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The Effect of Paternal Age on Outcome in Assisted Reproductive Technology Using the Ovum Donation Model
In: Reproductive sciences: RS : the official journal of the Society for Reproductive Investigation, Band 21, Heft 5, S. 590-593
ISSN: 1933-7205
Navigating Access to Cancer Care: Identifying Barriers to Precision Cancer Medicine
In: Ethnicity & disease: an international journal on population differences in health and disease patterns, Band 32, Heft 1, S. 39-48
ISSN: 1945-0826
Objective: Precision medicine is revolutionizing cancer treatment. However, there has been limited investigation of barriers patients endure to access precision cancer medicine. This study aims to report the experiences of underserved patient populations with limited access to genomic testing, clinical trials, and precision cancer treatment.Methods: A mixed-method study was employed to quantitatively evaluate patients (N=300) seeking precision cancer medicine between January 2014- August 2017. Qualitatively, we conducted semi-structured interviews with eight case managers who navigate the health care and health insurance systems to provide patients with access to precision cancer medicine care. All interviews were analyzed to identify themes.Results: Within our patient cohort, 69% were diagnosed in stage I of cancer disease. Overall, 27 patients (9%) were denied treatment as a final outcome of their case due to insurance denials, 35 patients (12%) died before gaining access to precision cancer medicine, and 6 patients (2%) received precision cancer medicine through clinical trials. Four broad thematic areas emerged from the qualitative analysis: 1) lack of patient, provider and insurer knowledge of precision cancer medicine; 2) barriers to clinical trial participation; 3) lack of patient health literacy; and 4) barriers to timely access to care.Conclusion: Our combined analyses suggest that both system-level and patient-level barriers limit patient access to precision cancer medicine options. Additionally, we found that these barriers may exist not only for traditionally underserved patients, but also for resourced and insured patients trying to access precision cancer medicine. Ethn Dis. 2022;32(1):39-48; doi:10.18865/ed.32.1.39
AudiWFlow: Confidential, Collusion-resistant Auditing of Distributed Workflows
We discuss the problem of accountability when multiple parties cooperate towards an end result such as multiple companies in a supply chain or departments of a government service under different authorities. In cases where a full trusted central point does not exist, it is difficult to obtain a trusted audit trail of a workflow when each individual participant is unaccountable to all others. We propose AudiWFlow, an auditing architecture which makes participants accountable for its contributions in a distributed workflow. Our scheme provides confidentiality in most cases, collusion detection and availability of evidence after the workflow terminates. AudiWFlow is based on verifiable secret sharing and real-time peer-to-peer verification of records; it further supports multiple levels of assurance to meet a desired trade-off between the availability of evidence and the overhead resulting from the auditing approach. We propose and evaluate two implementation approaches for AudiWFlow. The first one is fully distributed except for a central auxiliary point that, nevertheless, needs only a low level of trust. The second one is based on smart-contracts running on a public blockchain which is able to remove the need of any central point but requires the integration with a blockchain.
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A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical Decision-Making
In: Ethnicity & disease: an international journal on population differences in health and disease patterns, Band 29, Heft 1, S. 1-8
ISSN: 1945-0826
Objective: The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study investigates primary care providers' use of race in clinical practice.Methods: Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial Attributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers' knowledge of human genetic variation.Results: In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians' score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67).Conclusions: Physicians had more knowledge of genetic variation and used patients' race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further exploration of these differences is needed, including examination of physicians' and NPs' beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care disparities.Ethn Dis.2019;29(1):1-8; doi:10.18865/ ed.29.1.1.
An Examination of John Henryism in Adults Living with Sickle Cell Disease
In: Journal of racial and ethnic health disparities: an official journal of the Cobb-NMA Health Institute
ISSN: 2196-8837
Abstract
Background
John Henryism (JH) is a behavioral predisposition for high-effort coping with adversity. JH has been associated with hypertension in Black Americans with low socioeconomic status (SES) and is also found to be associated with psychological well-being. Sickle cell disease (SCD), a rare genetic disease largely affecting Black Americans in the United States, presents as a chronic condition that may benefit from a deeper understanding of the impact of JH on overall health.
Purpose
This study examined the association between high and low JH and diastolic blood pressure, systolic blood pressure, hypertension prevalence, and sleep function. We relied on the biopsychosocial transaction model to adjust for relevant clinical and sociodemographic variables.
Methods
This was a cross-sectional secondary analysis of 274 adults with SCD living in the United States and recruited between 2014 and 2020. Study visits consisted of physical examinations, medical history, demographic, and psychosocial questionnaires. Adjusted linear regressions estimated associations between high and low JH and diastolic and systolic blood pressure as well as self-reported sleep function. Multivariable logistic regression was used to examine associations with hypertension prevalence.
Results
High JH was significantly associated with lower diastolic blood pressure (β = − 2.98; 95% confidence interval = − 5.92, − 0.04) but higher sleep dysfunction (β = 2.76; 95% confidence interval = 1.45, 4.07).
Conclusions
Overall, we found positive psychological coping resources associated with high JH, with the exception of sleep.
Trial Registration.
ClinicalTrials.gov Identifier: NCT02156102.
An exploration of the current state of information assurance education
In: Cooper, Stephen and Nickell, Christine and Piotrowski, Victor and Oldfield, Brenda and Abdallah, Ali E. and Bishop, Matt and Caelli, Bill and Dark, Melissa and Hawthorne, E. K. and Hoffman, Lance and Pérez, Lance C. and Pfleeger, Charles and Raines, Richard and Schou, Corey and Brynielsson, Joel (2009) An exploration of the current state of information assurance education. In: An Exploration of the Current State of Information Assurance Education. ACM, pp. 109-125.
Information Assurance and computer security are serious worldwide concerns of governments, industry, and academia. Computer security is one of the three new focal areas of the ACM/IEEE's Computer Science Curriculum update in 2008. This ACM/IEEE report describes, as the first of its three recent trends, "the emergence of security as a major area of concern." The importance of Information Assurance and Information Assurance education is not limited to the United States. Other nations, including the United Kingdom, Australia, New Zealand, Canada, and other members from NATO countries and the EU, have inquired as to how they may be able to establish Information Assurance education programs in their own country. The goal of this document is to explore the space of various existing Information Assurance educational standards and guidelines, and how they may serve as a basis for helping to define the field of Information Assurance. It was necessary for this working group to study what has been done for other areas of computing. For example, computer science (CS 2008 and associate-degree CS 2009), information technology (IT 2008), and software engineering (SE 2004), all have available curricular guidelines. In its exploration of existing government, industry, and academic Information Assurance guidelines and standards, as well as in its discovery of what guidance is being provided for other areas of computing, the working group has developed this paper as a foundation, or a starting point, for creating an appropriate set of guidelines for Information Assurance education. In researching the space of existing guidelines and standards, several challenges and opportunities to Information Assurance education were discovered. These are briefly described and discussed, and some next steps suggested.
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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
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