Comparative analysis of breast and lung cancer survival rates and clinical trial enrollments among rural and urban patients in Georgia

Objectives:Rural patients have poor cancer outcomes and clinical trial(CT)enrollment compared to urban patients due to attitudinal,awareness,and healthcare access differential.Knowledge of cancer survival disparities and CT enrollment is important for designing interventions and innovative approaches to address the stated barriers.The study explores the potential disparities in cancer survival rates and clinical trial enrollments in rural and urban breast and lung cancer patients.Our hypotheses are that for both cancer types,urban cancer patients will have longer 5-year survival rates and higher enrollment rates in clinical trials than those in rural counties.Methods:We compared breast and lung cancer patients’survival rates and enrollment ratios in clinical trials between rural(RUCC 4-9)and urban counties in Georgia at a Comprehensive Cancer Center(CCC).To assess these differences,we carried out a series of independent samples t-tests and Chi-Square tests.Results:The outcomes indicate comparable 5-year survival rates across rural and urban counties for breast and lung cancer patients,failing to substantiate our hypothesis.While clinical trial enrollment rates demonstrated a significant difference between breast and lung cancer patients at CCC,no significant variation was observed based on rural or urban classification.Conclusion:These findings underscore the need for further research into the representation of rural patients with diverse cancer types at CCC and other cancer centers.Further,the findings have considerable implications for the initiation of positive social change to improve CT participation and reduce cancer survival disparities.

The Impact of Demographics and Cultural Tourism on University Enrollments in Calabria, Italy

The decline in the birth rate,which has been uninterrupted in Italy since the mid-1960s,has had a significant impact on many aspects of society.As far as the educational system is concerned,this phenomenon has acted like a wave,first causing a decline in the population of the first school age groups,then in the other groups,until recently affecting the 19-25 age group,which includes the majority of university students.As a result,the majority of Italian universities have seen a decline over time in both enrollments(matriculations)and student numbers(enrollments),although the situation varies from one area to another.In the Mezzogiorno,this trend is even more pronounced,since an increasing number of resident students tend to favor universities in the Centre-North,creating a South-Centre-North movement,which could be compared to a particular form of cultural tourism,without a similar flow in the opposite direction.Finally,the study highlights the probable consequences of the recent demographic depopulation on the future trend of university enrollment of residents aged 19-25 in the Calabria region,using the most recent demographic projections of Istat and constructing two evolutionary scenarios.In the first scenario,we have assumed that in the near future university enrollment rates remain constant throughout the period considered;in the second scenario,these rates instead experience a gradual and continuous increase.These results could be useful if further forecasts of university enrollments were to be made at the level of individual Calabrian universities.

Reform and Implementation of Teaching Management for Medical Graduate Students

With the expansion of medical graduate enrollment, there are some problems in graduate teaching management, such as shortage of faculty, insufficient funding, and single assessment management. This can be solved by improving the quality of enrollment, strengthening process management and quality monitoring, enhancing the quality of mentors, and building a management team. This provides theoretical support and practical guidance for the management of graduate education in medical colleges, which helps to improve the quality of graduate education and cultivate more high-quality medical talents for the national healthcare industry.

Research on Quality Assurance System of Talent Cultivation in Higher Vocational Colleges from the Background of Enrollment Expansion

The enrollment expansion of higher vocational education is not only a strategic measure to alleviate the structural contradiction of employment,but also an important support for economic transformation and upgrading.How to deal with the expansion of enrollment and ensure the quality of training is an important task of higher vocational colleges at this stage.Based on the development requirements of the new era,it is of great practical significance to build a perfect quality assurance system of talent training.

我国临床医学长学制博士生教育招生路径和培养模式比较

围绕建设中国特色高水平医学人才培养体系的关键问题,聚焦长学制临床医学博士生教育,比较分析临床医学八年一贯制、“4+4”模式、直博/硕博连读等长学制临床医学教育的不同招生路径和培养模式,提出创新发展临床医学博士生教育的若干政策建议。

Mobilization Initiatives for Enhancing Secondary School Students’ Enrolment into Vocational and Technical Education Program of Universities for Self Reliance in South East, Nigeria

This study focused on identification of mobilization initiatives for enhancing student’s enrolment into Vocational and Technical Education (VTE) programs in Nigerian Universities. Three research questions guided the study while three hypotheses were formulated and tested at 0.05 level of significance. The study was carried out in South East, Nigeria. Population for the study was 1340. Sample for the study was 753 obtained through proportionate (30%) stratified random sampling technique. A 38 item questionnaire was developed and used to collect data. Data obtained were analyzed using mean and standard deviation to answer research questions while t-test statistic was used to test hypotheses at probability of 0.05 level. It was found out by the study that 38 mobilization initiatives could be used to enhance students’ enrolment into Vocational and Technical Education Programs in Nigerian Universities. It was therefore recommended that the identified mobilization initiatives be implemented by relevant stakeholders to enhance secondary school students’ enrollment into VTE programs in Nigerian Universities.

