Abstract P6-16-04: A self-administered geriatric assessment tool for Spanish-speaking older women with breast cancer

Background: Almost a quarter of older adults in the United States will identify themselves as Hispanic/Latino by 2060. Our group has previously developed and validated a self-administered geriatric assessment tool which can be used to identify functional, psychological, social and cognitive impairments among older patients with various types of cancer. Among English-speaking older adults, completing this tool using paper/pencil or a tablet takes a median of 15-21 minutes (min), with < 10% needing assistance to answer it (Hurria, JOP 2016). However, the utilization of this tool among Spanish-speaking older adults has not been tested. We assessed the feasibility of administering a translated and validated Spanish version of our geriatric assessment tool for older Hispanic women with breast cancer, and identified their preferred format (tablet or paper/pencil).

Methods: Spanish-speaking women aged ≥ 65 years with a diagnosis of breast cancer completed the geriatric assessment twice on the same day. Patients were randomized into 3 groups: paper/pencil twice; tablet and paper/pencil in random order; and tablet twice. We assessed the proportion of patients requiring assistance to complete the geriatric assessment, the time needed to complete it, and the proportion of patients who thought the geriatric assessment was difficult/very difficult.

Results: 140 older women with breast cancer completed the geriatric assessment twice and were evaluable. Mean age was 71.6 years (SD 5.8), 53% had ≤ 8th grade education, 43% were married, 45% were retired, 32% were homemakers, and 6% were employed. The participants came from 13 different Spanish-speaking countries, although 70% were born in Mexico. For 90%, Spanish was their primary language, and 75% spoke only in Spanish at home. Regarding computer skills, 64% of the patients said they had none. 39% (n = 54) were unable to complete the geriatric assessment on their own; mean time to complete the geriatric assessment was 29 min (range 8-90); and 28% (n = 39) thought the geriatric assessment was difficult/very difficult. The most common reasons for needing assistance were difficulty understanding questions (39%) and visual problems (31%). Patients with ≤ 8th grade education took longer to complete the geriatric assessment (mean 37.2 vs 29.4 min, p < 0.01), and more often needed help completing the assessment (51% vs 19%, p < 0.01) than those with ≥9th grade education. 53% of the participants preferred using a tablet to answer the geriatric assessment, while 47% preferred paper/pencil.

Conclusions: A substantial proportion of Spanish-speaking older women with breast cancer required assistance to complete our self-administered geriatric assessment tool. This may be a consequence of the low educational level we found among this patient population. Tailoring assessments for diverse populations with particular attention to educational level is needed in multicultural settings.

Citation Format: Soto-Perez-de-Celis E, Vazquez J, Kim H, Sun C-L, Somlo G, Yuan Y, Waisman JR, Mortimer JE, Kruper L, Taylor L, Patel NH, Moreno J, Charles K, Roberts E, Uranga C, Levi A, Katheria V, Paredero-Perez I, Mitani D, Hurria A. A self-administered geriatric assessment tool for Spanish-speaking older women with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-04.

Current concepts and recent advances in understanding and managing lumbar spine stenosis

Lumbar spinal stenosis is a degenerative process that is extremely frequent in today’s aging population. It can result in impingement on the nerves of the cauda equina or on the thecal sac itself, and lead to debilitating symptoms such as severe leg pain, or restriction in the perimeter of ambulation, both resulting in dependency in daily activities. The impact of the disease is global and includes financial repercussions because of its involvement in the active work force group. Risk factors for the disease include some comorbidities such as obesity or smoking, daily habits such as an active lifestyle, but also genetic factors that are not completely elucidated yet. The diagnosis of lumbar stenosis can be difficult, and involves a combination of radiological and clinical findings. Treatment ranges from conservative measures with physical therapy and core strengthening, to steroid injections in the facet joints or epidural space, to a more radical solution with surgical decompression. The evidence available in the literature regarding the causes, diagnosis and treatment of lumbar spine stenosis can be confusing, as no level I recommendations can be provided yet based on current data. The aim of this manuscript is to provide a comprehensive and updated summary to the reader addressing the multiple aspects of this disease.

