Community perceptions of a rural medical school: a pilot qualitative study

BACKGROUND

This paper explores local community perceptions of a relatively new rural medical school. For the purposes of this paper, community engagement is conceptualized as involvement in planning, delivering, and evaluating the medical program. Although there are several reviews of patient involvement in medical curricula development, this study was designed to pilot an approach to exploring the perspectives of well members of the community in the transition of institutional policy on community engagement to one medical school.

METHODS

An advertisement in the local newspaper invited volunteers to participate in a telephone interview about the new medical school. An independent researcher external to the medical school conducted the interviews using a topic guide. Audio recordings were not made, but detailed notes including verbatim statements were recorded. At least two research team members analyzed interview records for emergent themes. Human research ethics approval was obtained.

RESULTS

Twelve interviews were conducted. Participants offered rich imaginings on the role of the school and expectations and opportunities for students. Most participants expressed strong and positive views, especially in addressing long-term health workforce issues. It was considered important that students live, mix, and study in the community. Some participants had very clear ideas about the need of the school to address specified needs, such as indigenous health, obesity, aging, drug and alcohol problems, teenage pregnancy, ethnic diversity, and working with people of low socioeconomic status.

CONCLUSION

This study has initiated a dialogue with potential partners in the community, which can be built upon to shape the medical school's mission and contribution to the society it serves. The telephone interview approach and thematic analysis yielded valuable insights and is recommended for further studies. Our study was limited by its small study size and the single recruitment source. The community is a rich resource for medical education, but there is a dearth of literature on the perspectives of the community and its role in medical education.

Beat note stabilization of mode-locked lasers for quantum information processing

We stabilize a chosen radio frequency beat note between two optical fields derived from the same mode-locked laser pulse train in order to coherently manipulate quantum information. This scheme does not require access or active stabilization of the laser repetition rate. We implement and characterize this external lock, in the context of two-photon stimulated Raman transitions between the hyperfine ground states of trapped 171Yb(+) quantum bits.

Quantum catalysis of magnetic phase transitions in a quantum simulator

We control quantum fluctuations to create the ground state magnetic phases of a classical Ising model with a tunable longitudinal magnetic field using a system of 6 to 10 atomic ion spins. Because of the long-range Ising interactions, the various ground state spin configurations are separated by multiple first-order phase transitions, which in our zero temperature system cannot be driven by thermal fluctuations. We instead use a transverse magnetic field as a quantum catalyst to observe the first steps of the complete fractal devil's staircase, which emerges in the thermodynamic limit and can be mapped to a large number of many-body and energy-optimization problems.

Spirometric standard of healthy Bangladeshi adults aged 18-40 years

Pulmonary function test of various types are utilized clinically and epidemiologically to measures the functional status of the lung and to asses the diseases. Spirometric standard for healthy Bangladeshi adults aged 18-40 years is conducted in National Institute of Diseases of Chest and Hospital (NIDCH). This is cross sectional study is establish normal value of lung functions for Bangladeshi adult. Total of 995 (628 males & 367 females) healthy adults were selected to obtain lung function values; from a healthy adult those who attended in the hospital as a patients attended and healthy stuff of NIDCH. A computerized spirometer was used to measure lung volume and flows in a standard way. The best of the three reading was taken as the correct value. Anthropometric parameters including age, weight and height were recorded appropriately and body mass index was calculated. The statistical package for the social science (SPSS-10.01) was used for the statistical analysis of the data. The pulmonary function data was separated by sex and classified on the basis of height weight age and body surface area. The mean and standard deviation was calculated for every such variable. The lung function variable shows a linear positive correlation with height, weight and age. Force vital capacity (FVC) and forced expiratory volume in 1st second (FEV1) increase in height. Males show higher values for lung function variables than female. Stepwise regression analysis was done using age, height and weight, BMI as independent variable strong correlation was found between lung function values and independent variables. Height shows the highest correlation. The regression equation for lung function variables was determined for males and females considering height as independent variable. Lung function values of Bangladeshi adult were significantly lower than Nigerian, British and American result but nearly similar to Indian result. Nomogram was constructed in relation to height for males and females.

