Explore the vast range of titles available.

Purpose Gynecologic cancer survivors often hesitate to raise sexual health concerns with their clinicians. We pilot tested Starting the Conversation (STC), a theory-guided intervention aimed at facilitating survivors’ clinical communication about sexual health. Methods Survivors ( N  = 32) were randomized 2:1 to STC (23-min video and accompanying workbook grounded in social cognitive theory that provides information and skills training for communicating with providers about sexual concerns, and resource guide) or control (resource guide only). Feasibility was assessed through enrollment, retention, and intervention completion rates (benchmarks: 60%, 80%, 70%); acceptability was assessed through post-intervention program evaluations (benchmark: 75%). Preliminary effects were assessed for sexual health communication (self-reported after next clinic encounter), self-efficacy for clinical communication about sexual health (post-intervention and 2-month follow-up), and sexual activity and anxiety/depressive symptoms (2-month follow-up). Results All feasibility/acceptability benchmarks were surpassed; 76% enrolled, 97% retained, ≥ 95% used intervention materials, and 100% endorsed STC as acceptable. Positive STC effects were seen for increases in self-efficacy (Cohen’s d’s = 0.45 at post-intervention; 0.55 at follow-up). In STC, 35% and 45% of women raised or asked about sexual health concerns during the post-intervention clinic visit, respectively, versus 0 and 27% in the control arm. Other measures showed little change. Conclusions Data support the STC intervention as feasible and acceptable, with promising effects for gynecologic cancer survivors’ communication about sexual health concerns. Because sexual health communication is relevant across the treatment trajectory, we included both on-treatment and post-treatment survivors. While this may be a limitation, it could also enhance sample generalizability. A larger trial is needed to determine efficacy. Implications for Cancer Survivors Communication about sexual health is important yet lacking for cancer survivors. Patient-focused interventions may help address concerns and improve survivors’ health outcomes.

Providing effective roadside warning devices for drivers of large trucks is critical on freeway connectors where speeds are relatively high but design speeds may be substantially less than on mainlanes. Identifying and testing appropriate methods of monitoring traffic on freeway connectors was also included in this research. Two monitoring systems evolved, one using roadway sensors and the other using roadside sensors. Roadway sensors consisted of both piezoelectric and inductive loop sensors, while roadside sensors applied infrared sensor technology. The roadway warning devices tested can be categorized as passive devices and active devices. Passive devices consisted of \"truck tipping\" warning signs, while the active device consisted of flashing lights mounted one above and one below a set of passive truck tipping signs on both sides of the roadway. Speed reduction, as associated with accident reduction, was the ultimate goal of these tests. The null hypothesis tested by ANOVA of no treatment effect in the presence of initial speed was rejected in all but one of four models, using the probability of a Type I error,$\\alpha,$equal 0.05. Speed reductions due to the active system were significant in AC and BC data sets, but not in AB data sets, suggesting that truck driver response to the lights occurred downstream of Location B. Truck weights were not significant in any tenable test results, and separation of trucks into the categories of combination and non-combination trucks, peak/off-peak periods, and day/night/dusk periods was not helpful in understanding variations in truck speeds. Cumulative speed distributions showed that the fastest trucks decreased their speeds by approximately 2 to 3 mph (3 to 5 kph) during the test period. Five of the seven single-vehicle truck accidents that were recorded on the I-610/US-59 connector in an 8 1/2 year period that were speed-related resulted in rollover. None occurred after installation of warning treatments being tested, although there were other prior years with no recorded accidents.

Dear Editor: In regard to the subject of fuel mileage of vehicles using a blend of 10 percent ethanol with gasoline versus 100 percent gasoline, ethanol's energy content is 65 percent that of gasoline on a volume basis.

Changes in the function and microbiome of the upper and lower gastrointestinal tract have been documented in Parkinson's disease (PD), although most studies have examined merely fecal microbiome profiles and patients with advanced disease states. In the present study we sought to identify sensitive and specific biomarkers of changes in the oral microbiome of early stage PD through shotgun metatranscriptomic profiling. We recruited 48 PD subjects and 36 age- and gender-matched healthy controls. Subjects completed detailed assessments of motor, cognitive, balance, autonomic and chemosensory (smell and taste) functions to determine their disease stage. We also obtained a saliva sample for profiling of microbial RNA and host mRNA using next generation sequencing. We found no differences in overall alpha and beta diversity between subject groups. However, changes in specific microbial taxa were observed, including primarily bacteria, but also yeast and phage. Nearly half of our findings were consistent with prior studies in the field obtained through profiling of fecal samples, with others representing highly novel candidates for detection of early stage PD. Testing of the diagnostic utility of the microbiome data revealed potentially robust performance with as few as 11 taxonomic features achieving a cross-validated area under the ROC curve of 0.90 and overall accuracy of 84.5%. Bioinformatic analysis of 167 different metabolic pathways supported shifts in a small set of distinct pathways involved in amino acid and energy metabolism among the organisms comprising the oral microbiome. In parallel with the microbial analysis, we also examined the evidence for changes in human salivary mRNAs in the same subjects. This revealed significant changes in a set of 9 host mRNAs, several of which mapped to various brain functions and showed correlations with some of the significantly changed microbial taxa. Unexpectedly, we also observed robust correlations between many of the microbiota and functional measures, including those reflecting cognition, balance, and disease duration. These results suggest that the oral microbiome may represent a highly-accessible and informative microenvironment that offers new insights in the pathophysiology of early stage PD.

