Addressing high cervical cancer rates in the Rio Grande Valley along the Texas-Mexico border: a community-based initiative focused on education, patient navigation, and medical provider training/telementoring

AIMS

Cervical cancer incidence and mortality rates are approximately 55% higher in the Rio Grande Valley (RGV) along the Texas-Mexico border compared with the average rates in the US. Our aim was to improve cervical cancer prevention efforts in the RGV through a comprehensive multilevel intervention initiative focused on community education, patient navigation, and training of local providers.

METHODS

We initiated a program in the RGV which consisted of (1) community education, (2) patient navigation, and (3) a training/mentoring program for local medical providers including hands-on training courses coupled with telementoring using Project ECHO® (Extension for Community Health Outcomes). We assessed the number of women undergoing cervical cancer screening, diagnosis, and treatment at three participating clinics caring for underserved women in the region.

RESULTS

From November 2014 to October 2018, 14,846 women underwent cervical cancer screening. A total of 2030 (13.7%) women underwent colposcopy for abnormal results (179% increase over baseline) and 453 women underwent loop electrosurgical excision procedures (LEEPs) for treatment of cervical dysplasia. Invasive cancer was diagnosed in 39 women who were navigated to a gynecologic oncologist for treatment. Seven local medical providers were trained to perform colposcopy and/or LEEP. Project ECHO telementoring videoconferences were held every 2 weeks for a total 101 sessions with an average of 22 participants per session and a total of 180 patient cases presented and discussed.

CONCLUSIONS

Our program led to a large number of women undergoing diagnosis and treatment of cervical dysplasia in the RGV. If sustained, we anticipate these efforts will decrease cervical cancer rates in the region. The program is currently being expanded to additional underserved areas of Texas and globally to low- and middle-income countries.

Operational domain for the new 3MW/1000s ECRH System on WEST

The ECRH system formerly used in Tore Supra is being upgraded to start on WEST in 2023, at a power level of 1MW and frequency of 105 GHz. Its ultimate 3MW/1000s capability is expected to enlarge the WEST operational domain by increasing margins with respect to H-mode access, and by providing additional flexibility in terms of achievable scenarios using impurity and/or MHD control. This flexibility is made possible using an antenna based on three steerable mirrors for controlled power injection. In order to determine an appropriate range of EC wave injection angles for WEST scenarios, the fast and reliable ray-tracing code REMA has been interfaced with the WEST IMAS database. This allows the EC power damping rate to be quickly assessed, as well as deposition profiles to be predicted in realistic plasma conditions. Based on a typical WEST discharge at central magnetic field B0~3.6 T, central line-averaged electron density nl~4 × 1019 m−3 and central electron temperature Te0~3keV, ray-tracing calculations have been performed. Comprehensive poloidal and toroidal angle scans, as well as variations of Bt, nl and Te0 with respect to the reference parameters have allowed an adequate range of injection angles to be determined for efficient use of ECRH and/or ECCD in typical WEST scenarios, and compared with the mechanical limits set by the antenna mechanical characteristics. In order to further characterize the effect of this new power source in WEST scenarios, EC wave deposition and current profiles from ray-tracing calculations have been included in integrated simulation codes. It has been shown that this additional power source could allow central electron heating to be achieved, potentially alleviating the issue of radiative collapse caused by impurities observed in some situations.

Efficacy and Safety of Ensovibep for Adults Hospitalized With COVID-19 : A Randomized Controlled Trial

BACKGROUND

Ensovibep (MP0420) is a designed ankyrin repeat protein, a novel class of engineered proteins, under investigation as a treatment of SARS-CoV-2 infection.

OBJECTIVE

To investigate if ensovibep, in addition to remdesivir and other standard care, improves clinical outcomes among patients hospitalized with COVID-19 compared with standard care alone.

DESIGN

Double-blind, randomized, placebo-controlled, clinical trial. (ClinicalTrials.gov: NCT04501978).

SETTING

Multinational, multicenter trial.

PARTICIPANTS

Adults hospitalized with COVID-19.

INTERVENTION

Intravenous ensovibep, 600 mg, or placebo.

