"Current", "Heated rods/vapour": how patients who refused radiotherapy in northern Sri Lanka understand radiation as a treatment modality for cancer

Purpose: Colloquially referred to as "current treatment", radiotherapy is a feared cancer treatment modality in post-war northern Sri Lanka. A significant proportion of patients either refuse or discontinue radiotherapy, even in the curative setting, leading to poor clinical outcomes. As the decision to reject/discontinue radiotherapy is often made late, substantial resources are wasted on patient preparation and immobilization devices, constituting a burden on the country's resource-constrained "free" healthcare system. This study explores patient perceptions that underlie decisions to refuse/discontinue radiotherapy at a cancer care facility in northern Sri Lanka. Methods and Materials: An exploratory descriptive qualitative study was carried out among 14 patients who refused/discontinued radiotherapy as a treatment modality for cancer. Participants were selected through purposive sampling. Data were collected through in-depth semi-structured interviews carried out by trained data collectors who had no prior interaction with the patients. The interviews were transcribed in Tamil and translated into English, coded using QDA Miner Lite v2.0.8 software, and thematically analyzed. Two researchers reached consensus at each stage of the analysis. Result(s): All participants referred to radiotherapy as "current" with several understanding the procedure to involve heated rods, hot vapour and/or electricity being placed on/transmitted to the tumour. Many pointed to gaps in the information provided by healthcare providers. The latter were perceived to focus on side effects without sufficiently discussing the methods and procedures that radiotherapy entails. While patients trusted the information shared by healthcare providers, in the absence of these crucial details, they relied on family members, neighbours, and villagers, to fill these gaps, often based on second- or third hand (at times terrifying) accounts of experiences with radiotherapy. Many participants indicated that they felt pressured by family members and loved ones to refuse radiation. Others spoke of fearing radiation, feeling ashamed to discuss their treatment plan due to the site of cancer (e.g., penis, cervix), and COVID-19, as reasons for refusing or discontinuing radiotherapy. However, all but three patients claimed they would recommend radiation to patients with cancer, especially when it was offered with curative intent, while the remainder were non-committal or felt radiation involved unacceptable side effects and suffering. Conclusion(s): Patients with cancer who refused or discontinued radiation therapy have significant information needs with respect to radiation. While oncological care needs to be more patient-centered, a general lack of staff with the required expertise/skills to provide this information and the high patient to doctor ratio serve as impediments.

Online Affinity of Instructing Methods for Using Personal-Efficacy and Reading Capacious During Covid-19

Now a days in EFL procedure of education the ability of reading became as significant belief and personal-efficacy reading as a basic understanding for students. By monitoring the acknowledged participates under the ballpark figure of large studying and methods of understanding, the impact of their observation is premeditated on reading of each one’s personal-efficacy. On a daily routine all these things are comparatively considered which are put into effect by teachers of handful in number. Approach towards exhibiting Extensive reading (ER) is inspected to be “more expensive, difficult, and time-consuming”. Method of recognition of elements in a various way for effective impact in putting its efforts to utilize for its empowerment. Paper has been segregated into two contexts: Association with attitude is considered as primary one and attitude is considered as secondary one. Whether knowledge work is understood by student or not is considered as the impact of ER by the first review. Procedure which are convenient is taken as the observations of student and is analysed as second one. The examinations are quantifiable to utilize the observations as information in terms of subjective way taken from students who belong to first academic year of reading course in a systematic way and 603 details of undergraduate students from KLEF of Guntur were chosen as participants for extant examination. In ER programme of includes and excludes “comprehension reading work” is treated as fundamental in the proposal of disclosures. In case of any, “the programme appeared to positively affect contributing students”. Techniques of classification like “decision tree and Mixed Model Database Miner (MMDBM)” are employed in this paper which leads to improvements of post-test to pre-test in ER group. Observations of students in ER results as optimistic and algorithm of MMDBM which leads to accuracy in higher rate in pre-test and post-test detection. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Lung Function and Radiographic Disease Worse Among Former Miners in Central Appalachia Than Other Regions of the United States

RATIONALE The COVID-19 pandemic has disrupted national spirometric surveillance of active and former U.S. coal miners since March 2020. Consequently data collected by the Health Resources and Services Administration (HRSA)-funded Black Lung Clinics Program (BLCP) represents the only major source of recent health data on U.S. former coal miners. Using the first available year of national BLCP data we examined associations between mining region and radiographic disease and lung function impairment. METHODS We analyzed pre-bronchodilator spirometry and International Labour Office chest radiograph classifications from miners seen across 15 BLCP grantees from July 1 2020 to June 30 2021. We calculated percent predicted (PP) and lower limits of normal (LLN) for forced expiratory volume in one second (FEV1) forced vital capacity (FVC) and FEV1/FVC ratio. We determined prevalence of patterns of spirometric abnormality (restrictive obstructive/mixed) and moderate to severe impairment (FEV1<70PP). We classified miners who worked the majority of their coal mining career in Kentucky Virginia or West Virginia as Central Appalachian miners. We examined associations between region worked and lung function impairment using logistic regression. RESULTS The 2,891 miners were predominantly non- Hispanic white (98.1%) and male (99.4%) with mean age 66 years (SD9.3). Mean coal mining tenure was 26 years (SD10.7) and 66% (n=1,900) were Central Appalachian miners. Thirty-seven percent had never smoked. Among those with chest radiographs (n=2,464 85%) Central Appalachian miners had a significant three-fold increase in progressive massive fibrosis (PMF) prevalence compared to miners who worked elsewhere in the U.S. (9% vs 3% p<.0001). Smoking history and spirometry were available in 66% (n=1,918). Of these 40% of never-smokers had abnormal spirometry (obstruction/mixed 10%;restriction 30%);among ever-smokers, 54% had abnormal spirometry (obstruction/mixed 27%;restriction 27%). Abnormal FEV1 was present in 30% of never smokers and 42% of ever-smokers. Mean FEV1PP was significantly lower among Central Appalachian miners compared to miners from other regions. Controlling for age, tenure, and pack-years, Central Appalachian miners had significantly elevated odds of having FEV1 impairment compared to non-Central Appalachian miners (OR 1.31, 95%CI 1.06,1.62). A subanalysis controlling for category of radiographic disease showed that odds of impairment remained elevated among Central Appalachian miners (OR 1.24, 95%CI 0.97,1.60). CONCLUSIONS Controlling for smoking, age, and tenure, former miners who worked most of their career in Central Appalachia have significantly increased odds of disabling impairment. These findings highlight the important role of HRSA-funded black lung clinics in understanding work-related lung disease among U.S. coal miners.

