Casual Link Research Articles

Thalamo-cortical neural mechanism of sodium salicylate-induced hyperacusis and anxiety-like behaviors

Tinnitus has been identified as a potential contributor to anxiety. Thalamo-cortical pathway plays a crucial role in the transmission of auditory and emotional information, but its casual link to tinnitus-associated anxiety remains unclear. In this study, we explore the neural activities in the thalamus and cortex of the sodium salicylate (NaSal)-treated mice, which exhibit both hyperacusis and anxiety-like behaviors. We find an increase in gamma band oscillations (GBO) in both auditory cortex (AC) and prefrontal cortex (PFC), as well as phase-locking between cortical GBO and thalamic neural activity. These changes are attributable to a suppression of GABAergic neuron activity in thalamic reticular nucleus (TRN), and optogenetic activation of TRN reduces NaSal-induced hyperacusis and anxiety-like behaviors. The elevation of endocannabinoid (eCB)/ cannabinoid receptor 1 (CB1R) transmission in TRN contributes to the NaSal-induced abnormalities. Our results highlight the regulative role of TRN in the auditory and limbic thalamic-cortical pathways.

Quantum Antitrust – A Unified Exclusionary Abuse Theory

Now that the judgments in Servizio Elettrico Nazionale and Unilever have made sense of previous case-law, a unified analytical framework can be predicated for all exclusionary abuses. It is made up of two limbs (artificiality/conduct deviating from competition on the merits and potential exclusionary effect/capability of foreclosing). The two limbs are two sides of the same coin, which consists of ascertaining whether the plausible rationale (in the sense of nature and economy) behind a dominant company’s conduct is to derive an advantage that equally efficient competitors cannot either derive by doing the same (first limb–artificiality) or offset by other means (second limb–potential effect). This exclusionary rationale, which is a cognitive state in the dominant company’s mind rather than an ontological reality, is objectivised by holistically judging the dominant company’s conduct against the backdrop of the relative efficiency of its competitors, which is the link between both limbs: if the inherent features of the company’s conduct and all the relevant circumstances surrounding it allow equally efficient competitors to either derive a similar advantage or to defeat its exclusionary effect by some other means, the conduct does not make anticompetitive sense (exclusion is not its plausible rationale). Owing to the very Darwinian nature of competition law, relative efficiency is the common “quantum” and, therefore, a useful yardstick for abuse from the historical, legal, teleological and practical perspectives, as well as from the points of view of causality and reality. Finally, plausibility would be the single standard of proof that could be rebutted by disproving either of the two limbs (in an Intel II-like fashion), either by providing an alternative non-exclusionary explanation that breaks the casual link or by putting forward an objective justification. All other tests and standards merely reflect the extent to which either the artificiality or the potential effects of the conduct can be presumed based on economic judgement or experience (as happened in merger control following CK Telecoms)–thus reconciling per se rules, consisting of an Art. 101-like cursory analysis, with a more economic approach.

Urinary phenotyping of SARS-CoV-2 infection connects clinical diagnostics with metabolomics and uncovers impaired NAD+ pathway and SIRT1 activation.

The stratification of individuals suffering from acute and post-acute SARS-CoV-2 infection remains a critical challenge. Notably, biomarkers able to specifically monitor viral progression, providing details about patient clinical status, are still not available. Herein, quantitative metabolomics is progressively recognized as a useful tool to describe the consequences of virus-host interactions considering also clinical metadata. The present study characterized the urinary metabolic profile of 243 infected individuals by quantitative nuclear magnetic resonance (NMR) spectroscopy and liquid chromatography mass spectrometry (LC-MS). Results were compared with a historical cohort of noninfected subjects. Moreover, we assessed the concentration of recently identified antiviral nucleosides and their association with other metabolites and clinical data. Urinary metabolomics can stratify patients into classes of disease severity, with a discrimination ability comparable to that of clinical biomarkers. Kynurenines showed the highest fold change in clinically-deteriorated patients and higher-risk subjects. Unique metabolite clusters were also generated based on age, sex, and body mass index (BMI). Changes in the concentration of antiviral nucleosides were associated with either other metabolites or clinical variables. Increased kynurenines and reduced trigonelline excretion indicated a disrupted nicotinamide adenine nucleotide (NAD+) and sirtuin 1 (SIRT1) pathway. Our results confirm the potential of urinary metabolomics for noninvasive diagnostic/prognostic screening and show that the antiviral nucleosides could represent novel biomarkers linking viral load, immune response, and metabolism. Moreover, we established for the first time a casual link between kynurenine accumulation and deranged NAD+/SIRT1, offering a novel mechanism through which SARS-CoV-2 manipulates host physiology.