MEASUREMENTS

Ensovibep was assessed for early futility on the basis of pulmonary ordinal scores at day 5. The primary outcome was time to sustained recovery through day 90, defined as 14 consecutive days at home or place of usual residence after hospital discharge. A composite safety outcome that included death, serious adverse events, end-organ disease, and serious infections was assessed through day 90.

RESULTS

An independent data and safety monitoring board recommended that enrollment be halted for early futility after 485 patients were randomly assigned and received an infusion of ensovibep (n = 247) or placebo (n = 238). The odds ratio (OR) for a more favorable pulmonary outcome in the ensovibep (vs. placebo) group at day 5 was 0.93 (95% CI, 0.67 to 1.30; P = 0.68; OR > 1 would favor ensovibep). The 90-day cumulative incidence of sustained recovery was 82% for ensovibep and 80% for placebo (subhazard ratio [sHR], 1.06 [CI, 0.88 to 1.28]; sHR > 1 would favor ensovibep). The primary composite safety outcome at day 90 occurred in 78 ensovibep participants (32%) and 70 placebo participants (29%) (HR, 1.07 [CI, 0.77 to 1.47]; HR < 1 would favor ensovibep).

LIMITATION

The trial was prematurely stopped because of futility, limiting power for the primary outcome.

CONCLUSION

Compared with placebo, ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 receiving standard care, including remdesivir; no safety concerns were identified.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Sarcoma felino posvacunal (FISS), reporte de caso en Colombia

El sarcoma felino posvacunal o sarcoma de sitio de inyección (FISS) en una neoplasia poco descrita en felinos en Colombia, se presenta posterior al uso de vacunas inactivas con adyuvante. El objetivo fue describir la presencia de un sarcoma felino posterior a la vacunación con leucemia felina virus inactivo, primer caso documentado en Colombia. Un felino, macho, mestizo, de 7 años de edad, esterilizado, vacunado con leucemia felina inactiva desde hace 3 años, desarrolla un nódulo de 5 cm de diámetro en la región dorsal, firme y no doloroso. En dermis profunda y músculo estriado, se evidencia proliferación neoplásica de células fusiformes, de crecimiento principalmente expansivo y en menor medida invasivo, que se organiza y forma haces cortos y fascículos largos que se entrecruzan, con focos densos y laxos y en focos se dispone en un patrón de espina de pescado. Las células presentan morfología fusiforme, ligeramente ovoide, irregular, algunas redondeadas, con citoplasma eosinófilo tenue e intenso en otros focos más densos. Se evidencia pleomorfismo celular y anisocitosis moderadas. Los núcleos presentan morfología redonda, ovoide e irregular. Se evidencia la presencia de uno o más nucléolos en algunas de sus células, cromatina principalmente granular fina, pleomorfismo nuclear y anisocariosis moderada. Se contabilizaron 4 mitosis en 10 campos con el objetivo de alto poder en 2,37 mm2, no se observa aparente invasión linfovascular, se evidencia compromiso de bordes laterales. Adicionalmente, discretos focos de necrosis multifocal < 50%, infiltrado inflamatorio mixto polimorfonuclear, neutrófilos moderados multifocales e infiltrado mononuclear linfocítico multifocal.

Assessment of endangered freshwater pearl mussel populations in the Northern Iberian Plateau in relation to non–native species: xenodiversity as a threat

In the last two decades, small populations of freshwater pearl mussels, Margaritifera margaritifera, have been recorded in Mediterranean rivers of the Iberian Northern Plateau. A survey was carried out in Castilla and León in 2018 to assess the development of populations of this species in all the rivers of known distribution and to update the threat classification. Thirty sections in the rivers Negro, Tera, Alberche and Águeda were positive for its presence, and another 50 stretches of seven rivers were negative. The species is currently distributed over about 22.5 km. Águeda and Tera populations have decreased dramatically in the last 14 years and are on the threshold of extinction. The Negro river supports the largest population, although the species has now disappeared in at least 61 % of the stretches that were inhabited in 2004. All populations showed very low densities and an ageing population structure, with no recruitment for decades. The presence of non-native invasive alien species (NIS) was higher than in a previous regional survey, with the signal crayfish representing the greatest threat. We observed changes in benthic microhabitats and direct predation of adults and glochidia conglutinates. In the Alberche River, in strict syntopy with M. margaritifera and two other mussel species, 10 NIS were detected. The current hydrological and ecological conditions in the Duero watershed support the settlement of exotic species to the disadvantage of native mollusks, which are more demanding in terms of microhabitats.

