Relationship-building to develop an Indigenous community-based epidemiological study investigating developmental resilience factors among children with prenatal substance exposure

Tribal Nations experience substance misuse at high rates often attributed to historical and contemporary traumas. In response, several Tribal Nations are addressing these issues through efforts to promote recovery and prevention to substance misuse. Study objectives were to partner with a Tribal Nation to develop a study to explore factors that contribute to the wellbeing of families to children with prenatal substance exposure and disseminate findings that can be translated back into the community. We applied Community-based participatory research (CBPR), strengths-based, and community-driven approaches during this two-year study development phase. We experienced challenges and identified solutions to partnering with one Tribal Nation on an epidemiological mixed-methods study centered on families with children that have prenatal substance exposure. Key inputs were becoming familiarizing with the community setting, structural supports for CBPR research, incorporating Indigenous CBPR principles, and developing a Community Advisory Team. We successfully collaborated with the Confederated Salish Kootenai Tribes Early Childhood Services program to develop a robust study design and a dissemination plan to ensure translation of study findings to the community. The robust study design consisted of common themes specific to a highly stigmatized study population, substance-abusing pregnant women, to protect participant confidentiality. Research alignment with community goals, allotting meaningful time to develop a research partnership, and incorporating culturally sensitive and community-relevant measures contributed to the successful development of an effective and rigorous study to better serve the Tribal Nation on addressing substance misuse.

Modelling the effects of cold temperature during the reproductive stage on the yield of chickpea (Cicer arietinum L.)

During the reproductive stage, chilling temperatures and frost reduce the yield of chickpea and limit its adaptation. The adverse effects of chilling temperature and frost in terms of the threshold temperatures, impact of cold duration, and genotype-by-environment-by-management interactions are not well quantified. Crop growth models that predict flowering time and yield under diverse climates can identify combinations of cultivars and sowing time to reduce frost risk in target environments. The Agricultural Production Systems Simulator (APSIM-chickpea) model uses daily temperatures to model basic crop growth but does not include penalties for either frost damage or cold temperatures during flowering and podding stages. Regression analysis overcame this limitation of the model for chickpea crops grown at 95 locations in Australia using 70 years of historic data incorporating three cultivars and three sowing times (early, mid, and late). We modified model parameters to include the effect of soil water on thermal time calculations, which significantly improved the prediction of flowering time. Simulated data, and data from field experiments grown in Australia (2013 to 2019), showed robust predictions for flowering time (n = 29; R² = 0.97), and grain yield (n = 22; R² = 0.63-0.70). In addition, we identified threshold cold temperatures that significantly affected predicted yield, and combinations of locations, variety, and sowing time where the overlap between peak cold temperatures and peak flowering was minimal. Our results showed that frost and/or cold temperature-induced yield losses are a major limitation in some unexpected Australian locations, e.g., inland, subtropical latitudes in Queensland. Intermediate sowing maximise yield, as it avoids cold temperature, late heat, and drought stresses potentially limiting yield in early and late sowing respectively.

An innovative Antimicrobial Stewardship Program for children in remote and regional areas in Queensland, Australia: optimizing antibiotic use through timely intravenous-to-oral conversion

BACKGROUND

Little is known about the benefits of timely conversion from intravenous (IV) to oral antibiotic therapy in children. We evaluated appropriateness of IV to oral conversion of antibiotic therapy in remote and regional areas following the implementation of a multifaceted package of interventions.

METHODS

The intervention package: clinician guidelines, medication review stickers, patient information leaflets, and educational resources was implemented in seven facilities in Queensland, Australia. Children with community acquired pneumonia and skin and soft tissue infections were switched to oral therapy if they met the required 'IV-to-oral switch' criteria. Data was collected for a 7-month period from May to November for the baseline (2018) and the intervention (2019) phases.

RESULTS

There were 357 patients enrolled in the study with 178 in the baseline and 179 in the intervention phase. The percentage of patients who were eligible to switch to oral therapy, within 24 hours of eligibility, increased from (156/178) 87.6% in the baseline phase to (174/179) 97.2% in the intervention phase (p = 0.003). The average number of extra IV days decreased from 0.45 days in the baseline period to 0.18 days in the intervention period (p < 0.001). The median patient length of stay was 2 days for both phases. The only adverse events recorded were line-associated infiltrates, with a decrease from 34.3% (61/178) (baseline) to 17.9% (32/179) (intervention) (p < 0.001).

CONCLUSION

A multifaceted intervention package to enhance timely IV to oral conversion of antibiotic therapy for children in remote and regional facilities is effective.