Carbon dioxide's direct impact on down-regulating the human species

Much is said about carbon dioxide (CO2) affecting climate; rising global temperatures, rising sea levels, and stagnating ocean currents being often cited results. Less is said about what CO2 does directly to human physiology should anthropogenic trends not abate. Past mass extinctions have been correlated to airborne CO2 levels rapidly rising above 1000 ppm (Ward, 2007); a value that may be seen by the end of this century. This study proposes as humankind confronts climate changes brought on by rising atmospheric CO2 concentration, as levels rise over 1000 ppm humans may also be inundated by the direct effects of CO2. While this has already been proposed by others, this study goes on to introduce a straight forward model for helping quantify the impact of airborne CO2 on human physiology which shows the onset of hypercapnic bloodstream pH levels in humans begin to appear when atmospheric CO2 levels approach 3000 ppm. However, upon examination of data from past submarine studies, a physiological response may occur in humans at much lower atmospheric CO2 levels due to a slow buildup of CO2 in the body over time. A casual link between atmospheric CO2 levels and the calcium balance in the human body is established providing rationale for the possibility of a greater occurrence of vascular calcification and concurrent bone demineralization in the greater general population when atmospheric CO2 levels rise. Noted is the likelihood of neurological effects at CO2 levels around 1000 ppm is suggested by several past studies. Note is also made of other organisms such as fish having much lower arterial pressures than humans making them more vulnerable to environmental CO2 changes as found by other studies. This study concludes CO2's direct impact to the human physiology as well as other life is not as benign as many like to suggest, and beyond climate change, appears as a mechanism for undermining human sustainability deserving closer scrutiny, and greater discussion.

Emotional intelligence and organisational commitment of Lecturers at Kyambogo University

The study examined the casual link between emotional intelligence and organisational commitment of lecturers at Kyambogo University. Specifically, the study examined the link between the four emotional intelligence competencies of self-awareness, self-management, social awareness, and relationship management with organisational commitment of full-time lecturers at Kyambogo University. The three-component model of organisational commitment by Allen and Meyer, which describes it in terms of affective, normative, and continuance commitment, was used to assess the concept. Using the correlational research design, the study adopted the quantitative approach. The study participants were 175 full-time lecturers of the selected university. The data were collected using a self-administered questionnaire. Structural equation modelling (SEM) using SmartPLS was used to analyse the data. The study findings indicated that while self-management and social awareness were significant determinants of organisational commitment of full-time lecturers, relationship management and self-awareness were positive but insignificant determinants of organisational commitment. The study concluded that while self-management and social awareness are essential for the organisational commitment of lecturers, relationship management and self-awareness are not. Therefore, it was recommended that to promote the organisational commitment of lecturers, university managers should take cognisance of lecturers' self-management and social awareness more than relationship management and self-awareness.

