Evaluation of the Spanish-Language Cancer Educational Webinar Series "Vamos a educarnos contra el cáncer" with the RE-AIM Framework

The COVID-19 pandemic disrupted healthcare for patients with chronic diseases, including cancer. Barriers to healthcare increased, especially for racial and ethnic minorities. While many institutions developed webinars to educate community members, few webinars used a community-based participatory approach, employed a theory-based engagement design, and were evaluated. This manuscript reports the outcomes of "Vamos a educarnos contra el cáncer," a 2021 webinar series. Monthly educational webinars were conducted in Spanish on cancer-related topics. The presentations were delivered by Spanish-speaking content experts from different organizations. Webinars were conducted using the video conferencing platform Zoom. Polls were launched during the webinar to collect data and evaluate each webinar. The RE-AIM model of reach, effectiveness, adoption, implementation, and maintenance was used to evaluate the series. The SAS Analytics Software was used for analysis and data management. Two hundred ninety-seven people participated with over 3000 views of the webinar recordings (Reach); 90% rated the sessions as good or excellent (Effectiveness); 86% agreed to adopt or improve a cancer-related behavior, and 90% reported willingness to adopt or improve a cancer-related action for someone else (Adoption); 92% reported feeling engaged (Implementation). The series has produced a resource library, manual of operations, and agreement of the Hispanic/Latino Cancer Community Advisory Board (CAB) to continue the webinar series in the future (Maintenance). Overall, these results highlight the impact of this webinar series and provide a standard approach to planning, delivering, and evaluating webinars as a strategy for cancer prevention and control in a culturally appropriate manner.

Abstract 212: Identification by mass spectrometry of unique phosphoproteins subsequent to signaling through c-ErbB2

The receptor tyrosine kinase c-ErbB2 is amplified in breast and ovarian cancer. The linear pathways through which signals by c-ErbB2 are transduced is well known. However, second generation questions that address spatial aspects of signaling remain. To address this, we have undertaken a mass spectrometry approach to identify phosphoproteins. We have used two tyrosine kinase inhibitors, Lapatinib and CP724714, that inhibit phosphorylation of c-ErbB2 to identify phosphoproteins. SKOV-3, an ovarian cancer cell line that endogenously overexpresses c-ErbB2 was grown in culture without serum for 72 hrs. Cells were then stimulated in the presence or absence of inhibitor with EGF (100ng/ml) as a ligand for 60 mins. Subsequently, cells were lysed and evaluated by western blotting with anti-phosphotyrosine antibody (4G10). Following stimulation of cells with EGF, maximal phosphorylation of c-ErbB2 was observed at 60 minutes. Lapatinib (10μM) and CP724714 (15μM) completely inhibited phosphorylation of c-ErbB2, which was confirmed by immunoprecipitation. This was further confirmed by the inhibition of downstream effectors (Erk1/2, Akt). Lapatinib (10 μM) also completely inhibited phosphorylation of EGFR while CP724714 (15μM) only inhibited partially. Cellular lysates were prepared from quiescent cells (grown without serum), after stimulation with EGF in the presence or absence of inhibitors. Purified phosphoproteins from all three samples following digestion with trypsin were subjected to mass spectrometry (Nano LC ESI MS/MS). We identified totally 62 phosphoproteins. Twenty seven phosphoproteins were observed in all the 3 samples while 17 phosphoproteins were identified both in the EGF stimulated and lapatinib treated samples. Eighteen unique phosphoproteins were observed only in the EGF stimulated sample suggesting that they are specific to signaling by c-ErbB2. The novel phosphoproteins included the proteins that partcipate in carbohydrate metabolism,cytoskeleton, cell migration and proliferation. We have evaluated two phosphoproteins, LASP-1 and Aldose reductase that has not been previously described following phosphorylation of c-ErbB2. LASP-1 is an oncogene and is located as the same arm 17q21 as c-ErbB2. It was not expressed in the normal ovary or fallopian tube. However, it was over-expressed in 17% of tumours (n=85) from patients with ovarian cancer. c-ErbB2 was not expressed in tumours that expressed LASP1. Aldose reductase is a cytosolic NADPH dependent oxidoreductase that catalyzes the reduction of glucose to sorbitol, the first step in polyol pathway of glucose metabolism. The activity of aldose reductase in reducing NADPH as a substrate was significantly higher in lysates from EGF stimulated as compared to the starved cells. Identification of phosphoproteins by using mass spectrometry is promising in identifying novel substrates and pathways following phosphorylation of c-ErbB2.

