Symptom Clusters and Survival in Portuguese Patients with Advanced Cancer

This study aimed to identify clusters of symptoms, to determine the patient characteristics associated with identified, and determine their strength of association with survival in patients with advanced cancer (ACPs). Consecutively eligible ACPs not receiving cancer-specific treatment, and referred to a Tertiary Palliative Care Clinic, were enrolled in a prospective cohort study. At first consultation, patients rated 9 symptoms through the Edmonton Symptom Assessment System (0-10 scale) and 10 others using a Likert scale (1-5). Principal component analysis was used in an exploratory factor analysis to identify. Of 318 ACPs, 301 met eligibility criteria with a median (range) age of 69 (37-94) years. Three SCs were identified: neuro-psycho-metabolic (NPM) (tiredness, lack of appetite, lack of well-being, dyspnea, depression, and anxiety); gastrointestinal (nausea, vomiting, constipation, hiccups, and dry mouth) and sleep impairment (insomnia and sleep disturbance). Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter survival was observed for patients with the NPM cluster (58 vs. 23, P < 0.001), as well as for patients with two or more SCs (45 vs. 21, P = 0.005). In a multivariable model for survival at 30-days, age (HR: 0.98; 95% CI: 0.97-0.99; P = 0.008), hospitalization at inclusion (HR: 2.27; 95% CI: 1.47-3.51; P < 0.001), poorer performance status (HR: 1.90, 95% CI: 1.24-2.89; P = 0.003), and NPM (HR: 1.64; 95% CI: 1.17-2.31; P = 0.005), were associated with worse survival. Three clinically meaningful SC in patients with advanced cancer were identifiable. The NPM cluster and the presence of two or more SCs, had prognostic value in relation to survival.

Repositories for open education and improving discoverability of OERs

Presentation given at 2016 Association for Learning Technology conference at University of Warwick (ALT2016). This presentation shares key findings from my MSc thesis on discoverability strategies for OERs after a small scale study into Jisc UKOER projects. The origins, key features and recent improvements to EdShare, the OER repository solution which is available through EPrints Services at the University of Southampton, is highlighted. Repositories provide an excellent way of archiving, preserving and managing content, but is this enough for OERs. OERs are about more than simply sharing, and this presentation highlighted a number of development areas under consideration for EdShare, to become a more open digital space.

Investigating the AGN-starburst connection in a nearby Seyfert galaxy with ALMA and multiwavelength data

The astrophysical context in which this thesis project lies concerns the comprehension of the mutual interaction between the accretion onto a Super Massive Black Hole (SMBH) and the Star Formation (SF), that take place in the host galaxy. This is one of the key topic of the modern extragalactic astrophysical research. Indeed, it is widely accepted that to understand the physics of a galaxy, the contribution of a possible central AGN must be taken into account. The aim of this thesis is the study of the physical processes of the nearby Seyfert galaxy NGC 34. This source was selected because of the wide collection of multiwavelength data available in the literature. In addition, recently, it has been observed with the Atacama Large Submillimeter/Millimeter Array (ALMA) in Band 9. This project is divided in two main parts: first of all, we reduced and analyzed the ALMA data, obtaining the continuum and CO(6-5) maps; then, we looked for a coherent explaination of NGC 34 physical characteristics. In particular, we focused on the ISM physics, in order to understand its properties in terms of density, chemical composition and dominant radiation field (SF or accretion). This work has been done through the analysis of the spectral distribution of several CO transitions as a function of the transition number (CO SLED), obtained joining the CO(6-5) line with other transitions available in the literature. More precisely, the observed CO SLED has been compared with ISM models, including Photo-Dissociation Regions (PDRs) and X-ray-Dominated Regions (XDRs). These models have been obtained through the state-of-the-art photoionization code CLOUDY. Along with the observed CO SLED, we have taken into account other physical properties of NGC 34, such as the Star Formation Rate (SFR), the gas mass and the X-ray luminosity.

