In two minds about screening: an investigation of cervical cancer prevention among Irish women

Cervical cancer is the second most common female cancer worldwide. Cervical screening programmes can reduce the incidence of cervical cancer by up to 80 percent if the invited women participate. Previous Irish research has associated screening attendance with subjective norms, anticipated regret, higher socio-economic status and education. Greater perceived screening barriers and lacking knowledge were associated with avoidance. These findings support a variety of expectancy-value theories of behaviour. They also suggest that expectancy-value theories could benefit from the inclusion of affective predictors of behaviour, like anticipated regret. In 2008 the Republic of Ireland introduced the National Cervical Screening Programme (NCSP). This research seeks to identify the predictors of participation in the NCSP. A systematic review of reviews showed that predictors of screening participation clustered into environmental and psychological influences. There is a gap in the evidence synthesis of associations with personal characteristics and health beliefs. Thematic analysis of focus group interviews confirmed the validity of many screening predictors identified by the systematic review and expectancy-value theories. A survey of these predictors suggested that reduced screening barriers might encourage first-time participation, while regular attendance requires greater endorsement of screening benefits and stronger subjective norm and intention. Positive attitude, rather than knowledge, appeared to be crucial for strong intention, so the final study piloted an experiment comparing the utility of positive attitude in strengthening intention to the utility of information provision. Despite lacking significant differences between conditions, content analysis of participant comments suggested that a full trial would be worthwhile, given purposive sampling and improved sample retention. These findings agree with previous Irish research on the importance of screening intention, although its association with attitude appeared to be stronger in the present research. The findings further indicate that future screening promotion should consider interventions based on patients’ experiences of screening.

A Micro-Opto-Electro-Mechanical System (MOEMS) for Microstructure Manipulation

Microstructure manipulation is a fundamental process to the study of biology and medicine, as well as to advance micro- and nano-system applications. Manipulation of microstructures has been achieved through various microgripper devices developed recently, which lead to advances in micromachine assembly, and single cell manipulation, among others. Only two kinds of integrated feedback have been demonstrated so far, force sensing and optical binary feedback. As a result, the physical, mechanical, optical, and chemical information about the microstructure under study must be extracted from macroscopic instrumentation, such as confocal fluorescence microscopy and Raman spectroscopy. In this research work, novel Micro-Opto-Electro-Mechanical-System (MOEMS) microgrippers are presented. These devices utilize flexible optical waveguides as gripping arms, which provide the physical means for grasping a microobject, while simultaneously enabling light to be delivered and collected. This unique capability allows extensive optical characterization of the structure being held such as transmission, reflection, or fluorescence. The microgrippers require external actuation which was accomplished by two methods: initially with a micrometer screw, and later with a piezoelectric actuator. Thanks to a novel actuation mechanism, the “fishbone”, the gripping facets remain parallel within 1 degree. The design, simulation, fabrication, and characterization are systematically presented. The devices mechanical operation was verified by means of 3D finite element analysis simulations. Also, the optical performance and losses were simulated by the 3D-to-2D effective index (finite difference time domain FDTD) method as well as 3D Beam Propagation Method (3D-BPM). The microgrippers were designed to manipulate structures from submicron dimensions up to approximately 100 µm. The devices were implemented in SU-8 due to its suitable optical and mechanical properties. This work demonstrates two practical applications: the manipulation of single SKOV-3 human ovarian carcinoma cells, and the detection and identification of microparts tagged with a fluorescent “barcode” implemented with quantum dots. The novel devices presented open up new possibilities in the field of micromanipulation at the microscale, scalable to the nano-domain.

