Patient characteristics associated with definitive diagnosis of metastatic pancreatic cancer in those initially diagnosed with cancer of unknown primary.

Cancer of unknown primary (CUP) and pancreatic cancer (PC) are malignancies associated with poor prognosis. CUP is the fourth most common cause of cancer mortality in the US, and median survival time is 3-4 months. PC is the third most common cause of cancer mortality in the US, and median survival time for patients with stage 3 or 4 PC is 2-3 months. The present study aimed to understand the patient characteristics of those initially misdiagnosed with CUP who ultimately received a diagnosis of PC. The present study used 2010-2015 Surveillance, Epidemiology, and End Results-Medicare data, a US population-based cancer registry linked to Medicare health insurance claims. Odds ratios (ORs) and 95% confidence intervals were calculated using two binary logistic regression models to compare the characteristics of patients who received definitive diagnosis between the CUP-PC group (those with an initial diagnosis of CUP who eventually received a stage 3 or 4 PC diagnosis) and the PC group (those diagnosed with stage 3 or 4 PC only). Approximately 26% of patients who received a definitive diagnosis of metastatic PC started with an initial diagnosis of CUP (n=17,565). The odds of definitive PC diagnosis in patients with CUP were lower for those with a comorbidity score of 0 [OR, 0.85 (95% CI: 0.79, 0.91)] and epithelial/unspecified histology [OR, 0.76 (95% CI: 0.71, 0.82)]. The odds of definitive PC diagnosis in patients with CUP were higher for patients of other race [OR, 1.27 (95% CI: 1.13, 1.43)] compared with white patients. Definitive diagnosis of PC in patients with CUP was lower in patients who were older with fewer or no comorbidities and unspecified histology. The complexity of CUP diagnosis and patient performance status may influence delays in diagnosis to a known primary site.

Adverse childhood experiences, antenatal stressful life events, and marijuana use during pregnancy: A population-based study.

Cumulative exposure to adverse childhood experiences (ACEs) and antenatal stressful life events (ASLEs) are independently associated with marijuana use during pregnancy. However, research has not explored how both exposures may influence marijuana use jointly. Assessing the joint associations of ACEs and recent ASLEs on marijuana use can identify people who may benefit from early intervention. Data come from the Nevada Pregnancy Risk Assessment Monitoring System, 2017-2020 (N = 2483). We assessed eight measures of ACEs before age 18 and fourteen measures of ASLEs twelve months before giving birth. Generalized estimating equations estimated the direct and joint associations (additive and multiplicative interaction) of ACEs and ASLEs on marijuana use during pregnancy. 9.8% used marijuana during the most recent pregnancy. Compared to people who reported no ACEs, those reporting 1 ACE (adjusted prevalence ratio[aPR] = 1.96, 95% confidence interval [CI] = 1.30-2.94), 3 ACEs (aPR = 3.58, 95%CI = 2.69-4.77), and 4+ ACEs (aPR = 3.67, 95%CI = 2.36-5.72) were more likely to use marijuana. Compared to people reporting no ASLEs, those reporting 4+ ASLEs (aPR = 3.12, 95% CI = 1.64-5.92) were more likely to use marijuana. There was evidence of interaction for high ACE and ASLE exposure on an additive scale. ACEs and ASLEs were independently associated with marijuana use during pregnancy, and there was evidence of additive interaction. Screening for ACEs and ASLEs during pregnancy, referrals to appropriate behavioral health services, and trauma-informed approaches are important to address marijuana use during pregnancy.

Patient Characteristics Associated with Definitive Diagnosis of Metastatic Pancreatic Cancer in Those Initially Diagnosed with Cancer of Unknown Primary.

Purpose: Cancer of unknown primary (CUP) is the fourth most common cause of cancer mortality in the U.S. Median survival after CUP diagnosis is 3-4 months. As CUP and metastatic pancreatic cancer (PC) are comparable in prevalence and survival, PC diagnosis is a useful endpoint to assess patient characteristics associated with definitive diagnosis in older patients who initially present with CUP. Methods: This study used 2010-2015 SEER-Medicare data. Logistic regression models compared patient characteristics who received definitive diagnosis in two subsets: CUP-PC and PC only. Results: Approximately 26% of patients who received a definitive diagnosis of metastatic pancreatic cancer started with an initial diagnosis of CUP (n=17,565). The odds of definitive diagnosis in CUP-PC were lower for those with a comorbidity score of 0 (OR 0.85 [0.79, 0.91]) and epithelial/unspecified histology (OR 0.76 [0.71, 0.82]). The odds of definitive diagnosis in CUP-PC were higher for patients of Other race (OR 1.27 [1.13, 1.43]) compared to White patients. Conclusion: Definitive diagnosis of CUP-PC was favorable in patients in the Other race category with fewer or no comorbidities. Unfavorable characteristics included older patients and those with epithelial/unspecified histology. Future studies will focus on patterns of care and survival in patients with CUP-PC.