Preventing Tuberculosis (TB) in health workers and silica-exposed occupations

The COVID-19 pandemic has reminded us of the importance of workplace exposures and transmission in the control of airborne infectious diseases. The importance of workplace transmission of Tuberculosis (TB) has been well documented for decades, yet these past lessons have largely gone unheeded for health workers and silica-exposed occupations which are some of the highest risk subpopulations. It is estimated that health care workers who represent 3% of the global population made up 14% of reported COVID-19 and the same front-line workers are at three times greater risk for active TB compared to the general population. Despite these known risks, multiple studies have demonstrated that few health workers are provided with training or protections. Workplace TB prevention measures overlap with measures known to reduce the spread of COVID-19 and include improved ventilation, UV germicidal irradiation, personal protective equipment and training. These dual pandemics present an opportunity to refocus investment in Infection Prevention Control (IPC) measures in healthcare settings. Silica dust exposures and silicosis are known to significantly increase the risk of active TB among miners, construction workers and other exposed occupations. Reducing silica dust exposures has been shown to reduce TB incidence in high-risk workers. Recent studies have demonstrated that informal sector miners experience much higher rates of TB infection than large-scale miners. However, low-cost dust controls have been shown to reduce respirable silica dust by 80% which can have a large impact in reducing TB and silicosis. Workplace interventions to reduce TB in healthcare setting and among silica-exposed workers are cost effective and are considerably less expensive than treatment. The International Commission on Occupational Health (ICOH) has been taking an active role in working to increase recognition of workplace interventions to reduce TB transmission. Starting in 2017 the organization spear-headed efforts at the United Nations (UN) to gain recognition for workplace interventions in the General Assembly TB declaration (2018) and has since engaged with UN agencies, the World Bank and other global TB funding organizations. There is a considerable need to expand primary prevention in the workplace as part of the global TB response.

An Education Process Mining Framework: Unveiling Meaningful Information for Understanding Students’ Learning Behavior and Improving Teaching Quality

This paper focuses on the study of automated process discovery using the Inductive visual Miner (IvM) and Directly Follows visual Miner (DFvM) algorithms to produce a valid process model for educational process mining in order to understand and predict the learning behavior of students. These models were evaluated on the publicly available xAPI (Experience API or Experience Application Programming Interface) dataset, which is an education dataset intended for tracking students’ classroom activities, participation in online communities, and performance. Experimental results with several performance measures show the effectiveness of the developed process models in helping experts to better understand students’ learning behavioral patterns.

Breakthrough Infections of SARS-CoV-2 Gamma Variant in Fully Vaccinated Gold Miners, French Guiana, 2021.

An outbreak of severe acute respiratory syndrome coronavirus 2 caused by the Gamma variant of concern infected 24/44 (55%) employees of a gold mine in French Guiana (87% symptomatic, no severe forms). The attack rate was 60% (15/25) among fully vaccinated miners and 75% (3/4) among unvaccinated miners without a history of infection.

Using Neural Networks in Order to Analyze Telework Adaptability across the European Union Countries: A Case Study of the Most Relevant Scenarios to Occur in Romania.

Our study addresses the issue of telework adoption by countries in the European Union and draws up a few feasible scenarios aimed at improving telework's degree of adaptability in Romania. We employed the dataset from the 2020 Eurofound survey on Living, Working and COVID-19 (Round 2) in order to extract ten relevant determinants of teleworking on the basis of 24,123 valid answers provided by respondents aged 18 and over: the availability of work equipment; the degree of satisfaction with the experience of working from home; the risks related to potential contamination with SARS-CoV-2 virus; the employees' openness to adhering to working-from-home patterns; the possibility of maintaining work-life balance objectives while teleworking; the level of satisfaction on the amount and the quality of work submitted, etc. Our methodology entailed the employment of SAS Enterprise Guide software to perform a cluster analysis resulting in a preliminary classification of the EU countries with respect to the degree that they have been able to adapt to telework. Further on, in order to refine this taxonomy, a multilayer perceptron neural network with ten input variables in the initial layer, six neurons in the intermediate layer, and three neurons in the final layer was successfully trained. The results of our research demonstrate the existence of significant disparities in terms of telework adaptability, such as: low to moderate levels of adaptability (detected in countries such as Greece, Croatia, Portugal, Spain, Lithuania, Latvia, Poland, Italy); fair levels of adaptability (encountered in France, Slovakia, the Czech Republic, Hungary, Slovenia, or Romania); and high levels of adaptability (exhibited by intensely digitalized economies such Denmark, Sweden, Finland, Germany, Ireland, the Netherlands, Belgium, etc.).