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Vincenzo JL, Caulley J, Scott AJ, Wilson BS, Wingood M, Curran GM. Integrating STEADI for Falls Prevention in Outpatient Rehabilitation Clinics: An Outcomes Evaluation Using the RE-AIM Framework. Gerontologist 2024; 64:gnad117. [PMID: 37638852 PMCID: PMC10943501 DOI: 10.1093/geront/gnad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to describe the implementation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Initiative (2018-2021) for screening and assessing all older adults ≥65 years for falls risk across 34 outpatient rehabilitation clinics within a large health system. RESEARCH DESIGN AND METHODS We described the Implementation process and strategies. Using Electronic Health Records (EHRs), we identified Reach, Adoption, and Maintenance of screenings and physical assessments to identify fall risk among older adults. RESULTS STEADI Implementation strategies included health system mandates, EHR revisions, email instructions, educational sessions and resources, clinical leads and champions, and chart audits. Reach: 76.4% (50,023) had a completed screening, and 44.1% screened at risk for falls. Adoption: Clinic-level adoption varied, with most performing screenings. Profession-level adoption was highest for physical therapists (PTs; 94.2% initiated, 80.6% completed) and lowest for speech-language pathologists (SLPs; 79.8% initiated, 55.9% completed). Reach and Adoption of functional outcomes measures (FOM): PTs completed an FOM on 59.5% of at-risk patients, occupational therapists on 11.6%, and SLPs on 7.9%. Maintenance: All measures declined 1%-10% annually between 2018 and 2021. DISCUSSION AND IMPLICATIONS STEADI screening and FOMs were implemented systemwide in 34 outpatient rehabilitation clinics, reaching over 50,000 older adults. Screening adoption rates varied by clinic. PTs had the highest adoption rate. All adoption rates declined over time. Future research should consider an implementation science approach with input from key partners before implementation to identify barriers and develop strategies to support STEADI in outpatient rehabilitation.
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Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Jamie Caulley
- Rehabilitation Services, Providence St. Joseph Health, Portland, Oregon, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Brian S Wilson
- Rehabilitation Services, Providence St. Joseph Health, Portland, Oregon, USA
| | - Mariana Wingood
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Internal Medicine, Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Geoffrey M Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
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Willis DE, Kaholokula JK, Andersen JA, Selig JP, Bogulski CA, Scott AJ, McElfish PA. Racial Misclassification, Discrimination, Consciousness, and Self-Rated Health Among Native Hawaiian and Pacific Islander Adults in the USA. J Racial Ethn Health Disparities 2024; 11:730-738. [PMID: 36892814 PMCID: PMC9997430 DOI: 10.1007/s40615-023-01556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Medical researchers have historically utilized the variable of race uncritically, rarely defining race, rarely acknowledging it as a social construct, and often omitting information about how it was measured. In this study, we use the following definition of race: "a system of structuring opportunity and assigning value based on the social interpretation of how one looks." We examine the influence of racial misclassification, racial discrimination, and racial consciousness on the self-rated health of Native Hawaiian and Pacific Islanders (NHPI) living in the United States of America (USA). METHODS Our analysis used online survey data from a subgroup of NHPI adults living in the USA (n = 252) who were oversampled as part of a larger study of US adults (N = 2022). Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA. Statistical analyses include weighted and unweighted descriptive statistics for the sample, as well as a weighted logistic regression for poor/fair self-rated health. RESULTS Odds of poor/fair self-rated health were greater for women (OR = 2.72; 95% CI [1.19, 6.21]) and those who experienced racial misclassification (OR = 2.90; 95% CI [1.20, 7.05]). No other sociodemographic, healthcare, or race-related variables were significantly associated with self-rated health in the fully adjusted results. CONCLUSIONS Findings suggest that racial misclassification may be an important correlate of self-rated health among NHPI adults in the US context.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Cari A Bogulski
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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Andersen JA, Scott AJ, Rowland B, Willis DE, McElfish PA. Associations between COVID-19 Death Exposure and COVID-19 Vaccine Hesitancy and Vaccine Uptake. South Med J 2023; 116:519-523. [PMID: 37400094 DOI: 10.14423/smj.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVES The aim of the study was to determine the relation between coronavirus disease 2019 (COVID-19) death exposure and COVID-19 vaccine hesitancy and vaccine uptake among Arkansans, controlling for sociodemographic factors. METHODS Data were collected from a telephone survey administered in Arkansas between July 12 and July 30, 2021 (N = 1500) via random digit dialing of telephone landlines and cellular telephones. Weighted data were used to estimate regressions. RESULTS Controlling for sociodemographic variables, COVID-19 death exposure was not a significant predictor of COVID-19 vaccine hesitancy (P = 0.423) or COVID-19 vaccine uptake (P = 0.318). Younger individuals, those with lower levels of education, and those who live in rural counties were more likely to be COVID-19 vaccine hesitant. Older individuals, Hispanic/Latinx individuals, those who reported higher levels of education, and those who reported living in urban counties were more likely to have reported receiving the COVID-19 vaccine. CONCLUSIONS Many efforts to promote COVID-19 vaccines have focused on prosocial norms, including encouraging vaccination to protect the community from COVID-19 infection and death; however, COVID-19 death exposure was not related to COVID-19 vaccine hesitancy or uptake in the present study. Future research should examine whether prosocial messaging is effective in decreasing hesitancy or motivating some individuals to receive the vaccine among those who have been exposed to COVID-19 deaths.
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Affiliation(s)
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale
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Reece S, CarlLee S, Scott AJ, Willis DE, Rowland B, Larsen K, Holman-Allgood I, McElfish PA. Hesitant adopters: COVID-19 vaccine hesitancy among diverse vaccinated adults in the United States. Infect Med (Beijing) 2023; 2:89-95. [PMID: 38013742 PMCID: PMC10038887 DOI: 10.1016/j.imj.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 07/11/2023]
Abstract
Background Despite the United States (US) having an abundant supply of COVID-19 vaccines, vaccination rates lag behind other high-income countries, suggesting that vaccine hesitancy and attitudes play a greater role in public health measures than pure supply and access. With the acknowledgment that vaccination attitudes and status may or may not be correlated, this study examined COVID-19 vaccine hesitancy among vaccinated US adults by asking: 1) What is the prevalence of COVID-19 vaccine hesitancy among the vaccinated? 2) Does COVID-19 vaccine hesitancy vary across sociodemographic characteristics? 3) Does COVID-19 vaccine hesitancy vary by healthcare access and influenza vaccination over the past 5 years? Methods Data were collected through an online survey of 2022 US adults with a final analytic sample of 1383 vaccinated respondents. Results Overall, 48.8% of vaccinated adults reported some level of hesitancy, while a slight majority reported they were "not at all hesitant". Younger respondents, women, and Black and American Indian or Alaska Native participants had greater adjusted odds of being more hesitant towards receiving the COVID-19 vaccine. Respondents who had a primary care physician had greater adjusted odds than those who did not have a primary care physician of being more hesitant towards receiving the COVID-19 vaccine. Conclusions This is the first population-based national sample study examining COVID-19 vaccine hesitancy among vaccinated individuals from subgroups of distinctive backgrounds in order to inform targeted strategies for reducing vaccine hesitancy. Findings can assist in efforts to increase vaccination rates and also decrease vaccine hesitancy at the national level.
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Affiliation(s)
- Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Kristin Larsen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Ijanae Holman-Allgood
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
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McElfish PA, Selig JP, Scott AJ, Rowland B, Willis DE, Reece S, CarlLee S, Macechko MD, Shah SK. Associations Between General Vaccine Hesitancy and Healthcare Access Among Arkansans. J Gen Intern Med 2023; 38:841-847. [PMID: 36323819 PMCID: PMC9629763 DOI: 10.1007/s11606-022-07859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Vaccines provide protection against numerous diseases that can cause serious illness and death. However, vaccine hesitancy threatens to undermine progress in reducing preventable diseases and illness. Vaccine hesitancy has been shown to vary by sociodemographic characteristics. However, studies examining associations between healthcare access and vaccine hesitancy are lacking. OBJECTIVE Using a statewide random sample of Arkansas adults, we examined the relationship between general vaccine hesitancy and healthcare access. DESIGN From July 12 to 30, 2021, participants were contacted by landlines and cellular phones using random digit dialing. PARTICIPANTS A total of 1500 Arkansas adults were surveyed. Black/African American and Hispanic/Latinx adults were oversampled to ensure adequate representation. The survey had a cooperation rate of 20%. MAIN MEASURES The dependent variable was an ordinal measure of general vaccine hesitancy. Age, gender, race, education, relationship status, and rural/urban residence were included in the model. Healthcare access was measured across four domains: (1) health insurance coverage; (2) having a primary care provider (PCP); (3) forgoing care due to cost; and (4) time since last routine checkup. The relationship between general vaccine hesitancy and healthcare access was modeled using ordinal logistic regression, controlling for sociodemographic characteristics. KEY RESULTS Mean age was 48.5 years, 51.1% were women, 28% reported a race other than White, and 36.3% held a bachelor's degree or higher. Those with a PCP and those with health insurance had approximately two-thirds the odds of being more hesitant ([OR=0.63, CI=0.47, 0.84] and [OR=0.68; CI=0.49, 0.94]) than those without a PCP and those without health insurance. Participants reporting a routine checkup in the last 2 years were almost half as likely to be more hesitant than those reporting a checkup more than 2 years prior (OR=0.58; CI=0.43, 0.79). CONCLUSIONS Results suggest improving access to health insurance, PCPs, and routine preventative care services may be critical to reducing vaccine hesitancy.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Michael D Macechko
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Andersen JA, Purvis RS, Scott AJ, Henske J, Edem D, Selig JP, Hudson J, Bing WI, Niedenthal J, Otuafi H, Riklon S, Anzures E, George A, Alik D, McElfish PA. Lessons learned from the pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands. Contemp Clin Trials Commun 2023; 32:101086. [PMID: 36817737 PMCID: PMC9929673 DOI: 10.1016/j.conctc.2023.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Background The Republic of the Marshall Islands (RMI) has a high rate of type 2 diabetes mellitus (T2DM). To address the high rate of T2DM, we tested a culturally adapted family model of diabetes self-management education and support (F-DSMES). We report the results of the 12-month post-intervention data collection and describe the lessons learned from the delivery of the F-DSMES intervention. Methods Recruitment took place in four churches in Majuro and included 10 h of content delivered over 8-10 weeks. Forty-one participants with T2DM were included. The primary study outcome was glycemic control measured by a change in HbA1c. We also conducted participant interviews to document the participant-reported barriers encountered during the F-DSMES intervention. Results Participants did not show improvements in their biometric markers; however, participants did show improvement on multiple measures of diabetes knowledge and family support. We identified five areas to improve future interventions: 1) issues with recruitment, retention, and attendance; 2) needing help accessing information and additional healthcare provider counseling; 3) struggles with adhering to diet recommendations; 4) difficulty getting exercise, and 5) improving lessons within the intervention. Conclusion Although the biomarker data did not show improvement, valuable information was gained to improve the development of larger-scale trials. The results provide evidence of the need for these trials and the desire of participants to continue pursuing this effort. Others doing similar work in other low-to-middle income countries will need to take into consideration the potential barriers and facilitators within participants' social and physical environments.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Joseph Henske
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Edlen Anzures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA,Corresponding author. College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
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McElfish PA, Rowland B, Scott AJ, Andersen JA, CarlLee S, McKinnon JC, Reece S, Meredith‐Neve SM, Macechko MD, Gurel‐Headley M, Willis DE. Hesitant adopters: An examination of hesitancy among adults in Arkansas who have taken the COVID-19 vaccine. Clin Transl Sci 2022; 15:2316-2322. [PMID: 36004689 PMCID: PMC9538052 DOI: 10.1111/cts.13367] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023] Open
Abstract
Recent research suggests people who report vaccine hesitancy may still get vaccinated; however, little is known about hesitancy among those who chose to vaccinate. The current study focused on individuals who received the coronavirus disease 2019 (COVID-19) vaccine despite their hesitancy, whom we refer to as "hesitant adopters." With the understanding that vaccine attitudes and vaccine behaviors may or may not be correlated, we examined the prevalence of COVID-19 vaccine hesitancy among those who have been vaccinated, how COVID-19 vaccine hesitancy varies across sociodemographic groups, and how COVID-19 vaccine hesitancy relates to other factors (prior health care access and influenza vaccination behavior over the past 5 years). Random digit dialing of telephone landlines and cell phones was used to contact potential survey respondents, rendering a sample of 1500 Arkansan adults. Approximately one-third of those who received a COVID-19 vaccine also reported some level of hesitancy. Among hesitant adopters, 5.3% said they were "very hesitant," 8.8% said they were "somewhat hesitant," and 17.1% said they were "a little hesitant." Black/African American and Hispanic/Latinx respondents reported more hesitancy than White respondents, and female respondents reported greater hesitancy compared to male respondents. Greater hesitancy was associated with non-metro/rural residence, forgoing health care due to cost, and lower influenza vaccination rates over the past 5 years. Findings suggest those who are hesitant may get vaccinated despite their hesitancy, illustrating the complexity of vaccination behaviors. Prevalence of hesitancy among the vaccinated has implications for communication strategies in vaccine outreach programs and may help to reduce stigmatization of hesitant adopters.
