Local Centers Research Articles

Mortality Rate and Years of Life Lost Due to Breast and Gynecologic Cancers in Southern Iran 2004-2019: A Population-Based Study.

There is an increase in the incidence of breast and gynecologic cancers in Iran during the last three decades. Literature is inadequate about the Years of Life Lost (YLL) attributed to these cancers in Iran. Mortality data due to these cancers amongst females aged >20 yr from 2004 to 2019 was acquired from "Electronic Death Registry System", Fars Province, Iran. Using local health centers' databases and national census reports from 1996 to 2016, the age-standardized incidence rate (ASR) per 100,000 people were estimated. YLLs were calculated using the WHO's 2015 "YLL template". During 2004-2019, 1886 and 829 deaths occurred due to breast and gynecologic cancers, respectively. The ASR due to breast and gynecologic cancers showed a significant increasing trend (P<0.001 for each). The total YLL due to breast, cervical/uterine/vaginal/vulvar, and ovary cancers' deaths in the 16-year period were 33,077, 7,172 and 6,584 yr, respectively. The highest YLLs were observed in 50-59-year-old females, followed by 40-49- and 60-69-year-old females. The 16- year trend of YLL rate due to premature mortality in breast cancer, ovary cancer and cervix cancer was increasing: annual percent change (APC) was 7.6% (95% CI: 5.5-9.7, P<0.001), 19.0% (95% CI: 12.2-26.1, P<0.001) and 9.2% (95% CI: -9.2 to 31.3, P>0.05, respectively. Mortality rate and YLLs due to breast and gynecologic cancers have been increased in southern Iran during the last twenty years. Early detection programs and allocating treatments at early stages should be prioritized.

Association Between Bladder Cancer and Environmental Risk Factors in Guilan Province: A Case-Control Study

Background: Occupational settings expose workers to various substances linked to cancer risk, influenced by exposure intensity and duration. Considering the diverse work conditions across Iranian cities and the unexplored link between occupation and bladder cancer (BC) in Guilan Province, identifying high-risk occupations and industries is imperative for implementing preventive measures in the region. Objectives: To investigate the effect of people's occupations on bladder cancer in Guilan Province. Methods: The study encompassed 266 diagnosed BC patients in Guilan Province who received treatment at local healthcare centers, along with 191 control individuals aged 18 and over. Data for the cases were meticulously recorded in medical records at the Guilan Cancer Registry. The same checklists, including demographic characteristics, comorbidities, addiction status, water consumption habits, environmental exposures, current and previous occupation, previous history of cancer, and family history of cancer, were recorded for the controls. Odds ratios and their 95% confidence intervals were estimated using adjusted logistic regression (LR). Results: The study found that the odds ratio of bladder cancer (BC) was 2.80 (95% CI: 1.26 - 6.21) for the age group 60 - 70 years and 18.2 (95% CI: 7.31 - 45.6) for individuals above 70 years. Rural dwelling increased the risk by 5.06-fold, while well water consumption and regular opium use amplified it by 6.12-fold and 2.58-fold, respectively. Exposure to tar and carbon derivatives led to a 3.53-fold increase in risk, and exposure to combustion/greenhouse gases showed a 10.72-fold increase. Chemical-related occupations, tar, carbon derivatives, smoking, and opium consumption were significant risk factors. Conclusions: Occupations involving chemical substances such as greenhouse gases, tar, and carbon derivatives are associated with a higher risk of bladder cancer (BC). Furthermore, smoking, opium use, and well water consumption significantly elevate the risk of this cancer.

