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Exam Code: PSP Practice exam 2022 by Killexams.com team
PSP Physical Security Professional (PSP) - 2022

ASIS - PHYSICAL SECURITY PROFESSIONAL (PSP)® exam PREPARATION PROGRAMMES
The Physical Security Professional (PSP)® credential is globally recognised as providing demonstrable proof of knowledge and experience in threat assessment and risk analysis; integrated physical security systems; and the appropriate identification, implementation, and ongoing evaluation of security measures. Those who earn the PSP are ASIS board-certified in physical security.

The CPP exam covers tasks, knowledge, and skills in eight broad domains

- Security principles and practices
- Business principles and practices
- Investigations
- Personnel security
- Physical security
- Crisis management
- Information security
- Crisis Management
- Legal Aspects

Physical Security Professional (PSP) - 2022
ASIS Professional test
Killexams : ASIS Professional test - BingNews https://killexams.com/pass4sure/exam-detail/PSP Search results Killexams : ASIS Professional test - BingNews https://killexams.com/pass4sure/exam-detail/PSP https://killexams.com/exam_list/ASIS Killexams : (ISC)2 aims to put 1 million people through its entry-level certification exam for free

(ISC)2 this week announced its “One Million Certified in Cybersecurity” program, which pledges to put one million people through its entry-level certification exam and education program for free.

The program builds upon the success of the (ISC)2  “100K in the UK” initiative, which offered 100,000 free exams and course enrollments for UK residents earlier this year.

This latest program was announced this week at the Cyber Workforce and Education Summit at the White House. The Biden administration brought together experts, private sector companies, and federal agencies to brainstorm around one of the most pressing challenges in cybersecurity: the lack of good people to fill the more than 714,000 open cybersecurity jobs.

Recent initiatives, including commitments to providing more training for cybersecurity jobs, are great, said Joseph Carson, chief security scientist and advisory CISO at Delinea. Carson said the industry must prioritize what it can do now and what it must do in the near future. 

“We need to accelerate the need for skilled workers in cybersecurity and fast-track them into the industry as the skills shortage only grows,” Carson said. “Cybersecurity is no longer simply an issue to be dealt with within our industry. It’s one that can influence all of society. That means everyone needs cybersecurity skills training to reduce the continued risks of cyberattacks. Cybersecurity is no longer just a career path, it’s an essential skill in today’s digital society."

John Bambeneek, principal threat hunter at Netenrich, said the typical path for new cybersecurity certified is obtain a bachelor's in computer science, get a master's in cybersecurity, and then earn professional certifications.

“This is simply too onerous considering it isn’t even providing the expertise we need,” Bambenek said. “Moving forward, we need a strong push to get entry-level cybersecurity education at the associate's level and for employers to accept that as sufficient.”

Fri, 22 Jul 2022 06:19:00 -0500 en text/html https://www.scmagazine.com/news/careers/isc2-aims-to-put-1-million-people-through-its-entry-level-certification-exam-for-free
Killexams : Paul Barker No result found, try new keyword!In 1993 Paul became the third security professional in the UK to be awarded the CPP qualification, and two years later he was instrumental in expanding the course in the UK by enabling the exam to be ... Fri, 15 Feb 2019 10:48:00 -0600 text/html https://www.sourcesecurity.com/people/paul-barker.html Killexams : Ultrasound of the Lateral Femoral Cutaneous Nerve in Asymptomatic Adults

Methods

This study met the guidelines set by the ethics committee of the Shanghai Sixth People's Hospital (Shanghai, China). All subjects were selected randomly and gave informed written consent for their inclusion in this study.

Subjects

A total of 120 subjects were prospectively included in the study. All study subjects were asymptomatic volunteers without any symptoms of pre-existing pain or dysesthesia in the distribution of the LFCN. Subjects with diabetes mellitus, pregnancy, peripheral neuritis, and a history of injury or surgery on the spinal column, pelvis, or the groin were excluded from the study.

Ultrasound

Each subject was positioned supine and was scanned bilaterally by an investigator (J.A., 10 years of neuromuscular ultrasound experience) using the Mylab 90 (Esaote, Genoa, Italy) with an 18 MHz linear array transducer.

The ultrasound transducer was placed in the transverse position and was first placed 1–2 cm distal to the lateral IL. Initially, the tensor fasciae latae muscle and the sartorius were imaged (Figure 1). To verify the tensor fasciae latae muscle, the transducer was sometimes moved distally. As the distal tensor fasciae latae muscle inserts into the iliotibial band, the echo of the muscle of the tensor fasciae latae muscle should sonographically disappear. The LFCN was then identified in the intermuscular space between the tensor fasciae latae muscle and the sartorius. Because there was substantial contrast between the echo characteristics of the LFCN and that of the surrounding tissue, the LFCN could be easily identified and usually showed an ovoid hypoechoic structure with hyperechoic dots within it (Figure 2). which was similar to the other of the peripheral nerve. The nerve cross-sectional area (CSA) at this site was measured bilaterally in all 120 participants. When the LFCN was identified using ultrasound and then the angle of incidence of the probe was adjusted until it was perpendicular to the nerve, the smallest cross-sectional image was obtained. Because the CSA of the LFCN is so small that the trace function on the ultrasound device is unable to trace the nerve, the CSA was calculated from an area formula for ovals (CSA= Pi * A * B *1/4, Pi=3.14, A=the longest side of the oval, B=the shortest side of the oval). If the LFCN had several branches, the CSA of the anterior branch was measured. The CSA was measured three times, and the mean value was recorded. Then, the transducer was slowly moved proximally along the LFCN to the IL. The IL is noted as a linear hyperechoic structure running from the pubic tubercle to the ASIS.[12,18] The number of nerve branches at the level of the IL and the relationship between the LFCN and IL were assessed. The distance between the LFCN and the ASIS was also measured. By observing the course of the nerve, the nervous structure assed was identified LFCN and not another nerve structure.

Figure 1.

Schematic diagram showing the course of the LFCN and the initial location of the probe. ASIS: anterior superior iliac spine; LFCN: lateral femoral cutaneous nerve; TEL: tensor fasciae latae muscle; IL: inguinal ligament; S: Sartorius.

Figure 2.

Transverse ultrasound image of the LFCN lying within the intermuscular space between the tensor fasciae latae muscle and the sartorius. LFCN: lateral femoral cutaneous nerve; TEL: tensor fasciae latae muscle; S: Sartorius; R: rectus femoris.

To test the difficulty or ease of using our protocol to detect the LFCN, the other two radiologists (Y.X. and F., who both had 2 years of neuromuscular ultrasound experience) were trained by J.A to perform the ultrasound examination procedure for inspecting the LFCN, and the time taken to identify the nerve was recorded. Intraobserver reliability was evaluated in 30 cases that were selected by the radiologist (Y.X.).

Statistical Analyses

All parameters were compared bilaterally. Numerical and categorical variables were compared by independent unpaired t-tests and by the Chi-squared test, respectively. A regression analysis of the data that compared age, sex, height, weight, and the distance between the ASIS and LFCN was performed. The intraobserver reliability was assessed according to the kappa coefficient. A p value of less than 0.05 was considered significant.

Thu, 14 Jul 2022 12:01:00 -0500 en text/html https://www.medscape.com/viewarticle/778894_3
Killexams : Malcolm Smith, CPP No result found, try new keyword!The senior security executive can no longer make business proposals on intuition, present security strategy or recommendations that fail to stand the test ... the Professional Certification Board (non ... Thu, 18 Feb 2016 23:23:00 -0600 text/html https://www.sourcesecurity.com/people/malcolm-smith.html Killexams : The greater trochanter triangle; a pathoanatomic approach to the diagnosis of chronic, proximal, lateral, lower pain in athletes

Chronic pain experienced in the proximal, lateral, lower limb may arise from the femoro-acetabular joint, from the muscles and tendons that act upon it, from any of the structures that traverse the area, and from more remote structures such as the lumbar spine.

The aetiology of pathology in this area is not confined to either trauma or overuse. As a result many different sporting activities may have a causal role.

Without a clear clinical/pathological diagnosis, the subsequent management of chronic groin pain is difficult. The combination of complex anatomy, variability of presentation and the non-specific nature of the signs and symptoms makes the diagnostic process problematic.

