Clinical Facilities Research Articles

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Bacteriological analysis of hospital sewage of district Hospital Ratnagiri

Hospital sewage is a waste drained out from the various clinical facilities of the hospital. The hospital sewage contains pathogens which pose severe public health threat. Most hospitals lack sewage treatment facilities and discharge the sewage untreated directly in to the public sewer. The study was aimed to analyze the hospital sewage of District hospital Ratnagiri for Coliform count by MPN and serial plate dilution method, and identification of the Bacterial isolates by conventional method from the sewage. Physico-chemical parameters like Temperature, pH, TDS, COD, BOD5, samples were determined which affect the bacterial flora of the sewage. Presumptive and Confirmatory MPN test and Serial plate dilution was performed. Coliform were isolated and identified using Gram stain, Colony characteristics and Biochemical characteristics. Temperature was 28(+1.22)°c, pH 6.52(+0.10), TDS 251(+1.41) mg/l, COD 96.9(+0.82) mg/l and BOD 69.5 (+0.58) mg/l. TDS was higher, COD and BOD values were less as compare to the permissible limits. Presumptive MPN was >1.8 x 103, Confirmatory MPN was 3.3x101 per 100 ml and coliform count by serial dilution was 6x106 CFU/ml on Blood agar and 2x106 CFU/ml on MacConkey’s agar which indicated higher counts of coliform in the sewage. Common bacteria like Escherichia coli, Pseudomonas aeruginosa, Klebsiella peumonae, Chromobacter violaceum and Bacillus subtilis were isolated. The study reveals presence of significant coliform load in the hospital sewage which poses risk of infection to the community.

Virtual Clinics for Diabetes Care.

Virtual Clinics for Diabetes Care.

Evaluation of patient satisfaction with the virtual clinic in Jazan City: Saudi Arabia

Patient satisfaction is a key component in the quality of care and is an element in the dissemination and adoption of virtual clinic facilities. Evaluating patient satisfaction has become an essential indicator of healthcare performance and outcomes. The aim of the study was to evaluate patient satisfaction with the virtual clinic. A cross-sectional study was conducted using a convenience sample of 305 patients visiting a virtual clinic at three general hospitals in the Jazan region of Saudi Arabia. The study was conducted using a quantitative descriptive correlational design. The researcher employed the Telehealth Satisfaction Scale to assess patient satisfaction with virtual clinic care. Satisfaction scores were compared between groups using an independent sample t-test and one-way analysis of variance. The study indicated that patients reported a high degree of satisfaction with their virtual clinic. Most scale item averages were greater than 3, indicating ratings of "good" to "excellent" satisfaction. There was no statistically significant relationship between patient satisfaction with the virtual clinic and sociodemographic characteristics. Despite the fact that virtual clinics in the healthcare sector in the Jazan area are relatively new, the survey results show high levels of satisfaction with the service. The courtesy, respect, sensitivity, and friendliness of the virtual clinic staff and respecting patients' privacy were essential to patients, demonstrating that virtual clinics may improve access to care.

The genomic landscape of rare disorders in the Middle East

BackgroundRare diseases collectively impose a significant burden on healthcare systems, especially in underserved regions, like the Middle East, which lack access to genomic diagnostic services and the associated personalized management plans.MethodsWe established a clinical genomics and genetic counseling facility, within a multidisciplinary tertiary pediatric center, in the United Arab Emirates to locally diagnose and manage patients with rare diseases. Clinical genomic investigations included exome-based sequencing, chromosomal microarrays, and/or targeted testing. We assessed the diagnostic yield and implications for clinical management among this population. Variables were compared using the Fisher exact test. Tests were 2-tailed, and P < .05 was considered statistically significant.ResultsWe present data on 1000 patients with rare diseases (46.2% females; average age, 4.6 years) representing 47 countries primarily from the Arabian Peninsula, the Levant, Africa, and Asia. The cumulative diagnostic yield was 32.5% (95% CI, 29.7–35.5%) and was higher for genomic sequencing-based testing than chromosomal microarrays (37.9% versus 17.2%, P = 0.0001) across all indications, consistent with the higher burden of single gene disorders. Of the 221 Mendelian disorders identified in this cohort, the majority (N = 184) were encountered only once, and those with recessive inheritance accounted for ~ 62% of sequencing diagnoses. Of patients with positive genetic findings (N = 325), 67.7% were less than 5 years of age, and 60% were offered modified management and/or intervention plans. Interestingly, 24% of patients with positive genetic findings received delayed diagnoses (average age, 12.4 years; range 7–37 years), most likely due to a lack of access to genomic investigations in this region. One such genetic finding ended a 15-year-long diagnostic odyssey, leading to a life-threatening diagnosis in one patient, who was then successfully treated using an experimental allogenic bone marrow transplant. Finally, we present cases with candidate genes within regions of homozygosity, likely underlying novel recessive disorders.ConclusionsEarly access to genomic diagnostics for patients with suspected rare disorders in the Middle East is likely to improve clinical outcomes while driving gene discovery in this genetically underrepresented population.