Native Women, Intimate Partner Violence, and Drug Use and Consequences: Prevalence and Associations Among Tribal College and University Students

Thesis (Ph.D.)--University of Washington, 2016-08

Regional Challenges in Achieving Open Access and Proposed Recommendations

Working Together to Promote Open Access Policy Alignment in Europe

Prevalence and associations of Trypanosoma spp. and Sodalis glossinidius with intrinsic factors of tsetse flies

Trypanosomiasis has been identified as a neglected tropical disease in both humans and animals in many regions of sub-Saharan Africa. Whilst assessments of the biology of trypanosomes, vectors, vertebrate hosts and the environment have provided useful information about life cycles, transmission, and pathogenesis of the parasites that could be used for treatment and control, less information is available about the effects of interactions among multiple intrinsic factors on trypanosome presence in tsetse flies from different sites. It is known that multiple species of tsetse flies can transmit trypanosomes but differences in their vector competence has normally been studied in relation to individual factors in isolation, such as: intrinsic factors of the flies (e.g. age, sex); habitat characteristics; presence of endosymbionts (e.g. Wigglesworthia glossinidia, Sodalis glossinidius); feeding pattern; host communities that the flies feed on; and which species of trypanosomes are transmitted. The purpose of this study was to take a more integrated approach to investigate trypanosome prevalence in tsetse flies. In chapter 2, techniques were optimised for using the Polymerase Chain Reaction (PCR) to identify species of trypanosomes (Trypanosoma vivax, T. congolense, T. brucei, T. simiae, and T. godfreyi) present in four species of tsetse flies (Glossina austeni, G. brevipalpis, G. longipennis and G. pallidipes) from two regions of eastern Kenya (the Shimba Hills and Nguruman). Based on universal primers targeting the internal transcribed spacer 1 region (ITS-1), T. vivax was the predominant pathogenic species detected in flies, both singly and in combination with other species of trypanosomes. Using Generalised Linear Models (GLMs) and likelihood ratio tests to choose the best-fitting models, presence of T. vivax was significantly associated with an interaction between subpopulation (a combination between collection sites and species of Glossina) and sex of the flies (X2 = 7.52, df = 21, P-value = 0.0061); prevalence in females overall was higher than in males but this was not consistent across subpopulations. Similarly, T. congolense was significantly associated only with subpopulation (X2 = 18.77, df = 1, P-value = 0.0046); prevalence was higher overall in the Shimba Hills than in Nguruman but this pattern varied by species of tsetse fly. When associations were analysed in individual species of tsetse flies, there were no consistent associations between trypanosome prevalence and any single factor (site, sex, age) and different combinations of interactions were found to be significant for each. The results thus demonstrated complex interactions between vectors and trypanosome prevalence related to both the distribution and intrinsic factors of tsetse flies. The potential influence of the presence of S. glossinidius on trypanosome presence in tsetse flies was studied in chapter 3. A high number of Sodalis positive flies was found in the Shimba Hills, while there were only two positive flies from Nguruman. Presence or absence of Sodalis was significantly associated with subpopulation while trypanosome presence showed a significant association with age (X2 = 4.65, df = 14, P-value = 0.0310) and an interaction between subpopulation and sex (X2 = 18.94, df = 10, P-value = 0.0043). However, the specific associations that were significant varied across species of trypanosomes, with T. congolense and T. brucei but not T. vivax showing significant interactions involving Sodalis. Although it has previously been concluded that presence of Sodalis increases susceptibility to trypanosomes, the results presented here suggest a more complicated relationship, which may be biased by differences in the distribution and intrinsic factors of tsetse flies, as well as which trypanosome species are considered. In chapter 4 trypanosome status was studied in relation to blood meal sources, feeding status and feeding patterns of G. pallidipes (which was the predominant fly species collected for this study) as determined by sequencing the mitochondrial cytochrome B gene using DNA extracted from abdomen samples. African buffalo and African elephants were the main sources of blood meals but antelopes, warthogs, humans, giraffes and hyenas were also identified. Feeding on multiple hosts was common in flies sampled from the Shimba Hills but most flies from Nguruman had fed on single host species. Based on Multiple Correspondence Analysis (MCA), host-feeding patterns showed a correlation with site of sample collection and Sodalis status, while trypanosome status was correlated with sex and age of the flies, suggesting that recent host-feeding patterns from blood meal analysis cannot predict trypanosome status. In conclusion, the complexity of interactions found suggests that strategies of tsetse fly control should be specific to particular epidemic areas. Future studies should include laboratory experiments that use local colonies of tsetse flies, local strains of trypanosomes and local S. glossinidius under controlled environmental conditions to tease out the factors that affect vector competence and the relative influence of external environmental factors on the dynamics of these interactions.