The meaning of play for children and young people with physical disabilities: A systematic thematic synthesis

BACKGROUND

Children and young people with physical disabilities are often reported to play less than their typically developing peers. Few studies explore the meaning of play from the child's perspective; this study carried out a thematic synthesis of the findings of qualitative studies about the meaning of play following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

A search of CINAHL, AHMED, PsycINFO, MEDLINE, EMBASE, and ERIC was undertaken between September 2015 and March 2016. Qualitative studies exploring the meaning of play from the perspective of 0- to 18-year-olds with physical disabilities impacting function were included. Quality appraisal and thematic synthesis were undertaken in order to develop analytical themes.

RESULTS

Thirteen studies met the inclusion criteria in part addressing the meaning of play for children and young people with physical disabilities. Synthesis of the findings identified 5 analytical themes: Play can feel both positive and negative; play can draw attention towards or away from my disability; play is a social interaction; I participate differently to my peers, and needing help feels normal.

CONCLUSIONS

The themes highlight the potential for play experiences of individuals with physical disabilities being overlooked by parents and professionals; further research is needed to explore play experience from these individual's perspective.

A study of the reaction of ferrate with pentachlorophenol - kinetics and degradation products

Pentachlorophenol (PCP) is a persistent pollutant which has been widely used as a pesticide and a wood preservative. As PCP is toxic and is present in significant quantities in the environment, there is considerable interest in elimination of PCP from waters. One of the promising methods is the application of ferrate. Ferrate is an oxidant and coagulant. It can be applied as a multi-purpose chemical for water and wastewater treatment as it degrades a wide range of environmental pollutants. Moreover, ferrate is considered a green oxidant and disinfectant. This study focuses on the kinetics of PCP degradation by ferrate under different pH conditions. The formation of degradation products is also considered. The second-order rate constants of the PCP reaction with ferrate increased from 23 M^-1 s^-1 to 4,948 M^-1 s^-1 with a decrease in pH from 9 to 6. At neutral pH the degradation was fast, indicating that ferrate could be used for rapid removal of PCP. The total degradation of PCP was confirmed by comparing the initial PCP molarity with the molarity of chloride ions released. We conclude no harmful products are formed during ferrate treatment as all PCP chlorine was released as chloride. Specifically, no polychlorinated dibenzo-p-dioxins and dibenzofurans were detected.

Combined effects of flow condition and parasitism on shoaling behaviour of female guppies Poecilia reticulata

Group living in fish can provide benefits of protection from predators and some parasites, more efficient foraging for food, increased mating opportunities and enhanced energetic benefit when swimming. For riverine species, shoaling behaviour can be influenced by various environmental stressors, yet little is known how flow rate might influence the shoaling of diseased fish shoals. In view of the increasingly unpredictable flow rates in streams and rivers, this study aimed to assess the combined effect of flow condition and parasitism on the shoaling behaviour of a model fish species. Shoal size, shoal cohesion and time spent shoaling of female guppies Poecilia reticulata were compared when infected with the directly transmitted ectoparasite Gyrodactylus turnbulli under flow and static conditions. Flow condition was an important factor in influencing shoaling behaviour of guppies with the fish forming larger shoals in the absence of flow. When a shoal member was infected with G. turnbulli, shoal cohesion was reduced, but the magnitude of this effect was dependent on flow condition. In both flow and static conditions, bigger fish formed larger shoals than smaller counterparts. Future changes to stream hydrology with more frequent flooding and drought events will affect the shoaling tendency of fish. During high-flow events, diseased fish may not be able to keep up with shoal mates and therefore have a higher risk of predation. Additionally, these findings may be important for aquaria and farmed species where an increase in flow rate may reduce aggregation in fish.

Ottawa Cardiac Oncology Program wins 2013 Cancer Quality Council of Ontario Innovation Award

The Ottawa Cardiac Oncology Program (ocop) has won the 2013 Innovation award from the Cancer Quality Council of Ontario [...]

Treatment outcomes for male breast cancer: a single-centre retrospective case-control study

BACKGROUND

Male breast cancer (bc) is a rare disease, and the availability of information on treatment outcomes is limited compared with that for female bc. The objective of the present study was to compare disease-free (dfs) and overall survival (os) for men compared with women having early-stage bc.

METHODS

This retrospective case-control study compared men and women treated for stage 0-iiib bc at a single institution between 1981 and 2009. Matching was based on age at diagnosis, year of diagnosis, and stage. Treatment, recurrence, and survival data were collected. Kaplan-Meier analysis was used to calculate os and dfs.