Citation Format: C Sidhanth, Manoj Garg, P Manasa, S Krishna Priya, S Bindhya, S Sneha, R.P. Nagare, S Shirley, M Kanchan, Trivadi S. Ganesan. Identification by mass spectrometry of unique phosphoproteins subsequent to signaling through c-ErbB2 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 212. doi:10.1158/1538-7445.AM2017-212

Approaches for describing and communicating overall uncertainty in toxicity characterizations: U.S. Environmental Protection Agency's Integrated Risk Information System (IRIS) as a case study

Single point estimates of human health hazard/toxicity values such as a reference dose (RfD) are generally used in chemical hazard and risk assessment programs for assessing potential risks associated with site- or use-specific exposures. The resulting point estimates are often used by risk managers for regulatory decision-making, including standard setting, determination of emission controls, and mitigation of exposures to chemical substances. Risk managers, as well as stakeholders (interested and affected parties), often have limited information regarding assumptions and uncertainty factors in numerical estimates of both hazards and risks. Further, the use of different approaches for addressing uncertainty, which vary in transparency, can lead to a lack of confidence in the scientific underpinning of regulatory decision-making. The overarching goal of this paper, which was developed from an invited participant workshop, is to offer five approaches for presenting toxicity values in a transparent manner in order to improve the understanding, consideration, and informed use of uncertainty by risk assessors, risk managers, and stakeholders. The five approaches for improving the presentation and communication of uncertainty are described using U.S. Environmental Protection Agency's (EPA's) Integrated Risk Information System (IRIS) as a case study. These approaches will ensure transparency in the documentation, development, and use of toxicity values at EPA, the Agency for Toxic Substances and Disease Registry (ATSDR), and other similar assessment programs in the public and private sector. Further empirical testing will help to inform the approaches that will work best for specific audiences and situations.

The impact of continuous haemofiltration with high-volume fluid exchange during cardiopulmonary bypass surgery on the recovery of patients with impaired renal function: a pilot randomised trial

BACKGROUND

There is widespread variability in clinical practice within cardiac surgery units worldwide on the use of haemofiltration. The clinical impact and safety of this modality is, however, unknown.

OBJECTIVES

The primary pilot trial objectives were as follows: to assess the feasibility of randomising 60 patients with impaired kidney function undergoing on-pump coronary artery bypass graft (CABG) surgery within 6 months; to assess the suitability and reliability of our chosen outcome measures; to explore issues that may impact on recruitment into a definitive trial; and to undertake an exploratory economic evaluation.

DESIGN

A pilot, single-centre, open-label randomised trial.

SETTING

Liverpool Heart and Chest Hospital NHS Foundation Trust between November 2010 and March 2012.

PARTICIPANTS

Men and women, aged > 18 years of age, undergoing on-pump CABG surgery, who had pre-operative impaired kidney function indicated by an estimated glomerular filtration rate (eGFR) of < 60 ml/minute adjusted for 1.73 m(2) of body surface area.

INTERVENTIONS

Group 1: patients who received haemofiltration during bypass (experimental group). Group 2: patients who did not receive haemofiltration during bypass (control group).

MAIN OUTCOME MEASURES

(1) Feasibility outcome measures: barriers to recruitment to a larger trial were documented as observations made during the recruitment period of the trial. Reliability of data collection methods was monitored using a 13-point case record form validation check for data entry against the patient clinical notes and the trial database. (2) The main clinical outcomes were frequency of intensive care unit (ICU) stay of duration > 3 days and the length of ICU stay days. (3) Other clinical outcomes were the need for postoperative haemofiltration in the ICU, mechanical ventilation time, hospital stay, composite of outcome of unfavourable perioperative events and eGFR values at 6 weeks' follow-up. (4) Secondary health economic feasibility outcomes.

RESULTS

Recruitment into the pilot trial was from 21 November 2010 to 30 March 2012. Thirty-seven eligible patients were consented and successfully randomised into the trial arms (30%). The main issues impacting on recruitment were the high volume of off-pump CABG surgery within the centre; recruitment being restricted to research nurses' working hours of the week; issues arising associated with the screening process for identifying prospective eligible patients based on eGFR values; protocol deviations/treatment crossovers; and unexpected outbreaks of pandemic influenza and other infectious conditions. The data collection process was sufficiently robust, with few errors detected. The length of ICU stay days was deemed a suitable primary outcome. There was an overall trend towards reduction in the length of ICU stay for patients who were given intraoperative haemofiltration, more so for those with diabetes. The economic evaluation estimated that the incremental costs per person were £1744 lower for the intraoperative haemofiltration group, while the incremental benefits per person increased by 0.11.