Role of NGOs and CBOs in Waste Management

BACKGROUND

Developing cities like Khulna, the third largest metropolitan city in Bangladesh, have now begun to confess the environmental and public health risks associated with uncontrolled dumping of solid wastes mainly due to the active participation of non-governmental organizations (NGOs) and community-based organizations (CBOs) in municipal solid waste (MSW) management.

METHODS

A survey was conducted to observe the present scenarios of secondary disposal site (SDS), ultimate disposal site (UDS), composting plants, medical wastes management and NGOs and CBOs MSW management activities.

RESULTS

A total of 22 NGOs and CBOs are involved in MSW management in 31 wards of Khulna City Corporation. About 9 to 12% of total generated wastes are collected by door-to-door collection system provided by mainly NGOs and CBOs using 71 non-motorized rickshaw vans. A major portion of collected wastes is disposed to the nearest SDS by these organizations and then transferred to UDS or to private low-lying lands from there by the city authority. A small portion of organic wastes is going to the composting plants of NGOs.

CONCLUSION

The participation of NGOs and CBOs has improved the overall MSW management system, especially waste collection process from sources and able to motivate the residents to store the waste properly and to keep clean the premises.

Integration of Multi-Level Copper Metallization into a High Performance Sub-0.25μM Technology

We report the integration of six levels of Cu interconnects using dual inlaid patterning in a 0.2 μm logic technology. A review of process technology as well as device performance shortcomings using conventional aluminum metallization has been presented. Two tantalum based barriers, TaNx and Ta-Si-N as well as a titanium based barrier, CVD TiN, have been evaluated for their applicability. The use of embedded barriers wherein the barrier is formed below the surface of the dielectric has also been discussed as a potential option. No degradation to the device front-end parametrics were found with the choice of an appropriate barrier. Planarization by Cu CMP introduces surface topography that needs to be minimized in order to process multiple levels of interconnects within specified sheet resistance distributions for a range of line widths. Excellent results with highly planarized levels of metallization have consistently been achieved through an optimization of the unit processes and device integration.

Primary colon cancer site as a predictor of bevacizumab effectiveness in metastatic colon cancer patients

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Background: Bevacizumab has been approved by the FDA for first-line treatment in combination with chemotherapy for metastatic colon cancer. Although bevacizumab extends progression free survival and overall survival for many metastatic colon cancer patients, primary cancer site has not been examined as a predictor of its effectiveness.

Methods: Data regarding bevacizumab treatment for colorectal cancer were abstracted from the medical record of 175 patients treated at a large multi-specialty clinic. Data were collected regarding demographics, body mass index, weight loss, lifestyle variables (smoking status, drinking habit), history of colon polyps, family history of cancer, primary site of tumor in the colon, tumor stage, lymph node involvement, metastasis, tumor grade of metastasis, cancer cell type, symptoms related to the cancer, and other comorbidities (cardiovascular disease, diabetes mellitus, Crohn's disease, diverticulitis, and irritable bowel syndrome).Tumor response was measured by radiologic and biochemical markers. Univariate and multivariate analyses were performed using Fisher's exact test, Wilconox rank sum test, and unconditional logistic regression modeling.

Results: Univariate analysis demonstrated that positive tumor response was positively correlated with blood in stool (p=0.0301), advanced lymph node stage (p=0.048), and adenocarcinoma cancer cell type (p=0.0387), but negatively correlated with chemotherapy treatment of the primary tumor (p=0.0387) and primary site of the colon cancer (p=0.0328). Multivariate stepwise logistic regression analysis demonstrated that patients with primary tumor located in the transverse or descending/sigmoid colon were more likely (odds ratio=5.88, 95% confidence interval: 1.72–20.00; p=0.0046) to have a positive tumor response than patients whose primary tumor site was cecal/ascending colon.

Conclusions: Primary site of metastatic colon cancer may influence the effectiveness of bevacizumab therapy. Future randomized, controlled trials are needed to examine the primary site as a predictor of tumor response in metastatic colon cancer patients using bevacizumab therapy.

No significant financial relationships to disclose.

Impact of a cash-for-work programme on food consumption and nutrition among women and children facing food insecurity in rural Bangladesh

OBJECTIVE

To determine whether a cash-for-work programme during the annual food insecurity period in Bangladesh improved nutritional status in poor rural women and children.

