System-level recommendations for improved wellness for gynecologic oncologists: A Society of Gynecologic Oncology Review

Burnout and its negative sequelae are a persistent problem in gynecologic oncology, threatening the health of our physician workforce. Individual-level interventions such as stress management training, physical activity, and sleep hygiene only partially address this widespread, systemic crisis rooted in the extended work hours and stressful situations associated with gynecologic oncology practice. There is an urgent need for systematic, institution-level changes to allow gynecologic oncologists to continue the crucial work of caring for people with gynecologic cancer. We present recommendations for institution-level changes which are grounded in the framework presented by the National Plan for Health Workforce Well-Being by the National Academy of Medicine. These are aimed at facilitating gynecologic oncologists' well-being and reduction of burnout. Recommendations include efforts to create a more positive and inclusive work environment, decrease administrative barriers, promote mental health, optimize electronic medical record use, and support a diverse workforce. Implementation and regular evaluation of these interventions, with specific attention to at-risk groups, is an important next step.

Reef islands have continually adjusted to environmental change over the past two millennia

Global environmental change is identified as a driver of physical transformation of coral reef islands over the past half-century, and next 100 years, posing major adaptation challenges to island nations. Here we resolve whether these recent documented changes in islands are unprecedented compared with the pre-industrial era. We utilise radiometric dating, geological, and remote sensing techniques to document the dynamics of a Maldivian reef island at millennial to decadal timescales. Results show the magnitude of island change over the past half-century (±40 m movement) is not unprecedented compared with paleo-dynamic evidence that reveals large-scale changes in island dimension, shape, beach levels, as well as positional changes of ±200 m since island formation ~1,500 years ago. Results highlight the value of a multi-temporal methodological approach to gain a deeper understanding of the dynamic trajectories of reef islands, to support development of adaptation strategies at timeframes relevant to human security.

Comparison of low-density lipoprotein cholesterol equations in patients with dyslipidaemia receiving cholesterol ester transfer protein inhibition

Background

Low-density lipoprotein (LDL-C) lowering is imperative in cardiovascular disease prevention. Effectively translating the evidence for LDL-C lowering to maximize clinical and public health benefits depends on the availability of accurate LDL-C results from clinical laboratories to guide therapy. Furthermore, prior work has raised the possibility that cholesterol esterase transfer protein (CETP) inhibition could interfere with accurate assessment of LDL-C.

Purpose

We aimed to compare accuracy of three clinically implemented LDL-C equations in a clinical trial of CETP inhibition.

Methods

Men and women aged 18–75 years with dyslipidaemia were recruited from 17 sites in the Netherlands and Denmark. Patients were randomly assigned to one of nine groups using various combinations of the CETP inhibitor TA-8995, statin therapy, and placebo. In pooled measurements over 12 weeks, we calculated LDL-C by the Friedewald, Martin/Hopkins, and Sampson equations, and compared values with preparative ultracentrifugation (PUC) LDL-C as the reference measure (also known as “beta quantification”). Based on prior literature and dyslipidaemia guidelines, we examined correct classifications across the LDL-C 1.81 mmol/L cutpoint in the subgroup of patients with triglycerides of 1.69–4.51 mmol/L.