CONCLUSION

Given sufficient resources and broadening of the inclusion criteria, the recruitment into a larger multicentre trial is feasible and may demonstrate potential clinical and cost benefits of using intraoperative haemofiltration in this group of patients. However, owing to the small sample size in this pilot trial, no firm conclusions can be drawn from the findings at this stage. The outcomes of this pilot study are very encouraging and suggest that it is feasible to design a continuous superiority trial with the length of ICU stay days or time to tracheal extubation as the primary outcome measure, provided that guidelines for avoiding bias are implemented. An alternative primary outcome measure that avoids bias is mortality. The inclusion criteria should also be widened to include all cardiac surgery patients with impaired renal function.

TRIAL REGISTRATION

ISRCTN49513454.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 49. See the HTA programme website for further project information.

Death receptors as targets in cancer

Anti-tumour therapies based on the use pro-apoptotic receptor agonists, including TNF-related apoptosis-inducing ligand (TRAIL) or monoclonal antibodies targeting TRAIL-R1 or TRAIL-R2, have been disappointing so far, despite clear evidence of clinical activity and lack of adverse events for the vast majority of these compounds, whether combined or not with conventional or targeted anti-cancer therapies. This brief review aims at discussing the possible reasons for the lack of apparent success of these therapeutic approaches and at providing hints in order to rationally design optimal protocols based on our current understanding of TRAIL signalling regulation or resistance for future clinical trials.

LINKED ARTICLES

This article is part of a themed section on Emerging Therapeutic Aspects in Oncology. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2013.169.issue-8.

Foliar water supply of tall trees: evidence for mucilage-facilitated moisture uptake from the atmosphere and the impact on pressure bomb measurements

The water supply to leaves of 25 to 60 m tall trees (including high-salinity-tolerant ones) was studied. The filling status of the xylem vessels was determined by xylem sap extraction (using jet-discharge, gravity-discharge, and centrifugation) and by (1)H nuclear magnetic resonance imaging of wood pieces. Simultaneously, pressure bomb experiments were performed along the entire trunk of the trees up to a height of 57 m. Clear-cut evidence was found that the balancing pressure (P(b)) values of leafy twigs were dictated by the ambient relative humidity rather than by height. Refilling of xylem vessels of apical leaves (branches) obviously mainly occurred via moisture uptake from the atmosphere. These findings could be traced back to the hydration and rehydration of mucilage layers on the leaf surfaces and/or of epistomatal mucilage plugs. Xylem vessels also contained mucilage. Mucilage formation was apparently enforced by water stress. The observed mucilage-based foliar water uptake and humidity dependency of the P(b) values are at variance with the cohesion-tension theory and with the hypothesis that P(b) measurements yield information about the relationships between xylem pressure gradients and height.

Follicular dendritic cell sarcoma of oral cavity: report of 2 cases

We report 2 cases of Follicular Dendritic Cell Sarcomas of Oral Cavity in two elderly patients. The patients presented with oral cavity tumors. Initial tru-cut biopsies in both cases revealed spindle cell neoplasms. One of them was of low grade malignancy and showed positivity for of Vimentin. Few cells showed positivity for keratin and were negative for S-100 protein, CD 34, CD 68, EMA, SMA, HMB-45. A possible diagnosis of low grade fibrohistiocytic tumor was made. He underwent Lt total maxillectomy. Three years later he presented back with regional nodal metastasis. The regional lymph nodes showed features of follicular dendritic cell sarcoma. The second case revealed high grade spindle cell neoplasm and showed positivity for vimentin and S100 protein and was negative for EMA, keratin, CD-34, desmin, muscle actin and HMB-45. He was offered initial radio-therapy followed by hemifacial resection. The histology along with immuno histochemistry favoured a diagnosis of follicular dendritic cell sarcoma. He presented with local recurrence two months later. Both the cases are discussed in detail.