Earthquakes and entropy: Characterization of occurrence of earthquakes in southern Spain and Alboran Sea

We propose the use of entropy, H, as an indicator of the equilibrium state of a seismically active region (seismic system). The relationship between an increase in H and the occurrence of a great earthquake in a study area can be predicted by acknowledging the irreversible transition of a system. From this point of view, the seismic system evolves from an unstable initial state (due to external stresses) to another, where the stresses have dropped after the earthquake occurred. It is an irreversible transition that entails an increase in entropy. Five seismic episodes were analyzed in the south of the Iberian Peninsula, the Alboran Sea (Mediterranean Sea), and the North of Morocco: two of them of moderate-high magnitude (Al Hoceima, 2004 and 2016) and three of them of moderate-low magnitude (Adra, 1993-1994; Moron, 2007; and Torreperogil, 2012-2013). The results are remarkably in line with the theoretical forecasts; in other words: an earthquake, understood as an irreversible transition, must suppose an increase in entropy.

Strategies to Produce Grapefruit-Like Citrus Varieties With a Low Furanocoumarin Content and Distinctive Flavonoid Profiles

Pummelos and hybrids, such as grapefruits, have high furanocoumarin and low flavonoid contents. Furanocoumarins interact negatively with certain drugs, while flavonoids are antioxidant compounds with health benefits. To obtain new grapefruit-like varieties with low furanocoumarin and high flavonoid contents, diploid and triploid hybrid populations from crosses between diploid and tetraploid "Clemenules" clementine and diploid "Pink" pummelo were recovered and analyzed. With regard to furanocoumarins, triploids produce less bergapten, bergamottin and 6,7-DHB than diploids. Regarding flavonoids, triploids yielded more eriocitrin, narirutin, hesperidin and neohesperidin than diploids, whereas no differences were observed in neoeriocitrin and naringin. These results indicate that, the strategy to recover triploid hybrids by 4x × 2x crosses is more appropriate than the recovery of diploid hybrids by 2x × 2x crosses for obtaining grapefruit-like varieties of citrus with lower furanocoumarin and higher flavonoid contents.

Impact of ethylene degreening treatment on sensory properties and consumer response to citrus fruits

Degreening treatment is normally applied to early-season citrus varieties grown in the Mediterranean area in order to enhance the external colour when fruits have already reached internal maturity. Despite profound knowledge about the effect of ethylene on the physico-chemical quality of citrus fruit, less is known about its effect on consumers' expectations in the supermarket or consumer quality perceptions when they eat such fruit. In this study, three mandarin cultivars ('Owari', 'Clemenules' and 'Oronules') with two initial colours at harvest, and one orange cultivar, 'Navelina', were submitted to the degreening treatment under commercial conditions. The effect of treatment on both external and internal qualities perceived by consumers was evaluated. The main physico-chemical parameters were also determined. The degreening treatment slightly affected firmness, total soluble solids or acidity level in 'Owari' and 'Navelina'. However, sensory triangle tests, in which 100-122 consumers compared the internal quality of degreened fruit and control fruit, did not show significant differences between treatments for any of the studied cultivars. A survey based on images of citrus fruit was responded by 340 consumers; it showed that the degreening treatment strongly affected consumers' maturity expectations, which resulted in improved fruit liking expectations and increased the number of consumers willing to buy. The extent of this effect depended on the initial colour of the fruit submitted to degreening. In order to improve liking expectations, fruit should arrive on the market with an external colour index (CI = 1000a/Lb) between +10 and +20. We conclude that the ethylene degreening treatment, which did not have any effect on the internal quality that consumers perceive, is a potent postharvest tool to increase citrus fruit sales at the beginning of the season.