The influence of political ideology on greenhouse gas emissions

This research tests the casual link from political ideology to national greenhouse gas emissions by utilizing multinational panel data covering 98 countries during the period 1990–2016. Overall, the baseline results and robustness tests show a political divide on national greenhouse gas emissions, whereby compared to right-wing governments, left-wing governments are more likely to exhibit less carbon dioxide emissions. We further explore this topic from the perspectives of energy efficiency and education. Three-stage OLS regressions suggest that leftist parties increase energy efficiency and spend more on secondary education, which lead to less greenhouse gas emissions. We also introduce the interaction between political ideology and economic performance as well as globalization to test the moderating effects of economic performance and globalization. The study further looks into the interaction effects of political ideology and democracies on greenhouse gas emissions by dividing the whole sample into two sub-samples. The results indicate that the ideology effect on greenhouse gas emissions varies among countries with different economic performances or different degrees of political globalization, as well as between democracies and non-democracies.

MYOCARDITIS LINKED TO PFIZER-BIONTECH COVID-19 VACCINE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: The SARS-CoV-2 causing COVID-19 can have serious effects on the heart with recent data suggesting acute cardiac injury in almost one fifth of COVID-19 patients. Considering the recent role out of Covid-19 vaccine's to the general public there is a growing concern of COVID-19 related myocarditis being linked to the vaccine. Here we present a case of a young patient who presented with symptoms of COVID-19 after his second shot of COVID-19 vaccine, with subsequent development of myocarditis. CASE PRESENTATION: This patient is a 21 year old male with past medical history significant of mitral valve prolapse, and resting tachycardia, presented with a 2 day history of fevers, nausea, accompanied by shortness of breath, and chest pain. Patient had his 2nd shot of Pfizer-BioNTech Covid-19 vaccine 3 days prior to admission, symptom onset was after the administration of vaccine. Vitals on admissionm were within normal limits, EKG did not show any acute ischemic changes, no evidence pericarditis and or pulmonary embolism related changes. Troponins were trended, 460, 637, 832, significant for acute myocardial injury but with no evidence of MI based on character of chest pain and EKG changes. 2D echocardiogram showed Left Ventricular (LV) Ejection Fraction of 43%, with mildly reduced LV systolic function. CTA chest with IV contrast showed no aortic dissection., or pulmonary embolism. Cardiac MRI showed findings suggestive of acute myocarditis. Patient was treated symptomatically, troponins trended down, with resolution of chest pain. DISCUSSION: Myocarditis associated with the Pfizer-BioNTech Covid-19 vaccine, is a potential rare side effect. Even though a casual link has not been established. Considering the sequence of events for this patient, there is potentially a link between the two. Recently there have been 62 cases in Israel diagnosed after receiving the second dose of the Pfizer-BioNTech Covid-19 vaccine, incidentally most of these cases were in individuals under the age of 30, coinciding with our case. Investigations will be needed to determine what is making the younger population more prone to myocarditis after receiving the covid 19 vaccine. CONCLUSIONS: Myocarditis has been associated with COVID-19 infection. But the link with Pfizer-BioNTech Covid-19 vaccine is less established, with few cases providing a causal link. Recent studies have started to link the two, but further investigations are necessary to better understand the causal link, and what propogates the younger population to develop myocarditis after receiving the COVID-19 Vaccine. REFERENCE #1: https://www.forbes.com/sites/brucelee/2021/04/27/are-rare-cases-of-myocarditis-linked-to-pfizer-moderna-covid-19-vaccines/?sh=2b1641057442 DISCLOSURES: No relevant relationships by Tapan Buch, source=Web Response No relevant relationships by Pradeepto Ghosh, source=Web Response no disclosure on file for Amandeep Kaur;No relevant relationships by Kashyap Kela, source=Web Response No relevant relationships by jacob miller, source=Web Response no disclosure on file for Raza Naseer;no disclosure on file for Muhammad Siddique Pir;No relevant relationships by Princy Shah, source=Web Response No relevant relationships by Vijay Pratap Singh, source=Web Response

Industrial Sector output and Its Relationship with Government Expenditure, Credit, and Foreign Aid in Nepal

The study's goal is to look into the state, long-run relationship, and casual link of government spending, commercial bank lending, and foreign aid to Nepal's industrial sector output. The research design for this study is descriptive and analytical. The secondary data are processed using Excel and EViews10 software from 1989/90 to 2018/19. The Johnsen Co-integration test and Granger Causality test describe and analyze the relation and causal impact of variables. The credit of commercial banks highly influences industrial output. The industrial sector output, government expenditure, loans, and foreign aid were Co-integrated or had long-run association ship. This paper contributes to the policy debate on whether government expenditure and foreign support to the industrial sector are justified or not. The author is unaware of another study, finding, and location related to industrial output and its affecting factors like government expenditure, loans, and foreign aid.

