Occupational exposures among women beedi workers in Mysore District, India: A mixed-methods study protocol

Beedi is the most common smoking form of tobacco used in India. The rolling of beedis is performed primarily by women in settings that lack occupational safeguards. The aims of this protocol are to establish methods for the study of occupational exposures among women beedi workers and their experiences and challenges working with unburnt tobacco. This protocol employs a convergent parallel mixed-methods approach. Qualitatively, we plan to explore the experiences and challenges faced by women beedi workers using photovoice, a community based participatory method. Occupational exposures to pesticides will be assessed through the use of silicone wristbands worn for seven days by workers, and exposure to toxic metals and metalloids will be assessed in dust samples collected in the homes of workers. The outcomes will be analyzed to form policy recommendations to improve the occupational health of women beedi workers.

Systematic review study protocol of literature from 2018 to end of 2022 of stated preference studies about HIV care and prevention services around the world

BACKGROUND

There are currently over 38 million individuals around the globe living with the HIV and AIDS. As many HIV prevention and care services emerging for public use services become available to a wider audience, there is a growing need for more information about willingness to engage in these care and services. Stated preference research methods have been shown to be useful methods to help predict factors that influence health behaviours in the future.

RESEARCH QUESTION

This is a systematic review of findings from stated preference studies regarding the choices of people living with HIV or people at risk of contracting HIV to engage in HIV prevention or care.

METHODS

Our team plans to compile stated preference studies studying the choice to engage in HIV prevention or care services. Studies will be included from 1 January 2018 until 28 October 2022. There will be no restrictions on the language or location of the study. We will search databases including PubMed, PsycINFO, Embase, Scopus, Tufts CEA registry and CINAHL. Two researchers will review each article's title, abstract, then full-text and finally extract relevant data based on a predetermined process. Data will be presented in a narrative review and in an exploratory meta-analysis by subgroups of studies.

ETHICS AND DISSEMINATION OF RESEARCH

There is no need for an ethical review process of this study since all data used is available publicly. The findings of this study will be reported in relevant conferences and submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023397785.

Validation of metastasis-free survival as a surrogate endpoint for overall survival in localized prostate cancer in the era of docetaxel for castration-resistant prostate cancer

BACKGROUND

Prior work from the Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) consortium (ICECaP-1) demonstrated that metastasis-free survival (MFS) is a valid surrogate for overall survival (OS) in localized prostate cancer (PCa). This was based on data from patients treated predominantly before 2004, prior to docetaxel being available for the treatment of metastatic castrate-resistant prostate cancer (mCRPC). We sought to validate surrogacy in a more contemporary era (ICECaP-2) with greater availability of docetaxel and other systemic therapies for mCRPC.

PATIENTS AND METHODS

Eligible trials for ICECaP-2 were those providing individual patient data (IPD) after publication of ICECaP-1 and evaluating adjuvant/salvage therapy for localized PCa, and which collected MFS and OS data. MFS was defined as distant metastases or death from any cause, and OS was defined as death from any cause. Surrogacy was evaluated using a meta-analytic two-stage validation model, with an R2 ≥ 0.7 defined a priori as clinically relevant.

RESULTS

A total of 15 164 IPD from 14 trials were included in ICECaP-2, with 70% of patients treated after 2004. The median follow-up was 8.3 years and the median postmetastasis survival was 3.1 years in ICECaP-2, compared with 1.9 years in ICECaP-1. For surrogacy condition 1, Kendall's tau was 0.92 for MFS with OS at the patient level, and R2 from weighted linear regression (WLR) of 8-year OS on 5-year MFS was 0.73 (95% confidence interval 0.53-0.82) at the trial level. For condition 2, R2 was 0.83 (95% confidence interval 0.64-0.89) from WLR of log[hazard ratio (HR)]-OS on log(HR)-MFS. The surrogate threshold effect on OS was an HR(MFS) of 0.81.

CONCLUSIONS

MFS remained a valid surrogate for OS in a more contemporary era, where patients had greater access to docetaxel and other systemic therapies for mCRPC. This supports the use of MFS as the primary outcome measure for ongoing adjuvant trials in localized PCa.

