Enrollment of Spanish-speaking Latinx adults in clinical trials: Five lessons learned from a randomized study in substance use treatment

Latinx individuals are the largest ethnic minoritized group in the United States (US) at 19% of the population. However, they remain underrepresented in clinical research, accounting for less than 8% of clinical trial participants. Consideration of cultural values could help overcome barriers to inclusion in clinical trials and result in better recruitment and retention of Latinx individuals. In this commentary, we describe general guidance on culturally responsive modifications to facilitate the successful recruitment and retention of Spanish-speaking Latinx participants in Randomized Clinical Trials (RCTs) for substance use. We identify five culturally responsive strategies to help enroll participants in RCTs: 1. Create an ethnically diverse research team, 2. Assess available community partners, 3. Familiarize oneself with the target community, 4. Establish confianza (trust) with participants, and 5. Remain visible to participants and staff from recruitment sites. Representation of Latinx individuals in clinical trials is essential to ensure treatments are responsive to their needs and equitydriven. Some of these strategies can further research in helping to promote the participation of Latinx individuals experiencing substance use concerns, including outreach to those not seeking treatment.

Prenatal exposure to an environmentally relevant phthalate mixture alters ovarian steroidogenesis and folliculogenesis in the F1 generation of adult female mice

Phthalates are a family of chemicals that can be found in plastic and personal care products used by consumers every day and they are known endocrine disrupting chemicals that can disrupt female reproduction. In previous studies, an environmentally relevant phthalate mixture was shown to affect female reproduction in a transgenerational manner. However, limited information was available on the effect of phthalate mixtures on ovarian steroidogenesis and folliculogenesis. Ovarian steroidogenesis is important for producing hormones needed for reproduction and ovarian regulation, and folliculogenesis is essential for the development of ovarian follicles and successful fertility. Thus, this study tested the hypothesis that prenatal exposure to an environmentally relevant phthalate mixture adversely affects ovarian steroidogenesis and folliculogenesis in the F1 generation of adult female mice. Pregnant dams (F0 generation) were orally dosed with vehicle control or a phthalate mixture (20 μg/kg/day-500 mg/kg/day) daily from gestational day 10 to birth, and the adult F1 females were the offspring of the dosed dams. The ovaries of the F1 generation were collected at postnatal day 60. One ovary was used for histological examination of the numbers and percent of different follicle types. The other ovary was used to measure expression of theca and granulosa cell enzymes. Additionally, sera were collected for measuring hormone levels. The results indicate that prenatal exposure to the phthalate mixture decreases hormone levels and gene expression, alters the transitioning of follicle types, and leads to a higher incidence of atresia in the F1 generation offspring.

Transcriptome analysis during photostimulated recrudescence reveals distinct patterns of gene regulation in Siberian hamster ovaries†

In Siberian hamsters, exposure to short days (SDs, 8 h light:16 h dark) reduces reproductive function centrally by decreasing gonadotropin secretion, whereas subsequent transfer of photoinhibited hamsters to stimulatory long days (LDs, 16 L:8 D) promotes follicle stimulating hormone (FSH) release inducing ovarian recrudescence. Although differences between SD and LD ovaries have been investigated, a systematic investigation of the ovarian transcriptome across photoperiod groups to identify potentially novel factors that contribute to photostimulated restoration of ovarian function had not been conducted. Hamsters were assigned to one of four photoperiod groups: LD to maintain ovarian cyclicity, SD to induce ovarian regression, or post transfer (PT), where females housed in SD for 14-weeks were transferred to LD for 2-days or 1-week to reflect photostimulated ovaries prior to (PTd2) and following (PTw1) the return of systemic FSH. Ovarian RNA was extracted to create RNA-sequencing libraries and short-read sequencing Illumina assays that mapped and quantified the ovarian transcriptomes (n = 4/group). Ovarian and uterine masses, plasma FSH, and numbers of antral follicles and corpora lutea decreased in SD as compared to LD ovaries (P < 0.05). When reads were aligned to the mouse genome, 18 548 genes were sufficiently quantified. Most of the differentially expressed genes noted between functional LD ovaries and regressed SD ovaries; however, five main expression patterns were identified across photoperiod groups. These results, generally corroborated by select protein immunostaining, provide a map of photoregulated ovary function and identify novel genes that may contribute to the photostimulated resumption of ovarian activity.