Optimization of proton pencil beam positioning in collimated fields.

The addition of static or dynamic collimator systems to the pencil beam scanning delivery technique increases the number of options for lateral field shaping. The collimator shape needs to be optimized together with the intensity modulation ofspots. To minimize the proton field's lateral penumbra by investigating the fundamental relations between spot and collimating aperture edgeposition. Analytical approaches describing the effect of spot position on the resulting spot profile are presented. The theoretical description is then compared with Monte Carlo simulations in TOPAS and in the RayStation treatment planning system, as well as with radiochromic film measurements at a clinical proton therapy facility. In the model, one single spot profile is analyzed for various spot positions in air. Further, irradiation setups in water with different energies, the combination with a range shifter, and two-dimensional proton fields were investigated in silico. The further the single spot is placed beyond the collimating aperture edge ('overscanning'), the sharper the relative lateral dose fall-off and thus the lateral penumbra. Overscanning up to reduced the lateral penumbra by about 20% on average after a propagation of in air. This benefit from overscanning is first predicted by the analytical proofs and later verified by simulations and measurements. Corresponding analyses in water confirm the benefit in lateral penumbra with spot position optimization as observed theoretically and in air. The combination of spot overscanning with fluence modulation facilitated an additionalimprovement. The lateral penumbra of single spots in collimated scanned proton fields can be improved by the method of spot overscanning. This suggests a better sparing of proximal organs at risk in smaller water depths at higher energies, especially in the plateau of the depth dose distribution. All in all, spot overscanning in collimated scanned proton fields offers particular potential in combination with techniques such as fluence modulation or dynamic collimation for optimizing the lateral penumbra to spare normaltissue.

Comparison of different endometrial preparation protocols in frozen-thawed embryo transfer cycles in women with polycystic ovary syndrome

Aim: This study aimed to evaluate the most suitable endometrial preparation protocols such as hormone replacement therapy (HRT) with gonadotropin releasing hormone analogue (GnRH-a) suppression, HRT without GnRH-a suppression and mild ovarian stimulation (OS) for women with polycystic ovary syndrome (PCOS) undergoing frozen-thawed embryo transfer (FET).Material and Method: We conducted a historical cohort analysis of 161 women with PCOS who underwent the “freeze-all” strategy between December 2018 and August 2020 because of their high risk for ovarian hyperstimulation syndrome. Three endometrial preparation protocols were used: HRT with GnRH-a suppression (n=43); HRT without GnRH-a suppression (n=86); mild-OS (n=32).Results: The biochemical pregnancy results (55.8 % vs 54.65 % vs 53, p=0.900), ongoing pregnancy rates (44.2 % vs 43 % vs 40.62, p=0.572), and abort rates (20.8 % vs 21.3 % vs 23.52, p=0.900) were similar between the HRT with GnRH-a suppression, without GnRH-a suppression and mild-OS, respectively. This study showed no statistically significant difference between the three protocols in laboratory parameters (p&amp;gt;0.05). Conclusion: There was no statistically difference between three groups in terms of pregnancy outcomes. Dependent on clinical experience and facility, one of these protocols could be deployed for FET in women with PCOS.