Type 1 (11; 22)(q24: q12) translocation is common in Ewing’s sarcoma/ peripheral neuroectodermal tumour in south Indian patients

The Ewing's sarcoma family can present diagnostic difficulties. In the past the basis of diagnosis has been a exclusion. Identification of a specific translocation especially t(11;22) (EWS-FLI 1 fusion gene), which is seen in nearly 85 percent of Ewing's sarcoma cases can help in precise diagnosis. We have carried out a study on twenty patient samples diagnosed to have Ewing's sarcoma/peripheral neuroectodermal tumour (PNET)/small round cell malignant tumour. The study involved RT-PCR analysis for the fusion transcript, followed by sequencing to identify the specific type of fusion. Ninety percent (18/20) of the samples tested were found to be t(11;22) translocations involving EWS-FLI 1 genes. Sixty-one percent (11/18) were found to be type 1 fusion and seven were type 2 (39 percentage). This is the first study in India with quantitative information about the types of EWS-FLI 1 translocations present in Ewing's family of tumours in south Indian patients.

Pyoderma gangrenosum associated with osteomyelitis in a paediatric patient: a case report

Pyoderma gangrenosum is a rare ulcerative skin disorder mainly occurring in adults. It is seen less frequently in children. The cause is unknown but it may occur in association with several disorders. Osteomyelitis is a very rare association. We report a case of pyoderma gangrenosum associated with osteomyelitis in a two-year-old girl.

The discipline of hospital development: a conceptual framework incorporating marketing, managerial, consumer behavior, and adult learning theories

The purpose of this explanatory and prescriptive article is to identify interdisciplinary theories used by hospital development to direct its practice. The article explores, explains, and applies theories and principles from behavioral, social, and managerial disciplines. Learning, motivational, organizational, marketing, and attitudinal theories are incorporated and transformed into the fundamental components of a conceptual framework that provides an overview of the practice of hospital development. How this discipline incorporates these theories to design, explain, and prescribe the focus of its own practice is demonstrated. This interdisciplinary approach results in a framework for practice that is adaptable to changing social, cultural, economic, political, and technological environments.

Narrowing the organ donation gap: hospital development methods that maximize hospital donation potential

The purpose of this article is to identify and describe this organ procurement organization's hospital development methods that have markedly increased the quantity and quality of organ donor referrals. Procedures used include the establishment of organ donor programs (hospital donor programs) within each donor hospital. The goal for these hospital donor programs is to monitor and maximize organ procurement within each institution. Routine quality assurance or death audits along with referral data from the organ procurement organization's database provide both the organ procurement organization and the hospital donor program with the necessary information to evaluate organ procurement strengths and weaknesses. This data is used in concert with ongoing development activities, which include, but are not limited to, physician and staff education and frequent marketing visits. Early referral to the organ procurement organization of all nonsurvivable head injuries for evaluation as potential organ donors, and a timely request for donation by the organ procurement organization coordinator are emphasized. The results of these efforts have been gratifying. In 1989, 138 referrals and 41 organ donations occurred. In 1990, 174 referrals and 66 organ donations occurred. In 1991, 213 referrals and 71 organ donations occurred. In 1992, 228 referrals and 70 organ donations occurred. In the first 6 months of 1993, 146 referrals and 40 organ donations occurred, for a prorated figure of 292 referrals and 80 organ donations annually. In conclusion, these results appear to validate the benefits of this approach and its significant contribution to narrowing the donation supply and demand gap.

Effects of electrical stimulation or voluntary contraction for strengthening the quadriceps femoris muscles in an aged male population

Since musculoskeletal impairment increases with age, it is important to determine if exercise changes age-related muscle weakness. This study compared the training effects of electrical stimulation and voluntary isometric contraction, the traditional exercise, on the quadriceps femoris in males 65 years and older. Eighteen informed, nondisabled males, 72 +/- 4 years of age, participated in 12 training sessions over 4 weeks. Maximal voluntary isometric contraction (MVIC) torque was measured with a Cybex II dynamometer prior to and following training. An interclass correlation coefficient (3,1) of 0.982 demonstrated repeated reliable torque measurement. The electrical stimulation group trained at an average of 36% of pretest MVIC; the traditional exercise group trained at an average of 42% MVIC. Average (F = 14.06, p = 0.004) and peak (F = 14.32, p = 0.004) torque values were increased with both modes of training. Both methods of training using a low training load were effective in increasing torque in this older male sample. Electrical stimulation has the same potential as traditional exercise to provide improved strength for aged males. Future research should examine electrical stimulation in older persons with compromised ability to exercise using traditional methods.