Folliculogenic factors in photoregressed ovaries: Differences in mRNA expression in early compared to late follicle development

The early stages of ovarian folliculogenesis generally progress independent of gonadotropins, whereas later stages require signaling initiated by FSH. In Siberian hamsters, cycles of folliculogenesis are mediated by changes in photoperiod which depress the hypothalamic pituitary gonadal axis. Reduced gonadotropins lead to decreases in mature follicle development and ovulation; however, early stages of folliculogenesis have not been explored in regressed ovaries. We hypothesized that intraovarian factors that contribute predominantly to later stages of folliculogenesis would react to changes in photoperiod, whereas factors contributing to earlier stages would not change. To probe if the early stages of folliculogenesis continue in the photoinhibited ovary while late stages decline, we measured the mRNA abundance of factors that interact with FSH signaling (Fshr, Igf1, Cox2) and factors that can function independently of FSH (c-Kit, Kitl, Foxo3, Figla, Nobox, Sohlh1, Lhx8). While plasma FSH, antral follicles, and corpora lutea numbers declined with exposure to inhibitory photoperiod, the numbers of primordial, primary, and secondary follicles did not change. Expression of factors that interact with FSH signaling changed with changes in photoperiod; however, expression of factors that do not interact with FSH were not significantly altered. These results suggest that the photoinhibited ovary is not completely quiescent, as factors important for follicle selection and early follicle growth are still expressed in regressed ovaries. Instead, the lack of gonadotropin support that characterizes the non-breeding season appears to inhibit only final stages of folliculogenesis in Siberian hamsters.

Concomitant combination of active immunotherapy and carboplatin- or paclitaxel-based chemotherapy improves anti-tumor response

Recent preclinical evidence substantially supports the successful combination of chemotherapies and active immunotherapy for cancer treatment. These data sustain the effect of sequential combination schemes (vaccine plus chemotherapy or vice versa), which could be difficult to implement in clinical practice. Since chemotherapy is the standard treatment for most cancers, ethical issues forbid its delay and make difficult the evaluation of other treatments such as using an immunotherapeutic agent. Besides, vaccines must be applied as soon as possible to advanced cancer patients, in order to give them time to develop an effective immune response. Thus, a clinically attractive scenario is the concomitant application of treatments. However, little is known about the specific effect of different chemotherapeutic agents when combined with a cancer vaccine in such concomitant treatment. In this work, we analyze the influence of high-dose carboplatin or paclitaxel in the generation of a specific immune response when administered concomitantly with an OVA vaccine. Interestingly, neither carboplatin nor paclitaxel affects the humoral and CTL in vivo response generated by the vaccine. Moreover, an enhancement of the overall anti-tumor effect was observed in animals treated with OVA/CF vaccine combined with cytotoxic drugs. Moreover, the effect of the concomitant treatment was tested using a tumor-related antigen, the epidermal growth factor (EGF). Animals administered with EGF-P64k/Montanide and cytotoxic agents showed an antibody response similar to that from control animals. Therefore, our study suggests that carboplatin and paclitaxel can be concomitantly combined with active immunotherapies in the clinical practice of advanced cancer patients.

Morphometric changes associated with the reproductive cycle and behaviour of the intertidal-nesting, male plainfin midshipman Porichthys notatus

Morphometric changes in body condition, liver, sonic muscle and gonadal development associated with the annual reproductive cycle and behaviour of the intertidal-nesting male plainfin midshipman Porichthys notatus were investigated. Body condition of type I males rapidly increased during the pre-nesting (PN) period, peaked at the beginning of the summer nesting cycle and then gradually declined to lowest levels during the non-reproductive (NR) period. The gonado-somatic index of type I males peaked during PN and then declined during the summer nesting cycle to lowest levels at the end of the nest cycle and during NR. Indices of sonic muscle and liver of type I males were lowest during NR, gradually increased during PN and then peaked during the summer nesting cycle. Results indicate that body condition and fecundity of type I males were positively correlated with body mass at the end of the nest cycle. These findings as they relate to the annual reproductive cycle and behaviour of the type I male P. notatus are discussed.