How chemotherapy affects carcinoma genomes is largely unknown. Here we report whole-exome and deep sequencing of 30 paired oesophageal adenocarcinomas sampled before and after neo-adjuvant chemotherapy. Most, but not all, good responders pass through genetic bottlenecks, a feature associated with higher mutation burden pre-treatment. Some poor responders pass through bottlenecks, but re-grow by the time of surgical resection, suggesting a missed therapeutic opportunity. Cancers often show major changes in driver mutation presence or frequency after treatment, owing to outgrowth persistence or loss of sub-clones, copy number changes, polyclonality and/or spatial genetic heterogeneity. Post-therapy mutation spectrum shifts are also common, particularly C>A and TT>CT changes in good responders or bottleneckers. Post-treatment samples may also acquire mutations in known cancer driver genes (for example, SF3B1 , TAF1 and CCND2 ) that are absent from the paired pre-treatment sample. Neo-adjuvant chemotherapy can rapidly and profoundly affect the oesophageal adenocarcinoma genome. Monitoring molecular changes during treatment may be clinically useful. Oesophageal adenocarcinoma is often treated with chemotherapy before surgery. Here, the authors sequence cancer samples before and after chemotherapy and examine how the genome changes, focusing on changes in driver gene mutations and differential clonal evolution between good and poor responders.

Background Empirical evidence suggests data and insights from the clinical practice guidelines and clinical quality registries are not being fully utilised, leaving health service managers, clinicians and providers without clear guidance on how best to improve healthcare delivery. This lack of uptake of existing research knowledge represents low value to the healthcare system and needs to change. Methods Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews) were systematically searched. Included studies were published between 2000 and 2020 reporting on the attributes, evidence usage and impact of clinical practice guidelines and clinical quality registries on health service delivery. Results Twenty-six articles including one randomised controlled trial, eight before-and-after studies, eight case studies/reviews, five surveys and four interview studies, covering a wide range of medical conditions and conducted in the USA, Australia and Europe, were identified. Five complementary strategies were derived to maximise the likelihood of best practice health service delivery: (1) feedback and transparency, (2) intervention sustainability, (3) clinical practice guideline adherence, (4) productive partnerships and (5) whole-of-team approach. Conclusion These five strategies, used in context-relevant combinations, are most likely to support the application of existing high-quality data, adding value to health service delivery. The review highlighted the limitations of study design in opportunistic registry studies that do not produce clear, usable evidence to guide changes to health service implementation practices. Recommendations include exploration of innovative methodologies, improved coordination of national registries and the use of incentives to encourage guideline adherence and wider dissemination of strategies used by successful registries.

Performance measurement in construction has been a topic of academic and industry inquiry in the UK since the 1990s. Despite the time elapsed, there is little evidence of a consistent industry-wide performance framework that drives decision-making and supports consistent measurement of performance on construction projects. A review of academic advancements and industry practices has been conducted to understand performance measurement in the construction industry, including the metrics assessed, processes for collecting and analysing data, and current limitations. The adoption of digital technologies on construction projects can support timely measurement of performance metrics, allowing for feedback and corrective action to improve performance. However, organisations struggle to connect the top-down measurement value with the bottom-up data capture technologies. The study of an exemplar commercial project was used to inductively develop a data-to-dashboard strategy that supports decision making in construction. The proposed strategy aligns performance metrics, digital tools and processes, and data analysis techniques in a consistent approach to interpret performance-related data and understand key issues. The development and review of the strategy on a live construction project highlights the challenges experienced with multi-source data integration and the translation of information into knowledge that drives decisions and deployment of timely corrective measures. The application of the strategy would ensure a consistent definition of metrics early in the project, and the continuous measurement of leading indicators. Future research will review the proposed strategy on further case study projects and develop an industry-wide multi-level performance measurement framework that uses the proposed strategy to improve performance.

Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas. To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. This population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. Adherence to cancer screening based on the US Preventative Services Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. The overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. In this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.

There is growing evidence that areas characterised by high levels of social fragmentation have higher suicide rates. Previous ecological studies have focused on relatively large geographic areas and/or examined associations in all age groups combined. Negative binominal regression was used to assess age- and sex-specific suicide rate ratios for a range of census-derived indicators of the social, health and economic characteristics of small areas (mean population aged > or = 15: 4500) in England and Wales. Indicators of social fragmentation (e. g. proportion of people living alone or population mobility) were most consistently associated with suicide risk. For example, across quartiles of wards ranked according to increasing proportions of single-person households, age- and sex-adjusted suicide rate ratios were: 1.00, 1.05 (1.00, 1.11), 1.14 (1.08, 1.19) and 1.42 (1.36, 1.49). Associations were strongest in 15 to 44 and 45 to 64 year-olds. Associations with social fragmentation persisted after controlling for the effect of other area characteristics. Targeted mental health promotion and social policy initiatives to reduce area-health inequalities in suicide might usefully focus on areas with high levels of social fragmentation.