RESULTS

For the 144 eligible patients (72 men, 72 women), median age at diagnosis was 66.5 years. Treatments included mastectomy (72 men, 38 women), radiation (29 men, 44 women), chemotherapy (23 men, 20 women), and endocrine therapy (57 men, 57 women). Mean dfs was 127 months for women compared with 93 months for men (p = 0.62). Mean os was 117 months for women compared with 124 months for men (p = 0.35). In multivariate analysis, the only parameter that affected both dfs and os was stage at diagnosis.

CONCLUSIONS

This case-control study is one of the largest to report treatment outcomes in early-stage male bc patients treated in a non-trial setting. Male patients received systemic therapy that was comparable to that received by their female counterparts, and they had similar os and dfs. These results add to current evidence from population studies that male sex is not a poor prognostic factor in early-stage breast cancer.

Comparative cervical profiles of adult and under-18 front-row rugby players: implications for playing policy

OBJECTIVE

To compare the cervical isometric strength, fatigue endurance and range of motion of adult and under-18 age-grade front-row rugby players to inform the development of a safe age group policy with particular reference to scrummaging.

DESIGN

Cross-sectional cohort study.

SETTING

'Field testing' at Murrayfield stadium.

PARTICIPANTS

30 high-performance under-18 players and 22 adult front-row rugby players.

OUTCOME MEASURES

Isometric neck strength, height, weight and grip strength.

RESULTS

Youth players demonstrated the same height and grip strength as the adult players; however, the adults were significantly heavier and demonstrated substantially greater isometric strength (p<0.001). Only two of the 'elite' younger players could match the adult mean cervical isometric strength value. In contrast to school age players in general, grip strength was poorly associated with neck strength (r=0.2) in front-row players; instead, player weight (r=0.4) and the number of years' experience of playing in the front row (r=0.5) were the only relevant factors in multivariate modelling of cervical strength (R(2)=0.3).

CONCLUSIONS

Extreme forces are generated between opposing front rows in the scrum and avoidance of mismatch is important if the risk of injury is to be minimised. Although elite youth front-row rugby players demonstrate the same peripheral strength as their adult counterparts on grip testing, the adults demonstrate significantly greater cervical strength. If older youths and adults are to play together, such findings have to be noted in the development of age group policies with particular reference to the scrum.

Clinical outcomes of women with metastatic breast cancer treated with nab-paclitaxel: experience from a single academic cancer centre

BACKGROUND

Nab-paclitaxel is a solvent-free, taxane-based chemotherapy approved for the treatment of metastatic breast cancer (mbc). This study reports clinical benefit and toxicities experienced by women with mbc treated with nab-paclitaxel at the Ottawa Hospital Cancer Centre.

METHODS

Women with mbc treated with single-agent nab-paclitaxel between June 2006 and December 2010 were included in this analysis. Retrospective data obtained included demographics, disease characteristics, prior chemotherapy, nab-paclitaxel treatment, toxicity, and survival. Clinical benefit was defined as partial or complete response or stable disease (by clinical or radiologic evaluation, or both) at 6 months or more.

RESULTS

Of 43 women (mean age: 57.0 years; range: 34-74 years), most had disease positive for estrogen or progesterone receptor (72.1%, 58.1%), or both. Nab-paclitaxel was administered weekly (qw: 44.2%), every 3 weeks (q3w: 46.5%), q3w switched to qw (7.0%), or qw switched to q3w (2.3%). Median duration of therapy was 5.1 months (qw) and 3.0 months (q3w). Sensory neuropathy was the primary toxicity (45.4% qw, 38.1% q3w; p = 0.62). Clinical benefit was observed in most women (76.2% qw, 57.1% q3w; p = 0.20). Women receiving nab-paclitaxel had a median overall survival of 13.6 months qw (range: 8.1-28.3 months) and 10.8 months q3w (range: 5.9-17.9 months; p = 0.03). Regardless of dosing schedule, women experiencing clinical benefit lived significantly longer than those not experiencing a benefit (17.3 months vs. 7.7 months; hazard ratio: 0.14; 95% confidence interval: 0.06 to 0.33).

CONCLUSIONS

Our clinical experience demonstrates that most women treated with nab-paclitaxel experienced some clinical benefit. Patients achieving clinical benefit lived significantly longer than those who did not. Nab-paclitaxel was well tolerated, with the primary toxicity being mild sensory neuropathy. Nab-paclitaxel represents another treatment option, with a favourable toxicity profile, for women with mbc.

