Current Status and Future Direction to Address Disparities in Diversity, Equity, and Inclusion in Prostate Cancer Care.

PURPOSE OF REVIEW: Disparities in prostate cancer care and outcomes have been well recognized for decades. The purpose of this review is to methodically highlight known racial disparities in the care of prostate cancer patients, and in doing so, recognize potential strategies for overcoming these disparities moving forward. RECENT FINDINGS: Over the past few years, there has been a growing recognition and push towards addressing disparities in cancer care. This has led to improvements in care delivery trends and a narrowing of racial outcome disparities, but as we highlight in the following review, there is more to be addressed before we can fully close the gap in prostate cancer care delivery. While disparities in prostate cancer care are well recognized in the literature, they are not insurmountable, and progress has been made in identifying areas for improvement and potential strategies for closing the care gap.

Cost-effectiveness analysis of a community-based colorectal cancer screening program in Shanghai, China.

Background: Since 2011, through the Community-Based Colorectal Cancer Screening Program in Shanghai, China (SHcsp), residents aged >50 years were offered initial colorectal cancer screening using the fecal immunochemical test (FIT) and risk assessment questionnaire (RAQ) for free. Colonoscopy was then recommended for positive results. Objective: To evaluate the cost-effectiveness of the Community-Based Colorectal Cancer Screening Program in Shanghai, China from the payer perspective. Methods: This analysis estimated the long-term cost and effectiveness of the 2014-2016 SHcsp based on real-world follow-up data from the SHcsp database, Shanghai Cancer Registry System, vital statistics from Shanghai Municipal Center for Disease Control and Prevention and inpatient CRC expense data from hospitals. A decision-tree model and Markov model were constructed to simulate the 25-year health outcomes. The screening branch was the cohort with a definite diagnosis of adenoma, advanced adenoma, and CRC. The other branch was residents who were neither screened nor treated until CRC symptoms appeared. A payer prospective was adopted to measure direct costs and effectiveness by life years (LYs) and quality-adjusted life years (QALYs) gained, and were discounted by 3%. Stimulation robustness was tested by one-way sensitivity analysis. Results: Of 1,097,656 residents, 13,250 were diagnosed with adenoma, advanced adenoma, or CRC. Assuming those had not been found through screening, SHcsp resulted in 1,570.1 LYs and 13,984.3 QALYs gained at an extra cost of USD9.96 million. The incremental cost-effectiveness ratio (ICER) was USD6,342.02 per LY and USD712.08 per QALY obtained, far below the threshold of USD59,598 of three-time GDP per capita in Shanghai. Conclusion: The SHcsp was cost-effective than no screening strategy. The results were generalisable to the Chinese population for mass CRC screening.

Comparative Study of Two Short-Form Versions of the Montreal Cognitive Assessment for Screening of Post-Stroke Cognitive Impairment in a Chinese Population.

PURPOSE: Cognitive impairment (CI) is one of the most significant post-stroke complications. The Montreal Cognitive Assessment (MoCA) is widely applied to the early screening of post-stroke CI (PSCI), and has good sensitivity and specificity, but needs a long time to administer. Clinicians and researchers need shorter, more effective cognitive testing tools. The purpose of this study was to detect the sensitivity and specificity of two different short-form versions of the MoCA (SF-MoCA) for screening of PSCI in a Chinese population. METHODS: A total of 2,989 stroke participants were included from 14 hospitals in northern and southern China between June 2011 and September 2013. The sensitivity and specificity of the two SF-MoCA versions were compared. RESULTS: Using an MoCA score <26 as the critical value, the National Institute of Neurological Disease and Stroke-Canadian Stroke Network SF-MoCA showed sensitivity of 91% and specificity of 63% (PPV 71%, BPV 87%) with scores ≤10 points. The sensitivity and specificity of the Bocti SF-MoCA were 92% and 69% (PPV 75%, BPV 89%) with scores ≤7, respectively. The area under the curve was 0.885 (95% CI 0.873-0.897) and 0.912 (95% CI 0.902-0.922), respectively. CONCLUSION: The Bocti SF-MoCA can be used as a briefer and more effective screening tool for PSCI in Chinese.

Comparison of the Mini-Mental State Examination and Montreal Cognitive Assessment executive subtests in detecting post-stroke cognitive impairment.