Patterns of variability at the major histocompatibility class II alpha locus in Atlantic salmon contrast with those at the class I locus

In order to investigate the mechanisms creating and maintaining variability at the major histocompatibility (MH) class II alpha (DAA) locus we examined patterns of polymorphism in two isolated Atlantic salmon populations which share a common post-glacial origin. As expected from their common origin, but contrary to the observation at the MH class I locus, these populations shared the majority of DAA alleles: out of 17 sequences observed, 11 were common to both populations. Recombination seems to play a more important role in the origin of new alleles at the class II alpha locus than at the class I locus. A greater than expected proportion of sites inferred to be positively selected (potentially peptide binding residues, PBRs) were found to be involved in recombination events, suggesting a mechanism for increasing MH variability through an interaction between recombination and natural selection. Thus it appears that although selection and recombination are important mechanisms for the evolution of both class II alpha and class I loci in the Atlantic salmon, the pattern of variability differs markedly between these classes of MH loci.

Rapid evolution of the MH class I locus results in different allelic compositions in recently diverged populations of Atlantic salmon

We compared major histocompatibility class I allelic diversity in two currently reproductively isolated Atlantic salmon (Salmo salar) populations (Irish and Norwegian) with a common postglacial origin in order to test for among-population differences in allelic composition and patterns of recombination and point mutation. We also examined the evidence for adaptive molecular divergence at this locus by analyzing the rate of amino acid replacement in relation to a neutral expectation. Contrary to our prediction, and in contrast to the situation for other genetic markers, the two populations have almost nonoverlapping sets of major histocompatibility class I alleles. Although there is a strong signal of point mutation that predates population divergence, recent recombination, acting in similar, but not identical, ways in both populations appears to be a significant force in creating new alleles. Moreover, selection acting on peptide-binding residues seems to favor new recombinant alleles and is likely to be responsible for the rapid divergence between populations.

Cost savings of manual vacuum aspiration for endometrial sampling in El Salvador

Despite the existence of less costly and less invasive techniques to evaluate abnormal uterine bleeding, sharp curettage continues to be the most common form of endometrial sampling in the less developed world. Because manual vacuum aspiration (MVA) equipment is often associated with abortion care in countries where abortion is illegal, many practitioners have been slow to incorporate its use for other gynecological conditions. In this study, MVA was introduced in a large teaching hospital in El Salvador as an alternative for patients with abnormal uterine bleeding. Hospital cost, length of stay and complication rates were compared in a prospective, nonrandomized controlled study of 163 patients assigned to either traditional sharp curettage or MVA services. Patients were assigned to each group depending on the availability of trained providers. Methodologies for cost-savings analysis were modified to obtain more precise cost estimates. Use of MVA was associated with a significant cost savings of 11% and a hospital stay that was 27% shorter as compared to sharp curettage. Cost savings could be much higher if MVA was institutionalized as an ambulatory procedure with minimal or no preoperative evaluation and postoperative stay.

Treating incomplete abortion in El Salvador: cost savings with manual vacuum aspiration

When manual vacuum aspiration (MVA) was introduced to treat incomplete abortion at a regional training hospital in El Salvador, this study evaluated the impact of replacing sharp curettage with MVA. Hospital cost, length of hospital stay, complication rates and postabortion contraceptive acceptance were compared in a prospective, nonrandomized, controlled study of 154 women assigned to either traditional sharp curettage services or MVA services plus contraceptive counseling. Assignment depended on availability of trained providers. Compared to sharp curettage, use of MVA and associated changes in protocol led to a significant cost savings of 13% and shorter hospital stay of 28%. Dedicated family-planning counseling resulted in a threefold higher rate of contraceptive acceptance. Although the difference in cost was significant, much higher savings could be realized if minimal postoperative stays were implemented for both procedures. Barriers to early discharge include patient expectations, physician attitudes and training and hospital systems administration.