Abstract P3-04-11: Systemic treatment decision making for patients with stage I and II, hormone receptor positive, her2/neu negative breast cancer

Background: Oncotype DX is a clinically validated risk stratification tool that can predict the risk of recurrence and the benefit of adjuvant chemotherapy in women with hormone receptor positive (HR+), HER2/neu negative early stage breast cancer (EBC). This tool has been available to oncologists in Ontario since April 2010 at significant cost, yet no guidelines exist regarding their use. This retrospective chart review examined the factors that were associated with use of Oncotype DX at a tertiary care cancer centre.

Materials and methods: One hundred patients (pts) diagnosed with HR+, HER2/neu negative EBC (stage I-II), who underwent Oncotype DX testing between April 1, 2010, and June 30, 2011 were included in the study. A second control group of 100 patients with similar disease characteristics but who did not receive Oncotype DX testing were randomly selected. Data collection included demographics, tumor grade and stage, and Adjuvant! Online recurrence risk scores. The distribution of patients in each category was compared using the chi-square test to detect statistically significant differences between distributions.

Results: Median age in the Oncotype DX group was 58 years (r: 26–77) and 63 years (r: 30–81) in the control group. 20 patients in the Oncotype DX group were aged 35–49, 57 patients were aged 50–64, and 23 patients were aged 65 or older, while the control group had 16, 43, and 41 patients, respectively (p = 0.02). The Oncotype DX group had 72 pre- and perimenopausal pts and 28 postmenopausal patients, while the control group had 81 and 19 patients, respectively (p = 0.13). 20, 56, and 24 pts in the Oncotype DX group had grade 1, 2, and 3 histology, respectively, vs. 44, 44, and 12, respectively in the control group (p &lt; 0.01). The Oncotype DX group had 7 patients with tumors between 1–10 mm, 55 between 10.1–20 mm, 34 between 20.1–50 mm, and 4 greater than 50 mm, vs. 29, 42, 23, and 1, respectively in the control group (p &lt; 0.01). When 10-year Adjuvant Online recurrence scores were calculated using tamoxifen, 17, 67, and 16 patients in the Oncotype DX group had risk scores of &lt;15, 15–25, and &gt;25, respectively, vs. 62, 33, and 5 in the control group (p &lt; 0.01). When the scores were calculated using tamoxifen plus an aromatase inhibitor, 49, 42, and 9 patients in the Oncotype DX group, and 75, 24, and 1 patients in the control group fell into these categories, respectively (p &lt; 0.01). Median Oncotype DX recurrence score was 17 (r: 0–70), with 10-year recurrence risk of 11% (r:3–34%).

Conclusions: This single-centre series is aimed at identifying potential clinical and pathological factors which can influence physicians' decision to request Oncotype DX testing for pts with EBC. Physicians were more likely to request Oncotype DX testing for patients that were younger, had larger and higher grade tumors, and higher Adjuvant! Online recurrence risk scores. These results will be used to design a prospective study evaluating these factors and how Oncotype DX testing may influence treatment decision making.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-04-11.

Abstract P3-11-03: Treatment outcomes for early stage male breast cancer: a single centre retrospective case-control study

Background: Male breast cancer (BC) is a rare disease with a reported incidence of 1%, and treatment strategies are therefore driven by studies conducted in the female BC population. There is also limited information with regards to treatment outcomes for men with early stage BC, particularly when compared with their female counterparts. The objective of this study is to compare the disease free survival (DFS) and overall survival (OS) of males with early stage BC compared to age and stage matched females in a single institution.

Methods: A retrospective matched case-control study was conducted to compare male and female pts treated for stage 0 to IIIB BC, at the Ottawa Hospital Cancer Centre, between 1981 and 2009. Matching of male and female pts was done based on age at diagnosis (+/− 2 years), year of diagnosis (+/− 1 year), and disease stage. Data regarding surgery, adjuvant radiation, chemotherapy, and endocrine therapy was collected. Overall survival and disease-free survival were calculated using Kaplan-Meir analysis.