Immunogenicity and safety of a 10-valent pneumococcal conjugate vaccine administered as a 2 + 1 schedule to healthy infants in The Gambia: a single-centre, double-blind, active-controlled, randomised, phase 3 trial

Three pneumococcal conjugate vaccines (PCVs) are currently licensed and WHO prequalified for supply by UN agencies. Here, we aimed to investigate the safety and immunogenicity of SIIPL-PCV compared with PHiD-CV and PCV13, when administered to infants according to a 2 + 1 schedule. This single-centre, double-blind, active-controlled, randomised, phase 3 trial was done in Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine clinical trial facilities within two government health centres in the western region of The Gambia. Healthy, PCV-naive infants aged 6-8 weeks were enrolled if they weighed at least 3·5 kg and had no clinically significant health complaints, as determined by history and clinical examination. Eligible infants were randomly assigned (1:1:1) to receive either SIIPL-PCV, PHiD-CV, or PCV13 using permuted blocks of variable size. Parents and the trial staff assessing all study outcomes were masked to vaccine group. The first PCV vaccine was given with other routine Expanded Programme on Immunization vaccines when infants were aged 6-8 weeks (visit 1). At visit 2, routine vaccines alone (without a PCV) were administered. At visit 3, the second dose of the PCV was administered alongside other routine vaccines. At visit 4, a blood sample was collected. Visits 1-4 took place at intervals of 4 weeks. The booster PCV was administered at age 9-18 months (visit 5), with final follow-up 4 weeks after the booster (visit 6). The primary immunogenicity outcome compared the serotype-specific IgG geometric mean concentrations (GMCs) generated by SIIPL-PCV with those generated by PHiD-CV and PCV13, 4 weeks after the booster. We used descriptive 95% CIs without adjustment for multiplicity. Immunogenicity analyses were done in the per protocol population (defined as all children who received all the assigned study vaccines, who had an immunogenicity measurement available, and who had no protocol deviations that might interfere with the immunogenicity assessment). This trial was registered with the Pan African Clinical Trials Registry, PACTR201907754270299, and ClinicalTrials.gov, NCT03896477. Between July 18 and Nov 14, 2019, 745 infants were assessed for study eligibility. Of these, 85 infants (11%) were ineligible and 660 (89%) were enrolled and randomly assigned to receive SIIPL-PCV (n=220), PHiD-CV (n=220), or PCV13 (n=220). 602 infants (91%) were included in the per protocol immunogenicity population. The median age at vaccination was 46 days (range 42-56). 342 infants (52%) were female and 318 (48%) were male. Post-booster serotype-specific IgG GMCs generated by SIIPL-PCV ranged from 1·54 μg/mL (95% CI 1·38-1·73) for serotype 5 to 12·46 μg/mL (11·07-14·01) for serotype 6B. Post-booster GMCs against shared serotypes generated by PHiD-CV ranged from 0·80 μg/mL (0·72-0·88) for serotype 5 to 17·31 μg/mL (14·83-20·20) for serotype 19F. Post-booster GMCs generated by PCV13 ranged from 2·04 μg/mL (1·86-2·24) for serotype 5 to 15·54 μg/mL (13·71-17·60) for serotype 6B. Post-booster IgG GMCs generated by SIIPL-PCV were higher than those generated by PHiD-CV for seven of the eight shared serotypes (1, 5, 6B, 7F, 9V, 14, and 23F). The GMC generated by serotype 19F was higher after PHiD-CV. The SIIPL-PCV to PHiD-CV GMC ratios for shared serotypes ranged from 0·64 (95% CI 0·52-0·79) for serotype 19F to 2·91 (2·47-3·44) for serotype 1. The serotype 1 GMC generated by SIIPL-PCV was higher than that generated by PCV13, whereas serotype 5, 6A, 19A, and 19F GMCs were higher after PCV13. The SIIPL-PCV to PCV13 GMC ratios ranged from 0·72 (0·60-0·87) for serotype 19A to 1·44 (1·23-1·69) for serotype 1. SIIPL-PCV was safe and immunogenic when given to infants in The Gambia according to a 2 + 1 schedule. This PCV is expected to provide similar protection against invasive and mucosal pneumococcal disease to the protection provided by PCV13 and PHiD-CV, for which effectiveness data are available. Generating post-implementation data on the impact of SIIPL-PCV on pneumococcal disease endpoints remains important. Bill & Melinda Gates Foundation.