Development of Fe-Doped Ni2P-POx Electrocatalyst for Oxygen Evolution Reaction

Water electrolysis is extensively researched as a next-generation energy storage method to overcome the intermittency of renewable energy. Electricity generated from renewable sources such as solar and wind power can be converted into pure green hydrogen through water electrolysis. Despite the potential of green hydrogen as a renewable energy storage/carrier medium, the high overpotential resulting from the slow kinetics of oxygen evolution reaction (OER) and the use of expensive noble metals make cost-competitive hydrogen production a significant challenge. Anion exchange membrane water electrolysis (AEMWE) is one method for hydrogen production, offering economic advantages over proton exchange membrane systems as it allows for the use of relatively inexpensive transition metal catalysts like Ni, Fe, and Co due to its alkaline environment.Nickel phosphide (Ni2P)-based catalysts have emerged as highly promising candidates to accelerate the electrocatalytic OER. In particular, the introduction of Fe into Ni2P has been found to induce charge transfer, optimizing the electronic structure and accelerating the OER process. OER catalysts based on transition metal phosphides often exhibit a core-shell structure with phosphide at the core and oxide at the shell during OER measurements. This core-shell structure enhances OER performance through the oxide shell, complementing the deficient electrical conductivity of the phosphide core, resulting in superior catalytic activity and durability. From this perspective, transition metal phosphates are also being studied as electrocatalysts for OER. Phosphates, such as PO3 -, not only promote oxygen adsorbate adsorption but also induce a distorted local metal center geometry that favors OH- adsorption and further oxidation.To address these challenges, this study develops a facile and scalable synthesis of iron-doped nickel phosphide-phosphate (Fe-doped Ni2P-POx) nano-hybrid system as a superior noble-metal free OER powder-catalyst. The utilization of self-filling and pyrolysis approaches facilitates economically viable production of the highly porous phosphide catalyst with a high specific surface area and rough surfaces. X-ray diffractometer, X-ray photoelectron spectroscopy, and electron paramagnetic resonance elucidates the electronic structure modulation, resulting in phosphide-phosphate nano-hybrid structures. Consequently, the catalyst demonstrates excellent OER activity in 1 M KOH, with a significantly low overpotential of 283 mV at 20 mA cm-2, a small Tafel slope of 28.4 mV dec-1, and a superior exchange current density of 8.22 mA cm-2, surpassing state-of-the-art PGM catalysts. Furthermore, its durability over 20 hours indicates its excellent stability, mass transport properties, and mechanical robustness in alkaline media, underscoring its potential as an efficient OER catalyst to facilitate electrocatalytic hydrogen production. Figure 1

Understanding Atomic-Scale Dynamics of Defects in Complex Oxides for Memristive Devices

The exceptional resistive switching characteristics of complex oxides make them promising for use in memristors to mimic biological synapses in neuromorphic computing architectures in an energy-efficient manner. Specifically, the electrical conductance of complex oxides can be controllable switched across multiple orders of magnitude by either (a) electroforming a conduction channel (e.g., in tungsten oxide), or (b) inducing Mott-Hubbard transition (e.g., in rare-earth nickelates)– both via controlled migration of defects (such as oxygen vacancies) under applied bias. However, development of accurate neuromorphic computers (i.e., low variability) remains extremely challenging due to a lack of fundamental understanding of the atomic-scale processes that underlie migration and spatiotemporal evolution of oxygen vacancies (and other extended defects) over nano-to-mesoscopic length/timescales under applied electric field. Here, we demonstrate that a synergistic integration of density functional theory (DFT) calculation, ab initio/classical molecular dynamics (AIMD/CMD) simulations, precision synthesis, and multi-modal X-ray imaging experiments provides an effective route to address this knowledge gap. First, we use a combination of multi-modal X-ray imaging (with chemical/structural sensitivity) and CMD simulations to show that the intrinsic randomness of electroforming process in tungsten-oxide memristors can be minimized by careful introduction of sharp protrusions in the electrode gap. We find that sharp protrusions confine the electric field, which yields a reproducible distribution of oxygen vacancies over several switching cycles; and reliably form conduction channel in a specific location in the memristor. Next, we employed a large dataset of data from DFT calculations and short AIMD trajectories to develop deep neural network (DNN) models to accurately capture energetics, atomic forces, atomic charges, and maximally localized Wannier centers in rare-earth nickelates (RNO). CMD simulations based on these newly developed DNNs show that metal-insulator transition (MIT) in RNO occurs via a local structural distortion in the extended nickel structure, which facilitates the electronic instability and causes a sharp concomitant Ni-O bond and Ni-charge disproportion with decreasing temperature; this MIT is also strongly influenced by applied pressure and rare-earth ion. Furthermore, DFT calculations reveal the correlations the oxygen stoichiometry, OV distribution (including different NiOx motifs), OV transport, and electron-lattice coupling in perovskite nickelates. These results will be discussed in the context of controlling defect-induced transitions to design accurate and reliable memristive devices for neuromorphic computing platforms that are vital for artificial intelligence technologies.