Civil Rights Restoration and Recidivism

When a person is convicted of a felony offense, they lose the right to vote, the candidacy to sit on a jury, the ability to hold public office, and the right to own firearms. In addition, civil rights revocation also denies the eligibility of certain occupational licenses and state-funded scholarships. It is unknown, a priori, if civil right status influences labor market outcomes, voting behavior, or educational attainment, any of which may affect incentives for convicted felons to re-offend. As an aggregate measure of these channels, I analyze the casual link between civil rights restoration and rates of recidivism. To establish this relationship, this paper uses variation in the Rules of Executive Clemency, which affect an ex-felons’ ability to restore their civil rights. I find that restoring an individual’s civil rights reduces their probability to recidivate by 18 percentage points, which translates to a reduction in the overall recidivism rates by 1 percentage point.

Психологические аспекты организации гражданского процесса

The article analyses the psychological aspects in organizing civil proceedings. As a hypothesis, it was assumed that there is a casual link between the model of civil proceedings and their participants' psychology of behavior. As a result of the study, it is concluded that psychology of civil proceedings is influenced both by the organization of civil-law relations and the organizational model of civil proceedings.

The Link between Smoking and Covid 19 — A Short Review

Smoking is always said to be a risk factor in many of the health conditions. Smokers are always at a higher risk. COVID 19 is a whole new chapter of its own. Recent research has stated that in COVID-19 smokers are 14 times more prone to death. Awareness in Indians is lacking, and they do not know the effects of smoking. Literature refers to the comorbidities like smoking, cancer, cardiovascular disease, chronic obstructive pulmonary disease diabetes etc. as "pre-existing conditions”. The term coronavirus is used because of their appearance to a crown-like structure having long spikes of transmembrane glycoproteins. The link between coronavirus and smokers is still unknown. the role of angiotensin in smokers and its link-up with coronavirus needs to be understood. However, clarification regarding the casual link of these comorbidities to COVID-19 does not exist in the present literature. This article focuses on the link between smoking and COVID 19 and its effects. It provides detailed knowledge regarding the link between coronavirus and smokers, which is the need of the hour as awareness is necessary for the present condition. This article focuses on the present condition as well as the link between smokers and the coronavirus.

A Case Report on: Non-Symptomatic SARS-CoV-2 Results in Adverse Neurological Symptoms - Von Willebrand Factor (VWF) May Have A Casual or Causal Link

A Case Report on: Non-Symptomatic SARS-CoV-2 Results in Adverse Neurological Symptoms - Von Willebrand Factor (VWF) May Have A Casual or Causal Link

Endometriosis increases the risk for Sjögren syndrome: a nationwide prospective cohort study