The paper proposes a novel educational model based on pathoanatomic concepts. Anatomical reference points were selected to form a triangle, which provides the discriminative power to restrict the differential diagnosis, and form the basis of ensuing investigation.

This paper forms part of a series addressing the three-dimensional nature of proximal lower limb pathology. The 3G approach (groin, gluteal, and greater trochanter triangles) acknowledges this, permitting the clinician to move throughout the region, considering pathologies appropriately.

Tue, 01 Feb 2022 13:34:00 -0600 en text/html https://bjsm.bmj.com/content/43/2/146
Killexams : CREST Defensible Penetration Test Released

CREST provides commercially defensible scoping, delivery and sign-off recommendations for penetration tests

ROSELAND, N.J., Aug. 1, 2022 /PRNewswire/ -- CREST, the international not-for-profit, membership body representing the global cyber security industry, has announced the release of its CREST Defensible Penetration Test, a specification that provides recommendations on how penetration tests should be scoped, delivered and signed off. With significant growth in the numbers of penetration tests being carried out around the world, the need to define best practice has become increasingly important. CREST has worked alongside industry recognized and peer-selected experts to define a minimum set of expectations associated with a penetration test.

The guidance focuses on defining a CREST Defensible Penetration Test and is designed to help service providers and their clients to work more effectively together to conduct penetration tests.

"A CREST Defensible Penetration Test provides flexibility built around a minimum set of expectations that will drive better outcomes for buyers across the globe," explained Rowland Johnson, CREST President. "It provides the industry with a much needed commercially defensible assurance activity that is appropriately scoped, executed and signed off."

Across the globe it is widely acknowledged that the definitions, practices and expectations associated with a penetration test are inconsistent and fluid. This makes it difficult to define or parameterize a series of activities that looks at all possible requirements, engagements or scenarios. For example, a penetration test may need to assess a mobile phone at one end of the spectrum or an aircraft carrier at the other.

This new CREST guidance provides a best practice framework for penetration test defensibility and an assurance of penetration tester competence. It will help organizations that are looking to procure penetration testing services and organizations that deliver penetration testing services.

Only when the following three elements are satisfied, will the CREST Defensible Penetration Test be commercially defensible:

  • The need for penetration testing service providers to have appropriate policies, procedures, practices and methodologies

  • The need for all individuals involved in a penetration test to have appropriate levels of skills, experience and competency

  • The need for penetration testing service providers and the individuals conducting the assessment to work towards a defined and agreed test specification

More information on the CREST Defensible Penetration Test is available at: Implementation & Procurement Guides - CREST (crest-approved.org)

About CREST

CREST is an international not-for-profit, membership body representing the global cyber security industry. Its goal is to help create a secure digital world for all by quality assuring its members and delivering professional certifications to the cyber security industry.

CREST accredits almost 300 member companies, operating across dozens of countries, and certifies thousands of professionals worldwide. It works with governments, regulators, academe, training partners, professional bodies and other stakeholders around the world.

CREST members undergo a rigorous quality assurance process and employ competent professionals. Organizations buying their cyber security services from CREST members do so with confidence.

Media Contact:
Erin Jones 
704-664-2170 
ejones@avistapr.com

Cision

View original content:https://www.prnewswire.com/news-releases/crest-defensible-penetration-test-released-301596967.html

SOURCE CREST

Mon, 01 Aug 2022 02:00:00 -0500 en-US text/html https://finance.yahoo.com/news/crest-defensible-penetration-test-released-140000459.html
Killexams : Corona School Partners Headmaster Sports Academy for Easter Soccer Camp

In a move to promote youth development and empowerment through education and sports, over 300 students are expected to converge on Corona Secondary School, Agbara in April for a sports programme themed ‘Easter Soccer Camp’ being organised by the school, in collaboration with Headmaster Sports Academy Limited under the headship of the renowned ex-Super Eagles international icon, Mutiu Adepoju. Sunday Ehigiator reports

Next month, Corona Secondary School, Agbara will be hosting over 300 students, mostly youths at its expansive school premises in one of its kind sport fiesta with the theme ‘Easter Soccer Camp’, in collaboration with Headmaster Sports Academy Limited under the headship of renowned former Super Eagles icon, Mutiu Adepoju. The aim of the collaboration, according to the organiser, is to promote youth development and empowerment through education; to inculcate high moral and ethical values in students within and outside the wall of the classrooms; and to enrich the sports portfolios of all participating youths and students from within and outside the school environment.

In an interview with THISDAY, the Principal, Corona Secondary School, Agbara, Mrs. Chinedum Oluwadamilola revealed that aside the school’s commitment to always bring out the best from its students, help them stay true to their dreams and follow through their passion, the school agreed to go into the partnership because of Adepoju’s personality.

“With all his accomplishments in football, he has remained as humble as a dove. He exhumes good values with a simple lifestyle. He has remained someone that is down to earth and everyone can resonate with. As an embodiment of humility, he has demonstrated that you can achieve a lot without making a lot of noise about it. You can achieve without being in everybody’s face, without being scandalous; and his records are clean. This correlates with our school’s values and principles. “Mutiu is one of a kind; to have spent so much time in top place football and there was never a time you hear anything scandalous about him, even as a rumour, it is commendable. And this is a typical example of a sports personality we can encourage our students to emulate. As much as we want to expose our children to football, we also want them to learn from someone who has those good values that we resonate with.

“And during the camping period, which is only open to youths between the ages of 10 to 17, there is going to be a lot of scouts coming around to watch these boys and luckily, one or more of them could catch their interest. It is an open camp. Our students would be involved and interested students from other schools. They are to register through our website, www.coronaschools.org or via www.headmaster.ng with a registration fee as low as N3,000 and participation fee of N75,000 only. The camp is in two batches. The first batch will open from April 7 to 12, while the second batch will be from April 22 to 27 with a limited space of 300 students per batch.

Oluwadamilola added: “But the most amazing of all is that the camp is not just going to be all about football, they would be learning moral values, discipline, more on attitudinal dispositions from the officials involved; how to get scholarships to European, Canadian and American universities through sports achievements, even as they interact with other ex-international footballers. So it is an intensive sports clinic and many more.”

On the objective of the partnership, she said the management with the approval of the school board “decided to partner with the Headmaster Sports Academy to drive the school’s educational services in the areas of sports just as many corporate organisations partner with celebrities to drive or market their products; to enrich the sports portfolio of our students with a view to giving them an edge when they are seeking admission through scholarship into foreign universities; to supply participants the opportunity to express their talents, Strengthen their skills and become exposed to modern techniques in football. And to enable participants to acquire values such as teamwork, endurance and resilience which they will find useful and applicable to life outside sports.”

Highlighting the school’s achievements, Oluwadamilola said: “Corona School was founded with a mission to provide world-class education to children and to inculcate high moral and ethical values in them as they prepare for a lifelong learning, service and fulfilment. And over the years, the school has stayed true to its dreams by constantly being on top of its game. Apart from its affiliation with reputable associations such as member, Council of British International School (COBIS); member, Associate of International Schools in Africa (ASIS); member, Association of International School Educators of Nigeria, CSS is the only secondary school in West Africa to get highly coveted accreditation of the New England Association of Schools and Colleges (NEASC). Yet, we are a Nigerian school. In terms of academics, our students have recorded successes both in national and international examinations, of significant and note was the Standardized Aptitude Test (SAT) examinations, where two of our students scored highest in the whole universe.

“This was made possible because as a school, we place high premium on professional development of every cadre of our staff based on identified training needs. We therefore take advantage of annual international and local conferences, workshops and seminars in order to open up vistas of expansion in our teachers’ professional practice. We are highly committed to regular external accreditation and/or inspection. Ours is a demonstration of life-long learning and continuing professional development. We always strive to Strengthen on our operational processes from time to time,” she stressed.

In his remarks, Adepoju, who is the founde of Headmaster Sports Academy, said he is delighted to be associated with a programme that is centred on improving and invigorating the minds of children in sports, exposing them to the value, ethics and the wonderful world of football. “Our company is a sports, education and tour planning organisation that is established in Nigeria to influence children in sports and other academic activities both locally and internationally. The targeted age group of participants is between seven and 17 years and they are expected to be students.”