Home Waking Salivary Cortisone to Screen for Adrenal Insufficiency

BackgroundWorldwide, adults and children are at risk of adrenal insufficiency as a result of adrenal suppression from use of anti-inflammatory glucocorticoids and opiates, as well as infectious diseases. The adrenocorticotropin (ACTH) stimulation test is the reference standard for diagnosis of adrenal insufficiency but requires clinic attendance and venesection. Salivary cortisone reflects free serum cortisol, and samples can be collected at home and posted to a laboratory. We tested whether home waking salivary cortisone level could be used to screen for adrenal insufficiency.MethodsA prospective, diagnostic accuracy study was performed in patients at high risk of adrenal insufficiency. Patients collected a home salivary sample on waking and then attended the clinical facility for an ACTH stimulation test. Salivary cortisone was measured by liquid chromatography–tandem mass spectrometry. Receiver-operating characteristic curves were computed, and positive and negative predictive values were calculated.ResultsTwo hundred twenty patients were recruited. As measured by an ACTH stimulation test, the prevalence of adrenal insufficiency was 44%. The area under the receiver-operating characteristic curve for waking salivary cortisone as a predictor of adrenal insufficiency was 0.95 (95% confidence interval [CI], 0.92 to 0.97). Cutoffs to ensure a minimum of 95% sensitivity and specificity gave a negative predictive value of 96% (95% CI, 90 to 99) and a positive predictive value of 95% (95% CI, 87 to 99) to exclude and confirm adrenal insufficiency, respectively. Waking salivary cortisone data provided information similar to that of an ACTH stimulation test in 70% of participants. Eighty-three percent of patients preferred home salivary collection to clinic attendance.ConclusionsHome waking salivary cortisone sampling has accuracy for the diagnosis of adrenal insufficiency similar to that of a standard ACTH stimulation test. Patients found the at-home test to be more convenient than the hospital-based test. (Funded by the National Institute for Health Research.)

Deprescribing in Patients of Hypothyroidism Results in Better Health Outcome: A Case Series

Appropriate levothyroxine (LT4) dosing is essential in hypothyroid patients to maintain biochemical and clinical euthyroidism, but achieving appropriate plasma concentration of LT4 can be complicated by numerous disease states, foods, supplements, and commonly prescribed medications such as calcium supplements, pantoprazole etc. that potentially interfere with intestinal LT4 absorption. About one-third of treated patients are not receiving adequate treatment, leading to decreased quality of life, increased morbidity, and even increased mortality. Hypothyroid patients treated with LT4 must be careful to avoid concomitant ingestion of such medicines or optimal gap must be ensured between ingestions to prevent drug-drug interactions and reduce absorption of LT4. We describe two such real life cases managed in our clinical pharmacology consultation facility to highlight the importance of systematically evaluating the drug-drug interactions of levothyroxine with commonly used concomitant medications and how deprescribing of the same can result in attainment of optimum thyroid replacement with lesser doses of LT4 with better patient outcome.

Clinical supervisors’ experiences of factors affecting nursing students’ skills transfer from skills laboratory to practice