A methodology for the digital reconstruction of an interferogram, a schlieren image, or a shadowgram from a single digital holographic recording

This study presents an optical assembly and digital reconstruction method that is based on digital holography for characterizing transparent objects. The image-plane optical setup is based on a versatile Mach-Zehnder interferometer for the formation of controlled parallel fringe patterns, of tens micrometers of separations or less. The numerical reconstruction of the propagated wavefront by the hologram is performed by the Fresnel-Kirchhoff transform, and it is used of three ways: (a) interferometric phase reconstruction (as in interferometry) in the phase object position, (b) reconstruction of the wavefront amplitude at a determined distance from the object (shadowgraph technique), and (c) a composed digital reconstruction process of the wavefront amplitude, defined by a digital optical assembly for the selection of angular deflections produced by the phase object (schlieren technique). The resolving power of holographic reconstruction methodology proposed is determined by the sensitivity of hologram for detecting the interferometric phase. The fringe pattern of the hologram defines a minimum phase shift resolution of 0.15π rad. The scope of the technique is experimentally tested for a steady-state phase object.

Gender Differences in Use of Prolonged Nonoperative Therapies Before Index Lumbar Surgery

OBJECTIVE

The purpose of the present study was to assess for gender-based differences in the usage and cost of maximal nonoperative therapy before spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis.

METHODS

A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures from 2007 to 2016. This database consists of 20.9 million covered lives and includes private or commercially insured and Medicare Advantage beneficiaries. Only patients continuously active within the Humana insurance system for ≥5 years before the index operation were eligible. Usage was characterized by the cost billed to the patient, prescriptions written, and number of units billed.

RESULTS

A total of 4133 patients (58.5% women) underwent 1-, 2-, or 3-level posterior lumbar instrumented fusion. A significantly greater percentage of female patients used nonsteroidal anti-inflammatory drugs (P < 0.0001), lumbar epidural steroid injections (P = 0.0044), physical and/or occupational therapy (P < 0.0001), and muscle relaxants (P < 0.0001). The total direct cost associated with all maximal nonoperative therapy before index spinal fusion was $9,000,968, with men spending $3,451,479 ($2011.35 per patient) and women spending $5,549,489 ($2296.02 per patient). When considering the quantity of units billed, women used 61.5% of the medical therapy units disbursed despite constituting 58.5% of the cohort. When normalized by the number of pills billed per patient using therapy, female patients used more nonsteroidal anti-inflammatory drugs, opioids, and muscle relaxants.

CONCLUSIONS

These results suggest that gender differences exist in the use of nonoperative therapies for symptomatic lumbar stenosis or spondylolisthesis before fusion surgery.

Asymptomatic carriers of Leishmania infantum in patients infected with human immunodeficiency virus (HIV) in Morocco

In Morocco, visceral leishmaniasis (VL) is a parasitic disease caused by the flagellated protozoan parasite Leishmania infantum. L. infantum is transmitted by the bite of female phlebotomine sandflies, and its main reservoir hosts are domestic dogs. Asymptomatic infection with L. infantum is more frequent than clinically apparent disease. In HIV-infected patients, the risk of clinical VL is increased due to immunosuppression that may reactivate latent infections. However, coinfected subjects do not necessarily develop VL and may remain as asymptomatic carriers depending on their immune status. The present study investigates the asymptomatic carriers of L. infantum in HIV-infected patients in central Morocco, where human cases of visceral leishmaniasis by L. infantum have been reported. A total of 200 HIV-infected patients attending the Infectious Diseases Unit of the Ibn Zohar Hospital of Marrakech participated in the study. Parasitological and serological blood analyses included a direct microscopic examination (DME), culture in Novy-McNeal-Nicolle (NNN) medium, and serology by indirect immunofluorescence (IFI). We found prevalence rates of 5% (10/200) by IFI, 3% (6/200) by DME, and 2.5% (5/200) by culture. The parasite was identified as L. infantum by PCR from positive cultures.

Abstract P5-16-03: Global Cancer Institute online breast tumor boards: A tool to facilitate multidisciplinary discussions in resource-limited settings

Background: Multidisciplinary tumor boards (MTBs) are commonly practiced among specialists in high-income countries (HICs) to ensure evidence-based, concordant decisions for patient treatment. MTBs have also been shown to improve patient outcomes and quality of life. Cancer specialists in low-and middle-income countries (LMICs) have limited time and few opportunities to discuss breast cancer patient care with colleagues. The Global Cancer Institute (GCI) established online MTBs in 2012 to facilitate live telemedicine discussions of breast cancer case scenarios between specialists in LMICs and expert specialists in HICs. GCI MTBs aim to improve clinical knowledge and patterns of practice among specialists in LMICs with a low-cost, interactive, and educational tool.