Speaking on his mission for the forthcoming event, he said his company in partnership with Corona has come up with soccer camp programme that is designed to connect, expose and integrate children into the international world of football. “The youth soccer camp is a section of HSAL, which is established to create the best football experience for children by providing a solid platform in pursuing their football career, providing professional coaches with the required equipment to train them in becoming the best both locally and internationally.

“The benefits of this programme would include training by professional coaches including myself and a host of others; vast exposure about the game; standard equipment; good training equipment; and chances to be scouted out by professional clubs by engaging in the international tournament.

“Football is an ever growing and evolving platform which has the interest of billions of people worldwide, it is our duties as parents and guardians to contribute and encourage our children in walking this path of greatness so that they can be among the stars,” he said.

Commenting on the partnership, a member, Youth Football Development Committee, Nigerian Football Federation (NFF), Mr. Dotun Coker said “the partnership is a landmark event. I am aware they have approached about 10 schools and we are so delighted that Corona accepted to partner Headmasters Sports Academy, their values are in sync and in line with our youth football development policies. “The important thing here is to see these students turn out to be superstars in future and have an empowerment background to fall on. And we are encouraging more of this type of partnership.”

Speaking with THISDAY, a parent, Justice Habeeb Abiru described the partnership as wonderful, saying that there is nothing comparable to academics and sports, as both work hand-in-hand to better develop a child.

The school’s first team goalie, Uchenna Dike described the partnership as an “amazing opportunity for students to Strengthen on their football skills and showcase their passion for soccer”, while encouraging his school/team mates to participate and fully maximize the opportunities it would provide.

While the sports teacher, Mr. Awuru Joel believes the partnership is a big step in the right direction towards inculcating sports in students at an early age, he applauded the school for being a pioneer of sports development among secondary schools in Nigeria.

Fri, 15 Jul 2022 12:00:00 -0500 en-US text/html https://www.thisdaylive.com/index.php/2019/03/06/corona-school-partners-headmaster-sports-academy-for-easter-soccer-camp/
Killexams : Tecnoglass Reports Record Second Quarter 2022 Results

Tecnoglass Inc.

- Record Total Revenues of $169.1 Million Up 39% Year-Over-Year, All through Organic Growth -

- Record Single-Family Residential Revenues Increased 86% Year-Over-Year, Representing 45% of Total Revenues

- Growth Capex Investments on Track to End Year with Installed Production Capacity of Over $800 Million -

- Gross Margin of 43.5%, Up 310 Basis Points Year-Over-Year -

- Record Net Income of $33.4 Million and $0.70 Per Diluted Share -

- Record Adjusted Net Income1 of $33.0 Million and $0.69 Per Diluted Share -

- Adjusted EBITDA1 Up 51.7% Year-Over-Year to a Record $54.6 Million, or 32.3% of Total Revenues -

- Cash Flow From Operations of $35.9 Million -

- Backlog Expanded 19.5% Year-Over-Year to a Record $668 Million

- Board Increases Quarterly Dividend by 15% -

- Increases Full Year 2022 Growth Outlook to Adjusted EBITDA1 of $208 Million to $220 Million on Total Revenues of $620 Million to $640 Million -

BARRANQUILLA, Colombia, Aug. 04, 2022 (GLOBE NEWSWIRE) -- Tecnoglass, Inc. (NYSE: TGLS) (“Tecnoglass” or the “Company”), a leading manufacturer of architectural glass, windows, and associated aluminum products serving the global residential and commercial end markets, today reported financial results for the second quarter ended June 30, 2022.

José Manuel Daes, Chief Executive Officer of Tecnoglass, commented, "We are very pleased to report another quarter of record results led by continued strong demand for our single-family residential products and further sequential growth in our commercial business. The benefit of our vertically integrated business model and highly efficient manufacturing capacity are allowing us to maintain exceptional lead times for our customers, resulting in market share gains and profitable growth. The prudent investments we have made in automation, capacity enhancements and product innovation, in addition to our disciplined cost controls, are supporting our industry-leading adjusted EBITDA margin, which remains in excess of 30%. We believe the momentum in our business and established track record of exceptional cash flow further validates Tecnoglass’ unique vertically integrated business model and strategic positioning in attractive high-growth geographies across the U.S. We are excited by the trajectory of our business and look forward to delivering on our upwardly revised outlook for the full year 2022.”

Christian Daes, Chief Operating Officer of Tecnoglass, added, “Our activity in key U.S. regions remains strong for single-family and multifamily residential projects, as well as commercial projects, evidenced by record levels of invoicing during the month of July. Ongoing market share gains helped us produce revenue growth of 86% year-over-year in our single-family residential business, with projects in the historically resilient remodel and renovation end market representing approximately 65% of that business. The commercial side of our business has continued to experience sequential growth in each month this year, with the second quarter revenues up 15% compared to the prior year quarter. Furthermore, we ended the quarter with a record backlog of multifamily and commercial projects that now extend well into 2023. We intend to continue outperforming in our markets as a supplier of choice given our ability to maintain timely deliveries that help keep customers on schedule. We are reinvesting a portion of our significant cash flow into high-return capex investments that will allow us to end the year with installed production capacity equivalent to over $800 million of revenue. The Board’s 15% increase in our dividend demonstrates their confidence in our cash flow generation to remain strong. We are well positioned to drive additional success in our Company for many years to come.”

Second Quarter 2022 Results

Total revenues for the second quarter of 2022 increased 38.9% to $169.1 million, compared to $121.8 million in the prior year quarter, driven by strong growth in single-family residential activity, market share gains and the ongoing ramp up of the Company’s commercial activity. Single-family residential revenues increased approximately 86% year-over-year, representing 44.9% of total revenues for the second quarter, helped by continued strong demand within the repair and remodeling space, the ongoing expansion of the Company’s Multimax product line, and a larger customer base. Changes in foreign currency exchange rates had an adverse impact of $0.3 million on both Colombia revenues and total revenues in the quarter.

Gross profit for the second quarter of 2022 grew 49.9% to $73.6 million, representing a 43.5% gross margin, compared to gross profit of $49.1 million, representing a 40.4% gross margin in the prior year quarter. The 310 basis point improvement in gross margin mainly reflected operating leverage on higher sales, greater operating efficiencies related to automation and a higher mix of revenue from manufacturing versus installation activity as Tecnoglass continues to increase its mix of single-family residential products. Selling, general and administrative expense (“SG&A”) was $28.1 million compared to $20.4 million in the prior year quarter, with the majority of the increase attributable to shipping expense as a result of a higher sales volume and higher shipping rates. As a percent of total revenues, SG&A improved to 16.6% compared to 16.7% in the prior year quarter, primarily due to higher sales and better operating leverage on personnel, professional fees and other fixed expenses.

Net income was $33.4 million, or $0.70 per diluted share, in the second quarter of 2022 compared to net income of $19.6 million, or $0.41 per diluted share, in the prior year quarter, including a non-cash foreign exchange transaction gain of $2.5 million in the second quarter of 2022 and a $0.2 million gain in the second quarter of 2021. As previously disclosed, these non-cash gains and losses are related to the accounting re-measurement of U.S. Dollar denominated assets and liabilities against the Colombian Peso as functional currency.

Adjusted net income1 was $33.0 million, or $0.69 per diluted share, in the second quarter of 2022 compared to adjusted net income of $20.1 million, or $0.42 per diluted share, in the prior year quarter. Adjusted net income1, as reconciled in the table below, excludes the impact of non-cash foreign exchange transaction gains or losses and other non-core items, along with the tax impact of adjustments at statutory rates, to better reflect core financial performance.

Adjusted EBITDA1, as reconciled in the table below, increased 51.7% to $54.6 million, or 32.3% of total revenues, in the second quarter of 2022, compared to $36.0 million, or 29.5% of total revenues, in the prior year quarter. The improvement was driven by higher sales, a stronger gross margin and operating leverage on SG&A. Adjusted EBITDA1 included a $0.9 million contribution from the Company’s joint venture with Saint-Gobain, compared to $0.5 million in the prior year quarter.

Dividend

The Board of Directors of the Company today declared a quarterly cash dividend of $0.075 per share, representing a 15% increase from the previous dividend payment. The quarterly dividend will be paid on October 31, 2022 to shareholders of record as of the close of business on September 30, 2022.