Sources of Information and Communication About HPV Among Chinese Students Attending U.S. Colleges: Implications for Culturally Appropriate Strategies.

INTRODUCTION: Little is known about human papillomavirus (HPV) information sources and communication among Chinese students attending U.S. colleges. We assessed information sources and communication about HPV and HPV vaccines among this population. METHODOLOGY: A cross-sectional design with 449 participants was conducted by using a questionnaire and snowball sampling. Summary statistics and multiple logistic regression were used. RESULTS: The most common sources of HPV information included the internet and friends. Communication about HPV occurred most frequently among friends, family, and health professionals. Those who had better HPV knowledge and attitudes and were vaccinated against HPV were more likely to use internet, friends, family, and health professionals as their information sources. DISCUSSION: Because the internet, friends, and families are likely sources for HPV information and communication, future internet-based culturally appropriate education should offer information not only to Chinese students but also to their social circles. Cultural beliefs may affect HPV prevention and should be examined.

Reasons and influential recommendations associated with HPV vaccination among Chinese college students in the USA.

OBJECTIVES: To evaluate (a) reasons for not receiving recommended doses of the human papillomavirus (HPV) vaccine, (b) the most influential recommending source in getting the HPV vaccine, and (c) associated factors among Chinese college students in the United States. METHODS: A cross-sectional design utilizing a structured self-report questionnaire was used. PARTICIPANTS: A network sample of 449 participants aged 18 or older completed the survey between March and May of 2018. RESULTS: Only 172 participants (38.3%) had received the HPV vaccine. The most common reason was that participants had never received recommendations from healthcare providers regarding HPV vaccines. Recommendations from doctors were the most cited source in deciding HPV vaccine uptake. Factors associated with reasons and recommendation sources included attitudes toward HPV, gender, school year, age, major, and health insurance. CONCLUSIONS: Healthcare providers play an important role in promoting HPV vaccination among Chinese college students. More research is needed for this understudied population.

Knowledge, attitudes, and practices related to human papillomavirus vaccination among college students in a state university: Implications for nurse practitioners.

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and disproportionately affects adolescents and young adults. Although a safe and efficacious vaccine is available, many college students are unimmunized against HPV. Most students presenting to college health centers are within the age range for catch-up immunization, giving nurse practitioners (NPs) in this setting an opportunity to increase vaccination rates. More information is needed about college students' HPV knowledge, attitudes, and vaccination uptake so that NPs can make effective vaccine recommendations to this population. PURPOSE: To examine (a) Knowledge and attitudes about HPV and its vaccine; (b) HPV immunization practices; and (c) factors associated with HPV knowledge, attitudes, and vaccination among college students in a US university. METHODS: This cross-sectional quantitative study collected data from participants in a state university student health center. Data collected included knowledge, attitudes, and practices about HPV and its vaccine from 627 students. RESULTS: Participants had a moderately low HPV knowledge but positive attitudes toward HPV and its vaccine. Participants with a higher level of HPV knowledge were US born, health-related majors, married or divorced, and had positive attitudes. Higher HPV knowledge, vaccine uptake, and a family history of cervical cancer were associated with positive attitudes. Predictors for vaccine uptake include being a health-related major and positive vaccine attitudes. IMPLICATIONS FOR PRACTICE: The results of this study help NPs, registered nurses, and other health care providers make effective HPV vaccine recommendations to college students. Students with positive HPV attitudes can serve as peer educators to increase HPV vaccination awareness in this population.

Efficient estimation of a linear transformation model for current status data via penalized splines.

