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Roza Teshome,1 Irene Yang,2 Edom Woldetsadik,3 Eshetu Girma,4 Melinda Higgins,2 Jessica Wells2 1Department of Midwifery, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA; 3Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 4Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Roza Teshome, Tel +251-911028610, Email rozateshome2007@gmail.comBackground: Cervical cancer is one of the leading causes of cancer death in women, even though it is a preventable disease. Most deaths occur in low- and middle-income countries. In addition to early detection and receipt of standard treatments, survivorship is an important component of high quality of care across the cancer continuum.Objective: To assess the survival status of advanced-stage cervical cancer patients after cancer treatment has started.Methods and Materials: A one-year prospective cohort study was employed to assess the survival status of women with advanced stages of cervical cancer. A total of 180 cervical cancer patients were recruited, and the study was conducted from January 10, 2022, to September 20, 2023. Data entry and analysis were done in the SPSS 29 version. Descriptive statistics were used to examine participant characteristics. The Kaplan-Meier procedure and log rank test were used to estimate the duration of survival. Bivariate and multivariate Cox regression analyses were computed for predictor variables with survival status.Results: Patients receiving cancer treatment at FIGO stages IVA and IVB had survived by 56% and 24%, respectively, whereas patients receiving treatment at stages IIB and IIIA had survived by 100%. The estimated mean survival time at one-year follow-up was 5.706 months (95% CI: 3.785– 7.627) for patients with FIGO stage IVB, but 11.537 months (95% CI: 11.199– 11.887) for those with stages II and III (P < 0.001). Women over 60 years old had a 1.5-fold higher risk of death than those under 60 (HR: 1.482, P = 0.040).Conclusion: The one-year cumulative survival rate among advanced-stage cervical cancer patients was 77%. Major factors associated with survival were age, cancer stage, the presence of anemia, and waiting time for treatment.Keywords: survival status, advanced stage, cervical cancer, tikur anbessa specialized hospital, Ethiopia

Roza Teshome,1 Irene Yang,2 Edom Woldetsadik,3 Eshetu Girma,4 Melinda Higgins,2 Jessica Wells2 1Department of Midwifery, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA; 3Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 4Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Roza Teshome, Tel +251-911028610, Email rozateshome2007@gmail.comBackground: The development of health concepts beyond traditional markers of illness and death has made the evaluation of quality of life (QoL) crucial to patient care. Yet, there is little research evaluating the pre- and post-treatment QoL of cervical cancer survivors in Ethiopia.Objective: This study aimed to assess the pre- and post-treatment QoL of women diagnosed with advanced-stage cervical cancer.Methods and Materials: A cohort design was conducted at the Tikur Anbessa Specialized Hospital Oncology Center. A total of 166 cervical cancer patients were recruited consecutively. Data was collected through interviews with standardized questionnaires before and after treatment. The Wilcoxon rank test was used to assess the significant differences in pre-treatment and post-treatment quality of life. Additionally, the Mann-Whitney U-test was also employed. Statistical significance was determined with p-values < 0.05 and a 95% confidence interval.Results: Women who were in stages IVA and IVB were 24.7% and 10.2%, respectively. Both the global health scale (66.67 [47.92– 75] to 83.33 [66.67– 83.33]) and the functional domain QoL (66.67 [40– 80] to 70 [46.67– 86.66]) showed statistically significant improvements from pre-treatment to post-treatment QoL. Women under the age of 45 were found to have higher global health QOL (P < 0.001) and functional domain QOL (P = 0.029). Women presented in stages II and III had comparatively higher global health QoL (P = 0.008) and functional domain QoL (P = 0.021).Conclusion: Global health QOL and the majority of functional quality of life significantly improved following six months of cancer treatment. But there was no discernible change in terms of sexual enjoyment, sexual function, or activity. Age, marital status, the duration since diagnosis, the stage of the cancer, and the presence of comorbidities were the factors that affected the improvement of post-treatment quality of life.Keywords: pre-treatment, post-treatment, quality of life, cervical cancer, Ethiopia