THE DARK PERSONALITY AND JOB SUCCESS IN THE UNITED STATES ARMY: USE OF INTERPERSONAL MANIPULATION IN THE WORKPLACE

This dissertation relates job desires and outcomes to the Dark Personality (Psychopathy, Machiavellianism, Narcissism, Low Agreeableness, Low Honesty-Humility) in the United States Army. It purports that individuals high on the Dark Personality desire more power, money, and status, and that they obtain jobs that afford them these luxuries by using manipulation at work. Two pilot studies used samples of United States Army members to create and test index variables: Dark Personality, Total Manipulation in the workplace, Desire for Job Success, and Total Job Success in the Army. Individual personality traits, manipulation tactics, and job desires were examined in secondary analyses. Using a sample of 468 United States Army Members, central analyses indicated that Army members high on the Dark Personality desired Job Success. Likewise, army members higher on the Dark Personality used more Manipulation tactics at work, including the egregious tactics. Yet, using more Manipulation tactics at work predicted lower levels of Job Success in the Army. Most manipulation tactics had a negative impact on Job Success, with the exception of soft tactics like Reason and Responsibility Invocation. Together, these results indicate that selective use of soft manipulation predicted Job Success, but use of more manipulation tactics predicted less Job Success in the Army. Curvilinear results indicated that being either very low or very high on the Dark Personality predicted more Job Success in the Army, whereas having intermediate levels of the Dark Personality predicted less Job Success. Finally, possessing the Dark Personality and using more Manipulation tactics at work, together, predicted less Job Success in the Army. Collectively, the results indicate that army members with intermediate levels of the Dark Personality want more powerful and high paying jobs, yet their strategy of manipulating their coworkers to move up the job ladder does not result in higher ranking, higher paying Army positions. However, Army members highest on the Dark Personality achieved job success, defying the maladaptive influence that antisocial personality traits and manipulative behaviour had on job success for most Army members. Therefore, this dissertation indicates that successful corporate scoundrels exist in the Army, but there are few of them.

Randomized Trial for a Mobile Health Approach to Increase Uptake of Cervical Cancer Screening in Tanzania

Background: Largely due to low availability and uptake of screening in low- and middle-income countries, cervical cancer is the second ranked cancer among women in these countries. This is a tragedy because cervical cancer is one of the most preventable carcinomas. This thesis will investigate behaviour change methods, which capitalize on the recent exponential increase in ownership of mobile phones in Tanzania, to increase uptake of cervical cancer screening (CCS) in the Kilimanjaro region of Tanzania. Objectives: 1) To evaluate the effectiveness of behaviour change messages delivered via short message service (SMS) on the uptake of CCS in the Kilimanjaro region; 2) to evaluate the effectiveness of a transportation eVoucher on the uptake of CCS in the Kilimanjaro region; 3) to explore characteristics associated with CCS uptake in the Kilimanjaro region; and 4) to determine the attitudes towards and perceived benefit of behaviour change SMS messages and eVouchers intended to increase uptake of CCS. Methods: In the Kilimanjaro Region, 853 women participated in a randomized controlled trial. Baseline data was collected through self-report through systematic stratified random sampling. Participants were randomized to one of three groups: a control group, a group receiving behaviour change messages delivered via SMS, or a group receiving a travel eVoucher and identical SMS as the SMS group. A fieldworker recorded participants attending screening at the CCS clinics and administered a post-screening survey. The follow-up period was two months from the time of the participant’s enrolment. Logistic regression (both for the combined and stratified data sets) was used to determine associations between the behaviour change interventions, baseline characteristics and cervical cancer screening uptake. Results: All participants receiving SMS messages (SMS or eVoucher group) were more likely to attend cervical cancer screening in comparison with the control group. 83% of participants who attended screening shared the information contained in the messages with others. Conclusions: Behaviour change messages delivered via SMS and transportation eVouchers have the potential to increase uptake of cervical cancer screening in the Kilimanjaro region of Tanzania. Harnessing this potential will require implementing these interventions alongside other methods to achieve maximum impact.

Completion strategy or emphasis manipulation? Task support for teaching information problem solving

While most students seem to solve information problems effortlessly, research shows that the cognitive skills for effective information problem solving are often underdeveloped. Students manage to find information and formulate solutions, but the quality of their process and product is questionable. It is therefore important to develop instruction for fostering these skills. In this research, a 2-h online intervention was presented to first-year university students with the goal to improve their information problem solving skills while investigating effects of different types of built-in task support. A training design containing completion tasks was compared to a design using emphasis manipulation. A third variant of the training combined both approaches. In two experiments, these conditions were compared to a control condition receiving conventional tasks without built-in task support. Results of both experiments show that students' information problem solving skills are underdeveloped, which underlines the necessity for formal training. While the intervention improved students’ skills, no differences were found between conditions. The authors hypothesize that the effective presentation of supportive information in the form of a modeling example at the start of the training caused a strong learning effect, which masked effects of task support. Limitations and directions for future research are presented.