Balance Sheet & Liquidity

The Company ended the second quarter of 2022 with total liquidity of approximately $270 million, including cash and cash equivalents of $99 million and availability under its committed revolving credit facilities of $170 million. Given the Company’s continued growth in adjusted EBITDA1 and strong cash generation, debt leverage continues to trend lower and now stands at 0.5 times LTM net debt to adjusted EBITDA1, compared to 1.1 times in the prior year quarter.

Based on the Company’s record of strong financial performance, in May 2022 the Company amended its Credit Agreement with its syndicate of banks to remove the cap on restricted payments (including stock buybacks and dividend payouts) pursuant to the Company´s leverage ratio as defined in its Credit Agreement remaining below 1.5x net debt to adjusted EBITDA1.

Full Year 2022 Outlook

Santiago Giraldo, Chief Financial Officer of Tecnoglass, stated, “The momentum in our business continued into the third quarter with single-family residential projects representing a growing share of our revenues and the commercial business continuing to grow sequentially each month through this year. Based on our current invoicing schedule and underlying market demand, we are increasing our full year 2022 outlook for revenues to grow to a range of $620 million to $640 million and for adjusted EBITDA1 to increase to a range of $208 million to $220 million. This implies adjusted EBITDA growth of approximately 42% at the midpoint, putting us firmly on the path to achieve another year of record results in full year 2022.”

Webcast and Conference Call

Management will host a webcast and conference call on August 4, 2022 at 10:00 a.m. Eastern time (9:00 a.m. Bogota, Colombia time) to review the Company’s results. The conference call will be broadcast live over the Internet. Additionally, a slide presentation will accompany the conference call. To listen to the call and view the slides, please visit the Investor Relations section of Tecnoglass' website at www.tecnoglass.com. Please go to the website at least 15 minutes early to register, get and install any necessary audio software. For those unable to access the webcast, the conference call will be accessible by dialing 1-844-943-2944 (domestic) or 1- 973-528-0098 (international). Upon dialing in, please request to join the Tecnoglass Second Quarter 2022 Earnings Conference Call.

If you are unable to listen live, a replay of the webcast will be archived on the website. You may also access the conference call playback by dialing (800)-332-6854 (Domestic) or (973)-528-0005 (International) and entering passcode: 933766.

About Tecnoglass

Tecnoglass Inc. is a leading producer of architectural glass, windows, and associated aluminum products serving the multi-family, single-family and commercial end markets. Tecnoglass is the second largest glass fabricator serving the U.S. and the #1 architectural glass transformation company in Latin America. Located in Barranquilla, Colombia, the Company’s 3.8 million square foot, vertically-integrated and state-of-the-art manufacturing complex provides efficient access to over 1,000 global customers, with the U.S. accounting for more than 90% of revenues. Tecnoglass' tailored, high-end products are found on some of the world's most distinctive properties, including One Thousand Museum (Miami), Paramount (Miami), Salesforce Tower (San Francisco), Via 57 West (NY), Hub50House (Boston), Aeropuerto Internacional El Dorado (Bogotá), One Plaza (Medellín), Pabellon de Cristal (Barranquilla). For more information, please visit www.tecnoglass.com or view our corporate video at https://vimeo.com/134429998.

Forward Looking Statements

This press release includes certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements regarding future financial performance, future growth and future acquisitions. These statements are based on Tecnoglass’ current expectations or beliefs and are subject to uncertainty and changes in circumstances. actual results may vary materially from those expressed or implied by the statements herein due to changes in economic, business, competitive and/or regulatory factors, and other risks and uncertainties affecting the operation of Tecnoglass’ business. These risks, uncertainties and contingencies are indicated from time to time in Tecnoglass’ filings with the Securities and Exchange Commission. The information set forth herein should be read in light of such risks. Further, investors should keep in mind that Tecnoglass’ financial results in any particular period may not be indicative of future results. Tecnoglass is under no obligation to, and expressly disclaims any obligation to, update or alter its forward-looking statements, whether as a result of new information, future events and changes in assumptions or otherwise, except as required by law.

Adjusted net income (loss) and Adjusted EBITDA in both periods are reconciled in the table below.

Investor Relations:

Santiago Giraldo
CFO
305-503-9062
investorrelations@tecnoglass.com

Tecnoglass Inc. and Subsidiaries
Consolidated Balance Sheets
(In thousands, except share and per share data)
(Unaudited)

June 30,

December 31,

2022

2021

ASSETS

Current assets:

Cash and cash equivalents

$

98,620

$

85,011

Investments

2,407

1,977

Trade accounts receivable, net

114,218

110,539

Due from related parties

1,669

2,252

Inventories

111,914

84,975

Contract assets – current portion

16,310

18,667

Other current assets

23,554

22,854

Total current assets

$

368,692

$

326,275

Long-term assets:

Property, plant and equipment, net

$

183,594

$

166,629

Deferred income taxes

2,526

596

Contract assets – non-current

10,588

11,853

Long-term trade accounts receivable

4,279

3,995

Intangible assets

3,029

3,337

Goodwill

23,561

23,561

Long-term investments

55,059

51,160

Other long-term assets

4,282

4,157

Total long-term assets

286,918

265,288

Total assets

$

655,610

$

591,563

LIABILITIES AND SHAREHOLDERS’ EQUITY

Current liabilities:

Short-term debt and current portion of long-term debt

$

591

$

10,700

Trade accounts payable and accrued expenses

89,406

68,087

Due to related parties

4,186

3,857

Dividends payable

3,143

3,141

Contract liability – current portion

58,974

45,213

Other current liabilities

24,379

24,017

Total current liabilities

$

180,679

$

155,015

Long-term liabilities:

Deferred income taxes

$

3,403

$

3,417

Contract liability – non-current

47

78

Long-term debt

184,268

188,355

Total long-term liabilities

187,718

191,850

Total liabilities

$

368,397

$

346,865

SHAREHOLDERS’ EQUITY

Preferred shares, $0.0001 par value, 1,000,000 shares authorized, 0 shares issued and outstanding at June 30, 2022 and December 31, 2021, respectively

$

-

$

-

Ordinary shares, $0.0001 par value, 100,000,000 shares authorized, 47,674,773 and 47,674,773 shares issued and outstanding at June 30, 2022 and December 31, 2021, respectively

5

5

Legal Reserves

1,458

2,273

Additional paid-in capital

219,290

219,290

Retained earnings

139,709

91,045

Accumulated other comprehensive loss

(74,404)

(68,751

)

Shareholders’ equity attributable to controlling interest

286,058

243,862

Shareholders’ equity attributable to non-controlling interest

1,155

836

Total shareholders’ equity

287,213

244,698

Total liabilities and shareholders’ equity

$

655,610

$

591,563

Tecnoglass Inc. and Subsidiaries
Consolidated Statements of Operations and Comprehensive Income
 (In thousands, except share and per share data)
(Unaudited)

 

Three months ended

 

 

Six months ended

 

 

June 30,

 

 

June 30,

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Operating revenues:

External customers

$

168,657

$

121,401

$

302,679

$

232,576

Related parties

467

351

993

731

Total operating revenues

169,124

121,752

303,672

233,307

Cost of sales

95,492

72,622

169,707

138,868

Gross profit

 

 

73,632

 

 

 

49,130

 

 

 

133,965

 

 

 

94,439

 

Operating expenses:

Selling expense

(16,616

)

(12,030

)

(29,984

)

(23,113

)

General and administrative expense

(10,851

)

(8,332

)

(21,126

)

(17,125

)

Other professional fees

(678

)

-

(3,402

)

-

Total operating expenses

(28,145

)

(20,362

)

(54,512

)

)

(40,238

)

Operating income

 

 

45,487

 

 

 

28,768

 

 

79,453

 

 

 

54,201

 

Non-operating income (expenses), net

161

(229

)

503

(70

)

Equity method income

1,669

788

3,249

1,879

Foreign currency transactions gains (loss)

2,503

190

(406

)

145

Gain (loss) on debt extinguishment

-

169

-

(10,978

)

Interest expense and deferred cost of financing

(1,715

)

(2,442

)