Results

The analysis included 242 patients contributing 921 observations. The full distributions of differences between LDL-C estimates and PUC are shown in Figure 1. Overall median LDL-C differences between estimates and PUC were small: Friedewald, 0.00 (25th, 75th: −0.10, 0.08) mmol/L; Martin/Hopkins, 0.02 (−0.08, 0.10) mmol/L; and Sampson, 0.05 (−0.03, 0.15) mmol/L. In the subgroup with estimated LDL-C <1.81 mmol/L and triglycerides 1.69–4.51 mmol/L, the Friedewald equation underestimated LDL-C with a median difference versus PUC of −0.25 (−0.33, −0.10) mmol/L, whereas the Martin/Hopkins equation corrected this issue with a median difference of 0.00 (−0.08, 0.10) mmol/L and the Sampson equation showed tendency towards underestimation with a median difference of −0.06 (−0.13, 0.00) mmol/L. In patients with triglyceride levels of 1.69–4.51 mmol/L, Figure 2 shows the proportion of LDL-C levels classified by the equations as < or ≥1.81 mmol/L that were correctly classified when compared with PUC. All three equations showed >95% accuracy when estimated LDL-C levels were ≥1.81 mmol/L. However, the proportion of LDL-C observations <1.81 mmol/L that were correctly classified compared with PUC was 71.4% by Friedewald versus 100.0% by Martin/Hopkins and 93.1% by Sampson.

Conclusion

In Europeans with dyslipidaemia, our analysis shows improved accuracy in LDL-C when using contemporary LDL-C equations over the Friedewald equation, particularly when using the Martin/Hopkins equation. High levels of accuracy with the Martin/Hopkins equation were seen in individuals treated with CETP inhibition and even in the context of low LDL-C and high triglyceride levels.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Dezima and NewAmsterdam Pharma

977 The Role of Telephone Triage in Head and Neck Cancer Care in a Teaching Hospital

Introduction

NHS England sets standards to ensure prompt specialist review, diagnosis, and treatment of cancer. Patients with suspected cancer should receive specialist review within 14 days of referral, diagnosis by day 28 and first treatment by day 62. To reduce transmission during the SARS-CoV-2 pandemic, the NHS recommended telephone triage as the first specialist appointment. The effect of telephone triage on head and neck cancer timeframes in an NHS teaching hospital was assessed.

Method

Four head and neck cancer telephone triage clinics during July 2020 were selected at random. Clinical correspondence and the electronic patient records were reviewed for each patient and cancer pathway timeframes were analysed.

Results

31 patients were referred for telephone triage and 100% received specialist review within 14 days. Subsequently 17 (55%) patients were investigated, 12 (71%) of which received a diagnosis within 28 days. 4 patients received a cancer diagnosis, but none received first treatment within 62 days. 24 (77%) patients were seen in a face-to-face clinic after telephone triage on average 7 days after telephone triage.

Conclusions

In this sample, telephone triage allowed safe initial specialist review by meeting the 14-day standard. However, the 28-day diagnosis and 62-day treatment standards were not adhered to. Telephone triage does not largely reduce overall patient contact, with 77% of patients subsequently reviewed in a patient-facing setting. The addition of telephone triage delayed first clinical examination by a specialist by an average of 7 days, which may be a contributing factor to the delays seen in diagnosis and treatment.

Thrombospondin-1 and microRNA-1 expression in response to multiwalled carbon nanotubes in alveolar epithelial cells

Thrombospondin-1 (TSP-1) is a glycoprotein that plays a role in extracellular matrix (ECM) remodeling. Previously, we have shown that multiwalled carbon nanotubes (MWCNT) regulate ECM components TGFβ and its target Col3A1 in alveolar epithelial cells. In this study, we investigated the effect of MWCNT on TSP-1 and microRNA-1 (miR-1) in the regulation of TGFβ in ECM remodeling using alveolar epithelial A549 cells. A549 cells were treated with MWCNT (20 or 50 µg/mL) for 6 or 24 h and the expression of TSP-1 and miR-1, and the exogenous miR-1 effect on cell morphology were analyzed. MWCNT induced in a time- and dose-dependent manner the expression of TSP-1. miR-1 was suppressed by MWCNT after 6 or 24 h of treatment regardless of the dose. TSP-1 and miR-1 negatively correlated with each other, r = -0.58. Exogenous administration of miR-1 induced alveolar epithelial cell morphology changes including cell clustering, whereas inhibition of miR-1 induced less cell to cell contact, cell rounding, and cellular projections. IntAct molecular network interactions analysis revealed that TSP-1 interacts with 21 molecular factors including ECM genes, and molecules. These results indicate a relationship between that TSP-1, MWCNT, and TGFβ, and suggest TSP-1 may play a role in MWCNT-induced TGFβ and ECM remodeling. Moreover, these data also suggest an inverse relationship between TSP-1 and miR-1 and a potential role of miR-1 in MWCNT-induced fibrotic signaling. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1596-1606, 2017.