METHODS

The panel study involved a random sample of 895 households from over 50,000 enrolled in a cash-for-work programme between September and December 2007 and 921 similar control households. The height, weight and mid-upper arm circumference of one woman and child aged less than 5 years from each household were measured at baseline and at the end of the study (mean time: 10 weeks). Women reported 7-day household food expenditure and consumption on both occasions. Changes in parameters were compared between the two groups.

FINDINGS

At baseline, no significant difference existed between the groups. By the study end, the difference in mean mid-upper arm circumference between women in the intervention and control groups had widened by 2.29 mm and the difference in mean weight, by 0.88 kg. Among children, the difference in means between the two groups had also widened in favour of the intervention group for: height (0.08 cm; P<0.05), weight (0.22 kg; P<0.001), mid-upper arm circumference (1.41 mm; P<0.001) and z-scores for height-for-age (0.02; P<0.001), weight-for-age (0.17; P<0.001), weight-for-height (0.23; P<0.001) and mid-upper arm circumference (0.12; P<0.001). Intervention households spent more on food and consumed more protein-rich food at the end of the study.

CONCLUSION

The cash-for-work programme led to greater household food expenditure and consumption and women's and children's nutritional status improved.

Quantum simulation of frustrated Ising spins with trapped ions

A network is frustrated when competing interactions between nodes prevent each bond from being satisfied. This compromise is central to the behaviour of many complex systems, from social and neural networks to protein folding and magnetism. Frustrated networks have highly degenerate ground states, with excess entropy and disorder even at zero temperature. In the case of quantum networks, frustration can lead to massively entangled ground states, underpinning exotic materials such as quantum spin liquids and spin glasses. Here we realize a quantum simulation of frustrated Ising spins in a system of three trapped atomic ions, whose interactions are precisely controlled using optical forces. We study the ground state of this system as it adiabatically evolves from a transverse polarized state, and observe that frustration induces extra degeneracy. We also measure the entanglement in the system, finding a link between frustration and ground-state entanglement. This experimental system can be scaled to simulate larger numbers of spins, the ground states of which (for frustrated interactions) cannot be simulated on a classical computer.

Entanglement and tunable spin-spin couplings between trapped ions using multiple transverse modes

We demonstrate tunable spin-spin couplings between trapped atomic ions, mediated by laser forces on multiple transverse collective modes of motion. A sigma_{x}sigma_{x}-type Ising interaction is realized between quantum bits stored in the ground hyperfine clock states of ;{171}Yb;{+} ions. We demonstrate entangling gates and tailor the spin-spin couplings with two and three trapped ions. The use of closely spaced transverse modes provides a new class of interactions relevant to quantum computing and simulation with large collections of ions in a single crystal.

Chemokine receptors in advanced breast cancer: differential expression in metastatic disease sites with diagnostic and therapeutic implications

BACKGROUND

We investigated the expression of CXCR4, CCR7, estrogen receptor (ER), progesterone receptor (PR) and HER2-neu in human metastatic breast cancers to determine whether these biological biomarkers were preferentially expressed in any organ-specific metastases.

MATERIALS AND METHODS

CXCR4, CCR7, ER, PR and HER2-neu expression levels were evaluated by immunohistochemical staining using paraffin-embedded tissue sections of metastatic breast cancers (n = 41) obtained by either diagnostic biopsy or surgical resection.

RESULTS

The metastatic sites included the following: bone (n = 15), brain (n = 14), lung (n = 6), liver (n = 2), and omental metastases (n = 2). CXCR4 was expressed in 41% of cases, CCR7 expression was demonstrated in 10%, and HER2-neu overexpression was present in 27%. CXCR4 was more likely to be expressed in bone metastases than visceral metastases (67% versus 26%, P = 0.020). Visceral sites demonstrated a lower rate of CXCR4 positivity (33% and 23%, respectively, for lung and brain metastases). Similarly, CCR7 was more likely to be found in bone metastases than visceral sites (27% versus 0%, P = 0.037).