Chemical-modification studies on rat olfactory mucosa using a thiol-specific reagent and enzymatic iodination

1. A rat olfactory preparation, suitable for biochemical studies in vitro on olfactory mechanisms, is described. 2. The effects of the impermeant chemical modification reagents mersalyl (a thiol reagent) and enzymatic iodination, on the amplitude of the electroolfactogram (EOG) responses elicited from rat olfactory mucosa by pulses of odorant vapours was studied using 12 odorants differing widely in odour quality and molecular structure: amyl acetate, carvone, decanal, butylamine, cineole, citronellol, cresol, diacetyl, dimethylethyl-pyrazine, naphthalene, octanethiol and valeric acid. 3. Both reagents irreversibly reduced the EOG amplitude to all odorants to an extent dependent on the reagent concentration. Two subpopulations of animal preparations could be distinguished on the basis of the extent to which they survived the iodination whereas mersalyl appeared to sample a single population of preparations. 4. Small but statistically significant differences were observed between the responses of each odorant with each reagent but no simple correlation between either the molecular structure or odour quality of the odorants and the reagent effect is apparent for the case of mersalyl. With iodination the responses from the three flexible-aliphatic-chain odorants were reduced to a greater extent than the other odorants, all of which had a dissimilar molecular structure. 5. The ability of three odorants, amyl acetate, carvone and decanal, to protect the receptors for the odorants against chemical modification was investigated. The protecting odorants were applied directly to the mucosa as a dilute solution in Ringer's medium. No specific odorant protection effects were observed. 6. The results are discussed in relation to a model of the olfactory mechanism involving relatively non-specific receptor proteins. Each receptor type is envisaged as interacting weakly with a number of odorants and each odorant interacts with a number of receptors.

Access to data and the information explosion: oral contraceptives and risk of cancer

This report describes a technically feasible method to deal with the enormous volume of literature published regarding oral contraceptives. This subject was discussed in 3735 publications during the period from November 1977 through October 1980. Our findings showed that those papers reporting original, numeric relationships involving risk of cancer and use of oral contraceptives were one percent of the total 3735 publications. However, only seven of the 27 articles involved were authored by individuals from departments of obstetrics and gynecology. Further, only four of the 27 were published in journals devoted to obstetrics and gynecology. The analyses suggest a form of censorship taking place, in that the obstetrics/gynecology specialists do not have ready access to the primary data.

Factors modifying vitreous pressure in cataract surgery

A prospective study of 267 intracapsular cataract extractions was conducted to assesses what makes an eye soft and capable of safely receiving an intraocular lens implant. The study showed that the use of glycerol, given orally before the operation, plus retrobulbar anesthesia is the most effective way of reducing the vitreous pressure, that there is a direct relation between this reduction and age, and that there is no apparent correlation between the preoperative intraocular pressure and the vitreous pressure.

Comparison of cytocentrifugation and sedimentation techniques for CSF cytomorphology

Two methods of processing cerebrospinal fluid (CSF) cells for morphologic study were compared. The newer cytocentrifugation method, using the Shandon Cytospin apparatus, allowed slightly quicker processing of cells but did not appreciably influence the total time needed to fully study the cells. The preservation of cells, as measured by observation of cellular detail, was better after the use of older, more gentle, sedimentation technique. The sedimentation technique was generally found to yield a higher number of total cells. The loss of small cells by the sedimentation method was not statistically greater than with the cytocentrifugation method, but large cell collection was significantly better. The older sedimentation method is concluded to be preferable to the newer cytocentrifugation method for CSF cytomorphology.

A survey of computer search service costs in the academic health sciences library

The Norris Medical Library, University of Southern California, has recently completed an extensive survey of costs involved in the provision of computer search services beyond vendor charges for connect time and printing. In this survey costs for such items as terminal depreciation, repair contract, personnel time, and supplies are analyzed. Implications of this cost survey are discussed in relation to planning and price setting for computer search services.

An annotated bibliography of education for medical librarianship, 1940-1968

An attempt has been made in this bibliography to represent the various viewpoints concerning education for medical librarianship equally. The topics covered include: general background reading and readings for those interested in establishing courses in medical librarianship. The former includes annotations on the history and international aspects of the subject. The latter consists of annotations of articles on early courses and present courses in medical librarianship. A final area discussed is the Medical Library Association's Code for the Training and Certification of Medical Librarians.