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Affiliation(s)
- Pearl A. McElfish
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Brett Rowland
- Office of Community Health and ResearchUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Aaron J. Scott
- Office of Community Health and ResearchUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Jennifer A. Andersen
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sheena CarlLee
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Joshua C. McKinnon
- College of NursingUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sharon Reece
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sandra M. Meredith‐Neve
- Integrated Medicine Service LineUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Michael D. Macechko
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Morgan Gurel‐Headley
- College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
- Fay W. Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Don E. Willis
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
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Scott AJ, Basu Mallick A, Dotan E, Cohen SJ, Gold PJ, Hochster HS, Subramaniam S, Barzi A, Watts GS, Blatchford PJ, Messersmith WA. A Phase II Study Investigating Cabozantinib in Patients with Refractory Metastatic Colorectal Cancer (AGICC 17CRC01). Cancer Research Communications 2022; 2:1188-1196. [PMID: 36969746 PMCID: PMC10035393 DOI: 10.1158/2767-9764.crc-22-0169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/22/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Multi-tyrosine kinase inhibitors have shown clinical activity in metastatic colorectal cancer patients. Cabozantinib, a multi-tyrosine kinase inhibitor, exhibited potent antitumor activity superior to regorafenib in preclinical colorectal cancer patient-derived tumor xenograft models. This Phase II study aimed to investigate cabozantinib, a multityrosine kinase inhibitor, in refractory, metastatic colorectal cancer patients. Patients and Methods: A non-randomized, two-stage, phase 2 clinical trial evaluating 12 week PFS was conducted in 8 cancer centers across the United States between May 2018 and July 2020. Results: A total of 44 patients were enrolled between May 2018-May 2019, 40 of which were response evaluable. Of the total 769 reported adverse events (AE), 93 (12%) were ≥ grade 3. Five Grade 5 AEs were reported of which 4 were unrelated to study drug and 1 was reported as possibly related due to bowel perforation. Eighteen patients (45%) achieved 12-week PFS with stable disease or better (CI 0.29-0.62; p<0.001). One patient (3%) had a partial response, and 27 other patients achieved stable disease as best response per RECISTv1.1. Median PFS was 3.0 months, and median OS was 8.3 months. Of the 18 patients who achieved 12-week PFS, 12 had left-sided primary tumors, 11 were RAS wild type,11 were PIK3CA wild type, and 6 had previous regorafenib therapy. The 12-week PFS rate was higher in RAS wild type tumors compared to RAS mutant tumors (0.61 vs 0.32, p=0.11). Conclusions: This phase 2 study demonstrated clinical activity of cabozantinib in heavily pretreated, refractory mCRC patients, and supports further investigation.
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Affiliation(s)
- Aaron J. Scott
- Banner University of Arizona Cancer Center, Tucson, AZ, United States
| | | | - Efrat Dotan
- Fox Chase Cancer Center, Philadelphia, PA, United States
| | | | | | - Howard S. Hochster
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | | | - Afsaneh Barzi
- City Of Hope National Medical Center, Duarte, CA, United States
| | | | - Patrick J. Blatchford
- University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States
| | - Wells A. Messersmith
- University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States
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Abstract
As of May 17, 2022, more than a million deaths due to COVID-19 have been recorded in the US. For each COVID-19 death, there are an estimated nine bereaved family members and an unknown number of bereaved friends. This study aimed to assess the correlates of self-reported COVID-19 death exposure (i.e., loss of a close friend or family member) among US adults using online survey data (n = 1,869) collected between September 17, 2021 and October 3, 2021. One in four US adults in this national sample reported the loss of a close friend or family member due to COVID-19. The odds of losing a close friend or family member due to COVID-19 death were greater for those age 60 or older, all minoritized racial/ethnic groups except for Asian American respondents, married/coupled respondents, those who had foregone care due to cost in the past year, and those who reported a COVID-19 infection.
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Affiliation(s)
- Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Shashank S. Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Scott AJ, Sharman R, Shroff RT. Precision Medicine in Biliary Tract Cancer. J Clin Oncol 2022; 40:2716-2734. [PMID: 35839428 DOI: 10.1200/jco.21.02576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Precision medicine has become a dominant theme in the treatment of biliary tract cancers (BTCs). Although prognosis remains poor, technologies for improved molecular characterization along with the US Food and Drug Administration approval of several targeted therapies have changed the therapeutic landscape of advanced BTC. The hallmark of BTC oncogenesis is chronic inflammation of the liver and biliary tract regardless of the anatomical subtype. Subtypes of BTC correspond to distinct molecular characteristics, making BTC a molecularly heterogenous collection of tumors. Collectively, up to 40% of BTCs harbor a potentially targetable molecular abnormality, and the National Comprehensive Cancer Network guidelines recommend molecular profiling for all patients with advanced BTC. Use of circulating tumor DNA, immunohistochemistry, and next-generation sequencing continues to expand the utility for biomarker-driven management and molecular monitoring of BTC. Improving outcomes using biomarker-agnostic treatment for nontargetable tumors also remains a priority, and combinational treatment strategies such as immune checkpoint inhibition plus chemotherapy hold promise for this subgroup of patients.
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Affiliation(s)
- Aaron J Scott
- Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, AZ
| | - Reya Sharman
- Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, AZ
| | - Rachna T Shroff
- Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, AZ
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McElfish PA, Rowland B, Scott AJ, Niemeier J, Hoose DV, Long CR. Sugar-sweetened beverage consumption is associated with higher body mass index among Marshallese adults in Arkansas. Journal of Hunger & Environmental Nutrition 2022. [DOI: 10.1080/19320248.2021.1915907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Jill Niemeier
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Dalton V. Hoose
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, Arkansas USA
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12
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Willis DE, Andersen JA, Montgomery BEE, Selig JP, Shah SK, Zaller N, Bryant-Moore K, Scott AJ, Williams M, McElfish PA. COVID-19 Vaccine Hesitancy and Experiences of Discrimination Among Black Adults. J Racial Ethn Health Disparities 2022; 10:1025-1034. [PMID: 35391714 PMCID: PMC8989097 DOI: 10.1007/s40615-022-01290-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 01/12/2023]
Abstract
Early in the COVID-19 vaccine rollout, Black adults consistently reported more hesitancy than White adults, but few studies have examined variation in hesitancy among Black adults or its associations with racial discrimination. Data were collected from Black Arkansas residents age 18 and older (n = 350) between July 12th and July 30th, 2021, as part of a larger survey of Arkansans (N = 1500). Participants were recruited through random digit dialing of both landline and cell phones, with oversampling of Black and Hispanic residents. Respondents reported COVID-19 vaccine hesitancy, sociodemographic information, influenza vaccination history, pandemic-related experiences, and experiences of racial discrimination. Almost half (48.9%) of Black adults in Arkansas were not hesitant towards COVID-19 vaccines, while the remainder reported some level of hesitancy. Nearly a quarter were very hesitant (22.4%), while fewer reported being somewhat (14.0%) and a little (14.7%) hesitant. Using an ordered logistic regression with partial proportional odds, we find odds of COVID-19 vaccine hesitancy decreased as age and influenza vaccination increased. Odds of COVID-19 vaccine hesitancy were 1.70 times greater for Black adults who experienced the death of a close friend/family member due to COVID-19 and 2.61 times greater for individuals reporting discrimination with police or in the courts. Within-group analysis revealed nearly half of Black adults did not report any COVID-19 vaccine hesitancy and heterogeneity among those who were hesitant. Findings suggest there may be an important link between racial discrimination in the criminal justice system and COVID-19 vaccine hesitancy among Black adults.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Brooke E E Montgomery
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Nickolas Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Keneshia Bryant-Moore
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA.
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13
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McElfish PA, Rowland B, Scott AJ, Boyers J, Long CR, Felix HC, Kaholokula JK, Sinclair K, Bursac Z, Riklon S. Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults. J Immigr Minor Health 2022; 24:461-468. [PMID: 33837895 PMCID: PMC9540904 DOI: 10.1007/s10903-021-01194-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 01/26/2023]
Abstract
This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Janine Boyers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii At Manoa, Honolulu, HI, 96813, USA
| | - Ka'imi Sinclair
- Institute for Research and Education To Advance Community Health, College of Nursing, Washington State University, Seattle, WA, 98101, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL, 33199, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
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14
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Durando ML, Menghani SV, Baumann JL, Robles DG, Day TA, Vaziri C, Scott AJ. Four-Year Disease-Free Remission in a Patient With POLE Mutation-Associated Colorectal Cancer Treated Using Anti-PD-1 Therapy. J Natl Compr Canc Netw 2022; 20:218-223. [PMID: 35276675 DOI: 10.6004/jnccn.2021.7115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022]
Abstract
The stability of the human genome depends upon a delicate balance between replication by high- and low-fidelity DNA polymerases. Aberrant replication by error-prone polymerases or loss of function of high-fidelity polymerases predisposes to genetic instability and, in turn, cancer. DNA polymerase epsilon (Pol ε) is a high-fidelity, processive polymerase that is responsible for the majority of leading strand synthesis, and mutations in Pol ε have been increasingly associated with various human malignancies. The clinical significance of Pol ε mutations, including how and whether they should influence management decisions, remains poorly understood. In this report, we describe a 24-year-old man with an aggressive stage IV high-grade, poorly differentiated colon carcinoma who experienced a dramatic response to single-agent checkpoint inhibitor immunotherapy after rapidly progressing on standard chemotherapy. His response was complete and durable and has been maintained for more than 48 months. Genetic testing revealed a P286R mutation in the endonuclease domain of POLE and an elevated tumor mutational burden of 126 mutations per megabase, both of which have been previously associated with response to immunotherapy. Interestingly, tumor staining for PD-L1 was negative. This case study highlights the importance of genetic profiling of both early and late-stage cancers, the clinical significance of POLE mutations, and how the interplay between genetic instability and immune-checkpoint blockade can impact clinical decision-making.
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Affiliation(s)
- Michael L Durando
- 1Banner-University Medical Center Tucson, Tucson, Arizona.,2Division of Hematology and Oncology, Department of Medicine.,3University of Arizona Cancer Center
| | | | - Jessica L Baumann
- 5Department of Pathology, University of Arizona College of Medicine-Tucson, Tucson, Arizona.,6Now with Roche Tissue Diagnostics, Tucson, Arizona
| | - Danny G Robles
- 1Banner-University Medical Center Tucson, Tucson, Arizona.,7Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | - Tovah A Day
- 8Department of Biology, Northeastern University, Boston, Massachusetts; and
| | - Cyrus Vaziri
- 9Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Aaron J Scott
- 1Banner-University Medical Center Tucson, Tucson, Arizona.,2Division of Hematology and Oncology, Department of Medicine.,3University of Arizona Cancer Center
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15
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Scott AJ, Drevin G, Pavlović L, Nilsson M, Krige JEJ, Jonas E. Mentorship during undergraduate surgical training: comparing perceptions of medical students and faculty at two institutions in South Africa and Sweden. S AFR J SURG 2021; 59:183-190. [PMID: 34889544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Having a mentor during undergraduate surgical training has been shown to positively influence medical students by increasing interest in surgery, improving confidence, and assisting in career planning. This study aimed to evaluate and compare medical student and faculty perceptions of mentorship during undergraduate surgical training and compare results between two teaching institutions in South Africa and Sweden. METHODS An electronic, online questionnaire was anonymously distributed to medical students and general surgical faculty at the University of Cape Town (UCT), South Africa, and Karolinska Institutet (KI), Stockholm, Sweden. The questionnaire consisted of multiple choice, true or false, and five-point Likert scale questions, exploring perceptions of mentorship and role models, as well as rating the most important mentor characteristics. RESULTS Approximately one third (34.2%) of students stated they had a mentor during their surgical training, with significant differences found between student cohorts (p < 0.001). The 'registrar' was most commonly reported as the best role model for medical students by faculty from both UCT (50.0%) and KI (69.4%), as well as UCT students (36.6%). Students rated the following mentor qualities significantly higher compared to faculty: student encouragement (p = 0.037), adequate supervision (p = 0.007), setting of fair expectations (p = 0.002), and teaching skills (p = 0.010). CONCLUSION With significant differences existing in the perceptions of medical students and faculty regarding mentorship and role models during undergraduate surgical training in both South African and Swedish institutions, reconciling and harmonising these differences will be crucial in fostering constructive mentoring relationships.