Identification of the novel B*27:144 allele in an Irish Individual

The sequence of HLA-B*27:144 differs from HLA-B*27:05:02 by one nucleotide change at position 506.

FGF21 Regulates Sweet and Alcohol Preference

Fibroblast growth factor 21 (FGF21) is a hormone induced by various metabolic stresses, including ketogenic and high-carbohydrate diets, that regulates energy homeostasis. In humans, SNPs in and around the FGF21 gene have been associated with macronutrient preference, including carbohydrate, fat, and protein intake. Here we show that FGF21 administration markedly reduces sweet and alcohol preference in mice and sweet preference in cynomolgus monkeys. In mice, these effects require the FGF21 co-receptor β-Klotho in the central nervous system and correlate with reductions in dopamine concentrations in the nucleus accumbens. Since analogs of FGF21 are currently undergoing clinical evaluation for the treatment of obesity and type 2 diabetes, our findings raise the possibility that FGF21 administration could affect nutrient preference and other reward behaviors in humans.

Short Communication: Rapid separation of cis9, trans11- and trans7,cis9-18:2 (CLA) isomers from ruminant tissue using a 30 m SLB-IL111 ionic column

Turner, T., Rolland, D. C., Aldai, N. and Dugan, M. E. R. 2011. Short Communication: Rapid separation of cis 9, trans 11- and trans 7,c is 9-18:2 (CLA) isomers from ruminant tissue using a 30 m SLB-IL111 ionic column. Can. J. Anim. Sci. 91: 711–713. Rumenic acid (cis9,trans11-18:2) is the main natural isomer of conjugated linoleic acid (CLA). Rumenic acid has many purported health benefits, but effects of most other CLA isomers are unknown. Typically trans7,cis9-18:2 is the second most abundant CLA isomer, but it co-elutes with rumenic acid on conventional polar gas chromatography (GC) columns, requiring complimentary analysis with silver-ion high performance liquid chromatography (Ag+-HPLC). Herein we report a rapid method for analyzing rumenic acid and trans7,cis9-18:2 using a 30 m ionic-liquid GC column. Optimal resolution of the two CLA isomers was at 145°C and analysis of backfat from barley-fed cattle compared well with GC/Ag+-HPLC (y=0.978x – 0.031, r=0.985, P<0.001).

The pharmaceutical use of permethrin: sources and behavior during municipal sewage treatment

Permethrin entered use in the 1970s as an insecticide in a wide range of applications, including agriculture, horticultural, and forestry, and has since been restricted. In the 21st century, the presence of permethrin in the aquatic environment has been attributed to its use as a human and veterinary pharmaceutical, in particular as a pedeculicide, in addition to other uses, such as a moth-proofing agent. However, as a consequence of its toxicity to fish, sources of permethrin and its fate and behavior during wastewater treatment are topics of concern. This study has established that high overall removal of permethrin (approximately 90%) was achieved during wastewater treatment and that this was strongly dependent on the extent of biological degradation in secondary treatment, with more limited subsequent removal in tertiary treatment processes. Sources of permethrin in the catchment matched well with measured values in crude sewage and indicated that domestic use accounted for more than half of the load to the treatment works. However, removal may not be consistent enough to achieve the environmental quality standards now being derived in many countries even where tertiary treatment processes are applied.

Parental anxiety and family disruption following a first febrile seizure in childhood

OBJECTIVE

To evaluate the degree of parental anxiety and family disruption following a child's first febrile seizure.