(3,183

)

(5,964

)

Income before taxes

48,105

27,244

79,616

39,213

Income tax (provision)

(14,692

)

(7,601

)

(25,250

)

(11,289

)

Net income

 

$

33,413

 

$

19,643

 

$

54,366

 

$

27,924

(Loss) Income attributable to non-controlling interest

(219

)

(51

)

(319

)

(140

)

Income attributable to parent

 

$

33,194

 

$

19,592

 

$

54,047

 

$

27,784

Comprehensive income:

Net income

$

33,413

$

19,643

$

54,366

$

27,924

Foreign currency translation adjustments

(23,621

)

(1,185

)

(9,987

)

(16,819

)

Change in fair value derivative contracts

1,710

-

4,332

(159

)

Total comprehensive income

 

$

11,502

 

$

18,458

 

$

48,711

 

$

10,946

Comprehensive (loss) income attributable to non-controlling interest

(219

)

(51

)

(319

)

(140

)

Total comprehensive income attributable to parent

 

$

11,283

 

$

18,407

 

$

48,392

 

$

10,806

Basic income per share

$

0.70

$

0.41

$

1.14

$

0.59

Diluted income per share

$

0.70

$

0.41

1

$

1.14

$

0.59

Basic weighted average common shares outstanding

47,674,773

47,674,773

47,674,773

47,674,773

Diluted weighted average common shares outstanding

47,674,773

47,674,773

47,674,773

47,674,773

Tecnoglass Inc. and Subsidiaries
Consolidated Statements of Cash Flows
(In thousands)
(Unaudited)

 

Six months ended June 30,

 

 

2022

 

 

2021

 

CASH FLOWS FROM OPERATING ACTIVITIES

Net income

$

54,366

$

27,924

Adjustments to reconcile net income to net cash provided by (used in) operating activities:

Allowance for credit losses

580

748

Depreciation and amortization

10,462

10,515

Deferred income taxes

(1,016

)

424

Equity method income

(3,249

)

(1,879

)

Deferred cost of financing

726

623

Other non-cash adjustments

6

(19

)

Loss on debt extinguishment

-

2,333

Unrealized currency translation losses

911

2,555

Changes in operating assets and liabilities:

Trade accounts receivable

(4,792

)

(6,069

)

Inventories

(31,343

)

(2,082

)

Prepaid expenses

(690

)

(2,015

)

Other assets

1,652

(6,718

)

Trade accounts payable and accrued expenses

16,489

23,375

Accrued interest expense

(1

)

(7,171

)

Taxes payable

2,260

3,389

Labor liabilities

125

(132

)

Other liabilities

(2,047

)

(342

)

Contract assets and liabilities

17,538

14,677

Related parties

1,020

(23

)

CASH PROVIDED BY OPERATING ACTIVITIES

 

$

62,997

 

 

$

60,113

CASH FLOWS FROM INVESTING ACTIVITIES

Proceeds from sale of investments

-

166

Proceeds from sale of property and equipment

-

7

Purchase of investments

(933

)

(49

)

Acquisition of property and equipment

(26,250

)

(18,325

)

CASH USED IN INVESTING ACTIVITIES

$

(27,183

)

 

$

(18,201

)

CASH FLOWS FROM FINANCING ACTIVITIES

Cash dividend

(6,196

)

(2,621

)

Loss on debt extinguishment - call premium

-

(8,610

)

Deferred financing transaction costs

-

(88

)

Proceeds from debt

241

221,146

Repayments of debt

(15,367

)

(216,676

)

CASH USED IN FINANCING ACTIVITIES

$

(21,322

)

 

$

(6,849

)

Effect of exchange rate changes on cash and cash equivalents

$

(883

)

$

(2,334

)

NET INCREASE IN CASH

13,609

32,729

CASH - Beginning of period

85,011

67,668

CASH - End of period

$

98,620

$

100,397

SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION

Cash paid during the period for:

Interest

$

2,387

$

12,286

Income Tax

$

7,552

$

9,471

NON-CASH INVESTING AND FINANCING ACTIVITES:

Assets acquired under debt or supplier credit

$

5,835

$

937

Revenues by Region
(Amounts in thousands)
(Unaudited)

Three months ended

Twelve months ended

June 30,

June 30,

2022

2021

% Change

2022

2021

% Change

Revenues by Region

United States

161,478

109,879

47.0

%

534,103

393,177

35.8

%

Colombia

4,816

8,166

-41.0

%

19,385

31,717

-38.9

%

Other Countries

2,830

3,708

-23.7

%

13,662

14,689

-7.0

%

Total Revenues by Region

169,124

121,752

38.9

%

567,150

439,583

29.0

%

Reconciliation of Non-GAAP Performance Measures to GAAP Performance Measures
(In thousands)
(Unaudited)

The Company believes that total revenues with foreign currency held neutral non-GAAP performance measures, which management uses in managing and evaluating the Company's business, may provide users of the Company's financial information with additional meaningful bases for comparing the Company's current results and results in a prior period, as these measures reflect factors that are unique to one period relative to the comparable period. However, these non‑GAAP performance measures should be viewed in addition to, and not as an alternative for, the Company's reported results under accounting principles generally accepted in the United States.

Three months ended

Twelve months ended

June 30,

June 30,

2022

2021

% Change

2022

2021

% Change

Total Revenues with Foreign Currency Held Neutral

169,417

121,752

39.1

%

568,714

439,583

29.4

%

Impact of changes in foreign currency

(293

)

-

(1,564

)

-

Total Revenues, As Reported

169,124

121,752

38.9

%

567,150

439,583

29.0

%

Currency impacts on total revenues for the current quarter have been derived by translating current quarter revenues at the prevailing average foreign currency rates during the prior year quarter, as applicable.

Reconciliation of Adjusted EBITDA and Adjusted net (loss) income to net (loss) income
(In thousands, except share and per share data)
(Unaudited)

Adjusted EBITDA and adjusted net (loss) income are not measures of financial performance under generally accepted accounting principles (“GAAP”). Management believes Adjusted EBITDA and adjusted net (loss) income, in addition to operating profit, net (loss) income and other GAAP measures, is useful to investors to evaluate the Company’s results because it excludes certain items that are not directly related to the Company’s core operating performance. Investors should recognize that Adjusted EBITDA and adjusted net (loss) income might not be comparable to similarly-titled measures of other companies. These measures should be considered in addition to, and not as a substitute for or superior to, any measure of performance prepared in accordance with GAAP.

Reconciliations of the non-GAAP measures used in this press release are included in the tables attached to this press release, to the extent available without unreasonable effort. Because GAAP financial measures on a forward-looking basis are not accessible, and reconciling information is not available without unreasonable effort, we have not provided reconciliations for forward-looking non-GAAP measures.

A reconciliation of Adjusted net (loss) income and Adjusted EBITDA to the most directly comparable GAAP measure in accordance with SEC Regulation G follows, with amounts in thousands:

 

 

Three months ended

Six months ended

 

 

Jun 30,

Jun 30,

2022

2021

2022

2021

Net (loss) income

 

33,413

19,642

54,366

27,924

Less: Income (loss) attributable to non-controlling interest

(219

)

(51

)

(319

)

(140

)

(Loss) Income attributable to parent

33,194

19,591

54,047

27,784

Foreign currency transactions losses (gains)

(2,503

)

(190

)

406

(145

)

Non Recurring expenses (extinguishment of debt, bond issuance costs, provision for bad debt, acquisition related costs and other)

646

975

1,409

2,258

Non Recurring professional fees

678

-

3,402

-

Extinguishment of debt - Call Option Premium

-

-

-

8,610

Extinguishment of debt - Deferred Costs

-

(169

)

-

2,368

Joint Venture VA (Saint Gobain) adjustments

936

68

972

147

Change in FV of Hedging Derivatives

-

3

-

(182

)

Tax impact of adjustments at statutory rate

73

(206

)

(1,857

)

(3,917

)

Adjusted net (loss) income

33,024

20,072

58,379

36,923

 

 

Basic income (loss) per share

0.70

0.41

1.13

0.58

Diluted income (loss) per share

0.70

0.41

1.13

0.58

Diluted Adjusted net income (loss) per share

0.69

0.42

1.22

0.77

 