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Affiliation(s)
| | | | - L Pavlović
- Department of Medicine, Karolinska Institutet, Sweden
| | - M Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden
| | - J E J Krige
- Surgical Gastroenterology Unit, Division of General Surgery, University of Cape Town, South Africa
| | - E Jonas
- Surgical Gastroenterology Unit, Division of General Surgery, University of Cape Town, South Africa
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16
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Rowland B, Bogulski CA, Willis DE, Scott AJ, Gloster EE, Andersen JA. Experiences of Marshallese Food Processing Workers during the COVID-19 Pandemic. J Agromedicine 2021; 27:292-302. [PMID: 34736373 DOI: 10.1080/1059924x.2021.2002222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of this study was to conduct an exploratory assessment of COVID-19 mitigation steps and compare workplace experiences during the COVID-19 pandemic with Marshallese workers in other occupations. Marshallese adults residing in the continental United States (US) and Hawaii took part in an online survey. The sample was divided into two categories: food processing workers and workers in all other occupations. To examine differences between food processing workers and workers from all other occupations, we used Wilcoxon-Mann-Whitney U tests and Fisher's Exact tests. Of those employed at the time of the survey (n = 113), 31 were employed in food processing plants, and 82 were employed in another occupation. Food processing workers and workers in other occupations differed significantly on level of education, length of residence in the US, English-speaking ability, and health literacy. More food processing workers reported that their employers installed barriers or provided shields (45%), provided temperature screenings (71%), and tested for COVID-19 (61%) compared with those in other occupations. A larger proportion of food processing workers reported having no sick leave compared with workers in other occupations, although they reported COVID-19 testing and being insured at similar rates. This is the first study to examine Marshallese food processing workers' experiences during the COVID-19 pandemic. Our findings show that while some food processing employers implemented government-recommended guidelines to prevent the spread of COVID-19, preventative and protective measures were not comprehensively applied across the food processing industry, despite efforts by public health agencies and community partners.
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Affiliation(s)
- Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Cari A Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Erin E Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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17
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Shroff RT, Chalasani P, Wei R, Pennington D, Quirk G, Schoenle MV, Peyton KL, Uhrlaub JL, Ripperger TJ, Jergović M, Dalgai S, Wolf A, Whitmer R, Hammad H, Carrier A, Scott AJ, Nikolich-Žugich J, Worobey M, Sprissler R, Dake M, LaFleur BJ, Bhattacharya D. Immune responses to two and three doses of the BNT162b2 mRNA vaccine in adults with solid tumors. Nat Med 2021; 27:2002-2011. [PMID: 34594036 PMCID: PMC9004706 DOI: 10.1038/s41591-021-01542-z] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022]
Abstract
Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have shown high efficacy, but immunocompromised participants were excluded from controlled clinical trials. In this study, we compared immune responses to the BNT162b2 mRNA Coronavirus Disease 2019 vaccine in patients with solid tumors (n = 53) who were on active cytotoxic anti-cancer therapy to a control cohort of participants without cancer (n = 50). Neutralizing antibodies were detected in 67% of patients with cancer after the first immunization, followed by a threefold increase in median titers after the second dose. Similar patterns were observed for spike protein-specific serum antibodies and T cells, but the magnitude of each of these responses was diminished relative to the control cohort. In most patients with cancer, we detected spike receptor-binding domain and other S1-specific memory B cell subsets as potential predictors of anamnestic responses to additional immunizations. We therefore initiated a phase 1 trial for 20 cancer cohort participants of a third vaccine dose of BNT162b2 ( NCT04936997 ); primary outcomes were immune responses, with a secondary outcome of safety. At 1 week after a third immunization, 16 participants demonstrated a median threefold increase in neutralizing antibody responses, but no improvement was observed in T cell responses. Adverse events were mild. These results suggest that a third dose of BNT162b2 is safe, improves humoral immunity against SARS-CoV-2 and could be immunologically beneficial for patients with cancer on active chemotherapy.
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Affiliation(s)
- Rachna T Shroff
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA.
| | - Pavani Chalasani
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Ran Wei
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Daniel Pennington
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Grace Quirk
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
| | - Marta V Schoenle
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
| | - Kameron L Peyton
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jennifer L Uhrlaub
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Tyler J Ripperger
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mladen Jergović
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Shelby Dalgai
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Alexander Wolf
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | | | - Hytham Hammad
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Amy Carrier
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Aaron J Scott
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Janko Nikolich-Žugich
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
- University of Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Michael Worobey
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - Ryan Sprissler
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
- University of Arizona Genomics Core and the Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ, USA
| | - Michael Dake
- Office of the Senior Vice-President for Health Sciences, University of Arizona, Tucson, AZ, USA
| | | | - Deepta Bhattacharya
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA.
- BIO5 Institute, University of Arizona, Tucson, AZ, USA.
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18
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Shroff RT, Chalasani P, Wei R, Pennington D, Quirk G, Schoenle MV, Peyton KL, Uhrlaub JL, Ripperger TJ, Jergović M, Dalgai S, Wolf A, Whitmer R, Hammad H, Carrier A, Scott AJ, Nikolich-Žugich J, Worobey M, Sprissler R, Dake M, LaFleur BJ, Bhattacharya D. Immune Responses to COVID-19 mRNA Vaccines in Patients with Solid Tumors on Active, Immunosuppressive Cancer Therapy. medRxiv 2021:2021.05.13.21257129. [PMID: 34013289 PMCID: PMC8132263 DOI: 10.1101/2021.05.13.21257129] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vaccines against SARS-CoV-2 have shown high efficacy, but immunocompromised participants were excluded from controlled clinical trials. We compared immune responses to the Pfizer/BioNTech mRNA vaccine in solid tumor patients (n=53) on active cytotoxic anti-cancer therapy to a control cohort (n=50) as an observational study. Using live SARS-CoV-2 assays, neutralizing antibodies were detected in 67% and 80% of cancer patients after the first and second immunizations, respectively, with a 3-fold increase in median titers after the booster. Similar trends were observed in serum antibodies against the receptor-binding domain (RBD) and S2 regions of Spike protein, and in IFNγ+ Spike-specific T cells. Yet the magnitude of each of these responses was diminished relative to the control cohort. We therefore quantified RBD- and Spike S1-specific memory B cell subsets as predictors of anamnestic responses to additional immunizations. After the second vaccination, Spike-specific plasma cell-biased memory B cells were observed in most cancer patients at levels similar to those of the control cohort after the first immunization. We initiated an interventional phase 1 trial of a third booster shot (NCT04936997); primary outcomes were immune responses with a secondary outcome of safety. After a third immunization, the 20 participants demonstrated an increase in antibody responses, with a median 3-fold increase in virus-neutralizing titers. Yet no improvement was observed in T cell responses at 1 week after the booster immunization. There were mild adverse events, primarily injection site myalgia, with no serious adverse events after a month of follow-up. These results suggest that a third vaccination improves humoral immunity against COVID-19 in cancer patients on active chemotherapy with no severe adverse events.
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Affiliation(s)
- Rachna T. Shroff
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Pavani Chalasani
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Ran Wei
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Daniel Pennington
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Grace Quirk
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
| | - Marta V. Schoenle
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
| | - Kameron L. Peyton
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jennifer L. Uhrlaub
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Tyler J. Ripperger
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mladen Jergović
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Shelby Dalgai
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Alexander Wolf
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | | | - Hytham Hammad
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Amy Carrier
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Aaron J. Scott
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Janko Nikolich-Žugich
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
- University of Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Michael Worobey
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - Ryan Sprissler
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
- University of Arizona Genomics Core and the Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ, USA
| | - Michael Dake
- Office of the Senior Vice-President for Health Sciences, University of Arizona, Tucson, AZ, USA
| | | | - Deepta Bhattacharya
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
- BIO5 Institute, University of Arizona, Tucson, AZ, USA
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19
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McElfish PA, Narcisse MR, Selig JP, Felix HC, Scott AJ, Long CR. Effects of Race and Poverty on Sleep Duration: Analysis of Patterns in the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey and General National Health Interview Survey Data. J Racial Ethn Health Disparities 2021; 8:837-843. [PMID: 32815121 PMCID: PMC9810133 DOI: 10.1007/s40615-020-00841-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/07/2020] [Accepted: 08/04/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND There are health concerns associated with unhealthy sleep duration. A growing body of evidence indicates that there are disparities in sleep duration based upon race/ethnicity and socioeconomic status. Prior studies have suffered from inadequate measures of poverty and have not included Native Hawaiians and Pacific Islanders (NHPI). METHODS Using the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI-NHIS, the effect of race/ethnicity and poverty was examined for associations with sleep duration. RESULTS Significant differences among race/ethnicity groups and sleep duration were found in adjusted associations. Compared with Whites, NHPIs and Blacks were twice as likely to experience very short sleep; NHPI, Hispanic, and Blacks were more likely to experience short sleep; Blacks were also more likely to experience long sleep. Asians were less likely to experience unhealthy sleep (very short, short, or long sleep). Persons living in poverty were significantly more likely to experience very short sleep compared with persons not living in poverty. CONCLUSION This is the first population-based study that has examined the relationship between sleep duration and poverty with a large sample that included NHPI in relation to other races/ethnicities. The difference in sleep duration between NHPI and Asians provides a strong rationale for not aggregating Asian and NHPI data in population-based studies.
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Affiliation(s)
- Pearl Anna McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aaron J Scott
- Office of Community Health & Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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20
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Tolcher A, Babiker HM, Chung V, Kim E, Moser J, Karim R, Vandross A, Sommerhalder D, Scott AJ, Fakih M, Massarelli E, Adams J, Stewart J, Bossard C, Do L, White M, Beaupre DM, Borazanci E. Abstract CT112: Initial results from a Phase 1 trial of a first-in-class pan-CDC-like kinase inhibitor (SM08502) with proof of mechanism in subjects with advanced solid tumors. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Dysregulation of alternative pre-mRNA splicing has been identified as a common mechanistic driver of tumor initiation, disease progression, and emergence of therapy resistance. An iterative screening campaign identified SM08502, a potent pan-inhibitor of CDC-like kinases (CLKs), which are known to regulate alternative splicing. In preclinical studies, SM08502 inhibited growth and induced apoptosis in a broad array of tumor models. Study NCT03355066 is a two-part Phase 1 first-in-human study that evaluated the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of orally administered SM08502 in subjects with advanced solid tumors. In Part 1A of the study, which utilized an accelerated-titration/3 + 3 dose-escalation design, 19 subjects were administered SM08502 at doses ranging from 10 mg to 80 mg; a maximum tolerated dose has not yet been identified. Systemic exposures showed dose-dependent increases from 10 mg to 80 mg and the mean time to maximal concentration (tmax) ranged from 3.3 to 5.9 hours on Cycle 1 Day 1 and from 1 to 24.6 hours on Cycle 2 Day 1. SM08502 had low-to-moderate clearance and a high volume of distribution, which resulted in a long terminal half-life (t½ > 24 hours) and accumulation of approximately 2- to 3.9-fold. Based on preclinical tumor xenograft models, exposures (AUC and Cmax) in the expected therapeutic range were attained. The most commonly reported adverse events (AEs) included nausea (12/19 [63.2%]), diarrhea (10/19 [52.6%]), fatigue (8/19 [42.1%]), and vomiting (7/19 [36.8%]), with the most common grade 3 or greater AEs being diarrhea (3/19 [15.8%]), anemia (2/19 [10.5%]), and decreased lymphocyte count (2/19 [10.5%]). The most common possibly or probably related serious AE (SAE) was diarrhea (2/19 [10.5%]). Two subjects experienced dose-limiting toxicity: one at the 40 mg dose level (elevated liver function tests [ALT and AST]) and a second at the 80 mg dose level (diarrhea). In peripheral blood mononuclear cells, evidence for disruption of alternative splicing was detected through expression changes associated with mRNA splicing and nonsense-mediated decay. Further, direct evidence for CLK1 inhibition was observed at tolerated doses, which provided proof of mechanism. Radiological assessment demonstrated tumor shrinkage in two subjects with endometrial cancer. In addition, stable disease lasting longer than 6 months was observed in four subjects. Further dose finding is planned prior to the Part 2 expansion.
Conclusion: In this first-in-human study, PK and PD data demonstrate proof of mechanism for the pan-CLK inhibitor SM08502 at tolerated doses.
Citation Format: Anthony Tolcher, Hani M. Babiker, Vincent Chung, Edward Kim, Justin Moser, Raghad Karim, Andre Vandross, David Sommerhalder, Aaron J. Scott, Marwan Fakih, Erminia Massarelli, Jeffrey Adams, Joshua Stewart, Carine Bossard, Long Do, Michael White, Darrin M. Beaupre, Erkut Borazanci. Initial results from a Phase 1 trial of a first-in-class pan-CDC-like kinase inhibitor (SM08502) with proof of mechanism in subjects with advanced solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT112.