BackgroundIn South Africa, student nurses’ engagement in work integrated learning is a requirement of accredited nursing programmes. Successful work integrated learning requires collaboration between lecturers, clinical supervisors, preceptors and professional nurses in clinical facilities. Clinical supervisors included in the study are tasked with clinical teaching in the skills laboratory, supervision, support of nursing students with skills transfer during work integrated learning, and assessment. PurposeTo explore the experiences of clinical supervisors regarding the factors that affect nursing students’ skills transfer from the skills laboratory to the clinical practice environment. MethodsA qualitative exploratory, descriptive research design was used. A total of 40 clinical supervisors were employed for clinical education across the undergraduate and postgraduate programmes offered at the school of nursing. Twelve clinical supervisors participated in the study. Data were collected through semi-structured interviews. ResultsThree themes generated from the data revealed that the implementation of the skills laboratory methodology used in the school requires improvement. There are limitations in the infrastructure, and inadequate resources in the skills laboratory. Findings regarding the work environment included inconsistencies between clinical nursing education and expectations in practice; insufficient appropriate learning opportunities; student absenteeism; and lack of involvement of clinical staff in students’ work integrated learning. ConclusionCloser collaboration is required between nursing education and practice for the preparation of the future nursing workforce for the country. The implementation of the skills laboratory methodology and the use of resources must be reviewed, and resources that simulate real life practice must be procured.

Optimization of Radiation Shielding Considerations for Designing Halcyon Vault.

To determine the radiation shielding considerations for optimization of Halcyon vault shielding requirements. The primary and leakage workloads were estimated using actual clinical treatment planning and treatment delivery data acquired from three busy operational clinical Halcyon facilities. The effective use factor was determined based on a newer approach proposed in this paper using the percentage of patients treated with different treatment techniques. The transmission factor of the primary beam block, maximum head leakage, and patient scatter fractions around the Halcyon machine were experimentally determined. The first tenth-value layer (TVL1) and equilibrium tenth-value layer (TVLe) for 6 MV - flattening-filter-free (FFF) primary X-ray beam for ordinary concrete were measured. The primary and leakage workloads are estimated as 1 × 105 cGy/wk and 3.1 × 105 cGy/wk at 1 m respectively. The effective use factor is found as 0.114. The primary beam-block transmission factor is determined as 1.7 × 10-4 at 1 m distance from isocenter along the central beam axis. The maximum head leakage is noted as 6.23 × 10-4. The patient scatter fractions are reported for various planar angles around the Halcyon machine at a radial distance of 1 m in a horizontal plane passing through isocenter. The TVL1 and TVLe of 6 MV-FFF X-ray beam energy for ordinary concrete are found to be 33 and 29 cm, respectively. Using experimentally determined shielding considerations, the optimized vault shielding requirements for the Halcyon facility are calculated and a typical layout drawing is proposed.

Application of Invariant Analysesto Study Survival Trends of Patients onAntiretroviral Therapy (ART) and TB Treatment in Kenya

Kenya is one of the countries, globally, with a high burden of human immunodeficiency virus and tuberculosis. The co-infection between tuberculosis and human immunodeficiency virus/acquired immunodeficiency syndrome makes the management of the infection more complicated and reduces the chances of survival. The current study evaluates the trends in the survival of individuals with ART and TB management, especially in relation to various Counties in the country. The specific objective wasto establish the survival trends of patients on Antiretroviral Therapy (ART) and TB treatment in Kenya using Kaplan Meier function. The study used a retrospective cohort study design. The target population included patients on co-therapy TB and ART management who attended the health facilities between 1st January 2015 and 31st December 2019. The sample of the study was obtained from all the available HIV-TB co-infected patients’ records in National AIDS &amp; STIs Control Program (NASCOP) database (secondary data) from the selected counties in Kenya. Kaplan Meier estimator was used in the estimation of the survival function. Analysis was done using STATA v14.2 and Bayes’ v3.0.2. The study also found that HIV-TB patients’ death rates for the period between 2015 and 2019 varied from one County to another. The study also established that the distribution of TB and HIV deaths in the 47 Counties varied across the five years. In the year 2015, the total number of TB and HIV deaths in the 47 Countries was 1077, which decreased to 921 TB and HIV deaths in 2016 before decreasing to 391 in 2017, 106 in 2018 and 60 in 2019. The study found that the main factors significantly influencing HIV-TB confections include gender, marital status, WHO clinical stage, age, weight and facility levels.