Diluted Weighted Average Common Shares Outstanding in thousands

47,675

47,675

47,675

47,675

Basic weighted average common shares outstanding in thousands

47,675

47,675

47,675

47,675

Diluted weighted average common shares outstanding in thousands

47,675

47,675

47,675

47,675

Three months ended

Six months ended

Jun 30,

Jun 30,

2022

2021

2022

2021

Net (loss) income

 

33,413

19,643

54,366

27,924

Less: Income (loss) attributable to non-controlling interest

(219

)

(51

)

(319

)

(140

)

(Loss) Income attributable to parent

 

33,194

19,592

54,047

27,784

Interest expense and deferred cost of financing

1,715

2,442

3,183

5,964

Income tax (benefit) provision

14,692

7,601

25,250

11,289

Depreciation & amortization

5,211

5,218

10,462

10,507

Foreign currency transactions losses (gains)

(2,503

)

(190

)

406

(145

)

Non Recurring expenses (extinguishment of debt, bond issuance costs, provision for bad debt, acquisition related costs and other)

646

975

1,409

2,003

Non Recurring professional fees

678

-

3,402

-

Extinguishment of debt - Call Option Premium

-

-

-

8,610

Extinguishment of debt - Deferred Costs

-

(169

)

-

2,368

Joint Venture VA (Saint Gobain) EBITDA adjustments

936

503

1,761

1,341

Change in FV of Hedging Derivatives

-

3

-

(182

)

Adjusted EBITDA

 

54,569

35,975

99,920

69,539

Wed, 03 Aug 2022 23:44:00 -0500 en-AU text/html https://au.finance.yahoo.com/news/tecnoglass-reports-record-second-quarter-110000671.html
Killexams : Model for Early Detection of Breast Cancer in Low-Resource Areas: The Experience in Peru

Rates of breast cancer are increasing in low- and middle-income countries (LMICs) partly as a result of an epidemiologic shift caused by lifestyle changes, later reproductive age, and longer life expectancy.1 This is the case in Latin America, where breast cancer incidence is on the rise.2 At the same time, there is a clear disparity in breast cancer mortality, particularly in lower-resource areas outside of metropolitan centers, because women are more often diagnosed in later stages of breast cancer when treatment is less likely to be successful.3 In Peru, 57% of women diagnosed with cancer are diagnosed with stage III and IV disease at the national level4,5; these women require more intensive and expensive treatment and have significantly poorer outcomes.

Fortunately, the Peruvian government recognized this serious problem and launched a national program in 2012 that targeted five cancers, including breast cancer, to address cancer prevention, diagnosis, and treatment.6 The program provides these services free of charge to the poorest Peruvians. Cancer treatment is offered by the national cancer hospital, two regional cancer institutes, and major regional hospitals. Leveraging the Peruvian government’s commitment to cancer care, PATH, a nonprofit global health organization, collaborated with local and national health institutions, including the Ministry of Health, the National Cancer Institute of Peru, and the Northern Regional Cancer Institute, to establish a model of care for the early detection of breast cancer in low-resource communities. The WHO defines early detection as having two elements: early diagnosis of people with symptoms and screening of people without apparent symptoms.7 This work describes the process of implementing this model, which is designed to ensure that low-income women in rural areas can access treatment that is now both locally available and financially accessible in Peru. This model of care targets areas of Peru with minimal access to mammography. The cost for a mammogram is prohibitive for most rural and semirural women, and the few available machines are largely located in metropolitan centers. Furthermore, whereas Peru nationally has 55 mammogram machines in public hospitals, only four machines are located in urban areas of the northern region. There are 305,229 women older than age 50 years who live in this region.8 Mammography need far exceeds supply.9 In a setting with such poor access to mammography, clinical breast exams (CBEs) that are integrated into the primary health care infrastructure provide a resource-appropriate screening modality.10

In conjunction with colleagues from the Breast Health Global Initiative (BHGI), and using the BHGI resource-based guidelines as a planning tool, PATH worked with Peruvian partners to develop and pilot targeted screening interventions where they could have the greatest effect. Duggan et al11 describe the theory behind the BHGI resource-based service stratification and use the model developed in Peru to elucidate these concepts.

During its initial phases, the PATH-organized pilot model for early detection focused on a small-town health network in the northern region—an area similar to many communities in Peru.

Over a 6-year period, PATH worked with international experts, Peruvian cancer specialists, and regional partners to develop, pilot, adapt, and validate the comprehensive and resource-appropriate model of care for the early detection of breast cancer in low-resource settings and specifically tailored it to Peru (Fig 1).

Design and Pilot

The model now has five components (Table 1): health education by community health promoters to raise awareness among women about early breast cancer symptoms and the need for breast cancer screening, even without symptoms; CBE by professional midwives in a primary care setting; ultrasound triage for palpable masses detected with CBE; fine-needle aspiration (FNA) biopsy sampling by general physicians and gynecologists at local community hospitals, with referral if positive; and patient navigation to assure that women with a referral to tertiary care receive timely attention.

Table

Table 1 Health Care Levels and Tasks in Early Breast Cancer Detection Model

CBE is a cornerstone of the model of care, but must be complemented with adequate follow-up and the appropriate use of limited specialty health care services. The innovative approach of having general physicians carry out FNA sampling in this setting enables the government to decentralize services and detect breast cancer at earlier stages in more rural and remote areas. FNA is performed at the primary care level, and the specimen is interpreted by a trained cytopathologist at a cancer hospital. It is a model that is suitable for LMICs that can provide adequate diagnostic and cancer treatment services for women who have been identified as being in need of them.

PATH coordinated international teams of stakeholders to develop and validate educational and communication materials for health promoters to use in the community, as well as training curricula and manuals for CBE, ultrasound triage, FNA sampling, and patient navigation trainings. All health services that were offered as part of the care model were delivered by regular government employees paid by the local public health system. The project adapted and finalized checklists and clarified roles and responsibilities for supervision of the program in breast health. A process for changing the national health information system (HIS) to incorporate key breast indicators was also initiated as part of the project. Peru’s HIS remains only partly electronic, with information generated at the lower levels of the health care system still collected manually. PATH project staff worked closely with the Ministry of Health’s statistics teams to pilot modifications to the national HIS that would allow for the tracking of critical indicators in the national HIS.

Adaptation and Validation of the Model of Care

Over the course of 6 years, notable refinements were incorporated into the care model to address challenges related to the limited availability of specialty services, loss to follow-up, and age-appropriate use of screening exams. One refinement was the introduction of ultrasound triage of palpable masses to decrease the number of FNA biopsies required, thereby conserving limited cytopathology resources and reducing unnecessary procedures for women (Fig 2). An algorithm was developed to guide trained gynecologists and general physicians such that women with masses suggestive of cancer that were found on ultrasound triage were sent directly to the regional cancer institute for additional management and final diagnosis. Benign masses were sampled for confirmation, and benign cysts drained with return for follow-up in 1 year (Fig 2).

Another refinement was the training of volunteers in patient navigation. Early in the pilot implementation, midwives noted that women often failed to start treatment once they received a diagnosis. At least two of 10 women who were diagnosed with breast cancer delayed treatment and required intensive follow-up to re-engage them. Common reasons for this delay were fear about the illness and potential abandonment by their spouse. To address this issue, a group of health professionals working in cancer prevention created a patient navigator program to address delays in treatment. This working group included women hospital volunteers, psychologists, social workers, insurance representatives, and former patients with cancer. The training curriculum for patient navigators included the following topics: empowering patients with cancer, effective communication, medical information for breast cancer, health and insurance systems, directory of resources, lifestyle changes, and post-treatment issues.

One particularly appropriate local modification was made to the FNA biopsy–staining process. The head of cytopathology at the national cancer institute recognized that it was more feasible to use hematoxylin instead of toluidine blue to stain samples at regional hospitals when doctors assessed specimen adequacy. Hematoxylin is readily available in the country, whereas toluidine blue must be specially imported into Peru.