Determinants of Enrolment in Nigerian Universities

The study investigated the factors behind the enrolment profile in Nigerian universities using primary and secondary data. The secondary data were obtained from National University Commission （NUC） and published documents of National Bureau of Statistics （NBS） while primary data were from a survey of nine universities selected through purposive random sampling. The broad objective of this study is to identify the key factors influencing the enrolment profile in Nigerian universities and the extent to which human resource and funding affect enrolment. The study was empirical analysis which used Vector Auto-regression Model （VAR） and linear interactive or stepwise regression method for data analyses. The results showed that variables in the model （funding, academic and non-academic staff） accounted for 46.6% of the changes in enrolment and confirmed that both funding and academic staffhave effect on enrolment while the effect of non-academic staff is quite minimal. The model was statistically significant （F = 4.43） and also, funding （t = 3.00, p 〈 0.05）, academic staff （t = 1.77, p 〈 0.05） and their interactive effect （t = 2.97, p 〈 0.05） had significant effect on enrolment. While the effect of non-academic staff was not significant （t = 0.36, p 〉 0.05）. However, the interactive effect of funding and academic staff （KL） accounting for 25% of the changes in enrolment is more important than their individual effects： 5% for academic staff and 4% for funding. Therefore, interaction of funding and availability of academic staff has continued to constrain students＇ intake into Nigerian universities. The other factors not captured by the model but identified through the survey of nine Nigerian universities were： expansion of both primary and secondary education; education as passport to becoming elite; human resource needs; high rate of unemployment and population growth, United Nations Educational Scientific and Cultural Organization （UNESCO） education report and historical performance of the institution. The study therefore made some recommendations for Nigeria to enjoy economies of scale.

Patient Recruitment in Clinical Trials: Areas of Challenges and Success, a Practical Aspect at the Private Research Site

Enrolling in clinical trials could be time-sensitive and time-demanding tasks for the research site, especially if it is a private research organization compared to the research conducted at an academic or medical center. Every study differs in various aspects, such as phases, study indication, eligibility criteria, etc. In terms of meeting the enrollment deadline, typically, the study indication and availability of the patient’s population at the geographical area of the research site would decide if the trial could be time-consuming. Patient recruitment and retention are critical for the success of every clinical trial;however, worldwide, this area is facing tremendous pressure and challenges. Globally 55% of clinical trials terminated due to low recruitment, with an average enrollment success rate of 40% for Phase III and IV trials. Over 80% of clinical trial attempts fail to enroll, extending the study and adding new study sites. In the United States, more than 80% of clinical trials fail to achieve targeted patient enrollment, and 30% of study participants discontinue participation. This article reviewed various factors hindering clinical trial recruitment and retention and suggested strategies to make the research site successful.

Establishing the Forecasting Model with Time Series Data Based on Graph and Particle Swarm Optimization

In recent years,a wide variety of fuzzy time series(FTS)forecasting models have been created and recommended to handle the complicated and ambiguous challenges relating to time series data from real-world sources.However,the accuracy of a model is problem-specific and varies across data sets.But a model’s precision varies between different data sets and depends on the situation at hand.Even though many models assert that they are better than statistics and a single machine learning-based model,increasing forecasting accuracy is still a challenging task.In the fuzzy time series models,the size of the intervals and the fuzzy relationship groups are thought to be crucial variables that affect the model’s forecasting abilities.This study offers a hybrid FTS forecasting model that makes use of both the graph-based clustering technique(GBC)and particle swarm optimization(PSO)for adjusting interval lengths in the universe of discourse(UoD).The suggested model’s forecasting results have been compared to those provided by other current models on a dataset of enrollments at the University of Alabama.For all orders of fuzzy relationships,the suggested model outperforms its counterparts in terms of forecasting accuracy.