AIM: The Montreal Cognitive Assessment (MoCA) has been shown to be more sensitive in detecting executive dysfunction than the Mini-Mental State Examination (MMSE). However, it is still not known whether all the MoCA executive subtests contribute to the superior sensitivity. Thus, the present study aimed to determine how much executive abnormality was detected by the MMSE and MoCA executive subtests in a population-based cohort of Chinese post-stroke patients. METHODS: The MMSE and MoCA were collected from post-stroke patients (within 15 days to 1 month after stroke, including ischemic stroke and hemorrhagic stroke) in 14 hospitals of northern and southern China (including 10 top-graded hospitals and 4 community hospitals) between June 2011 and September 2013. The proportions of patients with incorrect MoCA executive subtests and the proportions of patients with incorrect MMSE executive subtests were compared. RESULTS: A total of 1222 patients (703 men and 519 women, aged 62.06 ± 10.68 and 62.76 ± 9.86 years, respectively) were recruited. The MoCA detected more patients with executive dysfunction than the MMSE (OR 15.399, 95% CI 12.631-18.773; P < 0.001). The likelihood of incorrect MMSE executive tasks increased across decreasing scores of MoCA executive tasks (P < 0.001 for trend). Compared with the MMSE three-step command test (15.5%), the MoCA trail-making (57.8%), abstraction (48.0%) and abstraction (measurement tool; 45.7%) detected more patients with executive dysfunction (P < 0.001), whereas the MoCA digit span forwards (4.3%) and backwards (11.6%) detected fewer patients (P < 0.001 and P = 0.005, respectively). CONCLUSIONS: The MoCA executive tasks are more sensitive in detecting executive dysfunction compared with the MMSE executive tasks. Geriatr Gerontol Int 2017; 17: 2329-2335.

Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma.

PURPOSE: Intrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma. METHODS: Patients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared. RESULTS: A total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002). CONCLUSION: Perfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma.

Just the sight of you: postural effects of interpersonal visual contact at sea.

The control of standing body posture is affected by mechanical perturbations, such as motion of the support surface. Postural activity also is responsive to subtle social factors: When 2 people interact there is spontaneous interpersonal coordination of their movements. We asked whether interpersonal postural coordination based on visual contact would be robust in the presence of mechanical perturbations that characterize sea travel. During an ocean voyage, pairs of participants stood facing together or facing apart. Interpersonal coordination of body sway was stronger when participants faced each other than when they faced apart. Furthermore, overall body movement was reduced when individuals faced together, suggesting that the sight of another person improved individuals' ability to compensate for ship motion. These findings provide the first evidence that the "soft" constraint of interpersonal visual contact can influence interpersonal postural coordination as people simultaneously adjust postural sway in response to powerful mechanical (i.e., "hard") constraints.

Cost-effectiveness of rotavirus vaccination programs in Taiwan.

BACKGROUND: In Taiwan, two rotavirus vaccines are available on the private market, but are not included in the National Immunization Program (NIP). To help assess whether to include rotavirus vaccines in the NIP, we examined the potential impact and cost-effectiveness of vaccination, from the health care system perspective alone. METHODS: We used a Microsoft Excel-based model to assess rotavirus vaccination impact on rotavirus disease burden and the cost-effectiveness of 2-dose and 3-dose vaccination programs among a birth cohort of Taiwanese children followed for 5 years. Principal model inputs included data on rotavirus disease burden and related healthcare costs, vaccination cost and coverage rates, and vaccine efficacy. Principal model outputs included the number of health-related events and costs averted and incremental cost per disability-adjusted life year averted. RESULTS: A national rotavirus vaccination program, regardless of number of doses per course, would prevent 4 deaths, >10,500 hospitalizations, and >64,000 outpatient visits due to rotavirus infection among children <5 years annually, resulting in ~80%, 90%, and 70% declines in these outcomes, respectively, and a ~$7 million decline in annual medical costs. A national 2- or 3-dose vaccination program would be cost-saving up to $13.30/dose ($26.60/course) or $7.98/dose ($23.94/course), respectively; very cost-effective up to $24.08 per dose ($48.16/course) or $15.18/dose ($45.54/course), respectively; and cost-effective up to $45.65/dose ($91.30/course) or $29.59/dose ($88.77/course), respectively. CONCLUSIONS: A national rotavirus vaccination program could substantially reduce rotavirus disease burden among Taiwanese children and be potentially cost-effective, depending on the vaccine price.

Proline as chiral auxiliary for the economical asymmetric synthesis of ruthenium(II) polypyridyl complexes.

A straightforward method for the synthesis of virtually enantiomerically pure ruthenium(II) polypyridyl complexes [Ru(pp)(pp')(pp")](PF(6))(2), pp = bidentate polypyridyl has been developed. The synthesis draws from the readily available racemic starting material cis-[Ru(pp)(pp')Cl(2)] and the natural amino acids l- or d-proline and relies on a dynamic asymmetric transformation under thermodynamic control.

The influence of an online auction's product price and e-retailer reputation on consumers' perception, attitude, and behavioral intention.

Online auctions combine the conventional auction model with information technology. However, information asymmetry within such auctions causes risks and uncertainties that influence consumer purchase intentions. In this study, a 2 (product price: high vs. low) × 2 (e-retailer reputation: high vs. low) experimental design was used to understand whether the product price and e-retailer reputation will influence consumers' perceived risk, attitude toward the website and purchase intention. The results of this study indicate that perceived risk negatively influences consumer attitude toward the website and online purchase intention, while consumer attitude toward the website positively influences purchase intention. Moreover, involvement moderates the influence of product price and e-retailer reputation only on social risk but does not have a significant effect on consumer attitude toward the website. This study contributes to a more comprehensive understanding of online auction users' behavior. Finally, the managerial implications, limitations and future research directions are also provided.