Oral and gastric helicobacter pylori : Effects and associations

This study consisted in the comparison of the prevalence of Helicobacter pylori (H. pylori) present in the stomach and in saliva of a sample of Portuguese adolescents and the assessment of the association between H. pylori infection with socio-demographic variables and prevalence of dental caries.

Some results on open-edge and open mobile guarding of polygons and triangulations

This paper focuses on a variation of the Art Gallery problem that considers open-edge guards and open mobile-guards. A mobile guard can be placed on edges and diagonals of a polygon, and the ‘open’ prefix means that the endpoints of such an edge or diagonal are not taken into account for visibility purposes. This paper studies the number of guards that are sufficient and sometimes necessary to guard some classes of simple polygons for both open-edge and open mobile-guards. A wide range of polygons is studied, which include orthogonal polygons with or without holes, spirals, orthogonal spirals and monotone polygons. Moreover, this problem is also considered for planar triangulation graphs using open-edge guards.

Assessment of student engagement among junior high school students and associations with self-esteem, burnout, and academic achievement

The aim of the study was to investigate the structure of affective and cognitive engagement using the Student Engagement Instrument (SEI; Appleton, Christenson, Kim, & Reschly, 2006) and to examine the associations to behavioral engagement, as well as student-reported self-esteem, burnout, and academic achievement among Finnish junior high school students. The analyses were carried out in the main sample of 2,485 students, as well as in an independent sample of 821 students. The results showed that the original five-factor structure of the SEI construed along three affective and two cognitive engagement factors fit the current data relatively well. Affective and cognitive student engagement correlated positively with an independent measure of behavioral engagement. Furthermore, affective and cognitive engagement were positively associated with student-reported self-esteem and academic achievement, and negatively with school burnout. The findings provided corroborating evidence for the psychometric properties and utilization of the SEI instrument for assessing the engagement of junior high school students. (DIPF/Orig.)

[Map of the city of Washington : showing the sub-divisions, grades, and the general configuration of the ground /

Cadastral map showing lot lines, lot numbers, and block numbers.

Nutritional risk among surgery patients and associations with hospital stay and postoperative complications

Introduction and Objectives: Nutritional Risk Screening (NRS 2002) is employed to identify nutritional risk in the hospital setting and determine which patients would benefit from nutritional support. The aim of the present study was to identify nutritional risk in patients admitted to the surgery ward and determine possible associations with hospital stay and postoperative complications. Methods: Three hundred fifteen surgery patients were evaluated in the first 24 hours since admission. Evaluations involved the calculation of the body mass index, the determination of weight loss ≥ 5% in the previous six months and the assessment of nutritional risk using the NRS 2002. Hospital stay (in days) and postoperative complications were also recorded. Results: A total of 31.1% of the patients were classified as being "at risk", among whom 98.3% had food intake 50% lower than habitual intake, 65.9% had weight loss ≥ 5% in the previous six months, 64.7% had a diagnosis of neoplasm, 59.9% were aged ≥ 60 years and 59.9% were candidates for non-elective surgery. Postoperative complications were recorded in 4.4% of the overall sample and were more frequent in patients at nutritional risk (p < 0.000). Hospital stay was also longer among the patients at nutritional risk (p < 0.01). Conclusion: A high percentage of surgery patients were at nutritional risk in the present study and associations were found with age ≥ 60 years, a diagnosis of neoplasm, non-elective surgery of the gastrointestinal tract, a reduction in habitual food intake and weight loss. Patients at nutritional risk had a greater frequency of postoperative complications and a longer hospital stay.