What Is the Impact of Major Diversion Attitude on Undergraduates' Learning Gains?--The Mediating Role of Course Perception

Major diversion is an important part of the large-category student enrollment and training model.The degree to which undergraduates recognize the logic of the major diversion system,their satisfaction with the diverted major,and their major identity after diversion all influence their subsequent learning process and outcomes.The questionnaire survey of undergraduates in this study discovered that major diversion attitude has a significant positive effect on undergraduates'learning gains;the mediating effect test discovered that course perception plays a partially mediating role between major diversion attitude and learning gains.Therefore,under the large-category student enrollment and training model,it is necessary to improve the major diversion system in terms of formulation,major selection guidance,and major identity promotion.Furthermore,strengthening the logical connection and content coupling of different types of courses,dealing with the proportion,priority,and sequence of courses,optimizing the allocation of course resources,and reasonably planning and setting courses all play an important role in improving undergraduate learning gains.

山东省定向医学生履约意愿及其与报考动机、政策认知和职业规划的关系

目的 调查山东省定向医学生的履约意愿并分析其与报考动机、政策认知和职业规划的关系,为完善定向医学生相关政策和培养方案提供政策建议。方法 采用整群抽样,对山东省4所高等院校的728名定向医学生进行问卷调查,对调查结果进行描述性分析、卡方检验和logistic回归分析。结果 28.7%的定向医学生不愿毕业后前往基层履约,仅有18.3%的学生因有志从事基层医疗卫生工作选择报考,31.3%的学生对定向医学生培养政策不了解,仅有4.8%的学生愿意在服务期满后继续留任基层医疗卫生机构。Logistic回归结果显示,报考动机、政策认知和职业规划对履约意愿均有显著影响。结论 山东省定向医学生的履约意愿不容乐观,报考动机外化、政策认知不足和职业规划模糊降低了其履约意愿。应通过加强政策宣传、完善配套制度和激励机制、强化定向医学生服务基层的内在动机来提高定向医学生的履约意愿。

Factors Influencing Students Decisions to Enrollment in Sudanese Higher Education Institutions

There is a growing body of literature that recognizes the importance of data mining in educational systems. This recognition makes educational data mining a new growing research community. One way to achieve the highest level of quality in a higher education system is by discovering knowledge from educational data such as students’ enrollment data. Many mining tools that aim to discover exciting correlations, frequent patterns, associations, or casual structures among sets of items in educational data sets have been proposed. One of the widely used tools is association rules. In this paper, the Apriori algorithm is used to generate association rules to discover the importance and correlation between factors that influence student’s decision to enroll in higher education institutions in Sudan. The algorithm is applied using a student’s enrollment data set that was created using a questionnaire and 800 students enrolled in governmental and private sector universities as a sample. This paper classifies factors that influence enrollment into: student’s demographic factors and four categories of enrollment related factors (Student and Society, Educational Institution, Admission, and Employment related factors), and determines the most influential factors in determining student’s decision to enroll in Sudanese universities. The analysis result shows that the Educational Institution related factors (50%) and Admission related factors (40%) are strongly influencing students’ enrollment decision, while the Employment related factors (10%) and Student and Society related factors (0%) have weak influence. The factors out of the 14 Educational Institution related factors that have a high impact are: reputation, diversity of study, quality of education, education facilities, and feasibility.

颈动脉斑块病理学:血栓、溃疡和卒中的发病机制

Background and Purpose:To determine the relationship between ulceration, thro mbus, and calcification of carotid artery atherosclerotic plaques and symptoms o f ipsilateral or contralateral stroke. Methods:We compared microscopic plaque m orphology from patients with and without stroke symptoms ipsilateral or contrala teral to the plaque. Plaques were characterized for ulceration, thrombus, and ca lcification. We analyzed plaques from 241 subjects: 170 patients enrolled in the Asymptomatic Carotid Atherosclerosis Study (ACAS) and 71 patients enrolled in t he North American Symptomatic Carotid Endarterectomy Trial (NASCET); 128 subject s had no history of stroke symptoms, 80 subjects had ipsilateral symptoms, and 3 3 had contralateral symptoms. Results:Plaque ulceration was more common in plaq ues taken from symptomatic patients than those without symptoms (36%versus 14% ; P < 0.001); frequency of ulceration was similar for plaques associated with ip silateral(34%) and contralateral (42%) symptoms. Thrombus was most common in p laques taken from patients with both ipsilateral symptoms and ulceration. The ex tent of calcification was unassociated with stroke symptoms. Conclusion:Carotid plaque ulceration and thrombosis are more prevalent in symptomatic patients. Ul ceration is more common in symptomatic patients regardless of side of carotid sy mptoms, whereas thrombus is associated with ipsilateral symptoms and plaque ulce ration.Preoperative identification of carotid ulceration and thrombus should lea d to greater efficacy of stroke prevention by carotid endarterectomy.