Electron transport through two interacting channels in Azurin-based solid-state junctions

The fundamental question of "what is the transport path of electrons through proteins?" initially introduced while studying long-range electron transfer between localized redox centers in proteins in vivo is also highly relevant to the transport properties of solid-state, dry metal-protein-metal junctions. Here, we report conductance measurements of such junctions, Au-(Azurin monolayer ensemble)-Bismuth (Bi) ones, with well-defined nanopore geometry and ~103 proteins/pore. Our results can be understood as follows. (1) Transport is via two interacting conducting channels, characterized by different spatial and time scales. The slow and spatially localized channel is associated with the Cu center of Azurin and the fast delocalized one with the protein's polypeptide matrix. Transport via the slow channel is by a sequential (noncoherent) process and in the second one by direct, off-resonant tunneling. (2) The two channels are capacitively coupled. Thus, with a change in charge occupation of the weakly coupled (metal center) channel, the broad energy level manifold, responsible for off-resonance tunneling, shifts, relative to the electrodes' Fermi levels. In this process, the off-resonance (fast) channel dominates transport, and the slow (redox) channel, while contributing only negligibly directly, significantly affects transport by intramolecular gating.

Posttraumatic stress disorder, depressive and cardiovascular disease symptoms among young patients receiving medical treatment in a heart centre: A cross-sectional study.

Exploring the connections between traumatic experiences and subsequent health outcomes is vital for informing clinical practices and public health policies. The study aimed to investigate the relationship between lifetime trauma exposure and posttraumatic stress disorder (PTSD), depressive and cardiovascular disease (CVD) symptoms. A total of 171 patients who received treatment in a local heart centre were included in this study. Several questionnaires such as the Life Event Checklist-5, Posttraumatic Stress Disorder Checklist for DSM-5 and Patient Health Questionnaire-9 were used to measure their traumatic experiences and PTSD and depressive symptoms, respectively. Physiological measures were also examined. Data were analysed using SPSS. The chi-square test showed significant differences in the percentage of reported PTSD symptoms among the patients with CVD (24.0%), patients with kidney disease (4.3%) and patients with other health problems (7.1%). The patients with CVD reported having a significantly higher percentage of PTSD and depressive symptoms than the patients with other medical conditions. The patients with CVD who reported having PTSD symptoms had significant systolic blood pressure (SBP) and heart rate changes compared to the patients who did not. The patients who reported PTSD symptoms had a significantly shorter sleep duration than their counterparts. The SBP and diastolic blood pressure differed significantly between the patients with and without PTSD symptoms. Earlier detection, prevention and intervention related to trauma exposure and PTSD symptoms are suggested to reduce the CVD risk.

The Influence of Altitude, Urbanization, and Local Vaccination Centers on Vaccine Uptake within an Italian Health District: An Analysis of 15,000 Individuals Eligible for Vaccination.

In Italy, free vaccinations for Herpes Zoster (HZ), pneumococcal (PCV), and influenza (FLU) are recommended each year for individuals turning 65. Despite this, achieving optimal vaccination coverage remains challenging. This study assesses coverage rates for HZ, PCV, and FLU in Forlì, Northern Italy, and examines how altitude, urban planning, and health organization variables (such as the presence of a vaccination center) impact vaccine uptake. Vaccination coverages were calculated for birth cohorts between 1952 and 1958 for each municipality in the Forlì area as of 1 March 2024. The geographical factors influencing the vaccination uptake were extracted from the Italian National Institute of Statistics (ISTAT) records and evaluated through a multivariate analysis. The sample analyzed included 15,272 vaccine campaign targets from Forlì's province (185,525 citizens); the vaccine uptake rates for HZ, PCV, and FLU were 26.9%, 36.7%, and 43.5%, respectively. Gender did not appear to influence vaccine uptake. Living in a flat area appeared to increase vaccine uptake in a statistically significant way for all the vaccinations when compared to a mountainous area (HZ: OR: 1.50, PCV: OR: 1.33, FLU: OR: 1.67). The presence of a vaccine service in low-urbanized areas was shown to increase vaccine uptake for all vaccinations (HZ: OR: 1.65, PCV: OR: 1.93, FLU: OR: 1.53) compared with low-urbanized areas without a vaccination center or more urbanized areas with a vaccination center. This study emphasizes the significance of the territorial context, along with the ease of access to vaccinations and geographic barriers, as key determinants in achieving vaccination targets. Local health authorities should consider these factors when implementing vaccination campaigns.