A Case Report of Association between Canine Hypothyroidism and Diabetes

Hypothyroidism is the most common hormonal disorder in dogs because of the low production of the hormones thyroxine (T4) and triiodothyronine (T3) by the thyroid gland. The main cause of hypothyroidism in adult dogs is primary hypothyroidism associated with destruction of the thyroid gland in lymphocytic or autoimmune thyroiditis, followed by idiopathic thyroid degeneration or idiopathic follicular atrophy. Dogs affected by hypothyroidism may develop diabetes mellitus due to the propensity for the development of other endocrine diseases associated with the immune-mediated attack against cellular antigens associated with endocrine system. In this case report, an eleven-year-old male Lhasa Apso was presented to the clinical facility with signs of apathy, anorexia and non-pruritic bilateral symmetric alopecia that extended to the tip of the tail but sparing the head and limbs. Other clinical manifestations included polyuria, polydipsia, and bilateral cataracts. The animal was submitted to the blood count, T4, T3, TSH dosage, biochemical tests, and imaging tests (cervical and abdominal ultrasonography). Exam results demonstrate the presence of hypothyroidism and diabetes mellitus. Since hypothyroidism corresponds to the most common endocrine disorder in dogs, and they are prone to the development of diabetes mellitus, the veterinarian must be aware of the clinical manifestations of these diseases.

A Case Report of Incidental Diagnosis of Cardiac Hypertrophy in Brazilian Short Hair Cat With Cholangitis and Renal Acute Insufficiency

The hypertrophic cardiomyopathy is the most common myocardial disease that affects felines and is characterized by hypertrophy of the left ventricle, may be primary or secondary associated with hyperthyroidism, systemic hypertension and subaortic stenosis. The clinical signs of hypertrophic cardiomyopathy are variable, and the cat may have a symptomatic or asymptomatic clinical presentation. Imaging diagnostic methods such as Doppler echocardiography and electrocardiography allow the clinician to classify the stage of the disease more efficiently to more clearly assess the need for treatment and prognosis. In this case report, a four year old male Brazilian short hair cat was presented to the clinical facility with signals of emesis. A heart murmur was found during cardiac auscultation. After treatment to stabilize the clinical condition of emesis, imaging tests (Doppler echocardiography, abdominal ultrasonography), electrocardiogram, blood count, T4 dosage and biochemical tests were performed. Exam results demonstrate the presence of cholangitis, acute kidney disease and a incidental findings of cardiac hypertrophy.

Identification of the Viral Pathogens in School Children With Acute Otitis Media in Central Java, Indonesia

Acute otitis media (AOM) is one of the most common infectious diseases in pediatric clinical facilities and has a significant impact on health care. It is a polymicrobial disease and is usually preceded by a viral upper respiratory tract infection. Data on the spectrum of viruses that cause AOM in Indonesia are still limited. This study analyzed nasopharynx (NP) samples collected from 119 school children with AOM in Banyumas Regency, Central Java, Indonesia. Viral RNA was extracted for cDNA synthesis, followed by PCR and sequencing tools for detection of a panel of respiratory viruses using family-level primers for Coronaviridae, Enterovirus, Bocavirus, and Pneumovirinae for bocavirus. In total, 37 out of 119 NP samples (31.1%) tested positive for viruses. Human rhinovirus B was the predominant virus identified (32.4%) followed by rhinovirus C (29.7%), human rhinovirus A (27%), and human bocavirus (5.4%). Rhinovirus are predominant viral pathogens within school children with AOM in Central Java, Indonesia.

Objective hearing threshold identification from auditory brainstem response measurements using supervised and self-supervised approaches