Företags potentiella manipulation av tillväxttakt i goodwillnedskrivningstestet : En kvantitativ studie av svenska och finska börsnoterade företag

Bakgrund och problem: I och med den nya standarden IAS 36 ska företagen göra uppskattningar angående den långsiktiga tillväxttakten i goodwillnedskrivningstestet. Detta innebär en möjlighet att manipulera tillväxttakten för att på så vis undvika eller framkalla nedskrivning av goodwill. Problemformulering: Hur påverkar utvalda variabler företags potentiella manipulation av angiven tillväxttakt? Syfte: Syftet med studien är att bidra med förklaringar till vad som påverkar att företag redovisar för höga respektive för låga tillväxttakter i goodwillnedskrivningstestet. Metod: Denna studie bygger på en kvantitativ metod där urvalet består av samtliga svenska och finska börsnoterade företag med redovisad goodwill. Utifrån existerade kunskap formuleras fyra hypoteser som testas mot empirin. Resultat och slutsats: Resultatet av denna studie visar inga signifikanta samband mellan den beroende variabeln manipulation och de oberoende variablerna storlek, skuldsättningsgrad, bransch och redovisningstillsyn. Den deskriptiva statistiken visar att i stort sett hälften av företagen manipulerar tillväxttakten.

Hematoma Cervical e Hemotórax Espontâneos no contexto de Neurofibromatose Tipo I

Introdução: A neurofibromatose tipo I (NF1), também designada doença de Von Recklinghausen, é causada por uma anormalidade no cromossoma 17, de transmissão autossómica dominante, responsável pela produção deficiente de neurofibromina. Caracteriza-se por displasia nos tecidos mesodérmicos e neuroectodérmicos, e tem uma incidência de um para 2.500-3.300 nascimentos. A presença de manchas café-au-lait, neurofibromas cutâneos e hamartomas da íris são sinais cardinais da doença. Primeiramente descrita por Ruebi em 1945, a patologia vascular é uma complicação subestimada e pouco reconhecida na NF1. A ocorrência de hemorragia fatal ou quase fatal está reportada ocasionalmente nas cavidades pleural, abdominal, retroperitoneu, tecidos moles do tronco e extremidades. Esta hemorragia massiva é causada pela rutura de vasos sanguíneos friáveis, característicos pelos níveis reduzidos de neurofibromina e consequente proliferação endotelial e de músculo liso nas artérias e veias. Uma das consequências clínicas mais sérias descritas na NF1 é a ocorrência de hemorragia severa e dificuldade em alcançar controlo hemostático. Objetivo: Exposição de caso clínico de extenso hematoma cervical e hemotórax espontâneos por rutura troncos venosos braquiocefálico, veia subclávia e junção subclávio-jugular em doente com NF1. Caso clínico: Relata-se caso clínico de mulher de 51 anos, com antecedentes conhecidos de NF1 e hipertensão arterial. Foi admitida no serviço de urgência em choque hipovolémico hemorrágico, no contexto de dor súbita no ombro direito e volumosa tumefação cervical direita. Em angioTC foi objetivado volumoso hematoma, envolvendo a região cervical direita, a região retrofaríngea-prevertebral, escavado supraclavicular direito, mediastino, associando a importante hemotórax direito. Procedeu-se a abordagem supraclavicular com drenagem do hematoma e identificação de fontes hemorrágicas, nomeadamente: tronco venoso braquicefálico, veia subclávia e confluência subclávio-jugular. Foi necessária secção da clavícula para controlo hemorrágico e realização de rafias dos troncos venosos com prolene. Intraoperatoriamente, foi evidente a fragilidade e friabilidade excessiva dos vasos sanguíneos. Após controlo hemorrágico, foi realizada videotoracoscopia para drenagem de hemotórax e evacuação de coágulos, confirmando-se a ausência de hemorragia ativa. No pós-operatório a doente recuperou estabilidade hemodinâmica, sem evidência analítica de queda de hemoglobina. Realizou-se angioTC, onde se confirmou franca melhoria do hematoma cervical direito e retrofaríngeo em critérios quantitativos, e ausência de extravasamento de contraste. Objetivou-se adicionalmente aneurismas acular da artéria vertebral direita, corrigido ulteriormente através de embolização com coils. Conclusão: A NF1 é uma doença genética que raramente se pode associar a hemorragia life- -threatening. A vasculopatia é uma complicação subestimada e pouco reconhecida na NF1. A existência de friabilidade vascular excessiva com consequente hemorragia espontânea na NF1 é rara e pode ser fatal, exigindo um diagnóstico rápido e tratamento atempado.