Results: A total of 144 pts (72 female; 72 male) were eligible for this study; median age at diagnosis for both groups was 74 years (r: 30–85). Median follow-up was 54 months (r: 2–204) for males and 54 months (r: 4–241) for females. All 72 men underwent mastectomy compared to 38 females (53%). Forty-four (61%) females received adjuvant radiation therapy compared to 29 (40%) males. Twenty (28%) females received adjuvant chemotherapy, compared to 23 (31%) males. All female pts had estrogen receptor positive (ER+) disease, while 59 males (13 unknown) had ER+ disease. An equal number of males and females (79%) received endocrine treatment. The mean DFS for females was 127 months (25th percentile 33 months; median 104 months; 75th percentile 174 months), compared to 93 months (25th percentile 46 months; median 88 months; 75th percentile 112 months) for males (p = 0.62). Mean OS for females was 117 months (25th percentile 40 months; median 107 months; 75th percentile 136 months), and 124 months (25th percentile 48 months; median 90 months; 75th percentile 128 months) for males (p = 0.35). In multivariate analysis, the only parameter that affected both DFS and OS was stage at diagnosis (hazard ratio 0.42, 95% CI 0.18–1.00; hazard ratio 0.25, 96% CI 0.09–0.68).

Conclusions: This is one of the largest case-cohort studies to report on treatment outcomes of early stage male BC pts treated in a non-trial setting. Male pts received comparable systemic therapy (chemotherapy/endocrine) as their female counterparts and DFS and OS were similar. These results add to current evidence from population studies that male sex is not a poor prognostic factor for treatment outcomes in early stage BC. The development of a national male breast cancer registry would facilitate the evaluation of modern treatment strategies and patient outcomes in this population.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-11-03.

PD04-04: Sexual Dysfunction in Women with Early Stage Breast Cancer on Endocrine Therapy: Encouraging Results from a Prospective Study

Background: While the side effects of endocrine therapy (ET) for early stage breast cancer (EBC) have been extensively studied, the link between ET and sexual dysfunction (SD) remains a contentious issue. Most studies have focused on documenting only the presence of problems in specific domains of endocrine symptoms (ES) (e.g. hot flushes, vaginal dryness) and sexual functioning (SF) (interest, satisfaction, arousal, lubrication) without also taking sexual distress into account. To our knowledge, there have been no prospective longitudinal studies evaluating SF and SD before the onset of ET and after treatment initiation. We report the initial 6 month results of this study of SD in women initiating ET for EBC.

Methods: Hormone receptor positive EBC post-menopausal women were approached for a larger study of SF aimed at comparing the prevalence of SD across endocrine agents (tamoxifen vs aromatase inhibitor) and at evaluating the impact of anxious predisposition and ES on SD. Here we report on changes in ES, SF and SD after 6 months of ET. SF was evaluated with the Female Sexual Function Index (FSFI) while sexual distress was assessed with the Female Sexual Distress Scale. ES were measured with FACT-B ES subscale. Participants completed questionnaires prior to initiation (T0) of ET and at 6 months (T1). SD was assessed using the APA classification.

Results: Between January 2009 and May 2011, 118 EBC patients entered the study and 83 have completed both assessments (mean age 62; 30% received chemotherapy). Over time, the levels of ES increased (p &lt;0.001). Despite the worsening of ES at T1, no decline in SF was observed, this for each FSFI domain (desire, arousal, lubrication, discomfort during intercourse and satisfaction). There was no change in the percentage of women reporting 1 or more sexual problems over time (85% vs 87%, ns) nor in the percentage who were sexually distressed (32% vs 34%, ns). The prevalence of SD did not increase after 6 months of ET (T0=28% vs T1=33%, ns). There were no differences in the percentage of women who worsened (i.e., no SD at T0 but SD at T1, 12%) and those who improved (SD at T0 but no SD at T1, 7%) over time (McNemar X2, p &gt;.5) Importantly, women classified as experiencing SD at T0 were more likely to also experience SD at T1 (OR=4.5, 95% CI=2.162 to 9.366) than women who had no SD at T0.

Discussion: This is the first prospective case cohort study evaluating ES, SF and SD in women with EBC on ET. The good news for women is that although ES increased during ET (p &lt; 0.001), this did not have a negative impact on sexual problems (85% vs 87%, ns) or SD (32% vs 34%, ns). This is encouraging news but longer follow-up of these women will provide further insight into the impact of ET on ES and SD over time (&gt; 6 months). The impact of specific types of ET on ES, and SD will also be evaluated. Of interest, the high uptake and high completion rate (&gt;80%) of questionnaires, indicate this is a matter of relevance and importance to women taking adjuvant ET and merits acknowledgement and sensitive discussion.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD04-04.