Abstract 075: Sex Differences in the Development of Autoimmune-Associated Hypertension

Systemic lupus erythematosus (SLE) is an autoimmune disorder with prevalent hypertension and is a novel disease model to study the link between chronic inflammation and hypertension. Because SLE is female-dominant, studies are usually conducted in female NZBWF1 mice, a well-established model of SLE. However, men are also diagnosed with SLE and the late onset and different clinical features draws interest. We hypothesize that sex differences exist in SLE and that female SLE mice have heightened disease, hypertension, and renal injury earlier than males. Female and male SLE and control ( NZW ) mice were monitored for albuminuria starting at 30 weeks of age and then at 35 weeks implanted with vascular catheters to allow measurement of blood pressure in conscious mice. At 30 weeks, female SLE mice had elevated plasma dsDNA autoantibodies, the hallmark of SLE, compared to male SLE (4.6e5 ± 1.3e5 vs. 6.3e4 ± 2.7e4 U/mL; n=3-5; all p<0.05), female controls (8.9e4 ± 3.3e4), and male controls (4.8e4 ± 9.3e3). At this same time point, 32% (7 out of 22) of female SLE mice had albuminuria versus 5% (1 out of 20) of male SLE, 5% (1 out of 22) of female controls, and no male controls. Although male SLE mice did not reach similar levels of dsDNA autoantibodies as SLE females (2.0e5 ± 4.6e4 vs. 3.9e5 ± 4.3e4; n=8-13; p=0.015), by 35 weeks, the autoantibodies were increasing in SLE males (2.0e5 ± 4.6e4 vs. 6.3e4 ± 2.7e4; p=0.157) and higher than male controls (4.3e4 ± 9.3e3; p=0.046). At 35 weeks, 63% (10 out of 16) of female SLE mice had albuminuria versus 5% (1 out of 19) of male SLE, 5% (1 out of 22) of female controls, and no male controls. Importantly, both female and male SLE mice were hypertensive at 35 weeks: blood pressure was higher in female SLE than female controls (152 ± 5 vs. 126 ± 3 mmHg; n=6-8; p=0.003) and in male SLE compared to male controls (152 ± 4 vs. 136 ± 4 mmHg; n=6-11; p=0.041). These data confirm the development of hypertension and renal injury in female SLE mice and suggest that male SLE mice develop hypertension with no renal involvement. Future studies will allow us to investigate the divergent mechanisms involved in autoimmune-induced hypertension in female and male mice, which will ultimately provide clues in sex differences in hypertensive humans with underlying chronic inflammation.

Position-dependent mass Schrödinger equation for exponential-type potentials

In quantum chemical calculations, there are two facts of particular relevance: the position-dependent mass Schrödinger equation (PDMSE) and the exponential-type potentials used in the theoretical study of vibrational properties for diatomic molecules. Accordingly, in this work, the treatment of exactly solvable PDMSE for exponential-type potentials is presented. The proposal is based on the exactly solvable constant mass Schrödinger equation (CMSE) for a class of multiparameter exponential-type potentials, adapted to the position-dependent-mass (PDM) kinetic energy operator in the O von Roos formulation. As a useful application, we consider a PDM distribution of the form [Formula: see text], where the different parameters can be adjusted depending on the potential under study. The principal advantage of the method is that solution of different specific PDM exponential potential models are obtained as particular cases from the proposal by means of a simple choice of the involved exponential parameters. This means that is not necessary resort to specialized methods for solving second-order differential equations as usually done for each specific potential. Also, the usefulness of our results is shown with the calculation of s-waves scattering cross-section for the Hulthén potential although this kind of study can be extended to other specific potential models such as PDM deformed potentials.

Abstract P5-13-05: Overcoming barriers to achieve a successful breast cancer patient recruitment: Professionals' views

Accurate recruitment in performing clinical trials is crucial to avoid delays in the availability of potential beneficial treatments for patients. However, optimal strategies to improve it remain elusive and highly variable. The aim of this study was to identify the factors affecting recruitment from a multi-professional approach.