Efectividad de un modelo de escuela de espalda en pacientes con dolor mecánico crónico cervical o lumbar

Programa de doctorado: Avances en Traumatología. La fecha de publicación es la fecha de lectura

Manipulation in U.S. REIT Investment Performance Evaluation: Empirical Evidence

We investigate whether Real Estate Investment Trust (REIT) managers actively manipulate performance measures in spite of the strict regulation under the REIT regime. We provide empirical evidence that is consistent with this hypothesis. Specifically, manipulation strategies may rely on the opportunistic use of leverage. However, manipulation does not appear to be uniform across REIT sectors and seems to become more common as the level of competition in the underlying property sector increases. We employ a set of commonly used traditional performance measures and a recently developed manipulation-proof measure (MPPM, Goetzmann, Ingersoll, Spiegel, and Welch (2007)) to evaluate the performance of 147 REITs from seven different property sectors over the period 1991-2009. Our findings suggest that the existing REIT regulation may fail to mitigate a substantial agency conflict and that investors can benefit from evaluating return information carefully in order to avoid potentially manipulative funds.

La manipulation des ressources alimentaires et du risque de prédation afin d’augmenter la vulnérabilité du cerf de Virginie à la chasse

L’utilisation de l’espace par une proie herbivore est souvent modulée par le compromis entre l’acquisition de fourrage et l’évitement de la prédation. Nous avons testé l’effet de la manipulation de la disponibilité de fourrage et du ratio couvert forestier/ouverture sur l’utilisation de l’espace par le cerf de Virginie (Odocoileus virginianus) et sa vulnérabilité à la chasse sportive sur l’île d’Anticosti. Nos résultats ont démontré que l’utilisation de l’espace par le cerf et sa vulnérabilité à la chasse peuvent être modifiées par différentes composantes structurales de l’habitat. L’augmentation de la disponibilité de fourrage a entrainé une plus grande utilisation des prairies fertilisées par le cerf, tandis que la diminution du ratio couvert forestier/ouverture a augmenté sa vulnérabilité à la chasse. Ces résultats procurent des pistes de solutions pour les gestionnaires fauniques qui doivent à la fois réduire les dommages causés par les hautes densités de cerfs et satisfaire les chasseurs en maintenant un nombre élevé d’observation de cerfs.

What kind of surgery for cervical carcinoma?

The incidence and mortality of cervical cancer have changed over the past 50 years in developed countries, but this kind of tumor still remains a significant clinical problem because it is the second most common cause of morbidity and mortality from cancer among women. After histological confirmation of invasive cervical cancer, the extent of disease was determined using clinical criteria to assign a stage. This assessment is important because, while for the other gynecologic cancers clinical information obtained by surgery and histopathological examination is implemented and concurs to define the staging of the disease, the cervical cancer tumor stage is given after the primary diagnosis. In this review we discuss how the surgical approach to cervical cancer has been evolved, in order to modulate the radicality of the intervention itself and thus to preserve the pelvic innervation. This step has been achieved by deepening knowledge of functional pelvic anatomy and modulating the radicality of hysterectomy according to well defined surgical landmarks.

Apicomplexans pulling the strings: manipulation of the host cell cytoskeleton dynamics

Invasive stages of apicomplexan parasites require a host cell to survive, proliferate and advance to the next life cycle stage. Once invasion is achieved, apicomplexans interact closely with the host cell cytoskeleton, but in many cases the different species have evolved distinct mechanisms and pathways to modulate the structural organization of cytoskeletal filaments. The host cell cytoskeleton is a complex network, largely, but not exclusively, composed of microtubules, actin microfilaments and intermediate filaments, all of which are modulated by associated proteins, and it is involved in diverse functions including maintenance of cell morphology and mechanical support, migration, signal transduction, nutrient uptake, membrane and organelle trafficking and cell division. The ability of apicomplexans to modulate the cytoskeleton to their own advantage is clearly beneficial. We here review different aspects of the interactions of apicomplexans with the three main cytoskeletal filament types, provide information on the currently known parasite effector proteins and respective host cell targets involved, and how these interactions modulate the host cell physiology. Some of these findings could provide novel targets that could be exploited for the development of preventive and/or therapeutic strategies.