Synergistic patient factors are driving recent increased pediatric urgent care demand.

We aimed to use the high fidelity urgent care patient data to model the factors that have led to the increased demand at our local pediatric urgent care centre. The dataset for this retrospective cohort study was obtained from our local healthcare centre's national reporting data for pediatric urgent care visits from 2006 to 2022. Variables analyzed included: basic patient demographics, chief complaint, triage urgency, date and time of registration/discharge, discharge diagnosis, and discharge destination. Statistical analysis of non-linear trends was summarized by locally estimated scatterplot smoothing splines. For machine learning, we used the tidymodels R package. Models were validated in training using k-fold cross validation with k = 5. We used univariate linear regression as a baseline model. After the data was standardized, correlation and homoscedasticity were evaluated between all parameter permutations. This dataset consisted of 164,660 unique visits to our academic centre's pediatric urgent care. Over the study period, there was an overall substantial increase in the number of urgent care visits per day, with a rapid increase beyond previous levels in 2021 and further in 2022. The increased length of stay trend was consistent across presenting complaint categories. The proportion of patients without primary care in 2022 was 2.5 times higher than in 2013. A random forest machine learning model revealed the relative importance of features to predicting a visit in 2022 were: longer stay, later registration in the day, diagnosis of an infectious illness, and younger age. This study identified a combination of declining primary care access, circulating viral infections, and shifting chief complaints as factors driving the recent increase in frequency and duration of visits to our urgent care service.

The utilization of mapping to improve the quality of community development in rural areas

Selayar Regency occupies the sixth position for stunting in South Sulawesi, with a prevalence of 32.1%. This problem is exacerbated by the community's limited access to information about stunting, so educational efforts are needed to disseminate stunting information presented using spatial mapping patterns. This activity aimed to develop village maps and identify high-stunting areas using spatial maps to improve the quality of community development. This map-making activity begins with data collection, and then data processing is carried out using ArcGIS software, digitization methods, and spatial analysis in the form of overlay analysis. Maps that have gone through the layout stage are then printed and submitted to the village government and health workers. The utilization of this map of strategic locations such as village offices, health centers, and local nutrition centers assesses the success of this services activity as a source of information in determining priority steps in preventing and handling stunting cases.

Assessing Blood Donors&amp;apos; Knowledge, Attitudes, and Practices Regarding Blood Donation - A Cross-Sectional Study

&amp;lt;i&amp;gt;Introduction: &amp;lt;/i&amp;gt;Blood donation is vital for saving lives in critical medical conditions, making it a global concern. Ensuring a stable blood supply is essential for emergency treatments, surgeries, and chronic disease therapies. Blood donors, including influential figures like imams, play a critical role in promoting and normalizing blood donation within communities. &amp;lt;i&amp;gt;Aim of the study: &amp;lt;/i&amp;gt;The aim of this study was to assess the knowledge, attitude and practices of blood donors toward blood donation. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;This cross-sectional study at Imam Training Academy of the Islamic Foundation, Bangladesh, included 200 Imams aged 18 above. Conducted from February 2023 to January 2024, data on knowledge, attitudes, and practices were collected through face-to-face interviews using a semi-structured questionnaire. Statistical analysis was performed with SPSS Version 26, considering a P-value of &amp;lt;0.05 as significant. Ethical clearance was obtained from the local ethical committee. &amp;lt;i&amp;gt;Result: &amp;lt;/i&amp;gt;The study findings indicate that the majority (61.5%) of participants were aged between 20-29 years, with 19.5% aged 30-39 years. Awareness about blood donation was moderate, with 45% aware of their blood group and Rh factor. Most participants (83.5%) understood that receiving infected blood can transmit diseases, and 65% correctly identified the interval for safe blood donation. Knowledge of local blood transfusion centers beyond BSMMU was low at 36%. Attitudes toward blood donation were overwhelmingly positive, with high agreement that donation saves lives (96.5%) and is a moral activity (97.5%). The preference for voluntary non-remunerated donation was unanimous (98%). However, only 35% of respondents had donated blood at least once, with 33.5% donating voluntarily. &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; The study found that blood donors had good knowledge and a positive attitude toward blood donation. However, most individuals were not donating blood regularly as volunteers.