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Affiliation(s)
| | | | | | | | - Justin Moser
- 5HonorHealth Research and Innovation Institute, Scottsdale, AZ
| | | | | | | | | | | | | | | | | | | | - Long Do
- 6Samumed, LLC, San Diego, CA
| | | | | | - Erkut Borazanci
- 5HonorHealth Research and Innovation Institute, Scottsdale, AZ
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21
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McElfish PA, Long CR, Bursac Z, Scott AJ, Chatrathi HE, Sinclair KA, Nagarsheth N, Calcagni M, Patolia J, Narcisse MR. Examining elevated blood pressure and the effects of diabetes self-management education on blood pressure among a sample of Marshallese with type 2 diabetes in Arkansas. PLoS One 2021; 16:e0250489. [PMID: 33886693 PMCID: PMC8062061 DOI: 10.1371/journal.pone.0250489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hypertension is a leading risk factor for heart attack and stroke. Undiagnosed hypertension increases the risk of heart attack and stroke. The risk of hypertension is increased for those with type 2 diabetes mellitus (T2DM). Diabetes self-management education (DSME) has been shown to be effective at improving clinical outcomes, including reducing blood pressure, but few studies have evaluated the effects of DSME for Native Hawaiians and Pacific Islanders. METHODS This study examined the baseline prevalence of diagnosed hypertension and undiagnosed high blood pressure and differences in health care access between those with diagnosed hypertension versus undiagnosed high blood pressure. The sample consisted of 221 Marshallese adults with T2DM participating in a DSME randomized controlled trial in northwest Arkansas. The study also examined the effects of DSME interventions on participants' blood pressure, comparing an Adapted-Family DSME with a Standard DSME. RESULTS Nearly two-thirds of participants had blood pressure readings indicative of hypertension, and of those, over one-third were previously undiagnosed. The frequency of doctor visits was significantly lower for those with undiagnosed high blood pressure. There were no differences in health insurance coverage or forgone medical care between those with undiagnosed high blood pressure versus diagnosed hypertension. Across all participants, a significant reduction in systolic blood pressure occurred between baseline and post intervention, and a significant reduction in diastolic blood pressure occurred between baseline and post-intervention, 6 months, and 12 months post-intervention. No differences were observed by study arm. CONCLUSION This study is the first to document the prevalence of diagnosed hypertension and undiagnosed high blood pressure, as well as the effects of DSME on blood pressure among a sample of Marshallese adults with T2DM.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Harish E. Chatrathi
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Ka‘imi A. Sinclair
- College of Nursing, Washington State University, Seattle, Washington, United States of America
| | - Nirav Nagarsheth
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Mikaila Calcagni
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Jay Patolia
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, United States of America
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22
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Arai H, Elliott A, Xiu J, Wang J, Battaglin F, Kawanishi N, Soni S, Zhang W, Millstein J, Sohal D, Goldberg RM, Hall MJ, Scott AJ, Khushman M, Hwang JJ, Lou E, Weinberg BA, Marshall JL, Lockhart AC, Stafford P, Zhang J, Moretto R, Cremolini C, Korn WM, Lenz HJ. The Landscape of Alterations in DNA Damage Response Pathways in Colorectal Cancer. Clin Cancer Res 2021; 27:3234-3242. [PMID: 33766816 DOI: 10.1158/1078-0432.ccr-20-3635] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/13/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Defective DNA damage response (DDR) is a hallmark of cancer leading to genomic instability and is associated with chemosensitivity. Although the mismatch repair system has been extensively studied, the clinical implications of other mechanisms associated with DDR alterations in patients with colorectal cancer remain unclear. This study aimed to understand DDR pathways alterations and their association with common clinical features in patients with colorectal cancer. EXPERIMENTAL DESIGN Next-generation sequencing and whole-transcriptome sequencing were conducted using formalin-fixed paraffin-embedded samples submitted to a commercial Clinical Laboratory Improvement Amendments-certified laboratory. Samples with pathogenic or presumed pathogenic mutations in 29 specific DDR-related genes were considered as DDR-mutant (DDR-MT) and the remaining samples as DDR-wild type (DDR-WT). RESULTS Of 9,321 patients with colorectal cancer, 1,290 (13.8%) were DDR-MT. The frequency of DDR-MT was significantly higher in microsatellite instability-high (MSI-H) cases than in microsatellite stable cases (76.4% vs. 9.5%). The DDR-MT genotype was higher in the right-sided, RAS-wild, BRAF-mutant, and CMS1 subgroups. However, these associations were primarily confounded by the distribution of MSI status. Compared with the DDR-WT tumors, the DDR-MT tumors had a higher mutational burden and gene expression levels in the immune-related pathway, which were independent of MSI status. CONCLUSIONS We characterized a distinct subgroup of patients with colorectal cancer with tumors harboring mutations in the DDR-related genes. These patients more commonly had MSI-H tumors and exhibited an activated immune signature regardless of their tumor's MSI status. These findings warrant further investigations to develop personalized treatment strategies in this significant subgroup of patients with colorectal cancer.
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Affiliation(s)
- Hiroyuki Arai
- Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Andrew Elliott
- Clinical and Translational Research, Medical Affairs, Caris Life Sciences, Phoenix, Arizona
| | - Joanne Xiu
- Clinical and Translational Research, Medical Affairs, Caris Life Sciences, Phoenix, Arizona
| | - Jingyuan Wang
- Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Francesca Battaglin
- Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Natsuko Kawanishi
- Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Shivani Soni
- Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Wu Zhang
- Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Joshua Millstein
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Davendra Sohal
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio
| | | | - Michael J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Aaron J Scott
- Department of Medicine, University of Arizona Cancer Center, Tucson, Arizona
| | - Moh'd Khushman
- Medical Oncology, Mitchell Cancer Institute, The University of South Alabama, Mobile, Alabama
| | - Jimmy J Hwang
- Department of Solid Tumor Oncology, GI Medical Oncology, Levine Cancer Institute, Charlotte, North Carolina
| | - Emil Lou
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Benjamin A Weinberg
- Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - John L Marshall
- Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Albert C Lockhart
- Department of Medicine, Division of Oncology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Phillip Stafford
- Department of Bioinformatics, Caris Life Sciences, Phoenix, Arizona
| | - Jian Zhang
- Department of Bioinformatics, Caris Life Sciences, Phoenix, Arizona
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Heinz-Josef Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
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23
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McElfish PA, Andersen JA, Felix HC, Purvis RS, Rowland B, Scott AJ, Chatrathi M, Long CR. Relationship between sleep duration and quality and glycated hemoglobin, body mass index, and self-reported health in Marshallese adults. Sleep Health 2021; 7:332-338. [PMID: 33707104 DOI: 10.1016/j.sleh.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To document sleep duration and sleep quality among a sample of Marshallese adults and to examine if sleep duration and quality are associated with type 2 diabetes, body mass index (BMI), and self-reported health in the Marshallese population. DESIGN Cross-sectional analysis of a staff-administered survey. SETTING Thirty Marshallese churches in Arkansas and Oklahoma. PARTICIPANTS The study includes 378 Marshallese participants, 56.6% female, with a mean age of 42.4 years (±11.6). Recruitment was limited to participants who were considered overweight, with a BMI >25 kg/m2. MEASURES Staff-administered surveys were used to collect data on sleep duration, sleep quality, and self-reported health. Clinical measures were collected by trained research personnel using standard tools and protocols. Kruskal-Wallis tests, Spearman's correlations, and nonparametric tests of trends were used to evaluate differences in HbA1c, BMIc, and self-reported health by sleep duration and quality. Multivariable analyses were used to test the associations, controlling for sociodemographic factors. RESULTS Fifty-four percent of the participants reported something other than normal sleep duration and 52.4% reported at least 1 night of difficult or interrupted sleep in the previous 2-week period. Longer sleep duration was associated with lower HbA1c and poorer sleep quality was associated with higher HbA1c. Poor sleep quality was associated with lower self-reported health. However, neither sleep duration nor quality was associated with BMI. The associations were found independent of sociodemographic factors. CONCLUSION This is the first study to document sleep duration and sleep quality, as well as the first study to examine the relationship between sleep and HbA1c, BMI, and self-reported health in Marshallese adults with a BMI >25 kg/m2. This research will be used to help develop sleep interventions to address type 2 diabetes health disparities in the Marshallese community.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA.
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Meena Chatrathi
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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McElfish PA, Scott AJ, Chatrathi HE, Rowland B, Long CR, Nagarsheth N, Calcagni M, Patolia J, Haggard-Duff LK, Selig JP. Undiagnosed Hypertension and Undiagnosed Type 2 Diabetes among Overweight and Obese Marshallese Participants in a Diabetes Prevention Program. Yale J Biol Med 2021; 94:5-12. [PMID: 33795978 PMCID: PMC7995951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertension and type 2 diabetes (T2D) are major public health issues that disproportionately affect minority communities, including Native Hawaiians and Pacific Islanders (NHPI). Minority communities are also more likely to have undiagnosed hypertension and T2D. Marshallese Pacific Islanders have been shown to have high proportions of diagnosed and undiagnosed hypertension and T2D. Using survey and biometric data collected from 378 overweight/obese Marshallese Pacific Islander adults, this study documents the prevalence of hypertension and T2D, as well as the prevalence of undiagnosed hypertension and T2D. The study also examines associations between undiagnosed hypertension and undiagnosed T2D and age group, sex, health care access (defined by foregone care due to cost and health insurance status), and body mass index (BMI). Among participants with blood pressure readings indicative of hypertension, 68.4% were undiagnosed, and among participants with HbA1c indicative of T2D, 31.6% were undiagnosed. A quarter of participants (24.5%) had blood pressure and HbA1c measures indicative of both undiagnosed hypertension and undiagnosed T2D. Undiagnosed hypertension was significantly associated with age group (p's<0.0001) and sex (p=0.028). Undiagnosed T2D was significantly associated with age group (p's<0.05), forgone care due to cost (p=0.018), health insurance status (p=0.035), and BMI (p=0.001). Participants in this study had high proportions of undiagnosed hypertension and undiagnosed T2D. These findings will be immediately useful for those working to address hypertension and T2D disparities among Marshallese and other NHPI populations.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of
Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Harish E. Chatrathi
- Office of Community Health and Research, University of
Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of
Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Nirav Nagarsheth
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Mikaila Calcagni
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Jay Patolia
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Lauren K. Haggard-Duff
- College of Nursing, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - James P. Selig
- Department of Biostatistics, University of Arkansas for
Medical Sciences, Little Rock, AR, USA
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Scott AJ, Vallejo J, Sarkar A, Smythe L, Regincós Martí E, Nichol GS, Klooster WT, Coles SJ, Murrie M, Rajaraman G, Piligkos S, Lusby PJ, Brechin EK. Exploiting host-guest chemistry to manipulate magnetic interactions in metallosupramolecular M 4L 6 tetrahedral cages. Chem Sci 2021; 12:5134-5142. [PMID: 34168772 PMCID: PMC8179613 DOI: 10.1039/d1sc00647a] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Reaction of Ni(OTf)2 with the bisbidentate quaterpyridine ligand L results in the self-assembly of a tetrahedral, paramagnetic cage [NiII4L6]8+. By selectively exchanging the bound triflate from [OTf⊂NiII4L6](OTf)7 (1), we have been able to prepare a series of host–guest complexes that feature an encapsulated paramagnetic tetrahalometallate ion inside this paramagnetic host giving [MIIX4⊂NiII4L6](OTf)6, where MIIX42− = MnCl42− (2), CoCl42− (5), CoBr42− (6), NiCl42− (7), and CuBr42− (8) or [MIIIX4⊂NiII4L6](OTf)7, where MIIIX4− = FeCl4− (3) and FeBr4− (4). Triflate-to-tetrahalometallate exchange occurs in solution and can also be accomplished through single-crystal-to-single-crystal transformations. Host–guest complexes 1–8 all crystallise as homochiral racemates in monoclinic space groups, wherein the four {NiN6} vertexes within a single Ni4L6 unit possess the same Δ or Λ stereochemistry. Magnetic susceptibility and magnetisation data show that the magnetic exchange between metal ions in the host [NiII4] complex, and between the host and the MX4n− guest, are of comparable magnitude and antiferromagnetic in nature. Theoretically derived values for the magnetic exchange are in close agreement with experiment, revealing that large spin densities on the electronegative X-atoms of particular MX4n− guest molecules lead to stronger host–guest magnetic exchange interactions. The tetrahedral [NiII4L6]8+ cage can reversibly bind paramagnetic MX41/2− guests, inducing magnetic exchange interactions between host and guest.![]()
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Affiliation(s)
- Aaron J Scott
- EaStCHEM School of Chemistry, The University of Edinburgh David Brewster Road Edinburgh EH93FJ UK
| | - Julia Vallejo
- EaStCHEM School of Chemistry, The University of Edinburgh David Brewster Road Edinburgh EH93FJ UK
| | - Arup Sarkar
- Department of Chemistry, Indian Institute of Technology Bombay Powai Mumbai 400076 India
| | - Lucy Smythe
- WestCHEM, School of Chemistry, University of Glasgow, University Avenue Glasgow G12 8QQ UK
| | - E Regincós Martí
- WestCHEM, School of Chemistry, University of Glasgow, University Avenue Glasgow G12 8QQ UK
| | - Gary S Nichol
- EaStCHEM School of Chemistry, The University of Edinburgh David Brewster Road Edinburgh EH93FJ UK
| | - Wim T Klooster
- UK National Crystallographic Service, Chemistry, Faculty of Natural and Environmental Sciences, University of Southampton England SO17 1BJ UK
| | - Simon J Coles
- UK National Crystallographic Service, Chemistry, Faculty of Natural and Environmental Sciences, University of Southampton England SO17 1BJ UK
| | - Mark Murrie
- WestCHEM, School of Chemistry, University of Glasgow, University Avenue Glasgow G12 8QQ UK
| | - Gopalan Rajaraman
- Department of Chemistry, Indian Institute of Technology Bombay Powai Mumbai 400076 India
| | - Stergios Piligkos
- Department of Chemistry, University of Copenhagen, Universitetsparken 5 2100 Copenhagen Denmark
| | - Paul J Lusby
- EaStCHEM School of Chemistry, The University of Edinburgh David Brewster Road Edinburgh EH93FJ UK
| | - Euan K Brechin
- EaStCHEM School of Chemistry, The University of Edinburgh David Brewster Road Edinburgh EH93FJ UK
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Scott AJ, Drevin G, Pavlovic L, Nilsson M, Krige JEJ, Jonas E. Mentorship during undergraduate surgical training: comparing perceptions of medical students and faculty at two institutions in South Africa and Sweden. S AFR J SURG 2021. [DOI: 10.17159/2078-5151/2021/v59n4a3534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT BACKGROUND: Having a mentor during undergraduate surgical training has been shown to positively influence medical students by increasing interest in surgery, improving confidence, and assisting in career planning. This study aimed to evaluate and compare medical student and faculty perceptions of mentorship during undergraduate surgical training and compare results between two teaching institutions in South Africa and Sweden METHODS: An electronic, online questionnaire was anonymously distributed to medical students and general surgical faculty at the University of Cape Town (UCT), South Africa, and Karolinska Institutet (KI), Stockholm, Sweden. The questionnaire consisted of multiple choice, true or false, and five-point Likert scale questions, exploring perceptions of mentorship and role models, as well as rating the most important mentor characteristics RESULTS: Approximately one third (34.2%) of students stated they had a mentor during their surgical training, with significant differences found between student cohorts (p < 0.001). The 'registrar' was most commonly reported as the best role model for medical students by faculty from both UCT (50.0%) and KI (69.4%), as well as UCT students (36.6%). Students rated the following mentor qualities significantly higher compared to faculty: student encouragement (p = 0.037), adequate supervision (p = 0.007), setting of fair expectations (p = 0.002), and teaching skills (p = 0.010 CONCLUSION: With significant differences existing in the perceptions of medical students and faculty regarding mentorship and role models during undergraduate surgical training in both South African and Swedish institutions, reconciling and harmonising these differences will be crucial in fostering constructive mentoring relationships Keywords: mentorship, role model, perception, surgical education
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McElfish PA, Scott AJ, Rowland B, Felix HC, Narcisse MR, Kaminicki KF, Long CR, Selig JP. Investigating the Association between English Proficiency and General Health among Marshallese Adults in the United States. J Health Care Poor Underserved 2021; 32:724-736. [PMID: 34120973 PMCID: PMC9756799 DOI: 10.1353/hpu.2021.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prior studies have not examined the association between English proficiency and health among Marshallese adults. Cross-sectional data from 378 Marshallese adults enrolled in a Diabetes Prevention Program study in Arkansas and Oklahoma were used to document English proficiency, assess the relationship between sociodemographic health-related characteristics and English proficiency, and examine the association between English proficiency and general health. Approximately one-fifth of participants reported limited English proficiency (LEP). One-fifth of participants reported being in fair or poor health. General health, age group, education, household food insufficiency, inability to afford necessities, and comorbidities were significantly associated with LEP. Participants with LEP were 78% less likely to report better general health compared with those who reported speaking English very well. Limited English proficiency was high among this sample of Marshallese adults. Findings highlight the need for additional Marshallese clinical interpretation and translation services.