A Study of pH Manipulation on Tumor Proliferation and the CTL Response

Adoptive Cell Transfer (ACT) Therapy is a cancer treatment that enhances and utilizes the body’s own immune system. However, this treatment has had limited success in clinical trials. We hypothesized that this is due to the immunosuppressive, acidic microenvironment of cancer tumors. We tested the effects of acidic, neutral, and basic environments in vitro on cytotoxic T lymphocyte (CTL) survival, activation, migration and killing ability and on cancer cell survival. We found that CTLs have most optimum survival, activation, and migration in a neutral environment, while the optimal extracellular conditions for EG-7 lymphoma are slightly acidic and B16-OVA melanoma survives best in physiological conditions. Future research should further study the killing ability of T cells in the three different environments and look to move to in vivo experiments.

Diagnostic utility of thyroglobulin measurement in the fine needle aspirates from cervical lymph nodes: a case report

Fine needle aspiration cytology (FNAC) is the more accurate diagnostic method for cervical lymph node (CLN) metastasis from differentiated thyroid cancers (DTC). However, FNAC diagnosis of cystic CLN is, in most cases, uninformative due to inadequate cellularity. Recently, thyroglobulin (Tg) detection in FNAC needle washout fluid has been shown to improve the diagnostic accuracy of FNAC, and its routine association with cytology is recommended. We here describe the case of a 20 yr old girl complaining of the recent appearance of palpable non-painful laterocervical nodes in the neck. Ultrasound examination revealed the presence of 3 cystic CLNs and 2 mixed thyroid nodules, with the larger one showing irregular margins. On the latter, and on 2 larger CLNs, FNAC was performed, and both Tg protein and mRNA were determined in the needle washout. The cytological analysis was not diagnostic for the two CLNs, while that of the thyroid nodule reported the presence of colloid and groups of thyrocytes with normal morphology. Both CLNs showed, however, high levels of Tg protein and were positive for Tg mRNA, suggestive of metastatic DTC. Based on these findings, the FNAC analysis was performed on the second smaller thyroid nodule suggesting (Tir4) the presence of PTC. The patient was then subjected to total thyroidectomy with lymph nodes resection of the central and homolateral compartments. The histological diagnosis confirmed the presence of a PTC in the small nodule and metastatic lymph nodes. In conclusion, this case confirms that the cytological diagnosis of cystic lymph nodes is challenging, and that the measurement of Tg protein and/or mRNA in the needle washout may overcome this limitation.

A relação do branqueamento não vital e a reabsorção cervical externa

A procura pelo padrão estético na Medicina Dentária tem crescido a cada ano, em função da necessidade da população em estar de acordo com os padrões estéticos da sociedade, que ditam dentes brancos, bem contornados e alinhados. O branqueamento para dentes não vitais é um procedimento utilizado há muito tempo e possui vantagens indiscutíveis, como o baixo custo, técnica conservadora e segurança. Porém, há muito tempo que se discute a relação do branqueamento interno com o aparecimento da reabsorção cervical externa. Muitos estudos foram realizados apresentando não só resultados diferentes, mas também pontos de vista diferentes envolvendo assuntos tais como o agente branqueador a ser escolhido e suas concentrações, qual deles possui melhor desempenho e qual o mais seguro. Por isso, essa revisão de literatura teve como objetivo realizar um levantamento de tais estudos através de pesquisa na qual foram identificados artigos sobre o tema, publicados em português e inglês e indexados no banco de dados B-on, PubMed, SciELO, MEDLINE e LILACS e discutir à luz dos conhecimentos científicos a relação de tal procedimento com o aparecimento da reabsorção cervical externa e quais medidas que podem ser tomadas pelo profissional para minimizar este risco. Diante do exposto, foi verificado que a Reabsorção Cervical Externa é um dos principais efeitos adversos do branqueamento interno, porém, há medidas que devem ser adoptadas pelo profissional para impedir ou minimizar este risco, como a utilização do tampão cervical, a não utilização do condicionamento ácido prévio ao branqueamento e não utilização de fontes de calor. Além disso, se torna muito importante que haja um acompanhamento do caso após o tratamento concluído, pois uma vez que haja o aparecimento da RCE, esta deve ser tratada o mais rápido possível.