Fuzzy Time Series Forecasting Based On K-Means Clustering

Many forecasting models based on the concepts of Fuzzy time series have been proposed in the past decades. These models have been widely applied to various problem domains, especially in dealing with forecasting problems in which historical data are linguistic values. In this paper, we present a new fuzzy time series forecasting model, which uses the historical data as the universe of discourse and uses the K-means clustering algorithm to cluster the universe of discourse, then adjust the clusters into intervals. The proposed method is applied for forecasting University enrollment of Alabama. It is shown that the proposed model achieves a significant improvement in forecasting accuracy as compared to other fuzzy time series forecasting models.

快速康复模式下结直肠癌传统开放手术与腹腔镜手术的疗效对比:一项基于多中心的随机对照试验(EnROL)

目的腹腔镜辅助手术和多重管理方案（即加速康复程序,Enhanced Recovery Program,ERP）极大地改变了结直肠癌患者的围手术期管理,并改善了临床治疗结局。然而,腹腔镜手术尚未成为世界范围内结直肠癌手术治疗的标准,大量有着良好开腹手术技术的外科医生仍采用传统手术方式治疗。究竟传统开腹手术辅助ERP能否与腹腔镜辅助的微创治疗匹敌？这一问题还存在争议。EnROL（Enhanced Recovery Open versus Laparoscopic）多中心随机对照试验旨在解答上述问题。资料和方法该研究为Ⅲ期多中心随机对照临床试验,纳入可择期手术的成年结直肠癌患者（年龄≥18岁）,按1∶1随机分配至腹腔镜组或开腹组,两组均应用快速康复多重管理程序（ERP）进行围手术期管理。通过纳入中心、肿瘤部位（结肠或直肠）、年龄组（〈66/66~75/〉75岁）再进行分层分析。研究的主要结局指标为术后1个月的机体疲劳感（使用多维疲劳量表MFI-20评价）,次要结局指标包括：住院时间、术后并发症、患者其他不适情况及身体机能（简表SF-36）。术后7天或更早出院之前,受试患者和结局评估人员都不知晓治疗情况。手术质量及病理评估由中心负责人员进行盲评。该研究在英国临床伦理委员会南部牛津中心B注册,注册号为No.07/H0605/150。结果研究从2008年7月开始,至2012年4月结束,共在英国的12个中心纳入204例病人（其中腹腔镜组103人,开放结合ERP组101人）。腹腔组的切除范围[（6.8±3.7）vs.（18.4±7.5）cm]以及术中出血量[（115±152）vs.（257±290）ml]较开腹组减少,但手术时间[（182±69）vs.（135±54）min]相对延长,总体手术相关损伤评分[（31.2±6.0）vs.（31.8±6.0）]没有明显差别。两组病人术后1个月的机体疲劳感评分无显著差异[MFI-20（12.28,95%CI：11.3~13.1）vs.（12.05,95%CI：11.2~13.1）;P=0.93]。然而,腹腔镜组的中位住院时间较开腹组明显缩短（5 vs.7天;四分位点间距：4~9 vs.5~11天;P=0.033）。其他次要结局和病理报告质量均未见显著差异。结论虽然有经验的外科医生运用开腹手术结合加速康复程序可使结直肠癌患者术后疲乏感及其他不适情况降低至腹腔镜手术治疗相当的水平,但是住院时间会有明显的延长。在治疗结局无明显差别的前提下,腹腔镜辅助结直肠癌手术结合快速康复程序更应被推广使用。

Summary overview of human gene therapy trials in the U.S.

It has been approximately six and one-half yearssince the first patient was enrolled in a gene therapyclinical trial. Since that important begining, this typeof genetic intervention has grown into a worldwideinvestigative activity involving about 2100 patients asof December 1996. Although it was initially

Feasibility Study of Enforcing Immunization Certificate Check Before Primary School or Kindergarten Enrollment in Guizhou Province, China