We propose a flexible and computationally efficient penalized estimation method for a semi-parametric linear transformation model with current status data. To facilitate model fitting, the unknown monotone function is approximated by monotone B-splines, and a computationally efficient hybrid algorithm involving the Fisher scoring algorithm and the isotonic regression is developed. A goodness-of-fit test and model diagnostics are also considered. The asymptotic properties of the penalized estimators are established, including the optimal rate of convergence for the function estimator and the semi-parametric efficiency for the regression parameter estimators. An extensive numerical experiment is conducted to evaluate the finite-sample properties of the penalized estimators, and the methodology is further illustrated with two real studies.

Human papillomavirus knowledge, attitudes, and vaccination among Chinese college students in the United States.

Human papilloma virus (HPV) is the most common sexually transmitted infection in the USA with some strains increasing the risk of certain cancers. The HPV vaccine, introduced in 2006, has reduced the infection rate, although racial/ethnic disparities in vaccination exist. Asian college students are among those with the lowest vaccination rates, however there has been little exploration as to why. The purposes of this study were to assess (a) knowledge and attitudes regarding HPV and its vaccine, (b) HPV vaccination practices, and (c) factors associated with HPV-related knowledge and attitudes, and vaccination among Chinese college students in the USA. This cross-sectional quantitative survey collected data face-to-face and online from 449 participants. The mean scores for HPV knowledge and attitudes were 40.87 and 2.36 indicating a low-to-moderate level of knowledge but a moderately positive attitude regrading HPV transmission and vaccination. Only half (50.8%) knew that the vaccination could be received after the age of 18 years. Only 38.3% reported having receiving at least one dose of the vaccine, with 92.4% receiving their first HPV vaccines in the USA. Multiple logistic regression showed that men and non-health sciences majors had lower knowledge about HPV. Older students, those without a primary care provider, and those who completed the survey in English had more negative attitudes about the HPV and vaccine. Participants who were younger, female, had a higher level of knowledge, had more positive attitudes, and completed the survey online were associated with better vaccination status. Findings from this study provide insight into Chinese college students' knowledge and attitudes about HPV and HPV vaccination and may be used to develop culturally sensitive programs that address the risk of HPV and the benefits of HPV vaccine.

Demographics, self-efficacy, benefits/barriers, stages of adopting pap testing among Korean American women.

Korean American women (KAW) experience the third highest incidence rate of cervical cancer among nine major Asian Americans. This study examined cervical cancer screening among KAW using constructs from the transtheoretical model (TTM). Using a cross-sectional survey design, 102 KAW aged 21-65 years of age were recruited through convenience sampling. Twenty-seven per cent of participants reported of never receiving a Pap smear. Women who were older and married were more likely to report being in the action/maintenance stages; women who perceived themselves to be in poor health were less likely to be in the action/maintenance stages. Higher self-efficacy and lower perception of barriers were significantly associated with more advanced TTM stages. The perceived benefits were not statistically different across TTM stages of change. A special attention should be given to young and unmarried KAW to increase screening participation. Impact statement What is already known on this subject? The utilisation of Pap test among Korean American women (KAW) was low. Using the transtheoretical model (TTM) approach has the potential to increase a screening adherence. What do the results of this study add? This is the first study to examine the association between TTM constructs related to Pap testing among KAW. Younger and unmarried women reported the lowest levels of screening attitudes or behaviours; and tailored efforts may be beneficial in increasing the screening among these women. What are the implications of these findings for clinical practice and/or further research? Increasing the self-efficacy and decreasing the barriers to obtaining Pap screening are critical to move Korean women to the advanced TTM stages. Further investigation is needed with KAW to fully understand the relationships between TTM constructs.

Scope-of-practice laws and expanded health services: the case of underserved women and advanced cervical cancer diagnoses.

BACKGROUND: Underserved women (rural, minority or poor) are disproportionally diagnosed with late-stage cervical cancer, indicative of inadequate access to, and use of, preventative healthcare. The Institute of Medicine (IOM) has proposed that nurse practitioners (NP) can address provider shortages among underserved populations, but to reduce shortages, scope-of-practice laws that restrict the delivery of care, must be revised. We examined the IOM recommendation of NP expanded scope-of-practice laws on reducing the disparity of underserved women diagnosed with late-stage cervical cancer. METHODS: We examined the cohort of 10 673 women diagnosed with cervical cancer between 2010 and 2014 and reported to the Surveillance, Epidemiology and End Results cancer registry. We linked state-level laws regarding NP scope-of-practice to patients with cancer by their state of residence, diagnosis date and law enactment date. Hierarchical regression was used to explore NP full scope-of-practice law's impact on late-stage cancer diagnoses considering the moderating effect of women living in medically underserved areas. We adjusted for known confounders available in this population-based data set. RESULTS: Medically underserved women living in states with laws that restrict NP full scope-of-practice are twofold more likely to be diagnosed with late-stage cancer; adjusted OR and 95% CI (OR 2.08, 95% CI 1.4 to 3.1). These disparities were not observed among underserved women living in areas with NP full scope-of-practice laws (OR 0.95, 95% CI 0.7 to 1.3). CONCLUSIONS: NP full scope-of-practice laws could provide a pragmatic and cost-effective solution to healthcare provider shortages associated with late stage of cervical cancer diagnoses among underserved women.

