outcomes of these pregnancies.

METHODS: I performed a systematic review of the literature published on the pregnancy outcomes of pre-viable PPROM following expectant management. I collected 17 high-quality studies through PubMed database search and reviewed them to obtain data on neonatal survival; maternal and neonatal morbidity; predictors for better neonatal survival and proportion of women opting for termination of pregnancies.

RESULTS: The overall survival to hospital discharge was 41.1%. Of these, 49.2% neonates survived without a major morbidity. Respiratory morbidity was the most common morbidity among surviving neonates. 37% neonates suffered from respiratory distress syndrome, 28% from bronchopulmonary dysplasia, and 9.8% from pulmonary hypoplasia. Sepsis occurred in 22.7% neonates. 49.3% pre-viable PPROM women developed chorioamnionitis. Other common maternal morbidities included cesarean delivery (33%) and placental abruption (30%). The predictors of better neonatal survival to discharge included later gestational age at PPROM, an absence of oligohydramnios, iatrogenic etiology of PPROM, and the C-reactive protein (CRP) level <1mg/dl on the first day of the presentation. Later gestational age at birth was associated with less neonatal morbidity. Overall, 21.1% of pre-viable PPROM women opted for the termination of pregnancy instead of expectant management.

CONCLUSION: The survival rate of pre-viable PPROM is poor, but it is not zero. 4 of every 10 affected neonates do survive and half of them are without any major morbidity. Maternal morbidity is still high, but serious maternal morbidities are rare.