Methods: A convergent mixed method study was used, including key informant in-depth interviews (n=13), 5 focus groups (n=40) and a 209-item Likert-scale survey for the measurement of a whole array of variables of interest (i.e. job attitudes, job satisfaction, job stressors and social status). A purposive sample of professionals from thirty-three clinical trial sites in Spain were targeted. Qualitative data were analyzed alongside quantitative data to document patterns and modifiers of recruitment performance. Audio material was recorded, transcribed verbatim and analyzed using the framework method.

Findings: Pattern observed in qualitative data was confirmed in quantitative analysis. A total of 32 key barriers to successful patient recruitment were identified and clustered in three categories. The most commonly reported barriers and facilitators regarding a multifactorial approach were: System/organization: Counting on experienced recruiters and having a strong team-workforce awareness (92,3%); automated recruitment software, scientific culture, recruiting philosophy, adequate workload demands (88%); high stimuli and interprofessional trust (84%). However, lack of time devoted to clinical research in favor of assistance demands, excessive workload and bureaucratic tasks were the most salient stressors to fulfill professional research and recruitment responsibilities (54%). Working team conditions: Insufficient workforce support as well as high employee turnover contributed to emotional exhaustion and depersonalization and to a lower personal accomplishment (15%). Interpersonal relations affected not only motivation and performance but professionalism satisfaction with outcomes. Professional recruiter characteristics: Professionals with a high level of expertise and academic specialization (&gt;5 years), greater active involvement in relevant clinical trials just as interprofessional prestige and recognition showed a greater satisfaction. Consequently, they were prompted to intensify their efforts to fulfill recruitment. The more effective clinical research settings were those better aligned with attributes for becoming high recruiters and with better multi-professional articulation. Suggestions to improve recruitment included providing professionals with devoted time for research, setting up collaborative research agreements, building a clinical research network, collaborative tumor registries, clinical trials data sharing resources, multidisciplinary functional units and committees, flexible staffing models and empowering oncologists/managers leadership.

Conclusions: This study provided useful understanding of how to maximize patient recruitment at clinical research sites. Strong team-workforce and adequate workload were the most important identified factors for achieving it. Results will be used to inform professionals and stakeholders of the next steps needed and to engage them to fulfill accurate recruitment.

Citation Format: Casas A, Gonzàlez X, Capelán M, Morales J, Fabián M, Ciruelos E, Gabriele G. Overcoming barriers to achieve a successful breast cancer patient recruitment: Professionals' views [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-05.

The new magnetic diagnostics in the WEST tokamak

The WEST tokamak consists of a major upgrade of the superconducting medium size tokamak Tore Supra aiming at testing ITER divertor components. Such modification has required rebuilding a full set of magnetic diagnostics. The project was started in 2013 and completed in 2016. The diagnostic consists of a set of 469 sensors (421 pick-up coils, 36 flux loops, and 12 Rogowski coils) installed in the WEST vacuum vessel. New analog integrators have been developed in order to obtain the magnetic field and flux from the raw signal of the sensors. During the startup phase of WEST, plasma currents of the order of a few kilo amperes were measured despite much larger current of the order of hundreds of kilo amperes flowing in nearby conducting structures. The diagnostic is now fully operational and exhibits a noise level of about 0.5 mT on the magnetic field, and 2.0 mWb on flux loops allowing identifying the plasma boundary with an accuracy of a few millimeters on a 2 ms time cycle.

Simultaneous recovery of Zn and Mn from used batteries in acidic and alkaline mediums: A comparative study

A parallel study of acidic and alkaline leaching for the recovery of Mn and Zn from spent alkaline batteries is outlined. Using H₂SO₄ as solvent and selecting appropriate conditions of temperature and concentration, all residues were dissolved except carbon. The separation and recovery of the two components were performed by electrodeposition with satisfactory results at pH values above 4 (current efficiency above 70% for Zn and Mn) but rather lower efficiencies as the pH decreased. Most of the Zn was selectively dissolved by alkaline leaching using a 6.5M NaOH solution, and its recovery was examined by means of both electrochemical and chemical processes. The expected formation of pure Zn by electrowinning failed due to the formation of ZnO, the content of which was highly dependent on the electrodeposition time. For short periods, Zn was the main component. For longer periods the electrodeposit consisted of agglomerated microparticles of ZnO with a minor fraction of Zn metal (barely 3% as measured by X-ray diffraction). A chemical reaction of the element with oxygen released at the anode surface might be responsible for its conversion to ZnO. A simple chemical route is described for the first time for the direct conversion of Zn(OH)₄^2- solution to nanostructured ZnO by lowering the pH to values around 12 using 2M HCl solution.