Methods: In each monthly, hour-long MTB, three de-identified breast patient case scenarios are presented in English by specialists in LMICs for live discussion with a multidisciplinary expert panel of breast specialists based in the US. Discussions are held for each case scenario and provide an overview of evidence-based treatment, international and resource-stratified clinical guidelines, clinical trials, and best clinical practices for limited resource settings. After each MTB, links to clinical practice guidelines, clinical trials, and other resources are shared with MTB attendees. For educational purposes, each MTB is privately live-streamed online and uploaded to a private YouTube channel for viewing by cancer specialists and trainees worldwide.

Results: The GCI MTB program has interacted with over 500 participants from 44 hospitals in 25 LMIC countries across Latin America (LA), Eastern Europe, Africa, and Asia. 17 expert breast cancer specialists from 10 US cancer centers provide multidisciplinary guidance for each case.

To date, 142 breast cancer case scenarios have been presented. For breast MTBs, 83% of case scenarios were invasive ductal carcinomas. Common subtypes presented were ER/PR+ (62%), HER2+ (31%), and triple negative disease (29%). 60 cases (43%) involved management of advanced disease in resource-limited settings.

Conclusions: GCI MTBs are a low-cost educational tool for specialists in LMICs to improve patterns of clinical practice and engage in multidisciplinary discussions with colleagues. GCI continues to expand its MTB among cancer facilities in LMICs worldwide. GCI will pilot the implementation of a LA-based online MTB conducted in Spanish for wider participation of community and rural/remote breast cancer specialists in the region.

Citation Format: St. Louis J, Espalter MC, Moreno J, Hambardzumyan V, Goss PE. Global Cancer Institute online breast tumor boards: A tool to facilitate multidisciplinary discussions in resource-limited settings [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-16-03.

Connectivity pattern modifies excited state relaxation dynamics of fluorophore-photoswitch molecular dyads

In order to modulate the emission of BODIPY fluorophores, they were connected to a diarylethene (DAE) photoswitch via phenylene-ethynylene linkers of different lengths and orientations. The latter allowed for modulation of the electronic coupling in the prepared four BODIPY-DAE dyads, which were compared also to appropriate BODIPY and DAE model compounds by steady state as well as time-resolved spectroscopies. In their open isomers, all dyads show comparable luminescence behavior indicative of an unperturbed BODIPY fluorophore. In strong contrast, in the closed isomers the BODIPY emission is efficiently quenched but the deactivation mechanism depends on the nature of the linker. The most promising dyad was rendered water-soluble by means of micellar encapsulation and aqueous suspensions were investigated by fluorescence spectroscopy and microscopy. Our results (i) illustrate that the electronic communication between the BODIPY and DAE units can indeed be fine-tuned by the nature of the linker to achieve fluorescence modulation while maintaining photoswitchability and (ii) highlight potential applications to image and control biological processes with high spatio-temporal resolution.

Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis

OBJECTIVE

Interdisciplinary management of elderly patients requiring spine surgery has been shown to improve short- and long-term outcomes. The aim of this study was to determine whether an interdisciplinary team approach mitigates use of intensive care unit (ICU) resources.

METHODS

A unique comanagement model for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Peri-operative Optimization of Senior Health Program (POSH) was launched with the aim of improving outcomes in elderly patients (>65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, comanages daily throughout hospital course, and coordinates multidisciplinary rehabilitation, along with the neurosurgical team. We retrospectively reviewed the first 100 cases after the initiation of the POSH protocol and compared them with the immediately preceding 25 cases to assess the rates of ICU transfer and independent predictors of ICU admission.

RESULTS

A total of 125 patients undergoing lumbar decompression and fusion surgery were enrolled in this pilot program. Baseline characteristics and intraoperative variables, as well as number of fusion levels and duration of surgery, were similar between both cohorts. There was a significant difference in the use of ICU services (ICU admission rates) between both cohorts, with the non-POSH cohort having a 3-fold increase compared with the POSH cohort (P < 0.0001). In a multivariate analysis, lack of an interdisciplinary comanagement team approach was an independent predictor for ICU transfers in elderly patients undergoing corrective surgery (odds ratio 8.51, 95% confidence interval 2.972-24.37, P < 0.0001).

