Summary of Literature Review. The research team realized the existence of a large number of research papers from the academic side that explore many areas that address the potential of transit smart card data such as passenger behavior analysis and market segmentation, system performance assessment, impact analysis of policy changes or service improvement, and data processing (such as trip purpose inference, etc.). Earlier projects were mostly focused on implementation and operational issues of smart card and AFC technologies, while newer studies have focused more on the uses of AFC data, and they can be wide-ranging. In general, transit agencies can benefit from the efficient use of AFC data to better understand the service needs of the transit users. For instance, AFC data can be used to assess the needs of special populations like older adults and people with disabilities by examining the preferred origins and destinations or the days and times of transit use. Furthermore, combining AFC data with other transit intelligent transportation systems (ITS) data can enhance the datasets available for decision making. To provide ideas on the potential uses of the AFC data, the following subjects were included: improving services for special populations, smart card applications, fare evasion, measuring activity similarity, inferring origin-destination demand, assessing transit loyalty, uses of electronic fare payment records, data for bus service and operations planning, travel behavior analysis, and mobility patterns of seniors, children and students, and adults. In addition, the use of data mining and big data techniques have been widely recognized as a powerful instrument to analyze large-scale data, identify patterns, and derive meaningful information that can be used to support planning and predictive analysis. The use of big data can be grouped into six categories: Service/Performance, Travel Behavior, Travel Demand, Management, Resilience and Health/Safety, and Other Topics. The selected work in this research study also included relevant North American and International experiences in the use of AFC data. The research identified innovative uses of the data and results from research studies in section 2.4. In this area, it is worthwhile mentioning the work of international researchers, as there is a vast amount of information that covers a variety of useful topics relevant to the use of AFC data. Although there is a wide variety of topics to cover, the areas captured in this research s...
Summary of Literature Review. Introduction/Background Despite the frequent statement that “most men die with prostate cancer, not of it” [1], the reality is that prostate cancer is second only to lung cancer as a cause of death from malignancy in American men. Specifically, in 2015, an estimated 220,800 American men were diagnosed with prostate cancer and 27,540 died of the disease [2]. In addition to the personal toll of these deaths, the direct economic cost of prostate cancer in the Unites States has been estimated at approximately $10 billion per year [3]. As with other malignancies, the primary goal during baseline evaluation of prostate cancer is disease characterization; that is, establishing disease extent, both local and distant, and aggressiveness. Determination of tumor aggressiveness is ultimately the most important factor, since this drives patient outcome. Several special circumstances make the accurate baseline evaluation of prostate cancer particularly challenging: • The currently available standard clinical tools used to evaluate prostate cancer, such as digital rectal examination, serum prostate-specific antigen (PSA) assay, and systematic biopsy results such as fraction of cores positive for cancer and Xxxxxxx score, are all subject to varying degrees of inaccuracy. Even radical prostatectomy, often regarded as the gold standard for pathological findings, is subject to variable interpretation. The published interobserver kappa values of 0.33 to 0.63 for the detection of extracapsular extension by different pathologists analyzing radical prostatectomy specimens [4,5] are about the same as the kappa values of 0.59 to 0.67 for different radiologists looking for extracapsular extension at magnetic resonance imaging (MRI) [6]. Multiple nomograms have been described, such as the Xxxxxx Tables or the X’Xxxxx risk stratification scheme, that aggregate data from these parameters in an attempt to better estimate tumor stage or tumor aggressiveness, [7,8]. These nomograms are a reasonable attempt to synthesize the data but ultimately are undermined by the inherent flaws and imprecisions of the input parameters [9,10]. That said, both the X’Xxxxx and the National Comprehensive Cancer Network (NCCN) risk stratification systems are widely used and are shown below (see Appendix 1 and Appendix 2). It should be noted that the number of positive biopsy cores and the clinical stage are both factors that appear to have relatively little prognostic impact when compared with the other mor...