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Dasari A, Morris VK, Allegra CJ, Atreya C, Benson AB, Boland P, Chung K, Copur MS, Corcoran RB, Deming DA, Dwyer A, Diehn M, Eng C, George TJ, Gollub MJ, Goodwin RA, Hamilton SR, Hechtman JF, Hochster H, Hong TS, Innocenti F, Iqbal A, Jacobs SA, Kennecke HF, Lee JJ, Lieu CH, Lenz HJ, Lindwasser OW, Montagut C, Odisio B, Ou FS, Porter L, Raghav K, Schrag D, Scott AJ, Shi Q, Strickler JH, Venook A, Yaeger R, Yothers G, You YN, Zell JA, Kopetz S. ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper. Nat Rev Clin Oncol 2020; 17:757-770. [PMID: 32632268 PMCID: PMC7790747 DOI: 10.1038/s41571-020-0392-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
An increasing number of studies are describing potential uses of circulating tumour DNA (ctDNA) in the care of patients with colorectal cancer. Owing to this rapidly developing area of research, the Colon and Rectal-Anal Task Forces of the United States National Cancer Institute convened a panel of multidisciplinary experts to summarize current data on the utility of ctDNA in the management of colorectal cancer and to provide guidance in promoting the efficient development and integration of this technology into clinical care. The panel focused on four key areas in which ctDNA has the potential to change clinical practice, including the detection of minimal residual disease, the management of patients with rectal cancer, monitoring responses to therapy, and tracking clonal dynamics in response to targeted therapies and other systemic treatments. The panel also provides general guidelines with relevance for ctDNA-related research efforts, irrespective of indication.
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Affiliation(s)
- Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Chloe Atreya
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Al B Benson
- Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA
| | - Patrick Boland
- Department of Medicine, Roswell Park Cancer Center, Buffalo, NY, USA
| | - Ki Chung
- Division of Hematology & Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Mehmet S Copur
- CHI Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Ryan B Corcoran
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Dustin A Deming
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrea Dwyer
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas J George
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Stanley R Hamilton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaclyn F Hechtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard Hochster
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MD, USA
| | - Federico Innocenti
- Center for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC, USA
| | - Atif Iqbal
- Section of Colorectal Surgery, Division of Surgery, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Samuel A Jacobs
- National Adjuvant Surgical and Bowel Project Foundation/NRG Oncology, Pittsburgh, PA, USA
| | - Hagen F Kennecke
- Department of Oncology, Virginia Mason Cancer Institute, Seattle, WA, USA
| | - James J Lee
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Christopher H Lieu
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Heinz-Josef Lenz
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - O Wolf Lindwasser
- Coordinating Center for Clinical Trials, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Clara Montagut
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fang-Shu Ou
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura Porter
- Patient Advocate, NCI Colon Task Force, Boston, MA, USA
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah Schrag
- Division of Population Sciences, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aaron J Scott
- Division of Hematology and Oncology, Banner University of Arizona Cancer Center, Tucson, AZ, USA
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - John H Strickler
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason A Zell
- Department of Epidemiology, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Babiker HB, Lenz HJ, Scott AJ, Rahimian S, Overman MJ. Abstract CT265: A phase 2 multicenter study to evaluate the efficacy of tilsotolimod in combination with nivolumab and ipilimumab for treatment of microsatellite-stable colorectal cancer (ILLUMINATE-206). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The checkpoint inhibitors pembrolizumab, nivolumab as monotherapy, and nivolumab in combination with ipilimumab are approved in the US for treatment of patients with previously treated microsatellite instability-high (MSI-high) or mismatch repair-deficient metastatic colorectal cancer (CRC). However, checkpoint inhibitors are not currently approved for treatment of microsatellite-stable (MSS) CRC, and patients do not appear likely to respond to these regimens. Tilsotolimod, an investigational Toll-like receptor 9 (TLR9) agonist, stimulates the innate and adaptive immune systems. In an ongoing phase 1/2 clinical study in patients with advanced melanoma who progressed on or after anti-PD-1 therapy (NCT02644967), intratumoral tilsotolimod in combination with ipilimumab was generally well-tolerated at the recommended phase 2 dose, with durable responses in some patients. Biopsies revealed localized activation of the Type-I interferon pathway, maturation of dendritic cells, and induction of MHC class I antigen presentation. Furthermore, dominant T cell clones are shared between injected and distant, non-injected lesions in responding patients.1
ILLUMINATE-206 (NCT03865082) is a phase 2 multicenter, open-label study of intratumoral tilsotolimod 8 mg in combination with ipilimumab and nivolumab at specified doses and schedules for all 3 agents. ILLUMINATE-206 will comprise multiple cohorts, including patients with immunotherapy-naïve, MSS-CRC who have received at least 2 prior regimens of therapy for advanced or metastatic disease including fluoropyrimidine-, oxaliplatin-, and irinotecan-based regimens. Eligible patients are ≥18 years with histologically-confirmed CRC, confirmed MSS status, measurable lesion(s) accessible for injection and RECIST assessment, ECOG performance status 0-1, life expectancy ≥4 months, adequate organ function, no prior TLR or immuno-oncology treatment, and no unstable CNS disease. The primary endpoint is objective response rate based on RECIST v1.1 and duration of response. Safety is a secondary endpoint, and paired blood or biopsy samples may be evaluated for tumor genetics, immune infiltrates, and gene expression. Additional patients may be enrolled in Part 1 after review of the data from the initial safety run-in of 10 patients. Based on data from Part 1, the cohort may be expanded during Part 2.
Reference Diab A, et al. Ann Oncol 2018;29(suppl_8):Abstract 1245PD.
Citation Format: Hani B. Babiker, Heinz-Josef Lenz, Aaron J. Scott, Shah Rahimian, Michael J. Overman. A phase 2 multicenter study to evaluate the efficacy of tilsotolimod in combination with nivolumab and ipilimumab for treatment of microsatellite-stable colorectal cancer (ILLUMINATE-206) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT265.
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Affiliation(s)
| | - Heinz-Josef Lenz
- 2University of Southern California Comprehensive Cancer Center, Newport Beach, CA
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Recio-Boiles A, Vondrak J, Veeravelli S, Mancuso JJ, Saboda K, Roe DJ, Riaz IB, Scott AJ, Elquza E, McBride A, Babiker HM. Analyzing outcomes of neoadjuvant and adjuvant treatment for borderline-resectable pancreatic adenocarcinoma in the perioperative period at an academic institution. Ann Pancreat Cancer 2020; 3:2. [PMID: 32313882 PMCID: PMC7170377 DOI: 10.21037/apc.2020.02.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Only 15-20% of pancreatic ductal adenocarcinoma (PDAC) patients are upfront surgical candidates at presentation, and for this cohort of patients, the 5-year survival is a mere 20% despite adjuvant therapy. Previous data indicate that in clinical practice most of these cases are "borderline-resectable," and there is currently no mature data on perioperative treatment. METHODS We performed a retrospective electronic chart review of patients with "borderline-resectable"PDAC treated at an academic comprehensive cancer center, dividing them into groups based on surgery alone, surgery plus neoadjuvant, adjuvant, or neoadjuvant plus adjuvant perioperative treatment groups. The objectives were to determine the median overall survival (mOS), progression-free survival (PFS) and disease-free survival (DFS). Statistical analysis was performed to assess the association of demographic, tumor traits, and interventions with OS, PFS and DFS. RESULTS Only surgery followed by adjuvant therapy showed an increase in mOS [hazard ratio (HR) 0.22; 95% CI, 0.09-0.51; P<0.001), after adjustment for radiation (yes vs. no), resection margins (R0 vs. R1 or R2), and tumor location (head vs. body or tail). Patients who received adjuvant therapy after surgery had 2.1 times greater odds to be alive at 24 months after diagnosis than those who had surgery alone (P=0.015). PFS and DFS were not statistically significantly different among treatment groups after adjustment. Those whose disease was located in the head of the pancreas had a significantly improved OS (HR =0.27; 95% CI, 0.11-0.64; P=0.003), PFS (HR =0.40; 95% CI, 0.17-0.94; P=0.035), and DFS (HR =0.30; 95% CI, 0.13-0.67; P=0.004). Negative margins led to a significant improvement in PFS (HR =0.30; 95% CI, 0.16-0.57; P<0.001) and DFS (HR =0.30; 95% CI, 0.16-0.57; P<0.001). Those who received radiation had a non-significantly improved OS, PFS, and DFS (P>0.05). CONCLUSIONS Our study corroborated that patients treated with adjuvant therapy after surgical resection had an mOS benefit as reported on prior phase III clinical trials. Patients with "borderline-resectable" pancreatic cancer are encouraged to participate in a clinical trial or clinically be treated with adjuvant therapy until more mature results from the ongoing perioperative prospective study are available.
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Affiliation(s)
| | - Jessica Vondrak
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | | | - James J. Mancuso
- Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathylynn Saboda
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Denise J. Roe
- University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | | | - Aaron J. Scott
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Emad Elquza
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Ali McBride
- University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Hani M. Babiker
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
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McElfish PA, Purvis RS, Scott AJ, Haggard-Duff LK, Riklon S, Long CR. "The results are encouragements to make positive changes to be healthier:" qualitative evaluation of Marshallese participants' perceptions when receiving study results in a randomized control trial. Contemp Clin Trials Commun 2020; 17:100543. [PMID: 32140610 PMCID: PMC7044511 DOI: 10.1016/j.conctc.2020.100543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background Study participants express a desire to receive the results of studies in which they have participated even when the results are not what researchers expected. Sharing results with participants is a core principle of community-based participatory research (CBPR), however, many researchers using a community-based participatory approach report that they encounter barriers to sharing results with study participants. Researchers at the University of Arkansas for Medical Sciences established a CBPR partnership with Marshallese community stakeholders in an effort to reduce the health disparities of this vulnerable population. Marshallese are a Pacific Islander population that faces significant health disparities and have a high prevalence of diabetes, obesity, obesity-related cancers, and other chronic diseases compared to the general US population. Methods A qualitative descriptive design was used to evaluate Marshallese participants' perceptions related to receiving results of a culturally adapted Diabetes Self-Management Education randomized control trial in which they participated. Participants were provided with a summary of their individual results as well as preliminary, overall aggregate study results. Interviews were conducted with half of (N = 111) of the 221 enrolled participants that provided them with the opportunity to share in-depth responses related to their perceptions of the study results they received. Results There was no statistically significant differences between study arms in participant desire to receive overall study results, desire to receive personal study results, or willingness to participate in future research. Participants described their desire for results and the effect of these results on their future behavior. Within the a priori theme of participants' desire for results, three subthemes emerged: 1) results showed current health status, 2) results showed improvement, and 3) demonstrated the overall results of the study. Within the a priori theme of effects of results on future behavior, two sub-themes emerged: 1) encourage future healthy behavior, and 2) encourage future research participation. Conclusions Participants overwhelmingly stated they wanted to receive personal and aggregate study results. This finding is consistent with previous qualitative studies that documented that participants want results. Marshallese participants also reported that receiving study results would affect their future health behavior. This study documents specifically how participants anticipate using the results of studies in which they participated. Clinical trials registration information The study is registered in clinicaltrials.gov (#NCT02407132).