Finally, during pilot implementation, the team found that many women who received CBE were younger than age 40 years because breast exams were considered a usual part of reproductive health and prenatal visits. PATH initiated discussions of the issue at the local, regional, and national levels with Peruvian health administration to emphasize the importance of targeting women age 40 to 65 years to decrease the likelihood of detecting benign changes in the breast that occur more frequently in younger women, conserve the time of physicians and midwives, and minimize strain on the newly implemented referral system for FNA and diagnostic procedures. The entire set of educational and training materials for this care model has been reviewed by the Peruvian School for Breast Health for validation and future national implementation.

Pilot

In 2011 and 2012, the initial phase of the pilot took place in one health network. Once the training curriculum and manuals had been developed and approved by the expert advising team, community health promoters and health professionals participated in relevant trainings (Fig 3). Trainers included international experts and Peruvian cancer institute professionals. In total, 48 health promoters, 36 midwives, 19 doctors, and 11 supervisors were trained during this phase of the pilot.

During the pilot implementation period (2011 to 2016), 15,000 women were reached with more than 900 educational sessions. Among the 13,500 women who received CBE, 321 breast abnormalities were found, 114 FNA biopsies were performed, and 10 cancers were identified. Women with cancer then initiated treatment at the regional cancer hospital. After the addition of ultrasound, the need for FNA biopsy was reduced by 65% in the first few months.

As a result of PATH’s analysis of the Peru HIS codes related to breast information, the Ministry of Health incorporated several code changes to capture key variables: first annual CBE, repeat CBE exam, FNA biopsy, and referral. The Ministry of Health has stated that it is considering adapting the existing HIS formats for cancer follow-up, which could unify cancer registry data nationally.

Another important outcome is the implementation of the patient navigation program led by volunteers who successfully steward women through the fragmented and sometimes bewildering process of cancer diagnosis and treatment. Trained navigators empower women to complete treatments and follow-up visits, assist in finding resources, and provide emotional support to women and their families throughout the process. This model has now been replicated in Lima by national cancer institute volunteers. After adapting the training curriculum, volunteers have presented this experience at several conferences and shared lessons that were learned with neighboring Latin American countries (E. Cisneros, personal communication, November 2016).

Perhaps one of the most significant outcomes from the pilot implementation phase was the development of the School for Breast Health in 2013 at Peru’s national cancer institute, in collaboration with PATH, as a center of excellence to focus explicitly on training promoters and health professionals in early breast cancer detection. The School for Breast Health provides national leadership in disseminating training throughout the country and has vetted the model of care that was piloted in the north. It has taken on a supervisory role using the checklists and tools that were developed for implementation. There have already been two examples of the self-seeding of the care model in new geographic areas. In one instance, one of the doctors who was originally trained in the pilot was transferred to a new health network where he continues to apply his knowledge and skills, receiving referrals of women with suspicious breast masses. During a 1.5-year period, this doctor evaluated 75 women, and performed 21 FNA biopsies . In the second case, doctors from the regional cancer institute organized and conducted training on CBE and FNA sampling for six doctors from three nearby health networks. Key elements of the model have been institutionalized at the national level. The Ministry of Health has approved FNA for use in secondary and tertiary health facilities for the early detection and diagnosis of breast cancer.

Frequent turnover of national and regional health administrations and professionals, however, is a common occurrence and can disrupt the continuity of the implementation of the early detection model.

The expansion started in July 2016 and extended services to nine additional health networks in Peru’s northern region. Professionals and community volunteers from 58 primary and secondary level health facilities received training in the five model components for a total of 95 health promoters, 194 professional midwives, eight doctors, and 29 patient navigators trained. Together with PATH, Peruvian experts have continued to refine the procedures, curricula, and manuals as they participate in regional-level trainings.

The local administration of the Ministry of Health in the northern region is an active partner in the expansion phase of the program. It has committed its staff to assist in the coordination of trainings and purchased the ultrasound equipment needed to successfully practice the triage algorithm. The main cancer coordinator for the nine networks uses part of her time to support the implementation of the model by troubleshooting potential roadblocks and managing institutional logistics. There is momentum and motivation to scale the model up in regional networks; midwives, doctors, and health promoters are energized to participate in this model that allows for the early detection of breast cancer for women in their communities. This expansion at the regional level will demonstrate the utility of the care model for the rest of the country. Currently, Peru’s Ministry of Health administrators are eager to see outcomes and subsequently explore implementation options in other regions.

The model for the early detection of breast cancer described here has proven to be effective and is feasible to implement—it is an example of real-life implementation in a low-resource area. With local experts and administrators involved at every step of the process, there is a sense of ownership and a desire to see it sustained and used in more remote rural areas.

Nonetheless, implementation of any new activity faces multiple challenges. Frequent turnover of health administration officials in LMICs creates a difficult environment for the maintenance of stability and sustainability. These changes can result from routine shifts that come with newly elected political parties or power struggles. Peru is no exception to this rule. In the 6 years since the pilot began, there have been five different regional health directors. The head of the national cancer institute has changed twice, and the current Peruvian Minister of Health is the fourth minister to lead the Ministry since the project began. With each of these shifts in power, the priorities and assignment of staff or funding can change. Given this scenario, it is important for international organizations to support capacity building and long-term collaboration.

The lack of databases and unified registries is another serious challenge for innovative programs. In Latin America, there is an overall need to Strengthen cancer surveillance, as well as quality, coverage, and data use.2 Better systems for data collection on the impact of these interventions are urgently needed for appropriate evaluation and adaptation. For example, in the pilot phase, it was difficult to track the number of women who came for CBEs as a result of exposure to health promotion sessions.

In addition, because the HIS is not set up for longitudinal tracking of individual women, it is difficult to assess whether women completed referrals. As noted above, changes to HIS that might aid in the evaluation of programs are complex and slow to be adopted—another key area in need of international support and one that would yield long-term benefits.

There are high levels of motivation and engagement among Peruvian health professionals to implement this comprehensive early breast cancer detection model. Having a dedicated coordinator for the logistical and administrative aspects of an early breast cancer detection program is crucial for sustainability. Fortunately, Peru has strong national champions for cancer.

Despite some challenges, this model is sound and there is local, regional, and national engagement in sustaining and continuing to expand the implementation of the model throughout the country. Similar to breast cancer detection programs that have been carried out in Malaysia and Egypt using CBE, this program model resulted in breast cancer downstaging and is feasible and affordable. Programs in Nepal and Malawi that have incorporated CBE have also proven to be effective.12

In Honduras, accurate opportunistic breast cancer education and screening resulted in increased uptake of services and may result in the earlier detection of breast cancer.13

Given the absence of screening mammography, the public health challenge is to bring breast cancer early detection and diagnostic services closer to women’s homes and to ensure appropriate follow-up and care. The model described here is eminently transferable with appropriate adaptation to specific country conditions, and should now be tested in other settings, within and outside of Peru.

© 2018 by American Society of Clinical Oncology
1. Bray F, Soerjomataram I: The changing global burden of cancer: Transitions in human development and implications for cancer prevention and control in Gelband H, Jha P, Sankaranarayanan R, Horton S (ed): Cancer: Disease Control Priorities (ed 3). Washington, DC, The International Bank for Reconstruction and Development/The World Bank, 2015,pp 2344 CrossrefGoogle Scholar
2. Bray F, Piñeros M: Cancer patterns, trends and projections in Latin America and the Caribbean: A global context. Salud Publica Mex 58:104-117, 2016 Crossref, MedlineGoogle Scholar
3. Ginsburg O, Bray F, Coleman MP, et al: The global burden of women’s cancers: A grand challenge in global health. Lancet 389:847-860, 2017 Crossref, MedlineGoogle Scholar
4. Poquioma Rojas E: Situación del cáncer de mama en el Peru. Presented at Instituto Nacional de Enfermedades Neoplasicas, Departamento de Epidemiologia y Estadística, Lima, Peru, December 5, 2011 Google Scholar
5. Instituto Nacional de Enfermedades Neoplasicas: Servicio de epidemiologia y estadistica. http://www.irennorte.gob.pe/epidemiologia-y-estadistica.php Google Scholar
6. Peru Ministerio de Salud: Plan Esperanza. http://www.minsa.gob.pe/portada/Especiales/2012/esperanza/ Google Scholar
7. World Health Organization: Guide to early cancer diagnosis.http://www.who.int/cancer/publications/cancer_early_diagnosis/en/ Google Scholar
8. Instituto Nacional de Estadistica e Informatica: Poblacion y vivienda. https://www.inei.gob.pe/estadisticas/indice-tematico/poblacion-y-vivienda/ Google Scholar
9. Peru Ministerio de Salud: Análisis de la situación del cancer en el Perú 2013. http://www.dge.gob.pe/portal/docs/asis_cancer.pdf Google Scholar
10. Schulman L, Willett W, Sievers A, et al: Breast cancer in developing countries: Opportunities for improved survival. J Oncol 2010:595167, 2010 MedlineGoogle Scholar
11. Duggan C, Dvaladze A, Tsu VD, et al: Resource-stratified implementation of a community-based breast cancer management program in Peru. Lancet Oncol 18:e607-e617, 2017 Crossref, MedlineGoogle Scholar
12. Gutnik LA, Matanje-Mwagomba B, Msosa V, et al: Breast cancer screening in low- and middle-income countries: A perspective from Malawi. J Glob Oncol 2:4-8, 2015 LinkGoogle Scholar
13. Kennedy LS, Bejarano SA, Onega TL, et al: Opportunistic breast cancer education and screening in rural Honduras. J Glob Oncol 2:174-180, 2016 LinkGoogle Scholar
Thu, 25 Jan 2018 22:00:00 -0600 en text/html https://ascopubs.org/doi/full/10.1200/JGO.17.00006
Killexams : Short Term Modulation of Trunk Neuromuscular Responses Following Spinal Manipulation