Summary of Literature Review. Introduction/Background Classical Hodgkin lymphoma (cHL) is a highly curable cancer, even in advanced stages. Although radiation therapy (RT) alone improved disease-free survival (DFS) for many years, the management of cHL has changed dramatically over the past 2 decades with the use of highly effective systemic therapies and the subsequent reduction in the use of radiation [1]. Even with combined-modality therapy (CMT), rates of relapse can vary from 5% for early-stage disease to 35% for more advanced stages [2,3]. Approximately 10% of patients will have disease that is refractory to initial therapy [4]. Even in the setting of relapsed or refractory disease, cHL remains salvageable. The standard of care for relapsed/refractory disease is either conventional chemotherapy or high-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT). The role of RT in relapsed/refractory disease remains controversial and is reviewed in these guidelines. Definitions and Determination of Relapsed/Refractory Disease Relapse or recurrence can be defined as the reappearance of disease after initial therapy and complete response (CR) in the site of prior disease and/or in new sites. Progression refers to evidence of increasing disease after achievement of stable disease, partial remission (PR), or CR, whereas refractory disease is a failure to achieve either a CR or PR and may represent a more significant degree of radiation or drug resistance [5,6]. Current National Comprehensive Cancer Network guidelines recommend biopsy to document relapse, progression, or refractory disease [7]. Until recently, guidelines as to how to document progression of disease in the setting of incomplete remission remained unclear [8]. Therefore, it is uncertain whether in practice biopsies are routinely performed according to this standard. However, biologic confirmation of disease is recommended. A biopsy may also be warranted in patients whose disease is refractory to therapy to confirm the initial diagnosis of cHL. The majority of relapses following a CR in patients treated for cHL occur within 3 years of therapy, so routine surveillance by clinical examination is an essential component of a survivorship plan (see the ACR Appropriateness Criteria® “Follow-up of Hodgkin Lymphoma” [9]). The use of routine imaging after a CR is being challenged by recent studies [10], so decisions regarding use can be made on an individual basis. A clear plan for surveillance is crucial as timing of ...
Summary of Literature Review. The emerging Key knowledge issue from cooperative legal framework in a devolved system of governance was the dynamic nature of education management in two levels of government that require continues consultation among all stakeholders. Secondly for a devolved system to remain relevant, continues legal and policy framework review may be adopted with objective being need based. The perspectives of decentralized system of governance also bring to fore issues of resources mobilization and allocation by the stakeholders, public participation in decision making, hierarchy of checks and balances is critical. Literature controversies noted remain on structural level of administration by individual counties. This could be informed by the social and economic demand of that county which is based on their local goals. The gaps remain on lack of dynamic and robust legal and policy framework that bring on board resources related issues, participation and checks and balance in provision education services in the two levels of government.
Summary of Literature Review. The ways in which individuals internalize societal norms and gender roles construct feminine and masculine identities and leads to differences in health behaviors (Airhihenbuwa & Xxxxxxx, 2004; Xxxxxx, et al., 2010). Men are less likely than women to adopt behaviors that promote wellbeing as a result of gender identities surrounding masculinity. Furthermore, these social norms are constructed and influenced by the broad sociocultural context. Due to the interaction between gender identities and the social context, many of these ideas are transforming. In order to ensure that public health interventions are effective, it is imperative that these interpersonal relations are understood.
Summary of Literature Review. Literature review shows that measles routine immunization coverage should be strong for each country. This means every country should meet 90% measles routine coverage in order to reach for the measles elimination goal. If the measles coverage is less than 90% measles outbreaks can occur. The second most important thing found from this review is that measles supplementary immunization is very important to control measles outbreaks but SIAsbe implemented effectively and at the correct time. This means microplanning, logistic supply, supervision and monitoring should be in place during XXXx. The supplementary measles immunization coverage should be more than 95% in each round of the campaign to eliminate measles. Finally the review suggests measles case based surveillance is effective for measles diagnosis, and for detecting as well as managing measles outbreaks. Findings from literature will help SEARO countries to improve measles routine immunization, to improve measles XXXx and to enhance measles surveillance in future for measles elimination.
