Low Levels of Lifetime Pap Test Receipt Among Vulnerable Guatemalans.

Low and middle-income countries, such as Guatemala, shoulder a disproportionate share of cervical cancer, a preventable disease in high income countries. Tangible obstacles, such as lack of access to health care, cultural differences, and insufficient infrastructure, and facilitators, such as being Ladino, married, and educated, have been identified in the literature related to cervical cancer prevention. The aim of this survey was to explore barriers and facilitators to cervical cancer prevention, comparing rural Indigenous and urban Ladino populations. We surveyed 139 women in two health clinics. Participants answered questions about demographic information, cervical cancer knowledge, and health care behaviors. We analyzed survey data with four bivariate models. Our results suggest vulnerable populations, such as rural Indigenous women who are single, illiterate, and lack education, face higher cervical cancer risk. Partnerships should be formed with health promotors and lay midwives to educate and encourage vulnerable populations to prevent cervical cancer.

Evaluation of ELISA-Based Multiplex Peptides for the Detection of Human Serum Antibodies Induced by Zika Virus Infection across Various Countries.

Zika virus (ZIKV) is a mosquito-borne Flavivirus with a positive-sense RNA genome, which are generally transmitted through the bite of an infected Aedes mosquito. ZIKV infections could be associated with neurological sequelae that, and otherwise produces similar clinical symptoms as other co-circulating pathogens. Past infection with one member of the Flavivirus genus often induces cross-reactive antibodies against other flaviruses. These attributes complicate the ability to differentially diagnose ZIKV infection from other endemic mosquito-borne viruses, making it both a public health issue as well as a diagnostic challenge. We report the results from serological analyses using arbovirus-specific peptides on 339 samples that were previously collected from 6 countries. Overall, we found that our multiplexed peptide-based ELISA was highly efficient for identifying ZIKV antibodies as early as 2 weeks post infection, and that it correlates with microneutralization, plaque reduction neutralization tests (PRNTs) and commercial tests for ZIKV in previously characterized samples. We observed that seropositivity varied by patient cohort, reflecting the sampling period in relation to the 2015-2016 ZIKV outbreak. This work evaluates the accuracy, specificity, and sensitivity of our peptide-based ELISA method for detecting ZIKV antibodies from geographically diverse regions. These findings can contribute to ongoing serological methods development and can be adapted for use in future studies.

Diversity of longhorned beetles (Coleoptera: Cerambycidae) in the Caribbean region of Colombia: temporal variation between two fragments of tropical dry forest / Diversidade de besouros serra-pau (Coleoptera: Cerambycidae) na região caribenha da Colômbia: variação temporal entre dois fragmentos de floresta seca tropical

Abstract: The tropical dry forest is under constant threat from many anthropic activities which are conducted indiscriminately, modifying the forest, and therefore, affecting species that are closely related to its phenology, such as longhorned beetles (Cerambycidae). The spatio-temporal variation of the cerambycid diversity in two fragments of tropical dry forest (Reserva Campesina la Montaña and La Flecha) in the Caribbean region of Colombia was analyzed. At each locality, four squared plots were delimited, and the beetles were collected with fruit traps, beating sheets and manual capture, and with light traps in the center. Five hundred eighty-seven specimens representing 128 species were collected, of which members of the tribe Ectenessini (Cerambycinae) were the most abundant. At the subfamily level, Cerambycinae was the most abundant (465 specimens) and diverse (73 species), followed by Lamiinae and Prioninae. The highest values of richness (110 species), abundance (428), biomass (21.18 g), and as well as the highest values of true diversity (1D= 73.44, 2D= 34.30) were found during the first precipitations. Regarding beta diversity, temporal variation was determined and mainly explained by a high percentage of turnover (> 70%). Lastly, the high diversity of Cerambycidae was associated with high values of relative humidity and canopy cover during the rainy season. This showed that the structure of the cerambycid community in the tropical dry forest of the Caribbean region of Colombia depends on these variables, which are closely related to precipitation.

Resumo: A floresta seca tropical está sob constante ameaça devido às muitas atividades antrópicas que são realizadas indiscriminadamente, modificando a floresta e, portanto, afetando espécies que se encontram muito relacionadas com a sua fenologia, tais como os besouros serra-pau (Cerambycidae). Foi analisada a variação espaço-temporal da diversidade de cerambícidos em dois fragmentos de floresta seca tropical ("Reserva campesina La Montaña e La Flecha") na região caribenha da Colômbia. Em cada localidade, quatro quadrantes foram delimitados e os besouros foram coletados usando armadilhas com isca de fruta, guarda-chuva entomológico, captura manual e armadilhas de luz. Quinhentos e oitenta e sete espécimes, de 128 espécies foram coletados, sendo os membros da tribo Ectenessini (Cerambycinae) os mais abundantes. Ao nível de subfamília, Cerambycinae foi a mais abundante (465 espécimes) e diversa (73 espécies), seguida de Lamiinae e Prioninae. Os valores mais altos de riqueza (110 espécies), abundância (428) e biomassa (21.18 g) foram encontrados durante as primeiras chuvas, assim como os valores mais altos de diversidade verdadeira (1D= 73.44, 2D= 34.30). Em relação à diversidade beta, a variação temporal foi determinada e principalmente explicada por uma alta porcentagem de substituição (> 70%). Por último, uma alta diversidade de Cerambycidae foi associada com altos valores de humidade relativa e cobertura vegetal durante a temporada de chuva, mostrando que a estrutura da comunidade de Cerambycidae na floresta seca tropical da Colômbia depende dessas variáveis, as quais são muito relacionadas com a precipitação.

Development and Validation of a Rapid Lateral Flow E1/E2-Antigen Test and ELISA in Patients Infected with Emerging Asian Strain of Chikungunya Virus in the Americas.