OT3-02-01: A 1-Year Prospective Longitudinal Study of the Role of Psychosocial Factors in Adherence to Adjuvant Endocrine Therapy in Early Breast Cancer

Background: Extensive evidence suggests that endocrine therapy (ET) and adherence to adjuvant ET directly impacts on disease-free and overall survival in women with hormone receptor positive (HR+) early stage breast cancer (EBC). Despite this, adherence to ET is suboptimal, with 35%-50% of patients discontinuing therapy earlier than recommended. Interventions to improve adherence are lacking, due in part to a poor understanding of the modifiable risk factors influencing adherence. Virtually all authors have focused on educational needs of patients and side effect management of ET but there remains a paucity of data on how potentially modifiable psychosocial factors present at outset of treatment initiation influence adherence. We believe that a better understanding of these factors may lead to interventions which enable women to adhere to long term life-saving therapies. This study aims to identify such factors guided by the Common-Sense Model of Self-Regulation which proposes that cognitive, emotional, coping and interpersonal factors are modifiable determinants of adherence.

Study Design: The study is a single centre prospective longitudinal quantitative study. Women diagnosed with HR+ EBC for which endocrine therapy is intended will be enrolled. Participants will complete questionnaires prior to initiating ET, then at 3, 6 and 12 months. The predictor variables are: 1) modifiable factors including illness and treatment cognitions, self-efficacy in coping with side effects anticipated or experienced, fear of breast cancer recurrence, trait anxiety, patient-physician interaction, 2) treatment-induced toxicities and 3) clinical factors including ET, chemotherapy, radiation, cancer stage and menopausal status. The outcome variable is adherence measured at each assessment post-treatment initiation with pill counts and participants'self-report.

Inclusion criteria: 1.Histologically proven Stage I, II, IIIa EBC; 2. Treatment with ET (tamoxifen or an aromatase inhibitor).

Specific Aims: To evaluate the impact on adherence to ET by 1) potentially modifiable psychosocial factors 2) side effects and 3) clinical factors.

Statistical Method: Adherence responses will be transformed into dummy coded variables (0=take ET as prescribed; 1=does not take ET as prescribed). For each assessment, several separate univariate logistic regressions will be conducted with demographic (age, education, work and marital status, ethnicity), cognitive (illness and treatment perception), emotional (fear of recurrence and anxiety), coping (self-efficacy), and patient-physician relationship (role preference, trust and satisfaction), severity of side effects and clinical factors, as independent predictors of adherence. Only predictors which are significant at the 0.25 level will be entered in subsequent hierarchical multiple regression models to identify the main determinants of adherence.

Accrual: Expected study accrual is 200 over 12–18 months. Accrual started in May of 2011 and 36 patients have been accrued to the study.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT3-02-01.

Stable charged cosmic strings

We study the quantum stabilization of a cosmic string by a heavy fermion doublet in a reduced version of the standard model. We show that charged strings, obtained by populating fermionic bound state levels, become stable if the electroweak bosons are coupled to a fermion that is less than twice as heavy as the top quark. This result suggests that extraordinarily large fermion masses or unrealistic couplings are not required to bind a cosmic string in the standard model. Numerically we find the most favorable string profile to be a simple trough in the Higgs vacuum expectation value of radius ≈10(-18)  m. The vacuum remains stable in our model, because neutral strings are not energetically favored.

Phase I/II trial of a dendritic cell vaccine transfected with DNA encoding melan A and gp100 for patients with metastatic melanoma

This trial tested a dendritic cell (DC) therapeutic cancer vaccine in which antigen is loaded using a novel non-viral transfection method enabling the uptake of plasmid DNA condensed with a cationic peptide. Proof of principle required the demonstration of diverse T lymphocyte responses following vaccination, including multiple reactivities restricted through both major histocompatibility complex (MHC) class I and II. Patients with advanced melanoma were offered four cycles of vaccination with autologous DC expressing melan A and gp100. Disease response was measured using Response Evaluation Criteria in Solid Tumours. Circulating MHC class I- and II-restricted responses were measured against peptide and whole antigen targets using interferon-γ ELIspot and enzyme-linked immunosorbent assay assays, respectively. Responses were analyzed across the trial population and presented descriptively for some individuals. Twenty-five patients received at least one cycle. Vaccination was well tolerated. Three patients had reduction in disease volume. Across the trial population, vaccination resulted in an expansion of effector responses to both antigens, to the human leukocyte antigen A2-restricted modified epitope, melan A ELAGIGILTV, and to a panel of MHC class I- and II-restricted epitopes. Vaccination with mature DC non-virally transfected with DNA encoding antigen had biological effect causing tumour regression and inducing diverse T lymphocyte responses.