PATIENTS AND METHODS

The families of all children presenting with their first febrile seizure to any of the three emergency departments in the Saskatoon District, Saskatchewan, were invited to participate in a telephone interview to assess the degree of parental anxiety and family dysfunction that was experienced. Parameters measured included co-sleeping with the child, parental sleep disturbance, parental fatigue, monitor use, the number of night time checks on a child, child care use, parental outings, parental fear of missing a seizure, parental perception of a child's increased vulnerability and the family's stress level. The interview, which was conducted shortly after presentation at the emergency departments, compared anxiety and dysfunction experienced during the two weeks immediately preceding the visit with that experienced during the two weeks following a febrile seizure. Potential predictors of anxiety and dysfunction, including details of the presenting seizure, past medical illnesses, family history, the family's socioeconomic status and parental perception of the risk of a febrile seizure were queried.

RESULTS

Thirty-one (89%) of 35 families who were eligible for the study participated. Parental anxiety and family dysfunction were significantly greater for nearly all of the parameters assessed during the two weeks following a seizure. Socioeconomic factors correlated most closely with anxiety and dysfunction before a febrile seizure; however, socioeconomic factors were less predictive of anxiety and dysfunction during the two weeks following a seizure.

CONCLUSIONS

Parental anxiety and family dysfunction are the rule following a child's first febrile seizure. Neither higher socioeconomic status nor an understanding of the low risk of sequelae associated with febrile seizures was strongly predictive of improved coping during the two weeks following a seizure.

Evidence based guideline for the management of bronchiolitis

Bronchiolitis in infants and children is a common presentation in both the general practice and emergency department settings.

Evidence based guideline for the management of croup

Croup is a common presentation in both the general practice and hospital emergency department setting. The relatively recent introduction of steroid use in the management of croup has resulted in decreased hospital admissions and improved outcomes for children.

Guideline development process for the Health for Kids in the South East project

Health for Kids in the South East (HFK) was a project funded by the Victorian Government Department of Human Services, Hospital Admission Risk Program. The project aimed to improve health outcomes for children in southeast Melbourne (Victoria) by building partnerships between child health clinicians and implementing best practice.

Evidence based guideline for the management of diarrhoea with or without vomiting in children

Acute diarrhoea in children is a common presentation in both the general practice and hospital emergency department settings. Current practice focuses on the prevention and management of dehydration in young children. However, general practitioners may not be aware of recommendations against the use of routine investigation, antidiarrhoeals and antiemetics in children or recommendations regarding dietary advice.

Confirmation of CHD7 as a cause of CHARGE association identified by mapping a balanced chromosome translocation in affected monozygotic twins

BACKGROUND

CHARGE syndrome has an estimated prevalence of 1/10,000. Most cases are sporadic which led to hypotheses of a non-genetic aetiology. However, there was also evidence for a genetic cause with reports of multiplex families with presumed autosomal dominant, possible autosomal recessive inheritance and concordant twin pairs. We identified a monozygotic twin pair with CHARGE syndrome and a de novo balanced chromosome rearrangement t(8;13)(q11.2;q22).

METHODS

Fluorescence in situ hybridisation was performed with BAC and PAC probes to characterise the translocation breakpoints. The breakpoint on chromosome 8 was further refined using 10 kb probes we designed and produced using sequence data for clone RP11 33I11, the Primer3 website, and a long range PCR kit.

RESULTS

BAC and PAC probe hybridisation redefined the breakpoints to 8q12.2 and 13q31.1. Probe RP11 33I11 spanned the breakpoint on chromosome 8. Using our 10 kb probes we demonstrated that the chromodomain gene CHD7 was disrupted by the translocation between exons 3 and 8.

DISCUSSION

Identifying that the translocation breakpoint in our patients occurred between exons 3 and 8 of CHD7 suggests that disruption of this gene is the cause of CHARGE syndrome in the twins and independently confirms the role of CHD7 in CHARGE syndrome.