A partially linear proportional hazards model for current status data.

For analyzing current status data, a flexible partially linear proportional hazards model is proposed. Modeling flexibility is attained through using monotone splines to approximate the baseline cumulative hazard function, as well as B-splines to accommodate nonlinear covariate effects. To facilitate model fitting, a computationally efficient and easy to implement expectation-maximization algorithm is developed through a two-stage data augmentation process involving carefully structured latent Poisson random variables. Asymptotic normality and the efficiency of the spline estimator of the regression coefficients are established, and the spline estimators of the nonparametric components are shown to possess the optimal rate of convergence under suitable regularity conditions. The finite-sample performance of the proposed approach is evaluated through Monte Carlo simulation and it is further illustrated using uterine fibroid data arising from a prospective cohort study on early pregnancy.

Penalized estimation for proportional hazards models with current status data.

We provide a simple and practical, yet flexible, penalized estimation method for a Cox proportional hazards model with current status data. We approximate the baseline cumulative hazard function by monotone B-splines and use a hybrid approach based on the Fisher-scoring algorithm and the isotonic regression to compute the penalized estimates. We show that the penalized estimator of the nonparametric component achieves the optimal rate of convergence under some smooth conditions and that the estimators of the regression parameters are asymptotically normal and efficient. Moreover, a simple variance estimation method is considered for inference on the regression parameters. We perform 2 extensive Monte Carlo studies to evaluate the finite-sample performance of the penalized approach and compare it with the 3 competing R packages: C1.coxph, intcox, and ICsurv. A goodness-of-fit test and model diagnostics are also discussed. The methodology is illustrated with 2 real applications.

Assessing perceived benefits/barriers and self-efficacy for cervical cancer screening among Korean American women.

A large proportion of Korean American women (KAW) do not receive regular cervical cancer screening. Self-report data from 102 KAW were analyzed by multiple linear regressions. As compared to women in action/maintenance, women in precontemplation/relapse stages were less likely to agree that a Pap test is important for health and were more likely to endorse barriers to testing (cost, not having a female doctor, preference for Korean medicine). Women in precontemplation/relapse stages also reported lower scores on self-efficacy items (travel large distances, pain perceptions, financial costs, and time). Differences in specific aspects may be informative for interventions to improve screening rates among KAW.

Perceived Benefits and Barriers of Cervical Cancer Screening Among Chinese American Women.

PURPOSE/OBJECTIVES: To explore the perceived benefits and barriers to cervical cancer screening among Chinese American women using stages of the Transtheoretical Model of Change.
. DESIGN: Cross-sectional design with self-report surveys. 
. SETTING: Chinese communities (e.g., churches, supermarkets, restaurants) in Northern California and Northern Nevada. 
. SAMPLE: 121 Chinese women aged 21-65 years living in Northern California and Northern Nevada. 
. METHODS: A snowball sampling technique using personal contacts was used.
. MAIN RESEARCH VARIABLES: Stages of change and perceived benefits and barriers to cervical cancer screening. 
. FINDINGS: Participants in the action/maintenance stage were most likely to believe that cervical cancer was treatable if caught early. Women in the contemplation/preparation stage were more likely to state that they worried about or feared screening, that it was too expensive, and that they would want to use Chinese medicine to cure an illness before trying Western medicine. Women in the precontemplation/relapse stage were most likely to report that they did not know where to get screened and that their partner would not want them to be screened.
. CONCLUSIONS: Perceived benefits and barriers to screening were differentially associated with the stages of change. Results may support culturally sensitive and theory-based programs to improve screening rates among Chinese American women. 
. IMPLICATIONS FOR NURSING: The results suggest the importance of cultural sensitivity among nursing providers when working with Chinese Americans to provide more relevant, holistic care.