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Affiliation(s)
- Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, United States
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, United States
| | - Lauren K Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, United States
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, United States
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, United States
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McElfish PA, Long CR, Bursac Z, Scott AJ, Felix HC, Schulz TK, Worley MA, Rowland B. Diabetes self-management education exposure and glycated haemoglobin levels among Marshallese participants in a randomized controlled study. Diabet Med 2020; 37:319-325. [PMID: 31769619 PMCID: PMC9827539 DOI: 10.1111/dme.14189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 01/11/2023]
Abstract
AIMS A randomized control trial (RCT) of diabetes self-management education (DSME), undertaken by a community-based participatory research (CBPR) partnership between the University of Arkansas for Medical Sciences (UAMS) and the Marshallese community in Arkansas. The RCT examined the effect of hours of intervention exposure, with the hypothesis that increased exposure is one reason the Adapted-Family DSME was found to be more effective than the Standard DSME. METHODS Some 221 Marshallese with type 2 diabetes were randomized to an Adapted-Family DSME group (in-home setting) (n = 110) or a Standard DMSE group (community setting) (n = 111). The Adapted-Family DSME included 10 h of education that covered the core self-care elements recommended by the American Diabetes Association (ADA) and American Association of Diabetes Educators' (AADE) recommendations. The Standard DSME included 10 h of intervention with all ADA and AADE core elements. RESULTS The number of hours of intervention exposure in the Adapted-Family DSME arm (mean = 8.0; median = 10.0) was significantly higher than the number of hours of intervention received in the Standard DSME arm (mean = 1.5; median = 0.0). As hypothesized, higher exposure was associated with a significant reduction in HbA1c in a model including only study arm and exposure (P = 0.01), and in a model including study arm, exposure, and all demographic variables (P = 0.046). CONCLUSIONS This finding is consistent with previous reviews that showed increased exposure to DSME produced improved glycaemic control and ≥ 10 h of DSME produces clinically meaningful reductions in HbA1c .
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street AHC5, Miami, FL 33199
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205
| | - Thomas K. Schulz
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703
| | - Mark A. Worley
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703
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McElfish PA, Long CR, Scott AJ, Hudson JS, Haggard-Duff L, Holland A, Schulz TK, Wilmoth RO, Selig JP. Pilot Implementation of Adapted-Family Diabetes Self-Management Education Into a Clinical Setting. J Prim Care Community Health 2020; 11:2150132720931289. [PMID: 32517573 PMCID: PMC7288836 DOI: 10.1177/2150132720931289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives: Marshallese are a Pacific Islander community that experience a disproportionate rate of type 2 diabetes. The purpose of this study is to evaluate the preliminary effectiveness and feasibility of an Adapted-Family Diabetes Self-Management Education (DSME) intervention among Marshallese adults diagnosed with type 2 diabetes and their family members when delivered in a clinical setting. Methods: Marshallese patients (primary participants) with type 2 diabetes (n = 10) and their family members (n = 10) enrolled in a pilot study deigned to evaluate an Adapted-Family DSME curriculum conducted by community health workers and a certified diabetes educator in a clinical setting. Primary and family participants' health information and biometric data (HbA1c, blood pressure, cholesterol, and body mass index) were collected at preintervention and 12 weeks postintervention. Results: All 10 primary participants and 8 of the family members received all 10 hours of the education intervention. Nine of the 10 primary participants and 8 of the 10 family members completed the pre- and postintervention data collection events. Primary participants demonstrated a mean decrease in HbA1c of 0.7%, from pre- to postintervention, as well as improved blood pressure and cholesterol. Family members demonstrated minor improvements in HbA1c and blood pressure. Conclusions: Results suggest preliminary effectiveness and feasibility of the Adapted-Family DSME in a clinic setting and will inform implementation of a fully powered study.
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Affiliation(s)
- Pearl A. McElfish
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R. Long
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Aaron J. Scott
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Jonell S. Hudson
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Lauren Haggard-Duff
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Angel Holland
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Thomas K. Schulz
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Ralph O. Wilmoth
- University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - James P. Selig
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA
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Affiliation(s)
- Aaron J Scott
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson
| | - Rachna T Shroff
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson
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McElfish PA, Long CR, James LP, Scott AJ, Flood-Grady E, Kimminau KS, Rhyne RL, Burge MR, Purvis RS. Characterizing health researcher barriers to sharing results with study participants. J Clin Transl Sci 2019; 3:295-301. [PMID: 31827902 PMCID: PMC6886004 DOI: 10.1017/cts.2019.409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/12/2019] [Accepted: 08/26/2019] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Research participants want to receive results from studies in which they participate. However, health researchers rarely share the results of their studies beyond scientific publication. Little is known about the barriers researchers face in returning study results to participants. METHODS Using a mixed-methods design, health researchers (N = 414) from more than 40 US universities were asked about barriers to providing results to participants. Respondents were recruited from universities with Clinical and Translational Science Award programs and Prevention Research Centers. RESULTS Respondents reported the percent of their research where they experienced each of the four barriers to disseminating results to participants: logistical/methodological, financial, systems, and regulatory. A fifth barrier, investigator capacity, emerged from data analysis. Training for research faculty and staff, promotion and tenure incentives, and funding agencies supporting dissemination of results to participants were solutions offered to overcoming barriers. CONCLUSIONS Study findings add to literature on research dissemination by documenting health researchers' perceived barriers to sharing study results with participants. Implications for policy and practice suggest that additional resources and training could help reduce dissemination barriers and increase the return of results to participants.
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Affiliation(s)
- Pearl A. McElfish
- Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Christopher R. Long
- Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Laura P. James
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications and Recruitment Center, Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Kim S. Kimminau
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Robert L. Rhyne
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Mark R. Burge
- Clinical and Translational Science Center, Health Science Center, University of New Mexico, Albuquerque, NM 87131, USA
| | - Rachel S. Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
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Metcalf PA, Baker JR, Scragg RK, Dryson E, Scott AJ, Wild CJ. Albuminuria in people at least 40 years old: effect of alcohol consumption, regular exercise, and cigarette smoking. Clin Chem 2019. [DOI: 10.1093/clinchem/39.9.1793] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We investigated the relation between albuminuria and life-style factors in 5670 people, ages 40 years and over, who participated in a health screening survey of a local workforce. The degree of albuminuria showed piecewise log-linear relationships with alcohol consumption and cigarette smoking, with changes in slope (and 95% confidence interval) corresponding with 5 (2, 8) g of alcohol/day and 10 (6, 14) cigarettes/day. After adjusting for age, gender, ethnicity, and other life-style variables, relative risks (95% confidence interval) of slight albuminuria for people consuming > 32 g of alcohol/day compared with nondrinkers, and for cigarette smokers compared with nonsmokers, were 1.74 (1.02, 2.98) and 1.37 (1.01, 1.88), respectively. However, there was no significant effect of exercise. We conclude that slight albuminuria is significantly associated with cigarette smoking and heavy alcohol consumption, consistent with its role as an index of risk of cardiovascular disease.
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Affiliation(s)
- P A Metcalf
- Department of Community Health, University of Auckland, New Zealand
| | - J R Baker
- Department of Community Health, University of Auckland, New Zealand
| | - R K Scragg
- Department of Community Health, University of Auckland, New Zealand
| | - E Dryson
- Department of Community Health, University of Auckland, New Zealand
| | - A J Scott
- Department of Community Health, University of Auckland, New Zealand
| | - C J Wild
- Department of Community Health, University of Auckland, New Zealand
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Nfonsam VN, Jecius HC, Janda J, Omesiete PN, Elquza E, Scott AJ, Nfonsam LE, Jandova J. Cartilage oligomeric matrix protein (COMP) promotes cell proliferation in early-onset colon cancer tumorigenesis. Surg Endosc 2019; 34:3992-3998. [PMID: 31617091 DOI: 10.1007/s00464-019-07185-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Colon cancer (CC) is the third most commonly diagnosed cancer in the USA. While the overall incidence is declining, it is rising alarmingly in young patients (EOCC). CC in young patients tends to be more aggressive and often diagnosed at more advanced stages and portend poorer prognosis. Our recently published data showed that EOCC is a distinct disease with unique molecular features compared to late-onset CC (LOCC). The Cartilage Oligomeric Matrix Protein (COMP) was shown to be significantly upregulated in EOCC and correlated with poor survival. However, the role of COMP in CC tumorigenesis, especially in young patients, is not well understood. Thus, the aim of this study was to elucidate the role of COMP in CC tumorigenesis by modulating COMP levels in vitro and test how it affects proliferation. Then, patient samples were evaluated by testing the levels of proliferation marker Ki67. In addition, this study investigates whether higher transcriptional mRNA levels of COMP seen in more aggressive early-onset CC correlate with protein levels compared to late-onset CC. METHODS COMP mRNA levels in fresh frozen colon tumors (young: n = 5; old: n = 5) were assessed by quantitative PCR (qPCR). Additionally, CC cell lines were profiled for COMP expression to choose an in vitro model to study the role of COMP in CC tumorigenesis. HT-29 (low COMP expression) and CaCo-2 (high COMP expression) cells were used for in vitro proliferation studies. Immunohistochemical (IHC) analysis was conducted to assess COMP and Ki67 protein levels in formalin-fixed paraffin-embedded (FFPE) colon tumors. RESULTS Significantly higher COMP expression levels were observed in fresh frozen EOCC compared to LOCC tumors. This observation confirmed our previously reported results from NanoString gene expression assay using FFPE samples. Cell proliferation was significantly increased in HT-29 and CaCo-2 cells upon treatment with human recombinant COMP protein after 48 and 72 h (P < 0.05). This increase was more profound in HT-29 cells. Staining for COMP and Ki67 revealed high COMP protein levels in EOCC compared to LOCC patients. CONCLUSION COMP mRNA and protein levels are significantly higher in EOCC patients. Higher COMP levels correlate with increased proliferation suggesting a role in CC tumorigenesis.
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Affiliation(s)
- V N Nfonsam
- Department of Surgery, University of Arizona, Tucson, AZ, 85724, USA.
| | - H C Jecius
- Department of Surgery, University of Arizona, Tucson, AZ, 85724, USA
| | - J Janda
- Department of Medicine, University of Arizona, Tucson, AZ, 85724, USA
| | - P N Omesiete
- Department of Surgery, University of Arizona, Tucson, AZ, 85724, USA
| | - E Elquza
- Division of Hematology and Oncology, Department of Medicine, Banner-University of Arizona Cancer Center, Tucson, AZ, 85724, USA
| | - A J Scott
- Division of Hematology and Oncology, Department of Medicine, Banner-University of Arizona Cancer Center, Tucson, AZ, 85724, USA
| | - L E Nfonsam
- Children's Hospital of Eastern Ontario, Ottawa, ON, K1H8L1, Canada
| | - J Jandova
- Department of Surgery, University of Arizona, Tucson, AZ, 85724, USA
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Recio-Boiles A, Veeravelli S, Vondrak J, Babiker HM, Scott AJ, Shroff RT, Patel H, Elquza E, McBride A. Evaluation of the safety and effectiveness of direct oral anticoagulants and low molecular weight heparin in gastrointestinal cancer-associated venous thromboembolism. World J Gastrointest Oncol 2019; 11:866-876. [PMID: 31662825 PMCID: PMC6815918 DOI: 10.4251/wjgo.v11.i10.866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastrointestinal cancer (GICA) is associated with a higher incidence of venous thromboembolism (VTE) compared to other solid tumors, moreover, recurrent VTE and major bleeding (MB) complications during anticoagulation treatment have an associated increase rate. GICA-VTE remains a challenging clinical scenario with MB concerns for utilization of direct oral anticoagulants (DOAC), especially with active cancer therapies.
AIM To evaluate patient risk factors, effectiveness (VTE) and safety (MB) of DOACs and low molecular weight heparin (LMWH) in patients with active GICA-VTE.
METHODS A retrospective chart review of patients receiving DOACs and LMWH with GICA and symptomatic or incidental VTE treated at comprehensive cancer center from November 2013 to February 2017 was performed. Inclusion criteria included active GI cancer diagnosed at any stage or treatment +/- 6 mo of VTE diagnosis, whom were prescribed 6 mo or more of DOACs or LMWH. The Chi-squared test was used for overall and the Fisher exact test for pairwise comparisons of the proportions of patients experiencing recurrent VTE and MB events. Odds ratios were used to compare the relative odds of the occurrence of the outcome given exposure to the risk factor.
