Cervical cancer is the fifth most common cancer in United States with more than 12,000 women diagnosed each year and more than 4,000 preventable deaths with minorities disproportionally represented. Cervical cancer prevention strategies rarely focus on the management of abnormal screening results. The purpose of this quality improvement project was to standardize the management program for abnormal cervical cancer screening results within an integrated health delivery system serving a large minority community. The Plan-Do-Study-Act model guided a comprehensive program evaluation with process improvement, including the creation of an electronic quality data reporting tool to formalize the work process and a quality control and assurance program with exception reports. The evaluation was completed with data to measure the timeliness of abnormal results outreach and continued clinical management. The data were evaluated over time with run charts. Also, an analysis of the data was done through pre- and post-test comparisons with 2-sample t tests to evaluate abnormal cervical cancer screening management before and after the revisions. Although the project did not show a statistically significant difference in the timeliness of outreach and follow-up of abnormal cervical cancer screening results due to the limited data set, the run charts trended positively for timeliness and consistent data reporting with no missed screening reports. Effective cervical cancer screening includes the accurate and timely management of abnormal results to reduce disparities in cervical cancer deaths. This project contributes to positive social change by responding to the Healthy People 2020 goal to reduce the incidence of cervical cancer deaths through a formal process to insure timely intervention for abnormal results in a largely minority community.

In 2015, there were 257,524 women with cervical cancer (CC) in the United States (U.S.). CC is preventable; screening detects early-stage cancer when treatment is most successful. This study aimed to identify predictors for CC screening adherence among U.S. women, describe predictors for screening adherence by marital status, and examine physician recommendation for CC screening and adherence to those recommendations. Predictors were grouped as demographic, acculturation, access to care, chronic conditions, and health behaviors. Descriptive analyses were performed on a sample of 10,667 women from the 2015 National Health Interview Survey, and multiple logistic regression models determined predictors of CC screening adherence, physician recommendations, and adherence to physician recommendations. Overall, 81.7% (95%CI=80.7-82.7%) of U.S. women adhered to CC screening guidelines. Adherence declined with increasing age after 39 years old. Never married women (adjusted odds ratio[aOR]=0.67, CI=0.56-0.79) or current smokers (aOR=0.70, CI=0.59-0.84) had lower odds, while college-educated women had greater odds (aOR=1.38, CI=1.14-1.67) of CC screening adherence. Among unmarried women, 78.6% adhered to CC screening. Unmarried women who were unemployed (aOR=0.48, CI=0.38-0.62), had no physician visits (aOR=0.58, CI=0.40-0.85), no usual source of care (aOR=0.67, CI=0.50-0.89), never heard of HPV (aOR=0.59, CI=0.46-0.76), never received HPV vaccine (aOR=0.50, CI=0.34-0.75), no birth control use (aOR=0.33, CI=0.23-0.47), no flu shot (aOR=0.62, CI=0.48-0.80), and perceived low breast cancer risk (aOR=0.66, CI=0.47-0.92) had lower odds of adherence. Among women with a physician, 55.6% received screening recommendations. Race/ethnicity, access to care, HPV knowledge and vaccine receipt, age when first child was born, and flu shot were significant predictors of physician recommendation for CC screening. Significant predictors of adherence to physician recommendation included education, employment, English proficiency, outpatient clinic visits, usual source of care, age when first child was born, birth control, alcohol use, smoking status, flu shot, and health status. Based on our results, two levels of intervention should be explored. First, targeted interventions are needed for women who are unmarried, have low socio-economic status, and limited access to care to reduce cervical cancer risk. Second, interventions for physicians to increase screening recommendations to all eligible women are needed to improve national screening rates.