Methods

Participant

Sixty participants (26 men and 34 women) with low back pain were included in this study and randomly assigned to either the experimental or the control group. To be included in study, participants had to be diagnosed with non-specific low back pain (mechanical origin). Participants were excluded if they presented with any of the following conditions: inflammatory rheumatic disease, infectious disease, neuromuscular disease, vascular disease, connective tissue disease, severe disabling pain, morbid obesity, neurologic signs and symptoms and pregnancy. All participants gave their written informed consent. Ethical approval for the study was granted by the Université du Québec à Trois-Rivières ethics committee (Ref. No. CER-10–156–06.07). Prior to the experimentation, each participant underwent a brief clinical evaluation to confirm their clinical status (non-specific low back pain) and to determine the presence of any contraindication to spinal manipulative therapy (if so the participant was excluded). They then completed the following questionnaires: the modified Oswestry disability index questionnaire (ODI), the fear avoidance belief questionnaire (FABQ), and visual analog pain scale (VAS: 100 mm from no pain to worst possible pain). Using a VAS score (100 mm from no pain to worst possible pain), pain was also assessed after each set of 5 flexion-extension movements. Baseline characteristics of participants are presented in Table 1.

Procedures

Trunk Flexion-Extension Tasks The trunk flexion-extension task consisted of four movement phases: 1) The subject stands still for 3 s (Quiet standing); 2) The subject bends forward over 5 s to reach a fully-flexed position (Flexion); 3) The fully-flexed position is held for 3 s (Full flexion); and 4) Trunk extension enables the subject to return to the initial upright position over 5 s (Extension). Movement was paced using an auditory metronome and verbal instructions were given to standardize the task. Five successive flexion-extension movements were performed by each participant before and immediately after a spinal manipulation (or control mobilization) applied to the middle lumbar segment.

The participants from the experimental group (n=30; 16 men and 14 women) were asked to lie down on the chiropractic table on their left side. Their trunk was slightly rotated to the right, with arms crossed over the chest. The left lower limb was extended, whereas the right leg and thigh were flexed at a 90° angle. An experienced clinician (20 years of practice as a chiropractor), blinded to the study objectives and experimental conditions, faced the participants at approximately 45°, stabilizing the subjects' right leg between the thighs and the trunk with his right hand. The chiropractor's fingers (left hand) made contact with the lateral margin of the L3 spinous process, and an impulse thrust with a lateral to medial vector was applied to the vertebral segment. This procedure has been described as a lumbar spinous pull by Peterson and Bergman.[19] The procedure as well as the targeted spinal segment (L3) were chosen mainly for technical purposes, namely to avoid any displacement of data acquisition instrumentation. Participants from the control group (n = 30; 18 men and 12 women) were positioned in a same left-side–lying posture, with the superior knee flexed and the trunk slightly rotated for 5 seconds. No spinal manipulation, however, was given. Subsequently, two sets of flexion-extension movements were performed 5 and 30 minutes after the manipulation.

Measurements

Electromyography Surface electromyography (sEMG) data were collected using bipolar electrodes applied bilaterally over the lumbar erector spinae muscles at the L2-L3 level and at the L4-L5 level (~3 cm from the midline). A ground electrode was placed over the left anterior superior iliac spine. Usual measures were taken to Strengthen skin impedance: excessive hair shaving, slight skin abrading with sandpaper and cleaning of skin with alcohol. EMG activity was recorded using a Delsys EMG sensor (Model DE2.1, Delsys Inc., Boston, MA, USA) with a common mode rejection ratio of 92 dB at 60 Hz, an input impedance of 1015 Ω, and analog to digital converted at 1000 Hz with a 12-bit A/D converter (PCI 6024E, National Instruments, Austin, TX, USA). EMG data were filtered digitally by a 10 to 450 Hz bandpass, zero-lag and fourth-order Butterworth filter. Data were collected by Labview (National Instruments, Austin, TX, USA) and processed by Matlab (MathWorks, Natick, MA, USA).

The root mean square (RMS) of the sEMG signals was calculated for each of the four phases of the flexion-extension task. RMS values were normalized using the RMS value in the extension phase of the first pre-intervention trial.[20] Left and right normalized EMG values were compared using Student's t-tests. Since no difference was observed (p>0.05), left and right EMG data were averaged for each segment (L2-L3 and L4-L5).[20,21] The experimental setup is presented in Figure 1.

Figure 1.

Representation of the experimental setup, including 8 infrared LEDs and EMG electrodes at L2 and L5 (erector spinae).

Kinematics Kinematics data were collected by a motion analysis system (OptotrakCertus, Northern Digital Inc., Waterloo, ON, Canada). Light-emitting diodes (LED) were positioned on the right side and back of the participant on 8 anatomical landmarks: (a) external malleolus; (b) Gerdy's tubercle; (c) lateral condyle of the femur; (d) greater trochanter; (e) anterior superior iliac spine (ASIS); (f) posterior superior iliac spine (PSIS); (g) L1; (h) T11. Data were sampled at 100 Hz and low-pass filtered by a dual-pass, fourth-order Butterworth filter with a cutoff frequency at 5 Hz.

Raw kinematic data were transformed into angles to evaluate the movement of the hip and the lumbar regions. Each angle was created by two converging vectors, each of them resulting from a line drawn between two LEDs. The hip angle was formed from the pelvic plateau vector (ASIS - PSIS) and the thigh vector (lateral condyle of the femur - greater trochanter). The lumbar angle resulted from the combination of the dorsal vector (T11 - L1) and the pelvic plateau vector (ASIS - PSIS). The lumbar and hip angles served to calculate the lumbar to hip (L/H) ratio which reports the specific contribution of both lumbar region and hip articulation to the movement. Total trunk flexion and extension angles were both divided in quartiles (Q1-Q4) for which the L/H ratio was computed.[20–22] The experimental setup is presented in Figure 1.

Statistical Analyses

Normality of distribution for every dependent variable was assessed with the Kolmogorov-Smirnov test and through visual inspection of data. All data were analysed according to a pre-established experimental design using Statistica software version 10 (StatSoft, Tulsa, OK, USA). One-way ANOVA was performed. T-tests for dependent samples were conducted for baseline values of continuous variables. Two-way (Group X Time) repeated-measures analyses of variance (ANOVAs) were conducted for each dependent variable (EMG, kinematics and pain). Since baseline analyses revealed a significant difference in baseline VAS scores, data were also analyzed using ANCOVAs, where group and time intervals represented the main factors and VAS scores the continuous predictor. Finally, whenever ANOVAs yielded a significant time effect for the VAS scores, polynomial contrasts were conducted to test for the linear trend. Statistical significance for all analyses was set at p < 0.05 (2-tailed).

Wed, 29 Jun 2022 12:00:00 -0500 en text/html https://www.medscape.com/viewarticle/803217_3
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