Hearing loss is a major health problem and psychological burden in humans. Mouse models offer a possibility to elucidate genes involved in the underlying developmental and pathophysiological mechanisms of hearing impairment. To this end, large-scale mouse phenotyping programs include auditory phenotyping of single-gene knockout mouse lines. Using the auditory brainstem response (ABR) procedure, the German Mouse Clinic and similar facilities worldwide have produced large, uniform data sets of averaged ABR raw data of mutant and wildtype mice. In the course of standard ABR analysis, hearing thresholds are assessed visually by trained staff from series of signal curves of increasing sound pressure level. This is time-consuming and prone to be biased by the reader as well as the graphical display quality and scale.In an attempt to reduce workload and improve quality and reproducibility, we developed and compared two methods for automated hearing threshold identification from averaged ABR raw data: a supervised approach involving two combined neural networks trained on human-generated labels and a self-supervised approach, which exploits the signal power spectrum and combines random forest sound level estimation with a piece-wise curve fitting algorithm for threshold finding.We show that both models work well and are suitable for fast, reliable, and unbiased hearing threshold detection and quality control. In a high-throughput mouse phenotyping environment, both methods perform well as part of an automated end-to-end screening pipeline to detect candidate genes for hearing involvement. Code for both models as well as data used for this work are freely available.

Cytochrome c in cancer therapy and prognosis.

Cytochrome c (cyt c) is an electron transporter of the mitochondrial respiratory chain. Upon permeabilization of the mitochondrial outer membrane, cyt c is released into the cytoplasm, where it triggers the intrinsic pathway of apoptosis. Cytoplasmic cyt c can further reach the bloodstream. Apoptosis inhibition is one of the hallmarks of cancer and its induction in tumors is a widely used therapeutic approach. Apoptosis inhibition and induction correlate with decreased and increased serum levels of cyt c, respectively. The quantification of cyt c in the serum is useful in the monitoring of patient response to chemotherapy, with potential prognosis value. Several highly sensitive biosensors have been developed for the quantification of cyt c levels in human serum. Moreover, the delivery of exogenous cyt c to the cytoplasm of cancer cells is an effective approach for inducing their apoptosis. Similarly, several protein-based and nanoparticle-based systems have been developed for the therapeutic delivery of cyt c to cancer cells. As such, cyt c is a human protein with promising value in cancer prognosis and therapy. In addition, its thermal stability can be extended through PEGylation and ionic liquid storage. These processes could contribute to enhancing its therapeutic exploitation in clinical facilities with limited refrigeration conditions. Here, I discuss these research lines and how their timely conjunction can advance cancer therapy and prognosis.

Proton Therapy in Canada: Toward Universal Access and Health Equity With a Publicly Funded Facility

Proton beam therapy (PBT) is utilized worldwide in the treatment of pediatric cancers and many cancers in adults as accumulating clinical evidence indicates dosimetric and toxicity advantages. However, Canada is the only G8 country without an operating clinical PBT facility. Access to out-of-country PBT referrals, adjudicated by individual provincial governments, varies across the country. The lack of domestic capacity for PBT, variability in public funding nationwide, and the anticipated future demand for PBT suggest unmet needs for health equity in Canadian cancer care. This article outlines the current state of access to PBT across Canadian provinces, domains of health inequities among those receiving PBT, and strategies for addressing health inequity in PBT, in the context of ongoing planning for a Canadian publicly funded facility. The lessons learned from the Canadian experience may be applicable to other jurisdictions seeking to improve fair, equitable access to PBT.

Suicide in prisons: describing trends and staff knowledge and preparedness to address suicide

PurposeSuicide prevention and intervention in prisons is a challenge. Prisons were not designed to be clinical facilities, yet with the growing numbers of people who face mental health challenges in prisons, staff require knowledge and skills to adequately address mental health crises, especially suicide. This study aims to: describe trends in suicide attempts and completions within one state’s prison system and measure staff knowledge and preparedness to address suicide.Design/methodology/approachThis research uses a nonexperimental research design and two data sources. Administrative data from 2000 to 2017 on serious suicide attempts and completions were analyzed, and all correctional staff employed in the state’s Department of Corrections were surveyed at one point in time. Univariate and bivariate analyses were conducted.FindingsThe number of serious suicide attempts trended up but completed suicides decreased. Correctional staff demonstrated high suicide knowledge of risk factors and warning signs of suicide. Staff who viewed a media-based suicide training displayed significantly more knowledge of suicide and perceived greater preparedness compared to staff who did not or did not recall viewing the training.Originality/valueCorrections staff play a key role in preventing suicides in prison. Innovative intervention is needed to increase suicide awareness, improve communication and enhance prevention skills.