Pre-injury polypharmacy predicts mortality in isolated severe traumatic brain injury patients.

BACKGROUND: The use of 5 or more medications is defined as polypharmacy (PPM). The clinical impact of PPM on the isolated severe traumatic brain injury (TBI) patient has not been defined. METHODS: A retrospective cohort study was performed at our academic level 1 trauma center examining patients with isolated TBI. Pre-injury medications were reviewed, and inhospital mortality was the primary measured outcome. RESULTS: There were 698 patients with an isolated TBI over the 5-year study period; 177 (25.4%) patients reported pre-injury PPM. There were 18 (10.2%) deaths in the PPM cohort and 24 (4.6%) deaths in the non-PPM cohort (P < .0001). Stepwise logistic regression analysis revealed a 2.3 times greater risk of mortality in the PPM patients (P = .019). CONCLUSIONS: Pre-injury PPM increases mortality in patients with isolated severe TBI. This knowledge may provide opportunities for intervention in this population.

Operating Room Efficiency: Benefits of an Orthopaedic Traumatologist at a Level II Trauma Center.

OBJECTIVES: Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. DESIGN: Retrospective review. SETTING: Level II community-based trauma hospital. PATIENTS/PARTICIPANTS: Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011. INTERVENTION: Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons. MAIN OUTCOME MEASUREMENTS: Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel's 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods. RESULTS: A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P , 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001). CONCLUSIONS: This study demonstrates that in our communitybased trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center.

OBJECTIVES: In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula. DESIGN: Retrospective review. SETTING: Level II Trauma center. PATIENTS: 828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures. INTERVENTION: Operative treatment with conventional or generic implants. RESULTS: The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period. CONCLUSIONS: Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used. LEVEL OF EVIDENCE: Therapeutic Level III.

Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System.

OBJECTIVES: The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital. DESIGN: Retrospective case series. SETTING: Level II trauma center. PATIENTS/PARTICIPANTS: One thousand one hundred four trauma patients with orthopaedic injuries. INTERVENTION: PA involvement. MAIN OUTCOME MEASUREMENTS: Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients. RESULTS: At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P . 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0.0034). Average length of stay decreased by 0.61 days (P = 0.27). CONCLUSIONS: Although the PA's collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Preparation of Photoluminescence Tunable Cu-doped AgInS2 and AgInS2/ZnS Nanocrystals and Their Application as Cellular Imaging Probes.

In this work, high-quality Cu doped AIS and AIS/ZnS NCs have been first synthesized via a surface doping approach. By varying Cu concentrations in doping, Cu doped AIS NCs exhibit a photoluminescence red-shift from around 600 nm to 660 nm with a decrease of quantum yield from around 30% to 20%. After ZnS coating or zinc etching on the Cu doped AIS NCs, Cu doped AIS/ZnS NCs present photoluminescence peaks from around 570 nm to 610 nm and high quantum yields in the range of 50 ~ 60%. Moreover, it is found that Cu doping can prolong the photoluminescence lifetime of NCs, and the average photoluminescence lifetime of Cu doped AIS and AIS/ZnS NCs is in the range of 300 ~ 500 ns. The resultant Cu doped AIS/ZnS NCs were further encapsulated with amphiphilic polymers and used as biocompatible photoluminescent probes in cellular imaging. The cellular imaging study shows that peptide-conjugated probes can specifically target U-87 brain tumor cells and thus they can be applied to the detection of endogenous targets expressed on brain tumor cells.

Latina Women and Cervical Cancer Screening: Decisional Balance and Self-Efficacy.

BACKGROUND: Latina women in the United States have greater cervical cancer mortality rates than non-Latina women because of their low rates of Papanicolau (Pap) smear screening. OBJECTIVES: The purpose of this article is to assess differences in perceived benefits, perceived barriers, and self-efficacy among Latina women to obtain Pap smears using the framework of the Transtheoretical Model. METHODS: A descriptive design with a snowball sample was used. The researchers assessed demographics, three perceived benefits, 12 barriers, and seven self-efficacy measures for 121 Latina women in northern Nevada. FINDINGS: Participants in precontemplation and relapse perceived greater barriers than those in action and maintenance for three items.