Objectives Sjogren syndrome (SS) is an autoimmune disease with oral manifestations. SS may result in hormonal imbalance and immune dysfunction, and its occurrence could be related to comorbidities, including endometriosis. The prevalence rate of endometriosis in women with chronic pelvic pain is greater than 33%, and in SS patients, the prevalence rate is 6.3%. Given the limited number of available studies, we sought to determine whether patients with endometriosis have a higher risk of SS. Study Design We performed a prospective cohort study of females with newly diagnosed endometriosis from 1999 to 2013 from the Longitudinal Health Insurance Database (LHID). Data on age and history of underlying comorbidities were retrieved from the LHID. Data on the use of corticosteroids and nonsteroidal anti-inflammatory drugs were also compared. A total of 16,214 patients were identified to have endometriosis. Among them, 15,949 patients received a diagnosis of SS after the index date and were included for analysis; 31,880 (7.10%) of 448,953 eligible patients without a history of endometriosis were recruited as age-matched controls. A Cox proportional hazard model was developed with endometriosis as the a priori dichotomous variable, with the aim to estimate the risk of SS in patients with endometriosis. A cumulative probability model was adopted to assess the time-dependent effect of endometriosis on the development of SS, implying the casual link of the association. Sensitivity analysis was conducted to further confirm the risk of SS in patients with endometriosis. Results The mean ± standard deviation age (38.8 ± 8.8 years) was the same for patients with or without endometriosis (P = .406). The Cox proportional hazard model analysis showed that patients with endometriosis were more likely to have SS than patients without endometriosis (adjusted hazard ratio [HR] = 1.5; 95% confidence interval [CI] = 1.27–1.77; P Conclusions Our findings suggest an association between endometriosis and a higher risk of SS. Endometriosis may be a risk factor for, or share a common cause with, SS. This is the first study with an extended follow-up period addressing both the timing and development of SS in patients with endometriosis.

Diffusion fiber tractography on phonological loop with Logopenic aphasia tau pathology: Fiber-specific white matter reductions in Alzheimer's disease, “is it a causal or casual link?”

Introduction Logopenic Aphasia (LA), a variant of primary progressive aphasia characterized with difficulty in retrieving precise words, names, or numbers and sentence repetition. Previous studies detailed that 50% of LA patients had (Alzheimer's disease) AD pathology, and characteristics of LA synchronize with language impairments in AD. Researchers believed that, the atrophy of Phonological loop (A sensorimotor circuit that includes auditory regions, the inferior parietal lobe, and Broca's area, which integrates phonological processing and executes motor output) cause LA. Methodology We focused on structural connectivity of Phonological loop using ;“Diffusion Imaging fiber Tractography;” with 60 DTI datasets (30 Males and 30 Females) of both control and progressive stages of Alzheimer's, with the age range 55–120 years, with IRB approval and made an attempt to correlate the Logopenic aphasia, with phonological loop fiber-specific white matter reductions in early AD. Results Overall progressive diminution was observed in the phonological loop of males (Figs 1 & 2) and left hemispheric deterioration is markedly seen in terms of both fibers and tract volume (significant at p