Glenna S Brewster,1 Melinda Higgins,1 Miranda Varrasse McPhillips,2 Kalisha Bonds Johnson,1 Fayron Epps,1 Katherine A Yeager,1 Donald L Bliwise,3 Kenneth Hepburn1 1Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA; 2University of Pennsylvania, School of Nursing, Philadelphia, PA, USA; 3Division of Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USACorrespondence: Glenna S Brewster, 1520 Clifton Road, NE, Atlanta, GA, 30322-4027, USA, Tel +1 404.712.9164, Email glenna.brewster@emory.eduIntroduction: Sleep disturbance is prevalent in caregivers of persons living with dementia (PLwD). Tele-Savvy, a 7-week virtual psychoeducational intervention, enhances caregivers’ competence and self-care, and reduces depression. While not explicitly designed to do so, Tele-Savvy can potentially improve caregivers’ disturbed sleep. The present study aimed to examine the longitudinal effects of Tele-Savvy on caregivers’ sleep quality and insomnia.Methods: This was a secondary data analysis of a 3-arm randomized control trial [Tele-Savvy (active treatment), Healthy Living (attention control), and usual care (waitlist control)]. Multilevel mixed modeling with intent-to-treat principles tested for group, time, and group-by-time effects. Effect sizes were estimated for all changes from baseline to the initial 6-month post-intervention point. Following completion of the 6-month post-randomization delay, we examined combined outcomes for Tele-Savvy.Results: Participants (n=137; mean age 64.7 years) were predominantly female (68.6%) and White (68.6%). We found no initial group-by-time effects for the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). For the combined Tele-Savvy group, there was a statistically significant improvement in ISI scores across time (p=0.050). The combined Tele-Savvy effect size for PSQI was d=0.126 and ISI was d=0.310.Discussion: Tele-Savvy resulted in a significant long-term reduction in insomnia symptoms in this sample of caregivers of PLwD and demonstrated a positive trend for improvement in their sleep quality. Since sleep disturbance is so prevalent among caregivers of PLwD, the inclusion of sleep health education into psychoeducation caregiver interventions may yield even better outcomes for caregivers.Plain Language Summary: Many caregivers of persons living with dementia have poor sleep. Tele-Savvy is a 7-week intervention that was delivered online to caregivers improved their caregiving skills and self-care and reduced their depressive symptoms; thus, Tele-Savvy may possibly improve their sleep problems. This study aimed to examine the effects of Tele-Savvy on caregivers’ sleep quality and insomnia over 6 months. Caregivers were randomly assigned to Tele-Savvy (intervention), Healthy Living (comparison intervention), and usual care (no initial intervention). One hundred and thirty-seven caregivers, predominantly female, who were on average 64.7 years, participated in this study and completed measures of insomnia and sleep quality. Insomnia symptoms improved and there was a positive trend for improved sleep quality across time for caregivers who received Tele-Savvy. Since so many caregivers have sleep problems, including sleep health education as a part of other caregiver interventions may lead to even better outcomes for caregivers.Keywords: psychoeducational intervention, Alzheimer’s disease, circadian rhythm, cognitive behavioral therapy for insomnia, depression