Autoimmunization to epidermal growth factor, a component of the immunological homunculus

Epidermal growth factor (EGF) is being tried as a vaccine in cancer immunotherapy with the aim of inducing neutralizing antibodies that might affect EGF-dependent tumors. Here we summarize our experience using the EGF self-molecule as an autoimmunigen. We report here that IgG anti-EGF antibodies are prevalent in healthy people and that augmentation of the response to EGF requires conjugation to an effective carrier and an adjuvant. Paradoxically, the response to EGF immunization could be enhanced by an 'immunosuppressive' treatment with cyclophosphamide, most probably by suppressing active control mechanisms. EGF is expressed in the thymus. Thus, EGF may be added to the immunological homunculus, the class of self-antigens to which there is both natural autoimmunity and natural regulation of the autoimmunity. The results using EGF as a vaccine can teach us about the homunculus and how to activate it.

Provision of hormonal contraceptives without a mandatory pelvic examination: the first stop demonstration project

CONTEXT

First Stop, an 18-month demonstration project that operated in 1996-1997, was designed to offer low-income adult women in California hormonal contraceptives without requiring a pelvic examination.

METHODS

An evaluation was undertaken to assess the contraceptives adopted by First Stop clients, compare health risks of these women with risks among women using traditional family planning clinics and assess clients'satisfaction. Data on 2,065 First Stop clients and 1,507 women attending traditional clinics were collected through several self- and clinician-administered instruments, including questionnaires, a telephone survey and medical chart abstractions.

RESULTS

After the initial First Stop visit, 38% of women adopted a more effective method than they had used at last sex, 4 7% remained with the same method, 12% switched to a less-effective method and 3% accepted no method. Of clients who were referred for additional medical care, 73% followed through on their referrals. Compared with clients at traditional clinics, First Stop clients were less likely to have a regular source of health care, but more likely to have made a health care visit in the past year. Most First Stop clients valued the project's services; 76% said it was important to be able to receive pills or injections without a pelvic examination.

CONCLUSIONS

Programs that provide hormonal contraceptives without requiring a pelvic examination can expand low-income women's access to these methods and improve the chances that they will obtain other reproductive health services.

Cauliflower somatic embryogenesis and analysis of regenerant stability by ISSRs

  To study the somatic embryogenesis of Brassica oleracea var. botrytis L., hypocotyls were placed on Murashige and Skoog's medium (1962) with 1 mg.l^-1 of 2,4-dichlorophenoxyacetic acid and 1 mg.l^-1 of kinetin to induce callogenesis. After transfer of the calli to the maturation medium, somatic embryos appeared. They developed into plantlets and the potential of regeneration of the calli was maintained for more than 8 months. Thirty-five plantlets were produced after 2 months of culture, then transplanted into soil. Inter-simple sequence repeat markers generated by trinucleotidic and tetranucleotidic primers were tested for their ability to characterise genomic variations in the obtained plants. The absence of polymorphism between different regenerants from the same cultivar indicates the conformity of the regeneration protocol.

Emergency contraception: advance provision in a young, high-risk clinic population

OBJECTIVE

To assess whether advance provision of emergency contraception increases its use and whether it has secondary effects on regular contraceptive use.

METHODS

We conducted a controlled trial of female clients, aged 16-24 years, who attended a publicly funded family planning clinic. Women were systematically assigned to receive an advance provision of emergency contraception and education (treatment) or education only (control). Among 263 participants enrolled (133 treatment, 130 control), follow-up was completed in 213 (111 treatment, 102 control). The main outcome measures were emergency contraception knowledge and use, frequency of unprotected sex, and pattern of contraceptive use in the past 4 months.

RESULTS

Participants were aware of emergency contraception at follow-up, but the treatment group was three times as likely to use it (P =.006). Although the treatment group did not report higher frequencies of unprotected sex than the control group, women in the treatment group (28%) were more likely than those in the control group (17%) to report using less effective contraception at follow-up compared with enrollment (P =.05). The proportion of women in both groups who reported consistent pill use increased from enrollment to follow-up (34% versus 45%); however, the control group (58%) was more likely than the treatment group (32%) to report consistent pill use at follow-up (P =.03).

CONCLUSION

Use of emergency contraception was increased by providing it in advance, but not by education alone. Changes to less effective contraceptive methods and patterns of pill use were potentially negative effects that need to be explored in relation to observed benefits.