Social Justice in Community Environments: A Collaborative Photovoice Process

A small New England University and a local community center undertook a community based participatory research approach to understand the community-driven factors that most impact health. Photovoice was utilized to collaboratively highlight priority issues and to collectively advocate for change. The Photovoice approach was particularly useful in this context to transcend language differences and foster community dialogue between community and institutional partners in a way that dismantled traditional — and historically harmful — power dynamics between institutions and communities. The goal of utilizing this participatory-based method was to support community-identified social-ecological change, advocate for identified environmental justice priority issues, and support sustained community involvement. The novel aspects of the approach included guiding students and community members through this process in a community-engaged learning context that brought together linguistically diverse populations with a foundation of cultural humility, respect, and multi-directional learning.

Type 2 Diabetes and Risk Factors in an Adult Population in Oujda, Eastern Morocco: A Cross-Sectional Observational Study.

Objectives The rapidly increasing prevalence of diabetes makes it a public health concern. Adopting a healthier lifestyle can prevent or delay the onset of type 2 diabetes (T2D), the most common type of diabetes, and its complications. The aim of this study is to determine the prevalence of diabetes at the level of local health centers in the prefecture of Oujda, Morocco, and its relationship with obesity, physical activity, and sociodemographic factors. Methodology In a cross-sectional study in first-line health centers, sociodemographic and bioclinical data were collected through convenient purposive sampling using anthropometric and blood glucose measurements and structured, comprehensible interview questionnaires. The International Physical Activity Questionnaire (IPAQ) questionnaire was used to measure the physical activity of the patients. The association of T2D with age, gender, education, occupation, obesity, and physical activity was analyzed. Results Out of 535 observed patients, 510 were included, mostly female with a minimum age of 18 years, with a prevalence of T2D of 16%. More than half of the patients were illiterate (56%) and 83% had no occupation. Obesity was prevalent, especially among diabetics, and only a minority were physically active according to WHO targets. Thirty-six percent of all patients and 46% of diabetics reported low levels of physical activity. Age and obesity were the main factors associated with T2D. Conclusion Obesity and T2D have a high prevalence in the Oujda region. A balanced diet and regular physical activity remain our best recommendations for preventing this disease. Special attention should be paid to women with diabetes in Arab countriesso that they can actively participate in prevention activities.

Evaluating Intelligent CPTED Systems to Support Crime Prevention Decision-Making in Municipal Control Centers

To maximize its synergetic effect across the cycle from prevention to response to post-crime management, crime prevention requires a balanced combination of spatial urban design and advanced crime prevention technologies for crime prediction and real-time response. This study derived intelligent Crime Prevention Through Environmental Design (CPTED) services and suggested a decision model based on the fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) to implement these services in municipal control centers. The analysis results are summarized as follows. First, this study established a fuzzy TOPSIS-based decision-making support model enabling local government control centers to effectively select intelligent CPTED service elements. Second, overall, operator-led Closed-Circuit Television (CCTV) and platform control technologies were identified as significant components of intelligent CPTED service elements. Third, a comparison by city size revealed that large cities in the Seoul metropolitan area rated system services for control based on advanced crime prevention infrastructure (e.g., the crime monitoring systems and real-time control drones/robots) relatively higher. In contrast, small and medium-sized cities in other provinces rated services that were perceptible to residents and improved crime-prone environments (e.g., artificial intelligence (AI) video analysis for living safety) relatively higher.

Matryoshka: Exploiting the Over-Parametrization of Deep Learning Models for Covert Data Transmission.