Sonya Chew,1 Hailey Kathryn Carroll,1 Waseem Darwish,1 Oleksandr Boychak,2 Michaela Higgins,1 John McCaffrey,1 Catherine Margaret Kelly1 1Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland; 2Department of Radiation Oncology, St Luke’s Radiation Oncology Network, Beaumont Hospital, Dublin, IrelandCorrespondence: Sonya ChewMater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, D07R2WY, IrelandTel +35318032000Fax +35318032113Email sonya_chew@yahoo.comPurpose: Around 30% of patients with breast cancer will develop brain metastases (BM). We sought to characterize the disease course, treatments and outcome for our patient cohort.Materials and Methods: We extracted clinicopathological data from electronic records from January 2015 to December 2020. Results were generated using SPSS statistics v27.Results: We identified 98 patients. Median overall survival (OS) from BM diagnosis was 3 months [hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)–], 8 months [HR+/HER2+], 7 months [HR–/HER2+] and 2 months [triple negative breast cancer (TNBC)]. Whole brain radiotherapy (WBRT) (n=48, 70%) was most frequently used followed by surgery (n=15, 22%) and stereotactic radiosurgery (n=6, 8%). In patients who received WBRT alone (n=40) the median OS post WBRT was 2.6 months.Conclusion: After BM development, half of the patients had systemic therapy and 70% had local therapy, but only the HER2 subgroup had a prolonged OS likely reflecting central nervous system (CNS) activity of anti-HER2 drugs. TNBC patients had the worst prognosis. Although our cohort is small, OS was > 1 year for 60% of HER2+ patients who received trastuzumab emtansine after BM development, which is encouraging for antibody drug conjugates and CNS activity. Patients who received WBRT had a higher burden of CNS disease and had an OS of less than 3 months.Keywords: metastatic, breast cancer, brain metastases, treatment, triple negative

Mostafa M Ghorab,1,2 Mansour S Alsaid,1 Maureen Higgins,3 Albena T Dinkova-Kostova,3–5 Abdelaaty A Shahat,1,6 Nehal H Elghazawy,7 Reem K Arafa7,8 1Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Department of Drug Radiation Research, National Center for Radiation Research & Technology, Atomic Energy Authority, Cairo, Egypt; 3Jacqui Wood Cancer Centre, Division of Cancer Research, Medical Research Institute, University of Dundee, Dundee, UK; 4Department of Medicine, 5Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 6Phytochemistry Department, National Research Center, Dokki, Giza, 7Zewail City of Science and Technology, 8Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt Abstract: The Kelch-like ECH-associated protein 1 (Keap1)/nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response elements pathway enables cells to survive oxidative stress conditions through regulating the expression of cytoprotective enzymes such as NAD(P)H:quinone oxidoreductase 1 (NQO1). This work presents the design and synthesis of novel anilinoquinazoline derivatives (2–16a) and evaluation of their NQO1 inducer activity in murine cells. Molecular docking of the new compounds was performed to assess their ability to inhibit Keap1–Nrf2 protein–protein interaction through occupying the Keap1–Nrf2-binding domain, which leads to Nrf2 accumulation and enhanced gene expression of NQO1. Docking results showed that all compounds can potentially interact with Keap1; however, 1,5-dimethyl-2-phenyl-4-(2-phenylquinazolin-4-ylamino)-1,2-dihydropyrazol-3-one (9), the most potent inducer, showed the largest number of interactions with key amino acids in the binding pocket (Arg483, Tyr525, and Phe478) compared to the native ligand or any other compound in this series. Keywords: Kelch domain, molecular modeling, Keap1/Nrf2, cytoprotection, NQO1 induction

Background: Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains controversial. The objective of this scoping review was to explore and map existing literature on the experiences of those who provide abortion care. Methods and findings: This exploratory review followed the Levac et al. guidelines and was reported in accordance with the PRISMA-ScR checklist. CINAHL, Cochrane, EMBASE, PsycInfo, PubMed, and Web of Science were used to identify peer-reviewed, original research articles published on providers' experience of abortion. We identified 106 relevant studies, which include a total sample of 4,250 providers from 28 countries and six continents. Most of the studies were qualitative (n = 83), though quantitative (n = 15) and mixed methods (n = 8) studies were also included. We identified two overarching themes: (1) Providers' experiences with abortion stigma and (2) Providers' reflections on their abortion work. Our findings suggest that providers from around the world experience challenges within society and their communities and workplaces which reinforce the stigmatization and marginalization of abortion and pose questions about the morality of this work. Most, however, are proud of their work, believe abortion care to be socially important and necessary, and remain committed to the provision of care. Conclusions: The findings of this review provide a comprehensive overview on the known experiences of providing abortion care. It is a key point of reference for international providers, researchers, and advocates to further this area of research or discussion in their own territories. The findings of this review will inform future work on how to support providers against stigmatization and will offer providers the chance to reflect on their own experiences. [ABSTRACT FROM AUTHOR]