Summary of Literature Review. Introduction/Background Pulmonary tuberculosis (TB) predominantly results from the transmission of aerosolized mycobacterium TB to susceptible hosts [1]. In the vast majority of cases, this results in subclinical disease with the immune system isolating the organism. In this setting, a person has latent TB and does not pose a risk to the community at large. The development of active infection within 1 year following exposure is termed primary TB and is classically described as a lobar pneumonia and/or mediastinal and hilar adenopathy. This pattern is most often seen in children and severely immunocompromised individuals. If active infection develops later than 1 year after initial exposure, it is considered to be reactivation TB, often presenting with apical posterior upper-lobe or superior- segment lower-lobe fibrocavitary disease and endobronchial spread through the airways. With modern molecular techniques it has been shown that radiographic patterns of primary and reactivation TB overlap, and thus the preferred terminology for TB infection is active TB [2]. The important public health issue is that both primary and reactivation TB present a risk of exposing the general population to TB infection. A high level of suspicion should be maintained in immunocompromised hosts, particularly those with AIDS, as imaging manifestations may not fit a classic primary or reactivation pattern; instead, these patients may present with mediastinal lymphadenopathy alone or a deceptively normal chest radiograph.
Summary of Literature Review. The United States contains only 5% of world’s population, but almost 25% of its prisoners (Alexander, 2010). While mass incarceration has made a major xxxx on our society as a whole, its xxxx on minority communities is the most troubling. It is expected that one in three young black men (Sentencing Project 2013) and three in four young black man in the nation’s capital, Washington D.C., (Alexander 2010) can expect to spend time in prison if current trends continue. In 1930, 22% of all of those admitted to prison were black; by 1992, this percentage had climbed to 51%. (Xxxxxxx 1999). Drug offenses alone account for two-thirds of the rise in federal incarceration and half the rise in state incarceration from 1985 to 2000 (Alexander, 2010). Drug arresting procedures that targeted low-income communities of color and sentencing policies that put more people in prison for longer have been the major factors responsible for mass incarceration (Alexander, 2010; Raphael & Xxxxx, 2013). As discussed, the driving factor for the “War on Drugs” and the “Tough on Crime” era was the rising public punitiveness from the 1960s through the 1980s, which were influenced by the news media’s overrepresentation of violent crimes, sensational coverage of drugs, and the news media’s association of crimes with African Americans and minorities. Furthermore, incarceration contributes to the perpetuation of an oppressive cycle towards minorities not only by the mass imprisonment of African American and Latino men and women, but by the obstacles in place for ex-convicts to re-enter society including employment discrimination, housing discrimination, denial of the right to vote, denial of food stamps and other public benefits, and exclusion from jury service (Alexander, 2010). These obstacles, in turn, increase the recidivism rate (Raphael and Xxxxx 2013). Incarcerated people are treated as second class citizens, exploited by the massive web of corporations that rely on prisons as an industry and maintain mass incarceration by playing as major obstacles for criminal justice reform (Xxxxx and Xxxxxxx 2010). Public opinion polls have shown that there has been an increasing desire for reform from the public and increasing support for rehabilitation, despite consistent support for punitive policies as well (Opportunity Agenda, 2014; Thielo, 2015). An analysis of public opinion shows that, although the public remains punitive, the public’s attitudes towards drug offenders has become less puni...