High-quality private machine learning (ML) data stored in local data centers becomes a key competitive factor for AI corporations. In this paper, we present a novel insider attack called Matryoshka to reveal the possibility of breaking the privacy of ML data even with no exposed interface. Our attack employs a scheduled-to-publish DNN model as a carrier model for covert transmission of secret models which memorize the information of private ML data that otherwise has no interface to the outsider. At the core of our attack, we present a novel parameter sharing approach which exploits the learning capacity of the carrier model for information hiding. Our approach simultaneously achieves: (i) High Capacity - With almost no utility loss of the carrier model, Matryoshka can transmit over 10,000 real-world data samples within a carrier model which has 220× less parameters than the total size of the stolen data, and simultaneously transmit multiple heterogeneous datasets or models within a single carrier model under a trivial distortion rate, neither of which can be done with existing steganography techniques; (ii) Decoding Efficiency - once downloading the published carrier model, an outside colluder can exclusively decode the hidden models from the carrier model with only several integer secrets and the knowledge of the hidden model architecture; (iii) Effectiveness - Moreover, almost all the recovered models either have similar performance as if it is trained independently on the private data, or can be further used to extract memorized raw training data with low error; (iv) Robustness - Information redundancy is naturally implemented to achieve resilience against common post-processing techniques on the carrier before its publishing; (v) Covertness - A model inspector with different levels of prior knowledge could hardly differentiate a carrier model from a normal model.

The Functional Positioning and Development of Educational Technology Centers in Local Universities

With the rapid development and widespread application of information technology, educational informatization has become an important direction for higher education reform. In this context, as the core force in promoting the development of educational informatization, the functional positioning and development strategy of local university educational technology centers are particularly crucial. This article aims to explore the functional positioning and development direction of local university educational technology centers from a new perspective, in order to contribute wisdom and strength to promoting the process of educational informatization and improving the quality of university teaching.

Project Vayoraksha: Implementation of novel mHealth technology for healthcare delivery during COVID-19 in geriatric population of Kerala.

Background & objectives mHealth technologies, with their potential in improving public health, have recently gained considerable interest in India, offering an opportunity to deliver tailored and low cost interventions to the selected populations, especially in resource-poor settings. Project Vayoraksha aimed at developing and pilot testing mHealth technology-assisted strategies (Vayoraksha mobile application and field Vayoraksha network) to improve healthcare delivery and reverse quarantine at the field level among the geriatric population. Methods This field operational research study was implemented in Pathanamthitta, Kerala, from October 2020 to July 2021. The Vayoraksha mobile phone application for the geriatric users and a web interface used by healthcare workers involved in the field Vayoraksha network was developed with multisectoral expertise. Vayoraksha had facilities for symptom surveillance, teleconsultation and assessment of needs and included a community-based system to monitor and meet their needs that can help in reverse quarantine of the geriatric population. Results The project was implemented using the field Vayoraksha campaign involving frontline health workers and community volunteers. A baseline survey of 4782 geriatric population in the study area was conducted in Phase I, and 2383 (49.8%) had access to a smartphone facility to use Vayoraksha. Of these, 1257 (52.7%) were covered under the 'field Vayoraksha campaign' using intersectoral coordination and community participation. A total of 750 (59.6%) geriatric individuals downloaded the application of whom, 452 (60.3%) used the services of Vayoraksha. Needs were registered by 56 (12.3%) individuals of which 46 (82.1%) were medical needs related to the management of chronic diseases. More than 70 per cent of the needs were met through the Vayoraksha field network under the local primary health centre. More than 80 per cent of the geriatric individuals reported symptoms related to COVID-19 during the intervention period. Compliance with quarantine was observed in 77.7 per cent of the geriatric populations. Among those who used Vayoraksha, 26 (5.7%) availed tele-counselling services, and 3 (0.6%) used teleconsultation facilities. It was observed that Vayoraksha users had a higher proportion of the geriatric population who were young, educated, having chronic morbidity and living with family. Regular symptom surveillance was done within this group; only 12 (2.6%) of them tested positive for COVID-19 during this study. Interpretation & conclusions Results of this pilot study are promising, with 60 per cent of the geriatric population downloading and using Vayoraksha within a short time. Technology-assisted interventions can supplement the existing system for improved healthcare delivery among the vulnerable groups and have good potential for scale-up in the near future in developing countries.