Similarities between the lipid proile of Mexican patients with lupus and the general population

Premature cardiovascular events have been observed in systemic lupus erythematosus (SLE) patients, but the reason for this accelerated process is still debatable; although traditional risk factors are more prevalent in such patients than in the general population, the do not seem to fully explain that enhanced risk. One of the most important conditions is a proatherogenic lipid proile. There is not enough data about it in Mexican SLE patients. Objective: To establish the differences in the lipid proiles between Mexican patients with SLE and the general population. Material and methods: Observational, transversal, descriptive and comparative study, between SLE patients and age-sex-matched healthy volunteers. We performed a full lipid proile (by spectrophotometry) 14 hours of fast. The results obtained were analyzed by the statistical program SPSS® Statistics version 17. Results: We studied the full lipid proiles of 138 subjects, 69 with a diagnosis of SLE and 69 agesex- matched healthy volunteers; 95.7% were females and 4.3% males. Average age was 30 years; average body mass index (BMI) 25.96 ± 5.96 kg/m² in SLE patients and 26.72 ± 4.36 kg/m² in the control group (p = 0.396). Average of total cholesterol 156 mg/dl in the SLE patients and 169.4 mg/dl in the control group (p =0.028); average of low density lipoprotein (LDL) cholesterol 85.27 mg/dl in the SLE patients and 97.57 mg/dl in the control group (p = 0.023). Conclusions: We did not ind statistical differences in the lipid proiles among patients and healthy volunteers, which could explain increased cardiovascular morbidity and mortality observed in SLE patients

Risk Factors and Associations for Hepatitis C Infection among Hispanic/Latino Intravenous Drug Users in Miami-Dade County, Florida

Hepatitis C infection (HCV) continues to disproportionately affect Hispanics/Latinos in the United States. Hispanic/Latino intravenous drug users (IDUs), because of their risky injection and sexual behaviors, are prone to HCV infection and rapid transmission of the virus to others via several routes. With a prevalence rate of approximately 75% among IDUs, it is imperative that transmission of HCV be prevented in this population. This study aims to examine the associations between demographic, injection and sexual risk factors to HCV infection in a group Hispanic/Latino IDUs in Miami-Dade County, Florida. Preliminary unadjusted results in this sample reveal that age (OR=4.592, p=0.004), weekly injection (OR=5.171, p=0.000), daily injection frequency (OR=3.856, p=0.000) and use of a dirty needle (OR=2.320, p= 0.006) were all significantly associated with HCV infection. Being born outside the U.S. was significantly negatively associated with HCV infection (OR=0.349, p=0.004). Additionally, having two or more sex partners in the past three months (OR=0.472, p=0.014) was negatively associated with HCV infection. After adjusting for all other variables, older age (AOR=7.470, p=0.006), weekly injection (AOR=3.238, p=0.007) and daily injection frequency (AOR=2.625, p=0.010) were all significantly associated with HCV infection. Being born outside the U.S. (AOR=0.369, p=0.019) was a significant protective factor for HCV infection, along with having two or more sex partners in the past three months (AOR=0.481, p=0.037). When analyzing the significant variables in a backward regression model, having 2 or more sex partners in the past three months was not significant at the p

Creativity, Clusters and the Competitive Advantage of Cities

Purpose – This paper aims to marry Michael Porter’s industrial cluster theory of traded and local clusters to Richard Florida’s occupational approach of creative and routine workers to gain a better understanding of the process of economic development. Design/methodology/approach – Combining these two approaches, four major industrial-occupational categories are identified. The shares of US employment in each – creative-in-traded, creative-in-local, routine-in-traded and routine-in-local – are calculated, and a correlation analysis is used to examine the relationship of each to regional economic development indicators. Findings – Economic growth and development is positively related to employment in the creative-in-traded category. While metros with a higher share of creative-in-traded employment enjoy higher wages and incomes overall, these benefits are not experienced by all worker categories. The share of creative-in-traded employment is also positively and significantly associated with higher inequality. After accounting for higher median housing costs, routine workers in both traded and local industries are found to be relatively worse off in metros with high shares of creative-in-traded employment, on average. Social implications – This work points to the imperative for the US Government and industry to upgrade routine jobs, which make up the majority of all employment, by increasing the creative content of this work. Originality/value – The research is among the first to systematically marry the industry and occupational approaches to clusters and economic development.