RESULTS A total of 144 patients were prescribed anticoagulation, in which 106 fulfilled inclusion criteria apixaban (27.3%), rivaroxaban (34.9%) and enoxaparin (37.7%), and 38 were excluded. Patients median age was 66.5 years at GICA diagnosis and 67 years at CAVTE event, with 62% males, 80% Caucasian, 70% stage IV, pancreatic cancer (40.5%), 30% Khorana Score (≥ 3 points), and 43.5% on active chemotherapy. Sixty-four percent of patients completed anticoagulation therapy (range 1 to 43 mo). Recurrent VTE at 6 mo was noted in 7.5% (n = 3), 6.8% (n = 2) and 2.7% (n = 1) of patients on enoxaparin, apixaban and rivaroxaban, respectively (all P = NS). MB at 6 mo were 5% (n = 2) for enoxaparin, 6.8% (n = 2) for apixaban and 21.6% (n = 8) for rivaroxaban (overall P = 0.048; vs LMWH P = 0.0423; all other P = NS). Significant predictors of a primary or secondary outcome for all anticoagulation therapies included: Active systemic treatment (OR = 5.1, 95%CI: 1.3-19.3), high Khorana Score [≥ 3 points] (OR = 5.5, 95%CI: 1.7-17.1), active smoker (OR = 6.7, 95%CI: 2.1-21.0), pancreatic cancer (OR = 6.8, 95%CI: 1.9-23.2), and stage IV disease (OR = 9.9, 95%CI: 1.2-79.1).
CONCLUSION Rivaroxaban compared to apixaban and enoxaparin had a significantly higher risk of MB on GICA-VTE patients with equivocal efficacy.
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Affiliation(s)
- Alejandro Recio-Boiles
- Department of Medicine, Hematology and Medical Oncology, University of Arizona Cancer Center, Tucson, AZ 85724, United States
| | - Sumana Veeravelli
- Department of Medicine, Internal Medicine Residency Program, University of Arizona, Tucson, AZ 85725, United States
| | - Jessica Vondrak
- Department of Medicine, Internal Medicine Residency Program, University of Arizona, Tucson, AZ 85725, United States
| | - Hani M Babiker
- Department of Medicine, Hematology and Medical Oncology, University of Arizona Cancer Center, Tucson, AZ 85724, United States
| | - Aaron J Scott
- Department of Medicine, Hematology and Medical Oncology, University of Arizona Cancer Center, Tucson, AZ 85724, United States
| | - Rachna T Shroff
- Department of Medicine, Hematology and Medical Oncology, University of Arizona Cancer Center, Tucson, AZ 85724, United States
| | - Hitendra Patel
- UC San Diego Health Moores Cancer Center, La Jolla, CA 92093, United States
| | - Emad Elquza
- Department of Medicine, Hematology and Medical Oncology, University of Arizona Cancer Center, Tucson, AZ 85724, United States
| | - Ali McBride
- University of Arizona College of Pharmacy, Tucson, AZ 85725, United States
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Choi B, McBride A, Scott AJ. Treatment with pembrolizumab after hypersensitivity reaction to nivolumab in a patient with hepatocellular carcinoma. Am J Health Syst Pharm 2019; 76:1749-1752. [DOI: 10.1093/ajhp/zxz189] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Purpose
The options for immunotherapy treatment are limited for treatment of hepatocellular carcinoma. In this case study, we report a case of successful alternation of one PD-1 inhibitor for another after a hypersensitivity reaction.
Summary
Nivolumab (Opdivo, Bristol-Myers Squibb) has been Food and Drug Administration (FDA) approved for a variety of malignancies, including a recent approval for hepatocellular carcinoma (HCC). Infusion-related reactions occur in less than 1% of patients, and although such reactions are rare, recognition of infusion-related reactions induced by nivolumab is an important aspect of its usage. The PD-1 checkpoint inhibitor pembrolizumab is also FDA approved for subsequent-line therapy in treatment of HCC. Thus far, approximately 0.2% of patients experienced severe infusion-related reaction in studies using pembrolizumab. A 70-year-old male with HCC had an infusion reaction to nivolumab that presented as facial flushing, dyspnea, and back pain. The patient received prompt administration of diphenhydramine and hydrocortisone, which led to the amelioration of symptoms and allowed the patient to complete his immunotherapy treatment. For the third dose of nivolumab, the patient received premedications prior to treatment, including diphenhydramine, hydrocortisone, and famotidine. During his infusion, the patient experienced facial flushing, coughing, chest tightness, and an itchy throat. The patient again received diphenhydramine and hydrocortisone to treat infusion-related symptoms and his therapy was discontinued. Because of the nivolumab infusion-related reaction, nivolumab was discontinued, and the patient was started on pembrolizumab. The patient tolerated pembrolizumab without any subsequent infusion-related reactions. Prompt recognition and attention to immunotherapy infusion-related reactions could potentially prevent the fatal complication of anaphylaxis with immune checkpoint inhibitors. In this report, we describe the successful transition from one anti–PD-1 therapy to another for continued immunotherapy treatment without any subsequent infusion reactions.
Conclusion
A patient with HCC was successfully treated with pembrolizumab after experiencing adverse effects with nivolumab.
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Affiliation(s)
- Briana Choi
- University of Arizona College of Pharmacy, Tucson, AZ
| | - Ali McBride
- Division of Hematology/Oncology, Department of Pharmacy, Banner-University of Arizona Cancer Center, Tucson, AZ
| | - Aaron J Scott
- Division of Hematology/Oncology, Department of Medicine, Banner-University of Arizona Cancer Center, Tucson, AZ
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Catenacci DV, Tesfaye A, Tejani M, Cheung E, Eisenberg P, Scott AJ, Eng C, Hnatyszyn J, Marina N, Powers J, Wainberg Z. Bemarituzumab with modified FOLFOX6 for advanced FGFR2-positive gastroesophageal cancer: FIGHT Phase III study design. Future Oncol 2019; 15:2073-2082. [PMID: 31094225 DOI: 10.2217/fon-2019-0141] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Bemarituzumab is an afucosylated monoclonal antibody against FGFR2b (a FGF receptor) with demonstrated monotherapy clinical activity in patients with late-line gastric cancer whose tumors overexpress FGFR2b (NCT02318329). We describe the rationale and design of the FIGHT trial (NCT03343301), a global, randomized, double-blind, placebo-controlled Phase III study evaluating the role of bemarituzumab in patients with previously untreated, FGFR2b-overexpressing advanced gastroesophageal cancer. Patients are randomized in a blinded fashion to the combination of mFOLFOX6 and bemarituzumab or mFOLFOX6 and placebo. Eligible patients are selected based on the presence of either FGFR2b protein overexpression determined by immunohistochemistry or FGFR2 gene amplification determined by circulating tumor DNA. The primary end point is overall survival, and secondary end points include progression-free survival, objective response rate and safety.
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Affiliation(s)
| | | | - Mohamed Tejani
- University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Cheung
- Innovative Clinical Research Institute, Whittier, CA, USA
| | | | - Aaron J Scott
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Clarence Eng
- Five Prime Therapeutics Inc., South San Francisco, CA, USA
| | | | - Neyssa Marina
- Five Prime Therapeutics Inc., South San Francisco, CA, USA
| | | | - Zev Wainberg
- University of California Los Angeles Medical Center (UCLA), Los Angeles, CA, USA
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Nfonsam VN, Jecius H, Chen D, Omesiete PN, Ewongwo AN, Elquza E, Scott AJ, Jandova J. Increasing Incidence of Colon Cancer in the Young: Assessing the Tumor Biology. J Am Coll Surg 2019; 229:79-90. [PMID: 30995524 DOI: 10.1016/j.jamcollsurg.2019.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The overall incidence of colon cancer (CC) is decreasing, but with increasing early-onset colon cancer (EOCC < 50 years old). Our recent study revealed unique overexpression of cartilage oligomeric matrix protein (COMP) in EOCC and its association with aggressiveness. The aim of this study was to assess CC biology, especially in the young, by evaluating the role of COMP in CC carcinogenesis and cancer progression, detecting COMP in serum and its association with disease stage. STUDY DESIGN Cancer and matching noninvolved tissue blocks from 12 sporadic EOCC and late-onset colon cancer (LOCC) patients of 4 disease stages were obtained from pathology archives. Ribonucleic acid expression profiling of 770 cancer-related genes using nCounter platform was performed. The COMP levels from 16 EOCC and LOCC serum samples were measured by ELISA. Carcinoembryonic antigen levels from these 16 samples were taken at the time of diagnosis. Transwell assay was performed to elucidate the role of COMP in motility and metastases. RESULTS Expression profiling revealed increased COMP levels in higher disease stage. There was 7-fold higher COMP expression (p ≤ 0.05) in stage III compare to stage I and its coexpression with GAS1, VEGFC, MAP3K8, SFRP1, and PRKACA. Higher COMP expression was seen in stage II compared with stage I (p = 0.07) and its coexpression withTLR2, IL8, RIN1, IRAK3, and CACNA2D2, and COMP was detectable in serum and showed significantly higher levels in EOCC compared with LOCC. Similar correlation was seen with CEA levels, but the difference was not significant. Transwell assay revealed significantly increased motility of HT-29 cells after treatment with recombinant COMP. CONCLUSIONS These findings suggest different tumor biology between EOCC and LOCC. Cartilage oligomeric matrix protein plays a significant role in CC carcinogenesis and has potential as biomarker for CC, especially aggressive EOCC.
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Affiliation(s)
| | - Hunter Jecius
- Department of Surgery, University of Arizona, Tucson, AZ
| | - Debbie Chen
- Department of Surgery, University of Arizona, Tucson, AZ
| | | | | | - Emad Elquza
- Department of Medicine, University of Arizona, Tucson, AZ
| | - Aaron J Scott
- Department of Medicine, University of Arizona, Tucson, AZ
| | - Jana Jandova
- Department of Surgery, University of Arizona, Tucson, AZ
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Scott AJ, Mason SE, Langdon AJ, Patel B, Mayer E, Moorthy K, Purkayastha S. Prospective Risk Factor Analysis for the Development of Post-operative Urinary Retention Following Ambulatory General Surgery. World J Surg 2019; 42:3874-3879. [PMID: 29947990 PMCID: PMC6244976 DOI: 10.1007/s00268-018-4697-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims Post-operative urinary retention (POUR) is a common cause of unplanned admission following day-case surgery and has negative effects on both patient and surgical institution. We aimed to prospectively evaluate potential risk factors for the development of POUR following day-case general surgical procedures. Methods Over a 24-week period, consecutive adult patients undergoing elective day-case general surgery at a single institution were prospectively recruited. Data regarding urinary symptoms, comorbidities, drug history, surgery and perioperative anaesthetic drug use were collected. The primary outcome was the incidence of POUR, defined as an impairment of bladder voiding requiring either urethral catheterisation, unplanned overnight admission or both. Potential risk factors for the development of POUR were analysed by logistic regression. Results A total of 458 patients met the inclusion criteria during the study period, and data were collected on 382 (83%) patients (74.3% male). Sixteen patients (4.2%) experienced POUR. Unadjusted analysis demonstrated three significant risk factors for the development of POUR: age ≥ 56 years (OR 7.77 [2.18–27.78], p = 0.002), laparoscopic surgery (OR 3.37 [1.03–12.10], p = 0.044) and glycopyrrolate administration (OR 5.56 [2.00–15.46], p = 0.001). Male sex and lower urinary tract symptoms were not significant factors. Multivariate analysis combining type of surgery, age and glycopyrrolate use revealed that only age ≥ 56 years (OR 8.14 [2.18–30.32], p = 0.0018) and glycopyrrolate administration (OR 3.48 [1.08–11.24], p = 0.0370) were independently associated with POUR. Conclusions Patients aged at least 56 years and/or requiring glycopyrrolate—often administered during laparoscopic procedures—are at increased risk of POUR following ambulatory general surgery. Electronic supplementary material The online version of this article (10.1007/s00268-018-4697-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A J Scott
- St Mary's Hospital, Imperial College Healthcare NHS Trust, 10th Floor QEQM, London, W2 1NY, UK. .,Faculty of Medicine, Imperial College London, London, UK.
| | - S E Mason
- Faculty of Medicine, Imperial College London, London, UK
| | | | - B Patel
- Department of Otolaryngology, Northwick Park Hospital, London, UK
| | - E Mayer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, 10th Floor QEQM, London, W2 1NY, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - K Moorthy
- St Mary's Hospital, Imperial College Healthcare NHS Trust, 10th Floor QEQM, London, W2 1NY, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - S Purkayastha
- St Mary's Hospital, Imperial College Healthcare NHS Trust, 10th Floor QEQM, London, W2 1NY, UK.,Faculty of Medicine, Imperial College London, London, UK
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43
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Scott AJ, Arcaroli JJ, Bagby SM, Yahn R, Huber KM, Serkova NJ, Nguyen A, Kim J, Thorburn A, Vogel J, Quackenbush KS, Capasso A, Schreiber A, Blatchford P, Klauck PJ, Pitts TM, Eckhardt SG, Messersmith WA. Cabozantinib Exhibits Potent Antitumor Activity in Colorectal Cancer Patient-Derived Tumor Xenograft Models via Autophagy and Signaling Mechanisms. Mol Cancer Ther 2018; 17:2112-2122. [PMID: 30026382 DOI: 10.1158/1535-7163.mct-17-0131] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 12/01/2017] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
Antiangiogenic therapy used in treatment of metastatic colorectal cancer (mCRC) inevitably succumbs to treatment resistance. Upregulation of MET may play an essential role to acquired anti-VEGF resistance. We previously reported that cabozantinib (XL184), an inhibitor of receptor tyrosine kinases (RTK) including MET, AXL, and VEGFR2, had potent antitumor effects in mCRC patient-derived tumor explant models. In this study, we examined the mechanisms of cabozantinib sensitivity, using regorafenib as a control. The tumor growth inhibition index (TGII) was used to compare treatment effects of cabozantinib 30 mg/kg daily versus regorafenib 10 mg/kg daily for a maximum of 28 days in 10 PDX mouse models. In vivo angiogenesis and glucose uptake were assessed using dynamic contrast-enhanced (DCE)-MRI and [18F]-FDG-PET imaging, respectively. RNA-Seq, RTK assay, and immunoblotting analysis were used to evaluate gene pathway regulation in vivo and in vitro Analysis of TGII demonstrated significant antitumor effects with cabozantinib compared with regorafenib (average TGII 3.202 vs. 48.48, respectively; P = 0.007). Cabozantinib significantly reduced vascularity and glucose uptake compared with baseline. Gene pathway analysis showed that cabozantinib significantly decreased protein activity involved in glycolysis and upregulated proteins involved in autophagy compared with control, whereas regorafenib did not. The combination of two separate antiautophagy agents, SBI-0206965 and chloroquine, plus cabozantinib increased apoptosis in vitro Cabozantinib demonstrated significant antitumor activity, reduction in tumor vascularity, increased autophagy, and altered cell metabolism compared with regorafenib. Our findings support further evaluation of cabozantinib and combinational approaches targeting autophagy in colorectal cancer. Mol Cancer Ther; 17(10); 2112-22. ©2018 AACR.