In today’s society, many people are physically inactive and the health care is for example usingPhysical activity on prescription (PaP) to work against it. In order to increase the physical activitylevel in people they need to feel motivated and there are many factors that can motivate people. The purpose of this survey is therefore to explore the leaders of PaP and their thoughts about whatmotivates clients with PaP to increase their physical activity levels. This is explored by aqualitative method incorporated with semi-structured interviews with four respondents who workswith PaP. The results were analyzed with a descriptive method that contributed to a narrativeanalysis, which was interpreted at some levels. The result showed that the primary methods therespondents used to motivate the clients with PaP was to set goals together and to individualize themotivational work. It was also important to the PaP-client to feel secure and it could be achievedthrough a good attitude and an understanding of why and how the PaP-client needed to implementa lifestyle-change. Finally, the most important was to investigate how the lifestyle-change processgone, through a follow-up. / I dagens samhälle är många människor fysiskt inaktiva och detta arbetar hälso- och sjukvårdenmot med hjälp av bland annat Fysisk aktivitet på recept. För att öka den fysiska aktiviteten hosmänniskor krävs att de har motivation och det finns många olika faktorer som kan motiveramänniskor. Syftet i denna undersökning var således att undersöka vad FaR-ledare ansåg motiverarFaR-klienter till att öka sin fysiska aktivitet. Detta undersöktes via en kvalitativ studie sominnehöll delvis strukturerade intervjuer med fyra respondenter som arbetade med Fysisk aktivitetpå recept. Resultatet analyserades sedan med en deskriptiv metod som bidrog till en berättandeanalys som tolkades i viss mån. Resultatet visade att de främsta metoderna respondenternaanvände sig av för att motivera FaR-klienterna var att sätta upp mål tillsammans ochindividanpassa motivationsarbetet. Det var även viktigt att FaR-klienten kände trygghet och detkunde uppnås via ett bra bemötande och förståelse för varför och hur denne ska genomföralivsstilsförändringen. Slutligen var det centralt att undersöka hur förändringsarbetet gått via uppföljning.

Abstract Post-activation potentiation (PAP) is a phenomenon where force output is acutely enhanced following muscular contraction. Previous research has documented enhanced performance in power-type light exercise following a heavy pre-load, such as vertical jumps following heavy squats. To date, the effect of PAP on moderately heavy exercise following a heavy pre-load has not been investigated. Purpose: The purpose was to examine whether PAP could be elicited in moderately heavy squats following a heavy squat pre-load, and if so, what intensity (as percentage of one repetition-maximum [1RM]) of pre-load elicited the highest PAP effect (measured as mean power, mean force and number of repetitions performed). Subjects: Seventeen resistance-trained males (age 24±2 years, length 182±8 cm, body mass 84.7±13.1 kg, squat 1RM 147.6±29.6 kg) with at least 2 years of experience of the squat exercise. Methods: After testing parallel squat 1RM at a separate session, subjects performed three testing sessions in a randomized order in a cross-over design; performance test at 80% of parallel squat 1RM (control), one repetition at 85% of 1RM followed 8 minutes later by the same performance test (PAP85), and one repetition at 93% of 1RM followed 8 minutes later by the same performance test (PAP93). Sessions were separated by six days. Force and power output was recorded using a linear encoder. Friedman’s test was used to reveal differences between conditions, and a Wilcoxon signed rank test was used to identify these differences. Results: There was an increase in number of repetitions performed for PAP85 (p=0.009) and PAP93 (p=0.001) compared to control, but not for mean power or mean force. There was no significant difference between PAP85 and PAP93 for number of repetitions (p=0.091). Conclusion: PAP can be elicited to improve performance in moderately heavy squats following a heavy squat pre-load in trained subjects, but only measured as number of repetitions performed, not force or power. PAP could therefore be useful not only for designing power training, but also for strength and hypertrophy training. KEYWORDS: squat, post-activation potentiation, PAP, strength, power, hypertrophy.