EFFICACY OF GENE XPERT MTB/RIF ASSAY AND AFB CULTURE IN DIAGNOSIS OF MYCOBACTERIUM TB COMPLEX ON EBUS TBNA

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Rationale – Tuberculosis and Sarcoidosis are two clinical entity that share same clinical, radiological and pathological features and differentiating between two might be an arduous task. As cultures for M. Tuberculosis in tissue specimens have prolonged turn-around times, rapid molecular methods such as MTB. Rif system has shown great promise in rapid diagnosis of tuberculosis through detection of DNA of M. Tuberculosis and concurrent identification of major mutation that confers rifampicin resistance. We aim to evaluate both efficacy and role of Xpert MTB / RIF Assay and Mycobacterium TB Culture for diagnosis of TB using EBUS TBNA samples in patients with intra-thoracic granulomatous lymphadenopathy. METHODS: This was a retrospective study of randomly selected 100 patients who underwent EBUS TBNA for intra-thoracic granulomatous lymphadenitis with Gene Xpert MTB / RIF Assay and diagnosed with either Tuberculosis or Sarcoidosis RESULTS: EBUS TBNA procedures were performed and a diagnosis of Sarcoidosis (n 17) or Tuberculosis (n 83) was made in 100 patients. Histological results with grades I to II were seen in 74 patients and grade III in 26 patients respectively. Necrotising granulomas were found in 26 / 83 (31.32%) while Non-necrotising granulomas were found in 57 / 83 (68.67%) patients diagnosed with Tuberculosis. Mycobacterium TB Culture was performed in 72 patients diagnosed with Tuberculosis and was positive in 11 patients – 09 / 26 Necrotising Granuloma vs 02 / 57 Non-necrotising Granuloma (34.61% vs 3.5%, P = 0.010). Gene Xpert MTB / RIF Assay were performed in 20 / 83 patients diagnosed with Tuberculosis and was positive in 4 patients – 01 / 07 Necrotising Granuloma vs 03 / 13 Non-necrotising Granuloma (14.30% vs 23.10%, P = 0.547). The Diagnostic Accuracy of Xpert MTB / RIF Assay in diagnosis of Tuberculosis was 70% (95% CI 45.72% to 88.10%), Sensitivity 40%, Specificity 100%, Disease Prevalence 50%, PPV 100%, NPV 62.50%. Of 2 patients finally diagnosed with Sarcoidosis also showed a positive result of Xpert MTB / RIF Assay which possibly suggests casual link between TB and Sarcoidosis CONCLUSIONS: Gene Xpert MTB / RIF Assay can be useful in patients with suspected Pulmonary TB either AFB smear negative or positive due to its rapid and simultaneous detection of Rifampicin resistance and especially beneficial in patients with MDR TB and HIV associated TB. Xpert MTB / RIF Assay has good sensitivity and PPV in context of culture positive intra-thoracic TB lymphadenopathy and can provide immediate diagnosis of likely drug resistance specially in highly endemic area like India CLINICAL IMPLICATIONS: Positive Xpert MTB / RIF Assay with very low MTB detection but culture negative results need to be read cautiously and should be well correlated with clinical and treatment history of patient since Gene Xpert Assay amplifies any DNA, of live or dead bacilli and required to avoid false positive result DISCLOSURES: No relevant relationships by UMANG SHAH, source=Web Response

Uncertainty and Manufacturing Stock Market in Korea

Purpose - We study the dynamic linkages of the economic policy uncertainty (EPU) in the US on the manufacturing stock market returns in Korea. In detail, we examine the casual link between EPU index in the US and the manufacturing stock indexes in Korea. Research design, data, and methodology - We measure mainly the distribution effect of the US EPU on the manufacturing stock market in Korea of 1990-2017 by the vector error correction model (VECM). Result - In result, we estimate the impact of the US EPU index has significantly a negative response to the manufacturing stock market in Korea such as non-metal stock index, chemical stock index, food stock index, textile·clothes stock index, automobile·shipbuilding stock index, machinery stock index, steel·metal stock index. Also the remaining variables such as electric·electronics stock index, S&P 500, and producer price index in Korea have a negative relationship with US EPU index. Conclusions - We find out that the relationship between EPU index of the US and the manufacturing stock market in Korea has the negative relationships. We determine the EPU of the US has the spillover effect on the industry stock markets in Korea.

The effect of thyroid hormone deficiency on erythropoiesis in dogs

This research aimed to evaluate the effect of thyroid hormone deficiency on the erythrocytic system in dogs. Dogs with clinical symptoms of hypothyreosis such as obesity, hyperpigmentation, and lethargy were selected. The dogs demonstrating breed predisposition to hypothyreosis were incorporated in the analysis: Dachshunds, Retrievers, and mixed-breed dogs. A detailed history was taken and clinical, hormonal, biochemical and haematological blood tests were performed. Peripheral blood samples were taken from 53 dogs. Finally, the dogs with the initial T4 (thyroxine) concentration < 1.3 µg/dl and animals demonstrating clinical improvement after a 2-month therapy with levothyroxine at a dose of 10 µg/kg administeredper ostwo times a day were qualified. The animals between 10 months to 13 years of age were divided into two groups: clinically healthy (control group, n = 35) and dogs presenting clinical symptoms of hypothyreosis (experimental group, n = 18). In this research, the broadly described normocytic normochromic non-regenerative anaemia was not diagnosed in dogs with hypothyreosis. However, a positive correlation between T4 and red blood cell indices such as the average mass of haemoglobin per red blood cell, concentration of haemoglobin in a given volume of packed red blood cells as well as a negative correlation with haematocrit value was discovered in the experimental group after the 2-month therapy with levothyroxine. These results point to the influence of thyroid hormones on erythropoiesis. This observation is partially consistent with other studies, which noted the casual link between the changes in red blood cell system and the function of thyroid in dogs and humans.