CONCLUSIONS

These results indicate that CXCR4 can contribute to the homing of breast cancer cells to the bone. This finding might have important clinical implications since patients with metastatic bone disease may achieve the highest benefit from a CXCR4-targeted therapy.

Successful surgical resection of advanced gastrointestinal stromal tumor post neoadjuvent therapy

We report a case of a 48-year-old Indian male who presented with swelling and firmness in his left upper part of the abdomen of one month duration with anorexia and weight loss. Initial examination revealed an intra abdominal mass of around 16.8x11.0x24.5cm with minimal left sided pleural effusion. A biopsy from the mass confirmed the diagnosis of gastrointestinal stromal tumour (GISTs) as supported by immmunohistochemistry results which showed strong positivity for c-kit while stains for smooth muscle actin, desmin, myoglobin, S100 Protein and cytokerstin remained negative. The patient was not suitable for surgical intervention in view of advanced tumor, and Imatinib Mesylate 400mg daily was started with the aim of making the tumor operable. Such therapy lasted for twenty months and was tolerated well by the patient. It then resulted in gradual tumor regression, following which the patient underwent successful tumor resection. Post surgical resection patient had no radiological evidence of intra abdominal tumor but mild left sided pleural effusion with left lower lobe atelectasis. The patient had uneventful post operative recovery and he is currently on Imatinib mesylate and tolerating treatment well with mild skin rash. The experience with preoperative imatinib on surgical resection rates and post operative outcomes is limited especially with primary locally advanced GISTs. In our case successful surgical resection was possible for a huge locally advanced GIST with unusually prolonged treatment of twenty months with imatinib preoperatively.

Survival among women with triple receptor-negative breast cancer and brain metastases

Abstract #6077

Background&#x2028; The purpose of this study was to determine the incidence of brain metastases in a cohort of women with early stage triple-receptor negative breast cancer and to evaluate the survival outcomes of these patients.&#x2028; Method&#x2028; Six hundred and seventy nine patients with early stage triple-receptor negative breast cancer diagnosed between 1980 and 2006 were identified. Cumulative incidence of brain metastases at 2- and 5-years following a diagnosis of early-stage triple receptor-negative breast cancer considering death as a competing risk was computed. Time to brain metastases was computed from the date of breast cancer diagnosis to the date of development of brain metastases. Cox proportional hazards models, adjusted for various patient and tumor characteristics, were then fitted to explore factors that could predict for the subsequent development of brain metastases in this cohort. Survival following a diagnosis of brain metastases was measured from the date of brain metastases diagnosis to the date of death from any cause. All survival outcomes were computed using the Kaplan – Meier product limit method and compared across groups using log rank statistic.&#x2028; Results&#x2028; Median age was 50 years (range 22 to 97 years) and median follow-up was 26.9 months (range 1.1 to 321.3 months. Overall 42 (6.2%) patients developed brain metastases of whom 16 (38.1%) had 3 brain lesions or less, 19 (45.2%) had more than 3 brain lesions and number of brain lesions was unknown in 7 (16.7%) patients. Overall cumulative incidence at 2- and 5-years was 5.6% (95% CI 3.8%-7.9%) and 9.6% (95% CI 6.8% - 13%) respectively. Twenty –four (3.5%) patients developed brain metastases as the first site of recurrence with cumulative incidence at 2- and 5-years observed to be 2.0% (95% CI 2.6% -6.0%) and 4.9% (95% CI 3.2%-7.0%) respectively. In the multivariable model factors such as age at primary tumor diagnosis, initial clinical stage, histological tumor grade, number of lymph nodes examined and tumor lymph-vascular invasion were not significantly associated with time to brain metastases. For the whole group of patients who developed brain metastases median survival was 2.9 months (95% CI 2.0 – 7.6 months). Among those who developed brain metastases as the first site of recurrence median survival was 5.8 months (95% CI 1.7 – 11.0 months).&#x2028; Conclusion&#x2028; Data from published studies have reported a 5-year cumulative incidence of brain metastases of approximately 5 % in an unselected breast cancer population. In our large single institutional study patients with triple-receptor-negative breast tumors we report higher early cumulative incidence compared to historical controls associated with poor survival. Patients with triple-receptor negative breast tumors may be an ideal cohort to target brain metastases preventive strategies.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6077.