<p>Bisphosphate 3'-nucleotidase (Bpnt1) is a member of a family of small molecule phosphatases whose activities depend on divalent cations and are inhibited by lithium. While the enzymes share many commonalities, they have distinct and non-­overlapping substrate pools. Of the seven mammalian members, two enzymes, gPAPP and Bpnt1, hydrolyze the same small molecule 3'-phosphoadenosine 5'-phosphate (PAP) but act in separate subcellular compartments, the Golgi apparatus and cytoplasm respectively. Hydrolysis of PAP, which is a metabolite of the inorganic sulfate incorporation pathway, is highly conserved throughout evolution from bacteria to yeast to humans. Evidence in multiple species has shown that inhibiting PAP hydrolysis leads to cellular toxicity as a result of its accumulation and also that these effects can be ameliorated by modulating the rate of its production. However, despite the abundant evidence of its importance</p><p>from studies in lower eukaryotes, the role of the cytoplasmic PAP phosphatase, Bpnt1, in more complicated mammalian physiological remains poorly understood. Here we report for the first time the generation and characterization of mice deficient for Bpnt1. Bpnt1 null mice do not exhibit skeletal defects, but instead develop severe liver</p><p>pathologies and deficiencies in intestinal iron absorption. Loss of Bpnt1 leads to tissue-specific elevations of the substrate PAP. To test the hypothesis that a toxic cellular accumulation of PAP accounts for the observed phenotypes, we generated a double mutant mouse that concomitantly down regulates bisphosphorylated nucleotide synthesis in the context of Bpnt1 deficiency. Remarkably, double mutants do not display any detectable physiological defects seen in Bpnt1 null mice. In addition, we have identified and characterized a novel substrate of 3'­nucleotidases, 3'-phosphoadenosine 5'-diphosphate (PAPP) that co-accumulates with PAPS and PAP and might play a role in mediating certain aspects of the physiological defects of Bpnt1 null mice. Overall, our study defines a role for Bpnt1 in mammalian physiology and provides mechanistic insights into the importance of cytoplasmic 3'-­</p><p>nucleotide hydrolysis to normal cellular function.</p> / Dissertation

Background: Post activation potentiation (PAP) is an increased muscular performance thatoccurs after maximal voluntary contraction. Previous studies have shown a significantincrease in explosive movements, such as sprint and jump performance, as an effect ofthese maximal contractions. Aim: The aim of this study was to analyze if PAP, in terms of heavy squats, has aperformance enhancing effect on 30 meter sprint, with a hypothesis that the maximal effortin the squat has a performance enhancing effect on 30 meter sprint. Method: Twelve healthy male Crossfit athletes from Crossfit Halmstad, age between x-x,volunteered to participate in the study, eleven of these completed all of the test sessions in thiscross-sectional study. During the first test session, the subjects attempted to set a onerepetition max (1RM) in the back squat. During the second and third test session, the subjectswere randomly divided into two groups and the subjects got to perform both the non-PAP andthe PAP protocol during different sessions, depending on which group they were in. Thesprint time was measured with a handheld stopwatch. Wilcoxon Signed Rank Test was usedto determine significant differences between sprint time after the two different protocols, andthe level of significance was set at p &lt; 0.05. Result: The result showed that there was no significant difference between PAP and non-PAPprotocols (p = 0,679). With a median value of 4,78 seconds, a minimum value of 4,59seconds and a maximum value of 5,54 seconds for the sprint trials after PAP and a medianvalue of 4,82 seconds, a minimum value of 4,59 seconds and a maximum value of 5,31seconds for the sprint trials without PAP, the results did not confirm the hypothesis. Conclusion: As an effect from the low number of participants, the result could be deceptive.The study could have show a different result if the number of participants would exceed atleast 25 subjects. There are no performance enhancing effects in the sprint after PAP, in thisstudy. Further research is required, to determine possible performance enhancing effectsfrom PAP.

Frankfurt-style cases are purported counterexamples to the principle of alternate possibilities, since they arecases in which agents appear to be morally responsible for their actions, even though they lack the ability todo otherwise. Philip Swenson has recently challenged these Frankfurt-style cases as effective counterexamplesto PAP by presenting a scenario in which an agent seems to lack morally responsibility for failing to save achild, since he couldn’t do otherwise. And since there’s no morally relevant difference between this case ofomission, and the traditional Frankfurt-style cases, we should therefore conclude that the agents in theFrankfurt-style cases lack morally responsibility for their actions as well. In the following paper I argue thatone could simply run Swenson’s argument in reverse, thereby showing that it is the agent in his case that ismorally responsible for his omission, rather than the other way around, and that Swenson therefore has failedto demonstrate that Frankfurt-style cases should be rejected as effective counterexamples to PAP.