Russian legal tradition

The purpose of this article is to discuss the traditional attitudes towards law which have been dominant in Russian society at different periods of its history. The article demonstrates the sources and causes of paternalism reinforcing the casual link between legality and obedience in the minds and practices of the Russian political authorities. Special attention is paid to the views on private property which took hold among the key Russian political thinkers of the late nineteenth and the early twentieth centuries, such as V. S. Solovyov and V. V. Rozanov, and the related state of the limited development of the Russian civil society in the late imperial era and throughout the Soviet period. In relation to this, an assumption is made that the attitude of the Bolsheviks to law and state was a crude form of continuing this contiguous tradition. In order to support these theses, a comparative analysis of the views of L. D. Trotsky and E. B. Khokhlov on the organization of labor during the first years of the Soviet regime is provided. The authors argue that the emergence of the early Soviet doctrine of the militarization of labor and the concomitant bureaucratic system of labor management was due to the authorities’ desire to centralize the distribution of factory production under the planned economy and the substantial public ownership of industry. A gradual change of social consciousness and practices during the recent decade — a trend that could not avoid affecting the current state of Russian legal studies and political thought — is thoroughly emphasized.

Late Stage Diagnostic of Breast Cancer at RSUD Arifin Achmad of Riau Province 2016

ABSTRACT
 
 Breast cancer examination delays is a condition where breast cancer patients come to know their condition exceeds the specified time (cancer stage III) when cancer can not differentiate well to get treatment. In Indonesia, almost 70% of breast cancer patients are too late to do examination. Data at Arifin Achmad Regional Public Hospital show increasing number of breast cancer cases, where in 2012 there were 145 cases, in 2013 there were 262 cases and in 2014 there were 584 cases.
 This research aims to know the factors that related to breast cancer examination delays such as knowledge, education, income, pain, fear, family support, BSE (breast elf examination), distance to health service, resources and family history of breast cancer.
 The research type is quantitative analytic observational. The research design is analytic cross sectional study. The populations are outpatients women with breast cancer who came to Arifin Achmad regional public hospital Riau Province and total sampel are 203 women. The data were analyzes by univariat, bivariat analyzes by chi square and multivariat analyzes by multiple logistic regression.
 The results of this research show that knowledge effect 3 times, income effect 3 times, distance to health service effect 2,5 times and pain effect 2 times to breast cancer examination delays.
 The conclusions of this study are there are casual link between knowledge, income, distance to health service and pain to breast cancer examination delays. Recommended to women to improve their knowledge about breast cancer examination and suggested to Health Departement of Riau Province through community health centers to give education and socialization about breast cancer to community.
 
 Keywords: Screening Delays, Breast Cancer, Knowledge, Income, Distance

Joint single-cell DNA accessibility and protein epitope profiling reveals environmental regulation of epigenomic heterogeneity

Here we introduce Protein-indexed Assay of Transposase Accessible Chromatin with sequencing (Pi-ATAC) that combines single-cell chromatin and proteomic profiling. In conjunction with DNA transposition, the levels of multiple cell surface or intracellular protein epitopes are recorded by index flow cytometry and positions in arrayed microwells, and then subject to molecular barcoding for subsequent pooled analysis. Pi-ATAC simultaneously identifies the epigenomic and proteomic heterogeneity in individual cells. Pi-ATAC reveals a casual link between transcription factor abundance and DNA motif access, and deconvolute cell types and states in the tumor microenvironment in vivo. We identify a dominant role for hypoxia, marked by HIF1α protein, in the tumor microvenvironment for shaping the regulome in a subset of epithelial tumor cells.