Active-learning strategies "can" improve science, technology, engineering, and mathematics (STEM) undergraduates' abilities to learn fundamental concepts and skills. However, the results instructors achieve vary substantially. One explanation for this is that instructors commonly implement active learning differently than intended. An important factor affecting how instructors implement active learning is knowledge of teaching and learning. We aimed to discover knowledge that is important to effective active learning in large undergraduate courses. We developed a lesson-analysis instrument to elicit teacher knowledge, drawing on the theoretical construct of teacher noticing. We compared the knowledge used by expert (n = 14) and novice (n = 29) active-learning instructors as they analyzed lessons. Experts and novices differed in what they noticed, with experts more commonly considering how instructors hold students accountable, topic-specific student difficulties, whether the instructor elicited and responded to student thinking, and opportunities students had to generate their own ideas and work. Experts were also better able to support their lesson analyses with reasoning. This work provides foundational knowledge for the future design of preparation and support for instructors adopting active learning. Improving teacher knowledge will improve the implementation of active learning, which will be necessary to widely realize the potential benefits of active learning in undergraduate STEM.

Trench‐parallel translation of the Central American Forearc (CAFA) is the result of strain partitioning along the Cocos and Caribbean (CA) convergent margin. Unlike the tectonics of northwestern Costa Rica and El Salvador, CAFA‐CA relative motion in Nicaragua is not accommodated on margin‐parallel fault systems. Rather, the northwest‐trending dextral shear is accommodated on margin‐normal sinistral strike‐slip faults that approximate the motion of a margin‐parallel fault (i.e., bookshelf faulting). We compare a new Global Positioning System interseismic horizontal velocity field to analytical and numerical models to show that the bookshelf faulting model can produce the observed velocity field and provide insight into the kinematics and configuration of the margin‐normal fault system. We find that a fault system with 20 km‐long parallel to sub‐parallel margin‐normal sinistral faults, spaced ∼5 km apart, locked from the surface to 5 km depth, and with interseismic slip deficits of 4 mm yr−1, can replicate the observed velocity field. These findings have implications for the region's seismic hazard where shallow moderate‐magnitude earthquakes will have reoccurrence intervals of ∼50 years. These findings are also important for volcanic hazard estimation and unrest forecasting because the margin‐normal faults are in the volcanic arc and magma‐tectonic interactions have been documented along the CAFA. Plain Language Summary: The Central American Forearc (CAFA) is a northwest‐moving tectonic block that is located between the Middle America Trench and the Central American Volcanic Arc (CAVA). Northwest‐oriented faults (i.e., faults parallel to the CAVA motion), have been found in Costa Rica, El Salvador, and Guatemala, representing the boundary between CAFA and CAVA. In eastern El Salvador, Nicaragua, and western Costa Rica, a different fault style has been identified where the faults are oriented perpendicular to the motion of the CAVA (bookshelf faulting). These faults are ancient structures that take up the motion between the CAFA and CAVA, which is easier than creating new faults parallel to the motion. We show that, in northwestern Nicaragua, the bookshelf faulting can produce the observed GPS data. We find that these faults should move at 4 mm/yr, are close to populated areas, and will produce M5 to M6 earthquakes every 50 years. Key Points: Bookshelf faulting accommodates northwest‐directed forearc motion on margin‐normal sinistral faultsStrain accumulation on margin‐normal sinistral faults agrees with GPS‐derived horizontal velocity field in northwestern NicaraguaShallow M > 5 upper‐plate earthquakes in the region will have reoccurrence intervals of ∼50 years [ABSTRACT FROM AUTHOR]