MPH, University of the Witwatersrand, Faculty of Health Sciences / Introduction Sex workers are considered to be a high risk group in the acquisition and transmission of sexually transmitted infections which include Human Immunodeficiency Virus (HIV) and Human Papillomavirus (HPV). Infection with HPV has been clearly established as a causative agent that infects the cells of the cervix and slowly causes cellular changes (dysplasia) or abnormal cells that can later develop into cancer. Women who are HIV positive are thought to be at higher risk of having HPV infection, and subsequently also at higher risk of having abnormal cervical lesions. Objectives The main focus of this study is to describe the prevalence of abnormal Pap-smears among sex workers and to further identify the difference between Pap-smear results of sex workers who are HIV-positive and HIV negative. Methods This is a retrospective descriptive study, where data was obtained from sex workers records from January 2004 to December 2006. The study population included all sex workers who attended the Esselen Street Clinic and sex worker outreach clinic in Hillbrow, in the inner-city of Johannesburg. Three hundred and nine records were randomly selected, of which 200 met the inclusion criteria. Data was collected on socio-demographic information including the age and place of residence, laboratory results (Pap-smear and HIV) and history of sexually transmitted infection at the last physical examination. Extracted data was captured in excel spreadsheet and transferred to Stata Computer Package software version 9.0 for data management and analysis. Descriptive analysis included frequency distributions of categorical variables (e.g. residence, Pap-smear results, HIV status and age group) and summary statistics of continuous variables (e.g. age). Pearson chi-square test or Fisher Exact test when necessary, where conducted to obtain proportions of the sex workers with abnormal Pap-smear results corresponding to each category of the explanatory variables for example age, HIV status and place of residence or business or business transactions. For continuous explanatory variables, such as age, two sample t-tests were used to determine differences between sex workers in terms of abnormal and normal Pap-smears. In all statistical considerations, a probability level of ≤0.05 was used. Results There were 200 records which were analysed to achieve the study objectives. These included 146 records of HIV positive (73%) and 54 of HIV negative sex workers (27%). Their ages ranged from 18 to 45 years with a mean of 26.85 years and median of 26.0 years. More than 70% (n=141) of the sex workers were below the age of 30 years. More than two thirds of sex workers lived in hotels and almost 90% was considered to be symptomatic for STIs. Eighty-eight (44%) of the sex workers were found to have had an abnormal smear result, of whom 58 (65.9%) were below the age of 30 years. Age, as a continuous variable, and place of residence (living on the street) was found to be statistically significantly associated with having an abnormal smear result. However, age (being older than 30), having symptoms of an STI and being HIV positive was not found to be statistically significantly associated with having an abnormal Pap-smear result. Conclusion This study has shown that the prevalence of abnormal Pap-smears among Hillbrow sex workers was high, especially in young sex workers. Sex workers who operated from the street were found to have a higher percentage of abnormal smear results as compared to those operating from the brothels and flats, signifying a need for a controlled environment and to improve sex workers access to health care services. No significant association was found between HIV status and abnormal Pap-smears. Further studies are required in this area. The study indicates that they may be a need to review the National Cervical Cancer Screening Policy to take into consideration the needs of high risk population, such as sex workers.

Cervical cancer is an emerging public health problem in developing countries. Globally, it is the 3rd most common malignancy in women after breast and colorectal cancers and 4th most frequent cancer in women, with an estimated 570,000 new cases and 311,000 deaths in 2018. Cervical cancer screening in the developed countries is credited with the reductions in cervical cancer morbidity and mortality during the last 50 years. However, nearly 90% of cervical cancer deaths occur in less developed countries. Ghana has a cervical cancer rate of 26.4%. Further, it is the highest cancer incidence faced among women 25 to 44 years and has a mortality rate of 17.4% in this age group. Knowledge, culture, attitude, and beliefs are known to limit women's participation in Pap test screening programs. Guided by the health belief model, the purpose of this quantitative study was to examine how knowledge, attitude, culture, and religious beliefs affected intent to seek Pap test screening among adolescent girls in Accra, Ghana. A total of 155 participants ages 16 to 20 years completed a 30-item questionnaire. Descriptive frequencies were calculated. Correlation and Chi-square tests were also performed to assess associations with intent to screen with Pap test. Most girls (92%) had never heard about Pap test screening. There were statistically significant correlations between cervical cancer knowledge (p=0.032) and attitude (p=0.001) with intent to participate in Pap test screening. However, culture (p=0.049) and religious beliefs (p=0.529) were not significantly associated with screening intent. The implications for social change include informing practice and research on how cervical cancer prevention programs can be tailored to girls living in countries where different cultural and religious values are practiced.

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 169-185). Available also in a digital version from Dissertation Abstracts.