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Affiliation(s)
- Aaron J Scott
- Division of Hematology and Oncology, Banner University of Arizona Cancer Center, Tucson, Arizona.
| | - John J Arcaroli
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Stacey M Bagby
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Rachel Yahn
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Kendra M Huber
- Department of Anesthesia, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Natalie J Serkova
- Department of Anesthesia, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Anna Nguyen
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Jihye Kim
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Andrew Thorburn
- Department of Pharmacology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Jon Vogel
- Department of Surgery, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Kevin S Quackenbush
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Anna Capasso
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Anna Schreiber
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Patrick Blatchford
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Peter J Klauck
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - Todd M Pitts
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
| | - S Gail Eckhardt
- Division of Medical Oncology, The University of Texas at Austin, Austin, Texas
| | - Wells A Messersmith
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, Colorado
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Scott AJ, Song EK, Bagby S, Purkey A, McCarter M, Gajdos C, Quackenbush KS, Cross B, Pitts TM, Tan AC, Eckhardt SG, Fenton H, Arcaroli J, Messersmith WA. Evaluation of the efficacy of dasatinib, a Src/Abl inhibitor, in colorectal cancer cell lines and explant mouse model. PLoS One 2017; 12:e0187173. [PMID: 29091939 PMCID: PMC5665512 DOI: 10.1371/journal.pone.0187173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/13/2017] [Indexed: 12/04/2022] Open
Abstract
Background Dysregulation of the Src pathway has been shown to be important at various stages of cancer. Dasatinib is a potent Src/Abl inhibitor and has demonstrated to have anti-proliferative and anti-invasive activity in many preclinical models. The objective of this study was to determine the anti-tumor activity of dasatinib using in vitro and in vivo preclinical colorectal (CRC) models. Methods CRC cell lines and patient-derived tumor explant (PDX) models were used to investigate the efficacy of dasatinib. We treated 50 CRC cell lines with dasatinib for 72 hours and proliferation was assayed by a sulforhodamine B (SRB) assay; an IC50 ≤ 0.08 μmol/L was considered sensitive. We treated 17 patient-derived CRC explants with dasatinib (50 mg/kg/day, administered once-daily) for 28 days to determine in vivo efficacy. Tumor growth inhibition (TGI) ≥ 50% was considered sensitive. Results We found that 8 out of 50 CRC cell lines reached an IC50 ≤ 0.08 μmol/L with dasatinib treatment. In addition, of 17 CRC explants grown in the xenograft mouse model, 2 showed sensitivity to dasatinib. The anti-tumor effects observed in this study were a result of G1 cell cycle arrest as the dasatinib sensitive CRC cell lines exhibited G1 inhibition. Moreover, those CRC cell lines that were responsive (0.08 μmol/L) to treatment demonstrated a significant baseline increase in Src and FAK gene expression. Conclusion Dasatinib demonstrated significant anti-proliferative activity in a subset of CRC cell lines in vitro, especially in those with increased Src expression at baseline, but only showed modest efficacy in CRC explants. Dasatinib is currently being studied in combination with chemotherapy in patients with advanced CRC, as its use as a single agent appears limited.
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Affiliation(s)
- Aaron J. Scott
- Division of Medical Oncology, Banner University of Arizona Cancer Center, Tucson, AZ, United States of America
- * E-mail:
| | - Eun-Kee Song
- Chonbuk National University Medical School, Jeonju, South Korea
| | - Stacey Bagby
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - Alicia Purkey
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - Martin McCarter
- Department of Surgery, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - Csaba Gajdos
- Department of Surgery, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - Kevin S. Quackenbush
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - Benjamin Cross
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - Todd M. Pitts
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - Aik Choon Tan
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - S. Gail Eckhardt
- Division of Medical Oncology, The University of Texas at Austin, Austin, TX, United States of America
| | - Hubert Fenton
- Department of Pathology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - John Arcaroli
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
| | - Wells A. Messersmith
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, United States of America
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Hardcastle TP, Seabourne CR, Kepaptsoglou DM, Susi T, Nicholls RJ, Brydson RMD, Scott AJ, Ramasse QM. Robust theoretical modelling of core ionisation edges for quantitative electron energy loss spectroscopy of B- and N-doped graphene. J Phys Condens Matter 2017; 29:225303. [PMID: 28394256 DOI: 10.1088/1361-648x/aa6c4f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Electron energy loss spectroscopy (EELS) is a powerful tool for understanding the chemical structure of materials down to the atomic level, but challenges remain in accurately and quantitatively modelling the response. We compare comprehensive theoretical density functional theory (DFT) calculations of 1s core-level EEL K-edge spectra of pure, B-doped and N-doped graphene with and without a core-hole to previously published atomic-resolution experimental electron microscopy data. The ground state approximation is found in this specific system to perform consistently better than the frozen core-hole approximation. The impact of including or excluding a core-hole on the resultant theoretical band structures, densities of states, electron densities and EEL spectra were all thoroughly examined and compared. It is concluded that the frozen core-hole approximation exaggerates the effects of the core-hole in graphene and should be discarded in favour of the ground state approximation. These results are interpreted as an indicator of the overriding need for theorists to embrace many-body effects in the pursuit of accuracy in theoretical spectroscopy instead of a system-tailored approach whose approximations are selected empirically.
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Affiliation(s)
- T P Hardcastle
- SuperSTEM Laboratory, STFC Daresbury Campus, Daresbury, WA4 4AD, United Kingdom. School of Chemical and Process Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom
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Booth A, Burger S, Scott AJ, Thomson D. The International Association of Student Surgical Societies: A brief history from 2014-2017. S AFR J SURG 2017; 55:2-5. [PMID: 28876615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The International Association of Student Surgical Societies (IASSS) was founded in 2011 to link up student surgical societies from around the world. These Societies have been formed by students with an aim to promote interest in surgical education and research amongst undergraduate medical students. Their formation has been fostered by the recent realization that adequate surgical care is a neglected component of global public health.1 The insufficient number of trained surgeons is one of the many barriers to meeting global surgical needs, especially in middle- and low-income countries. This barrier is one the IASSS aims to address.2,3 Since its inauguration, the IASSS has been active in creating opportunities for undergraduate medical students across the world to explore the full spectrum of surgery.
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Affiliation(s)
- A Booth
- Faculty of Health Sciences, University of Cape Town
| | | | - A J Scott
- Faculty of Health Sciences, University of Cape Town
| | - D Thomson
- Transplant Unit, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town
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Scott AJ, Kahn D. Factors influencing medical students in pursuing a career in surgery: a cross-sectional survey. S AFR J SURG 2017; 55:24-30. [PMID: 28876620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Many factors play a role in the decision of a medical student to pursue a career in surgery. With a decline in numbers of applications into surgical programmes seen globally, the aim of this study was to determine the factors that influence medical students in pursuing a career in surgery. METHOD A descriptive, cross-sectional survey was distributed online to all medical students studying at a tertiary, academic institution. Survey items obtained data on demographics, surgical interest and training, as well as factors affecting a surgical career. RESULTS A total of 245 medical students responded, of which 56% were female. The majority (69%) stated they were interested in pursuing a career in surgery. Despite 75% of respondents stating South Africa was a good place for surgical training, females reported significantly higher levels of agreement that surgical training would be better overseas when compared to males (p = 0.027). Overall, 20% were undecided on what surgical specialty they would pursue. The largest proportion of respondents (33%) stated that 'Length of training' was the main barrier to pursuing a career in surgery. Thirtythree (13.5%) respondents reported 'Female-unfriendly' as a barrier, of whom all were female. The greatest motivator to pursuing a career in surgery was 'Hands-on work', stated by 36% of respondents. CONCLUSION Though length of surgical training was deemed the principal barrier, the majority of students indicated they would pursue a career in surgery. Despite continued perceptions that surgery poses a female-unfriendly environment as a career, respondents held South African surgical training in high esteem, and were motivated by a clinically hands-on approach. These factors may play an important role in determining methods of improving numbers of surgical applications worldwide.
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Affiliation(s)
- A J Scott
- Faculty of Health Sciences, University of Cape Town
| | - D Kahn
- Department of Surgery, Division of General Surgery and Transplant Unit, University of Cape Town
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Minckler MR, Conser E, Figueroa JJ, Scott AJ, Gaither J, Amini R. The Semantics of Priapism and the First Sign of Chronic Myeloid Leukemia. Case Rep Emerg Med 2017; 2017:2656203. [PMID: 28638667 PMCID: PMC5468559 DOI: 10.1155/2017/2656203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/03/2017] [Accepted: 05/07/2017] [Indexed: 11/19/2022] Open
Abstract
Priapism is defined as an erection that persists beyond four hours, lasting beyond or unrelated to sexual stimulation (Salonia et al., 2014). Because the risk of ischemic damage and impotence is high with priapism (35%), management guidelines are directed towards rapid treatment of this condition (Salonia et al., 2014). This report describes the rare case of an 18-year-old male who presented to the Emergency Department (ED) three times with recurrent and worsening episodes of sustained penile erections. On the patient's third visit, he presented with priapism of greater than six-hour duration that was found to be the result of chronic myeloid leukemia. Clinician awareness of the diagnostic semantics and differential diagnosis surrounding priapism is pivotal in its urgent management.
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Affiliation(s)
| | - Ellie Conser
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Javier J. Figueroa
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | - Aaron J. Scott
- Department of Medicine, Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Joshua Gaither
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | - Richard Amini
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
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Scott AJ, Harris V, Lee A, Smith SD. Assessment of sun-protective attitudes and behaviours of australian medical students. J Eur Acad Dermatol Venereol 2017; 31:e497-e498. [PMID: 28449221 DOI: 10.1111/jdv.14298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A J Scott
- School of Medicine and Public Health, University of Newcastle, 2305, Newcastle, New South Wales, Australia
| | - V Harris
- Department of Dermatology, Royal North Shore Hospital, 2065, St Leonards, New South Wales, Australia.,Northern Clinical School, University of Sydney, 2065, St Leonards, New South Wales, Australia
| | - A Lee
- Department of Dermatology, Royal North Shore Hospital, 2065, St Leonards, New South Wales, Australia.,Northern Clinical School, University of Sydney, 2065, St Leonards, New South Wales, Australia
| | - S D Smith
- Department of Dermatology, Royal North Shore Hospital, 2065, St Leonards, New South Wales, Australia.,Northern Clinical School, University of Sydney, 2065, St Leonards, New South Wales, Australia.,The Dermatology and Skin Cancer Centre, Suite 4, 22 Watt St, Gosford, 2250, New South Wales, Australia
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Scott AJ, Paul AS. Collective Order and Economic Coordination in Industrial Agglomerations: The Technopoles of Southern California. ACTA ACUST UNITED AC 2016. [DOI: 10.1068/c080179] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We begin by remarking upon the pervasiveness of nonmarket institutional arrangements in capitalist economic systems. We then sketch out some typical generalized forms of collective order and economic coordination in industrial agglomerations—quasi-integration, voluntary associations, informal business cultures, and governmental institutions. With the aid of simple statistics we describe the growth of the high-technology industrial agglomerations (technopoles) of Southern California since the 1950s. The specific regulatory tasks and institutions engendered by this growth are reviewed in detail with special reference to transactional economies, innovation and technology transfer, labor supply, land development, and lobbying and local economic growth. We conclude with a brief discussion of some of the problems and predicaments experienced by high-technology industry in Southern California and in the USA in the current (neoconservative) policy environment.
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Affiliation(s)
- A J Scott
- Department of Geography, University of California-Los Angeles, Los Angeles, CA 90024, USA
| | - A S Paul
- Department of Geography, University of California-Los Angeles, Los Angeles, CA 90024, USA
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