Fertility preservation service for children and young adults at high risk of infertility; the hub and spoke model

PurposeTo evaluate the evolution of fertility preservation surgery in children and young adults at high risk of infertility from a single centre to a networked ‘Hub and Spoke’ service.MethodsA case note review of patients referred for ovarian or testicular cryopreservation between Jan 2013 and Dec 2023. Demographic data, procurement numbers, and site of procurement were collected. Specialist feedback was obtained to identify the challenges faced.ResultsOver time, the number of referrals increased from 4 to 349 patients per year with the number of Spoke centres rising to 36 ovarian and 16 testicular. In 2013–2014; 100% of procurement was ovarian as compared to 2023; 51% ovarian, 49% testicular. Of the 395 referrals in 2021, 81% (n = 319) went on to have procurement and storage of tissue. Between 2013 and 2016, 96% of cases were performed at the Hub. In 2023, 53/349 (15%) cases were performed at the Hub with the remaining 296 (85%) procured at Spoke sites. Surgical issues such as access to theatre, variation and availability of surgical equipment, thermal injury to ovarian tissue and variation in the size of the testicular specimen were identified.ConclusionThe Hub and Spoke model successfully delivers treatment to patients close to home as safely possible within their local treatment centre.

Use of HBsAg-positive donors in liver transplantation: An ILTS-EASL-AASLD multisociety survey.

The gap between organ supply and demand in liver transplantation remains large in most parts of the world. One strategy to increase the donor pool is to use grafts infected with HCV, HBV, and/or HIV viruses. We aimed to explore the current use of HBsAg-positive liver grafts worldwide. A prospective cross-sectional web-based survey was designed, with a total of 28 queries, assessing national and local regulations, center experience, and center-specific experience related to the topic, and sent to all members of International Liver Transplantation Society, European Association for the Study of the Liver, and American Association for the Study of the Liver, and promoted on social media. A total of 135 liver transplant centers answered the survey: 38% from WHO European Regions, 39% from American regions, and 9.7% from South-East Asian regions. Most of the participating centers (67.3%) had been performing liver transplantation for over 15 years, with a mean of 66.5 liver transplants per year, and 54% also performed living-donor liver transplants. HBV-related disease was the indication for liver transplantation in an average of 15% of all liver transplantation cases. Regarding national and/or regional regulations, 40% of the centers reported that the use of HBsAg-positive donors was permitted, and an additional 20% could use them under special circumstances. Thirty-two centers (31%) had previously used HBsAg-positive donors. Among these centers, 62.5% conducted living-donor liver transplants and showed an increased inclination towards the use of HBsAg-positive grafts in centers with elevated waitlist mortality. HBsAg-positive donors are underutilized worldwide. The use of HBsAg-positive liver grafts could help to increase the donor pool, particularly in highly endemic areas.

Problem-based learning of an intensive design studio block unit in collaboration with a local community centre

Problem-based learning of an intensive design studio block unit in collaboration with a local community centre

Questionnaire survey on cervical cancer screening and HPV awareness among patients at a local cancer center in Japan

BackgroundThe incidence of cervical intraepithelial neoplasia is increasing in Japan. Although human papillomavirus (HPV) vaccination and cancer screening are crucial in preventing cancer-related mortality, the cervical cancer screening rate in Japan was only approximately 43.6% in 2022. This study aimed to conduct an epidemiological analysis of cervical cancer by collecting data from individual patients.MethodsA questionnaire survey was administered to patients who visited our hospital between January 2017 and July 2023 owing to abnormal cervical cytological findings or a cancer diagnosis. Patients answered questions regarding their history of cervical cancer screening as well as their knowledge of HPV and cervical cancer.ResultsDuring the study period, 471 patients participated in the survey, with 35 declining to participate. Patients with Stage 1b1–4b primarily sought medical attention due to self-reported symptoms (P < 0.001); however, they were less likely to have undergone cervical cancer screening (P < 0.001). Additionally, older patients were less likely to be aware of the association of HPV with cervical and other cancers. Notably, 28 of the 129 patients with stage 1b1–4b cancer underwent cervical cancer screening within 2 years. The tumor location within the endocervical canal emerged as a significant factor contributing to the difficulty for an accurate diagnosis of precancerous or cervical cancer during cervical screening. Furthermore, non- squamous cell carcinoma (SCC) histology was another possible factor.ConclusionsOur findings suggest the need to widely disseminate information regarding the significance of cancer screening to increase cancer screening rates. Moreover, establishing strategies for improving the accuracy of detecting lesions during screening for non-SCC and endocervical canal tumors is crucial.