Since its 2013 emergence in the Americas, Chikungunya virus (CHIKV) has posed a serious threat to public health. Early and accurate diagnosis of the disease, though currently lacking in clinics, is integral to enable timely care and epidemiological response. We developed a dual detection system: a CHIKV antigen E1/E2-based enzyme-linked immunosorbent assay (ELISA) and a lateral flow test using high-affinity anti-CHIKV antibodies. The ELISA was validated with 100 PCR-tested acute Chikungunya fever samples from Honduras. The assay had an overall sensitivity and specificity of 51% and 96.67%, respectively, with accuracy reaching 95.45% sensitivity and 92.03% specificity at a cycle threshold (Ct) cutoff of 22. As the Ct value decreased from 35 to 22, the ELISA sensitivity increased. We then developed and validated two lateral flow tests using independent antibody pairs. The sensitivity and specificity reached 100% for both lateral flow tests using 39 samples from Colombia and Honduras at Ct cutoffs of 20 and 27, respectively. For both lateral flow tests, sensitivity decreased as the Ct increased after 27. Because CHIKV E1/E2 are exposed in the virion surfaces in serum during the acute infection phase, these sensitive and specific assays demonstrate opportunities for early detection of this emerging human pathogen.

A mixed methods approach to understand variation in lung cancer practice and the role of guidelines.

INTRODUCTION: Practice pattern data demonstrate regional variation and lower than expected rates of adherence to practice guideline (PG) recommendations for the treatment of stage II/IIIA resected and stage IIIA/IIIB unresected non-small cell lung cancer (NSCLC) patients in Ontario, Canada. This study sought to understand how clinical decisions are made for the treatment of these patients and the role of PGs. METHODS: Surveys and key informant interviews were undertaken with clinicians and administrators. RESULTS: Participants reported favorable ratings for PGs and the evidentiary bases underpinning them. The majority of participants agreed more patients should have received treatment and that regional variation is problematic. Participants estimated that up to 30% of patients are not good candidates for treatment and up to 20% of patients refuse treatment. The most common barrier to implementing PGs was the lack of organizational support by clinical administrative leadership. There was concern that the trial results underpinning the PG recommendations were not generalizable to the typical patients seen in clinic. The qualitative analysis yielded five themes related to physicians' decision making: the unique patient, the unique physician, the family, the clinical team, and the clinical evidence. A dynamic interplay between these factors exists. CONCLUSION: Our study demonstrates the challenges inherent in (i) the complexity of clinical decision making; (ii) how quality of care problems are perceived and operationalized; and (iii) the clinical appropriateness and utility of PG recommendations. We argue that systematic and rigorous methodologies to help decision makers mitigate or negotiate these challenges are warranted.

The landscape of knowledge translation interventions in cancer control: what do we know and where to next? A review of systematic reviews.

BACKGROUND: Effective implementation strategies are needed to optimize advancements in the fields of cancer diagnosis, treatment, survivorship, and end-of-life care. We conducted a review of systematic reviews to better understand the evidentiary base of implementation strategies in cancer control. METHODS: Using three databases, we conducted a search and identified English-language systematic reviews published between 2005 and 2010 that targeted consumer, professional, organizational, regulatory, or financial interventions, tested exclusively or partially in a cancer context (primary focus); generic or non-cancer-specific reviews were also considered. Data were extracted, appraised, and analyzed by members of the research team, and research ideas to advance the field were proposed. RESULTS: Thirty-four systematic reviews providing 41 summaries of evidence on 19 unique interventions comprised the evidence base. AMSTAR quality ratings ranged between 2 and 10. Team members rated most of the interventions as promising and in need of further research, and 64 research ideas were identified. CONCLUSIONS: While many interventions show promise of effectiveness in the cancer-control context, few reviews were able to conclude definitively in favor of or against a specific intervention. We discuss the complexity of implementation research and offer suggestions to advance the science in this area.

Suspected appendicitis in children: diagnostic importance of normal abdominopelvic CT findings with nonvisualized appendix.

PURPOSE: To determine whether lack of visualization of the appendix on otherwise normal abdominopelvic computed tomographic (CT) images can help exclude appendicitis in the pediatric population. MATERIALS AND METHODS: The study was institutional review board approved and HIPAA compliant. One thousand one hundred thirty-nine children suspected of having appendicitis were referred for CT examination between July 2002 and December 2006. Exclusion criteria included CT diagnosis of appendicitis or other cause of symptoms and lack of clinical follow-up. Consensus review was performed by two pediatric radiologists to determine normal examinations, leaving a final study group (nonvisualized appendix) of 156 patients (mean age, 9.6 years; boys, 7.2 years; girls, 10.2 years) and a control group (visualized appendix) of 421 patients (mean age, 11.0 years; boys, 9.8 years; girls, 11.2 years). In the control group, there were 168 subjects with a partially visualized (PV) appendix and 253 with a fully visualized (FV) appendix. Pericecal fat was graded according to published criteria. Diagnosis was confirmed at surgery or clinical follow-up. Negative predictive values were calculated with 95% confidence intervals (CIs). RESULTS: There were three false-negative findings (study group, two; control group, one [FV]). The negative predictive value of a normal CT examination in pediatric patients with a nonvisualized appendix was 98.7% (95% CI: 95.5%, 99.8%); that with a visualized appendix, 99.8% (95% CI: 98.7%, 99.99%); that with a PV appendix, 100% (95% CI: 97.8%, 100%); and that with a FV appendix, 99.6% (95% CI: 97.8%, 99.99%). CONCLUSION: Pediatric abdominopelvic CT images with nonvisualized appendix have a high negative predictive value, without significant difference from cases with a PV or even FV appendix. The false-negative rate was similar to those reported in two adult series.