Luteinising hormone-releasing hormone analogue reverses the cell adhesion profile of EGFR overexpressing DU-145 human prostate carcinoma subline

Cetrorelix, a luteinising hormone-releasing hormone (LHRH) analogue, has been shown to limit growth of the human androgen-independent prostate cell line DU-145, although other inhibitory actions may also be affected. Both growth and invasion of DU-145 cells are linked to autocrine epidermal growth factor receptor (EGFR) signalling. Invasiveness requires not only cells to migrate to conduits, but also reduced adhesiveness between tumour cells to enable separation from the tumour mass. Thus, we investigated whether Cetrorelix alters the DU-145 cell-cell adhesion and if this occurs via altered EGFR signalling. Pharmacologic levels of Cetrorelix limited the invasiveness of a highly invasive DU-145 subline overexpressing full-length EGFR (DU-145 WT). Extended exposure of the cells to Cetrorelix resulted in increased levels of the cell-cell adhesion complex molecules E-cadherin, alpha- and beta-catenin, and p120. Puromycin blocked the increases in E-cadherin and beta-catenin levels, suggesting that de novo protein synthesis is required. The Cetrorelix effect appears to occur via transmodulation of EGFR by a protein kinase C (PKC)-dependent mechanism, as there were no changes in DU-145 cells expressing EGFR engineered to negate the PKC transattenuation site (DU-145 A654); downregulation of EGFR signalling produced a similar upregulation in adhesion complex proteins, further suggesting a role for autocrine signalling. Cetrorelix increased the cell-cell adhesiveness of DU-145 WT cells to an extent similar to that seen when autocrine EGFR signalling is blocked; as expected, DU-145 A654 cell-cell adhesion also was unaffected by Cetrorelix. The increased adhesiveness is expected as the adhesion complex molecules moved to the cells' periphery. These data offer direct insight into the possible crosstalk pathways between the LHRH and EGFR receptor signalling. The ability of Cetrorelix to downregulate EGFR signalling and subsequently reverse the antiadhesiveness found in metastatic prostate cancer highlights a novel potential target for therapeutic strategies.

Comparison of the performance of selenite cystine and mannitol selenite enrichment broths in the isolation of Salmonella spp. from faeces

Over a four-month period, 4,658 routine faecal samples were examined in four laboratories and the isolation rates of Salmonella spp. from mannitol selenite (MS) and selenite cystine (SC) broths plated to xylose lysine desoxycholate agar (XLD) compared. The isolation rate by MS was 1.55% and by SC was 1.48%, a small difference which is not statistically significant. Significantly fewer colonies were selected for supplementary testing from SC than MS (p = 0.029), thus reducing confirmatory work. In laboratories where SC is already used for food and environmental work, an opportunity exists to limit stocked salmonella enrichment broths to SC alone.

Comparison of the performance of lactose and mannitol selenite enriched broths, subcultured to DCA and XLD agars, in the isolation of Salmonella spp. from faeces

Selenite-based enrichment broths using either lactose or mannitol as a carbohydrate source are generally used as selective enrichment media for the isolation of Salmonella spp. from human faeces in the UK, but few studies have compared the relative efficacy of the available formulations. A variety of solid media is used for the routine subculture from these selective broths, but similarly we have been unable to find published evidence as to which medium performs best. Four thousand and nineteen faecal samples were examined in four laboratories and the isolation rates of Salmonella spp. from lactose (LS) or mannitol selenite (MS) broths, plated onto either xylose lysine desoxycholate agar (XLD) or desoxycholate citrate agar (DCA) were compared. MS performed significantly better than LS (p = 0.02), recovering 95 salmonellae compared with 87. No significant difference in isolation rates was found between XLD and DCA, although colonial appearances of suspected salmonellae on XLD were much more specific, resulting in significantly fewer colonies having to be selected for supplementary testing (p < 0.001) and so reducing confirmatory work. An opportunity exists to simplify holdings of media by choosing to use the MS/XLD combination.