TLT-1 as a possible modulator of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by immune system hyperactivity and autoantibody production that can affect almost any organ system. TREM like transcript-1 (TLT-1) is a membrane receptor found in platelet α-granules with a soluble form (sTLT-1) detected in serum but not plasma of healthy individuals. The evaluations of patients suffering from diseases, such as sepsis, show a significant increase of plasma sTLT-1 levels. It is not known if TLT-1 plays a role in auto immune diseases such as Lupus. In the present study we evaluate the potential that TLT-1 may play a role in the etiology of SLE. We assessed the plasma of 46 SLE patients and compared to 28 healthy controls by ELISA. Our results showed that SLE patients had a significant decrease in plasma sTLT-1 levels compared to healthy controls (9.0 [7.2] vs. 18.6 [22.3] ng/ml, p=0.008). A negative correlation was observed between TLT-1 levels and LupusPRO [lupus symptoms (r = −0.388, p = 0.055). Based on this data; we hypothesized that SLE patients produce autoantibodies against TLT-1 in serum which might correlate with clinical aspects of the disease. To address this question; TLT-1 antibodies levels in serum were measured by ELISA. Our data suggests that a sub-population of SLE patients have TLT-1 autoantibodies. This data was further confirmed by confocal microscopy. Using HEK cells stably transfected with TLT-1; we evaluated the serum of SLE patients for the presence of TLT-1 autoantibodies using immunofluorescence. Our data confirms that a sub-population of SLE patients with active disease expresses antibodies against TLT-1 suggesting a possible role for TLT-1 during the pathogenesis of SLE and targets new treatment possibilities for lupus patients.

Neurotoxic kynurenine metabolism is increased in the dorsal hippocampus and drives distinct depressive behaviors during inflammation

The kynurenine pathway of tryptophan metabolism has an important role in mediating the behavioral effects of inflammation, which has implications in understanding neuropsychiatric comorbidity and for the development of novel therapies. Inhibition of the rate-limiting enzyme, indoleamine 2,3-dioxygenase (IDO), prevents the development of many of these inflammation-induced preclinical behaviors. However, dysregulation in the balance of downstream metabolism, where neuroactive kynurenines are generated, is hypothesized to be a functionally important pathogenic feature of inflammation-induced depression. Here we utilized two novel transgenic mouse strains to directly test the hypothesis that neurotoxic kynurenine metabolism causes depressive-like behavior following peripheral immune activation. Wild-type (WT) or kynurenine 3-monooxygenase (KMO)-deficient (KMO^-/-) mice were administered either lipopolysaccharide (LPS, 0.5 mg kg^-1) or saline intraperitoneally. Depressive-like behavior was measured across multiple domains 24 h after immune challenge. LPS precipitated a robust depressive-like phenotype, but KMO^-/- mice were specifically protected from LPS-induced immobility in the tail suspension test (TST) and reduced spontaneous alternations in the Y-maze. Direct administration of 3-hydroxykynurenine, the metabolic product of KMO, caused a dose-dependent increase in depressive-like behaviors. Mice with targeted deletion of 3-hydroxyanthranilic acid dioxygenase (HAAO), the enzyme that generates quinolinic acid, were similarly challenged with LPS. Similar to KMO^-/- mice, LPS failed to increase immobility during the TST. Whereas kynurenine metabolism was generally increased in behaviorally salient brain regions, a distinct shift toward KMO-dependent kynurenine metabolism occurred in the dorsal hippocampus in response to LPS. Together, these results demonstrate that KMO is a pivotal mediator of hippocampal-dependent depressive-like behaviors induced by peripheral LPS challenge.