CONCLUSIONS

Our study suggests that an interdisciplinary comanagement model between geriatrics and neurosurgery is independently associated with reduced use of critical care services.

Laboratorio, morfología y fisiología vegetal

Las plantas, al igual que los animales, son organismos dinámicos que cumplen con una serie de procesos metabólicos que les permiten mantener un cuerpo organizado el cual crece, se reproduce, se autorregula y se adapta al ambiente. Desde la aparición del hombre las plantas han estado estrechamente relacionadas con las diferentes actividades que él ha desarrollado.

Acción de una enzima presente en tejidos vegetales y animales

Las enzimas son proteínas específicas que actúan como catalizadores de las reacciones bioquímicas en todos los seres vivos. La actividad enzimática puede comprobarse experimentalmente mediante la identificación y cuatificación de los productos formados en las reacciones que ellas regulan. La acción de estos compuestos proteicos en una reacción es afectada por la variación de factores físicos y químicos tales como la temperatura, la concentración de la enzima y del sustrato, el pH, etc.

Cytokines and chemokines measured in dried SLA-stimulated whole blood spots for asymptomatic Leishmania infantum and Leishmania donovani infection

Whole blood stimulation with soluble Leishmania antigen (SLA), followed by plasma cytokine and chemokine determination, provides means of detecting subjects with asymptomatic Leishmania infection. This work examines the potential of Protein Saver 903 cards for the storage and transport of SLA-stimulated dried plasma spot samples. Blood was collected from asymptomatic and negative control subjects living in a Leishmania infantum- (Spain) and Leishmania donovani-endemic area (Bangladesh). After SLA-stimulation, three types of sample were prepared: frozen liquid plasma (-20 °C), and plasma dropped onto Protein Saver cards kept at -20 °C (DPS-FZ), and at ambient temperature (DPS-AT). The concentrations of IFN-γ, IL-2, CXCL10, CXCL9, CCL2 and CXCL8 in the thawed liquid plasma (TLP), DPS-FZ and DPS-AT samples were then determined. Strong correlations were seen between the TLP and DPS-FZ/AT samples for all the studied cytokines/chemokines in both the L. infantum and L. donovani areas. Protein Saver 903 cards would therefore appear to allow for the transport of SLA-stimulated plasma samples by courier at ambient temperature. The CXCL10 and CXCL9 detectable in these plasma spots provided robust markers for identifying asymptomatic subjects from both endemic areas. This easy procedure opens up new possibilities for field studies in resource-limited settings, which could help in Leishmania control.

CO2 saturated water as two-phase flow for fouling control in reverse electrodialysis

When natural feed waters are used in the operation of a reverse electrodialysis (RED) stack, severe fouling on the ion exchange membranes and spacers occurs. Fouling of the RED stack has a strong influence on the gross power density output; which can decrease up to 50%. Moreover, an increase in the pressure loss occurs between the feed water inlet and outlet, increasing the pumping energy and thus decreasing the net power density that can be obtained. In this work, we extensively investigated the use of CO₂ saturated water as two-phase flow cleaning for fouling mitigation in RED using natural feed waters. Experiments were performed in the REDstack research facility located at the Afsluitdijk (the Netherlands) using natural feed waters for a period of 60 days. Two different gas combinations were experimentally investigated, water/air sparging and water/CO₂ (saturated) injection. Air is an inert gas mixture and induces air sparging in the stack. In the case of CO₂, nucleation, i.e. the spontaneous formation of bubbles, occurs at the spacer filaments due to depressurization of CO₂ saturated water, inducing cleaning. Results showed that stacks equipped with CO₂ saturated water can produce an average net power density of 0.18 W/m² under real fouling conditions with minimal pre-treatment and at a low outside temperature of only 8 °C, whereas the stacks equipped with air sparging could only produce an average net power density of 0.04 W/m². Electrochemical impedance spectroscopy measurements showed that the stacks equipped with air sparging increased in stack resistance due to the presence of stagnant bubbles remaining in the stack after every air injection. Furthermore, the introduction of CO₂ gas in the feed water introduces a pH decrease in the system (carbonated solution) adding an additional cleaning effect in the system, thus avoiding the use of environmentally unwanted cleaning chemicals.