An evaluation of the performance of XLD, DCA, MLCB, and ABC agars as direct plating media for the isolation of Salmonella enterica from faeces

AIMS

To compare the performance of four media, singly and in combination, as direct plating media for the isolation of Salmonella enterica from human faeces.

METHODS

Two thousand four hundred and nine routine, faecal samples received by four laboratories were inoculated on to xylose lysine desoxycholate (XLD), desoxycholate citrate (DCA), mannitol lysine crystal violet brilliant green (MLCB), and alpha-beta chromogenic (ABC) agars using standardised protocols, reagents, and data collection. Isolates of presumptive salmonellae were identified using standard laboratory techniques and the results were analysed statistically.

RESULTS

Direct plating recovered 46 of the 60 possible isolates of Salmonella spp recovered via enrichment broth. No isolates were recovered from direct plating that were not recovered via selenite enrichment. MLCB gave the highest isolation rate individually (84.8%) and amounts of competing flora (CF) did not affect the recognition of colonies. ABC proved highly specific, but insensitive, and isolation rates were adversely affected by any amount of CF. Isolation rates from XLD and DCA were only affected when the CF load was heavy. DCA was least specific, with only 9.01% of picks positive and greatest number of confirmatory tests. XLD and MLCB, in combination, gave the highest isolation rate.

CONCLUSIONS

Where the earlier results of direct plating may be advantageous, XLD and MLCB provide the optimal combination. For non-typhi salmonellae, MLCB is the best, single direct plating medium. For routine diagnostic work, XLD is most effective.

A comparison of the isolation rates of Salmonella and thermophilic Campylobacter species after direct inoculation of media with a dilute faecal suspension and undiluted faecal material

Regardless of media used, dilution of faecal samples before direct plating may improve isolation rates and reduce subcultures by freeing organisms from the faecal mass and diminishing competing flora. Despite the routine use of dilution in many laboratories, it has never been established properly whether direct or dilute inocula should be used in primary plating of faeces. A total of 3764 faecal samples was examined in four laboratories with a standardised methodology. The isolation rates, competing flora and confirmatory work performed for Salmonella spp. and Campylobacter spp. from primary plating media with a dilute faecal inoculum were compared with those after direct inoculation of faecal material. Inoculum effects on the isolation of Shigella spp. could not be assessed as only one isolate occurred during the study period. The overall isolation rates of both major enteric pathogens were unaffected by the inoculum. However, significantly fewer wasted subcultures were recorded with a dilute inoculum for Campylobacter spp., and competing florawas reduced in all cases without diluting out small numbers of the pathogen.

A comparison of the performance of bacitracin-incorporated chocolate blood agar with chocolate blood agar plus a bacitracin disk in the isolation of Haemophilus influenzae from sputum

The lack of selectivity of chocolated blood agar (CBA), routinely used for the isolation of Haemophilus influenzae, may lead to masking of the growth of H. influenzae due to overgrowth of competing flora. Bacitracin can be used as a selective agent, either incorporated into the medium or applied to the medium in a filter paper. However, neither method has been evaluated or compared in a large study. Sputum samples (1990) were examined in four laboratories and the isolation rates of H. influenzae on chocolated blood agar with bacitracin added to the medium (BCA) and chocolated blood agar (CBA) with a bacitracin disk were compared. A plain blood agar plate was also inoculated to facilitate the isolation of Streptococcus pneumoniae so that its effects on the isolation of H. influenzae could be assessed. No significant difference was found between the isolation rates of H. influenzae on BCA and CBA with a bacitracin disk, although competing flora was greatly reduced and quantity of growth of H. influenzae increased on BCA. The presence of S. pneumoniae did not affect the isolation of H. influenzae in this study.