Summary of Literature Review. Introduction/Background Claudication is a symptom complex characterized by pain and weakness in an active muscle group, reproducibly precipitated by similar amounts of exercise and promptly relieved by rest. Claudication is most commonly a manifestation of peripheral arterial disease (PAD), but other disease entities can present similarly. Nonarterial etiologies represent up to 45% of patients being evaluated for claudication [1]. The most common nonarterial cause is neurogenic disease (especially spinal stenosis), but other diseases, such as compartment syndromes, pelvic tumors, and chronic venous occlusion, have also been associated with symptoms similar to claudication. In addition, most patients with peripheral arterial occlusive disease are asymptomatic, with as few as 6% to 20% of such patients having symptoms of claudication [2]. Estimates of the prevalence of claudication in the general population range from <1% to almost 8%, depending on age, gender, the geographic location of the population, and the diagnostic criteria used [3,4]. The presence of vascular disease in patients with symptoms of claudication is reliably established by a variety of noninvasive hemodynamic tests. In the absence of demonstrable arterial disease, imaging studies of other systems, such as the lumbar spine or soft tissues of the pelvis, may be indicated. If peripheral vascular disease is confirmed, additional studies may be indicated to screen the heart and carotid arteries for involvement [5]. Noninvasive hemodynamic tests such as the ankle brachial index (ABI), toe brachial index (TBI), segmental pressures, and pulse volume recordings (PVR) are considered the first imaging modalities necessary to reliably establish the presence and severity of arterial obstructions. Infrared thermography shows promise as an additional noninvasive examination [6]. Once confirmed by noninvasive hemodynamic studies, vascular imaging is used for diagnosing individual lesions and to triage patients for medical, percutaneous, or surgical intervention [7-9]. The indications for surgical or percutaneous intervention are controversial, and thus specific indications for imaging studies remain ill-defined. Factors that influence this decision include 1) the natural history of limb and patient survival, 2) the patient’s tolerance of symptoms and resulting changes in lifestyle, 3) the effectiveness of medical or exercise therapy, 4) the potential risks of invasive tests and treatments, and 5) the sho...
Summary of Literature Review. Introduction/Background Dyspnea is breathing discomfort that occurs at rest or at lower-than-expected levels of exertion [1,2]. In comparison to acute dyspnea, chronic dyspnea is shortness of breath lasting for more than 1 month [3]. Dyspnea may be due to new-onset acute disease, exacerbation of existing chronic illness, or new disease concomitant to chronic illness. Finding the cause of dyspnea is more difficult than it may appear [4]. Although multiple disorders may cause breathlessness, the majority are of cardiac and/or pulmonary origin. Every pulmonary or cardiac disease may induce dyspnea depending on disease progression [5]. The challenge is to establish a timely and cost-effective diagnosis [1]. Cardiac causes of dyspnea include myocardial disease (eg, ischemic and nonischemic cardiomyopathies), valvular heart disease (VHD) (eg, aortic stenosis/insufficiency, congenital heart disease, mitral valve stenosis/insufficiency), arrhythmia (eg, atrial fibrillation, inappropriate sinus tachycardia, sick sinus syndrome, bradycardia), and constrictive causes (eg, constrictive pericarditis, pericardial effusion/tamponade) [1,6]. Clinical diagnostic tools such as history, symptoms, and physical signs, along with chest radiography and electrocardiography, are used to discriminate cardiac causes from other causes of dyspnea in the emergency setting with high specificity (96%) but low sensitivity (59%) when using chest radiography alone [7,8]. Therefore, advanced diagnostic imaging plays an important role in evaluating dyspnea. Overview of Imaging Modalities Generally, computed tomography (CT) of the chest is the most appropriate imaging study to exclude suspected pulmonary causes of dyspnea. To confirm the diagnosis of pulmonary hypertension, right heart catheterization is needed [7]. Echocardiography is an important tool in the investigation of cardiac structure and function and should be performed in all patients with dyspnea of suspected cardiac origin [9,10]. Stress echocardiography is uniquely positioned to help characterize most potential cardiovascular etiologies of dyspnea, including global or regional systolic dysfunction due to myocardial ischemia [11,12]. Cardiac dyspnea may be also caused by ischemic heart disease. Although conventional catheter angiography remains the clinical gold standard technique to assess the coronary arteries, coronary CT angiography (CCTA) has emerged as an alternative noninvasive method for determining the presence, severity...