Objective To study the feasibility of enforcing immunization certificate check before children enroll in primary schools or kindergartens in Guizhou Province. Methods Quantitative and qualitative studies were conducted. The multi-stage and cluster sampling approach was adopted for the quantitative part of the study. A questionnaire was designed and 996 children and their keepers were interviewed. Principals, doctors or teachers of the primary schools, directors and child care nurses of kindergarten, and staff of immunization agencies were invited to take part in 12 focus group discussions; meanwhile, face-to-face individual in-depth interviews with 16 officials of the Health, Education and Governmental Departments at various levels were conducted. Results The total number of subjects was 996. 16.7% of the children in the study completed all the procedures of the National Immunization Programme. 34.3% of them had immunization certificates while the remainder 44.7% registered in immunization agencies. Factors, including the migrant children, doubt about vaccine efficiency, mother’s occupation and educational background, knowledge of the National Immunization Programme on targeted vaccines, played an important role in obtaining or not immunization certificates. 95% of the keepers interviewed thought the immunization certificates were useful; 94.8% of them considered the check was critical while only 3.6% of them thought it unnecessary. The first reason from those who found it unnecessary was that they feared that repeated immunization might affect their children’s health. The second reason was the cost of immunization, which some of them could not afford to pay. However, the Health Department expressed a favorable attitude to the checking scheme. Though the Education Department agreed that the scheme was essential, they worried that it would affect the enrollment rate.Conclusion In spite of the difficulty in administering immunization certificate check, the effort would be rewarding for raising the immunization coverage rate among the children in Guizhou Province.

Immediate and mid-term outcomes of drug-eluting stent in treatment of coronary artery stenosis with very long defuse lesions

Objectives To evaluate the feasibility, and immediate and mid-term outcomes of drug-eluting stents (DESs) in the treatment of coronary artery stenosis with very long defuse lesions(VLDL). Methods Inclusion criteria:

The impact of the New Cooperative Medical Scheme in Sangzhi County,Hunan Province

In August 2011,the Sangzhi County government,Hunan Province,adopted a series of new health care policies as a national pilot of the New Cooperative Medical Scheme(referred to as 2011 NCMS).These policies were designed to further resolve illness-led poverty and the poor state of health care in the local area.The program had a positive impact and spread to other regions in Hunan Province.This paper will discuss the progress made as a result of the policies and several issues that challenge the scheme in practice.A total sample of 1212 individuals and 303 households were included in the analysis,and98 interviews were conducted with people related to the scheme.Our major findings indicate that the 201!NCMS has significantly reduced the out-of-pocket medical payment of rural residents,and also increased the township hospitals'patient flow.However,the medical scheme still faces many challenging issues during the implementation.With the increasing interest among the Chinese policy makers in strengthening and promoting the Sangzhi Model,the impacts of the scheme deserve greater attention in practice so as to further improve NCMS in rural China.

Awareness of non-alcoholic steatohepatitis and treatment guidelines:What are physicians telling us?

BACKGROUND There is an acute need to raise awareness of non-alcoholic fatty liver disease/nonalcoholic steatohepatitis(NAFLD/NASH)among primary care physicians,endocrinologists and diabetologists to improve patient identification and address the current difficulties in NASH clinical trial enrollment.We examined the extent of knowledge and practice regarding NASH diagnosis and management guidelines.A randomized online convenience survey of 12869 physicians drawn from a national physician database of primary care physicians(PCPs),and gastroenterology and endocrinology specialists were queried via online survey.Our results,based on a cohort of 185 respondents,showed gaps in knowledge and practice between these three groups of practitioners,with primary care providers having the lowest adherence to published guidelines for diagnosis of NASH.Without clear knowledge and patient identification at the point of presentation-which is often in primary care or with specialties other than hepatology–many patients with NAFLD and NASH will remain undiagnosed and untreated,and clinical studies will continue to struggle with patient recruitment,hindering clinical development and optimal patient care.AIM To determine knowledge base concerning NASH diagnosis amongst gastroenterologists,endocrinologists and primary care physicians to improve referrals into clinical trials.METHODS A randomized online convenience survey of 12869 physicians drawn from a national physician database of PCPs,and gastroenterology and endocrinology specialists was conducted yielding a sample of 185 respondents.RESULTS The survey revealed that many physicians are either unaware of testing options other than biopsy,or do not use them in practice.Only 46%of endocrinologists and 42%of primary care physicians indicated they would refer a patient for specialist workup if they suspected NASH.Risk(25%)and inconvenience to patients(18%)are given as reasons for not referring those with suspected NASH for biopsy.For standard diagnostic algorithms such as Fibrosis-4 score,18%of PCPs,30%of endocrinologists and 65%gastroenterologists reported using these tests in clinical practice.CONCLUSION Substantial gaps in knowledge of the differences between NAFLD and NASH exist between these physician groups,with knowledge being particularly low among primary care doctors and endocrinologists.The use of a simple noninvasive screening algorithm may help to identify the right patients for clinical trials,which in turn will be vital to the development of effective and welltolerated treatments for this increasingly ubiquitous condition.