From study plans to capacity building: a journey towards health equity in cancer survivorship

This article highlights the importance of pausing and reflecting on one's motivation, capacity, and positionality when engaging in health equity research and encourages researchers to engage in critical self-reflection and contribute to the ongoing dialogue on the ethical conduct of health equity-focused cancer research. In response to the urgent need to address health disparities and improve health equity in cancer survivorship care, the Cancer Prevention and Control Research Network (CPCRN) Survivorship workgroup discussed developing a study focused on understanding how racism impacts patient engagement in cancer survivorship care. However, during the study's development, the workgroup recognized limitations in research team composition and infrastructure. The workgroup engaged in critical self-reflections, individually and collectively, leading to the halting of the research study. Consequently, they redirected their efforts towards strengthening the necessary infrastructure for conducting such research, including diverse investigator representation and equitable partnerships with cancer survivors. The description of this process, along with suggestions for reflection, may be helpful and informative to other researchers and research networks seeking to center marginalized voices and work in partnership to address healthcare and health equity.

Qualitative Analysis of Opinions and Beliefs Associated with the Use of Tobacco Dentifrice among Individuals Attending a Tobacco Counselling Session

BACKGROUND

Smokeless tobacco (SLT) use is positively associated with oral, oesophageal, and pancreatic cancers. The tobacco dentifrice is a type of SLT which is applied to the teeth and gums. It is available in different forms which include mishri, gul/gulmanjan, gudhaku, snuff, red tooth powder, and creamy snuff. This qualitative study aims to explore the opinions and beliefs associated with the harmful effects of tobacco dentifrice use.

METHODOLOGY

Thirty in-depth interviews were conducted among tobacco dentifrice users visiting a dental hospital. The data were coded and analysed using thematic analysis in ATLAS.ti software 8.

RESULTS

A total of 11 codes and six categories were generated which comprised of the reason for the initiation, awareness of health effects, perception of oral tobacco application, perception of quitting, the reason for continued use, and use in society. Family, peers, access to the product, curiosity were important factors to initiate the tobacco dentifrice use. Participants believed in the myth that tobacco dentifrice was beneficial for the teeth, gums, and bowel movements. The participants considered tobacco dentifrice to be less harmful than other forms of tobacco. However, some participants were aware of its adverse effects on health and have tried to quit in the past. None of the participants had taken any professional help for quitting.

CONCLUSION

There were strong beliefs and myths among the participants that tobacco dentifrice was beneficial for oral and general health. There is a need to create awareness and improve the standard of the health warning of such products.

Clinical Outcomes with Stereotactic Body Radiation Therapy for Oligometastatic Prostate Cancer: Results from a Prospective Registry Trial

PURPOSE/OBJECTIVE(S)

Metastasis-directed radiation therapy using stereotactic body radiation therapy (SBRT) in oligometastatic prostate cancer (Oligo PCa) has a demonstrated benefit for local control and biochemical recurrence free survival for men with oligorecurrent PCa; however, the impact of SBRT within other oligometastatic states and in the context of systemic therapy remains poorly characterized. In this study, we investigate prognostic factors for clinical outcomes in a prospective cohort of Oligo PCa patients treated with metastasis-directed SBRT.

MATERIALS/METHODS

Using a single-institution registry trial, we analyzed a prospective cohort of 86 patients with Oligo PCa (≤5 metastatic lesions) and treated with metastasis-directed SBRT between 2017- 2022. Patients were classified as synchronous, metachronous, or induced oligometastatic disease as per the ESTRO guidelines. We evaluated the time to radiographic progression (TTRP), defined as the time from SBRT start date to radiographic progression, as well as time to initiation of new treatment (TTNT), defined as the time from SBRT end date to initiation of new therapy (systemic or radiation therapy). Time to event (TTE) was defined as the time from SBRT start date to radiographic progression or initiation of new therapy, whichever occurred first. Patients without documented events were censored at the date of last disease assessment. Comparative analyses were performed using Kaplan-Meier and Cox proportional hazards regression methods.

RESULTS

Eighty-six men with Oligo PCa treated with SBRT were followed for a median of 16.4 months with M0 (73%), Oligo PCa (21%) or polymetastatic PCa (6%) GS > = 8 (63%) at initial diagnosis. At the time of treatment with initial SBRT, 21% had synchronous oligometastatic disease, 63% had metachronous or repeat oligorecurrence or oligoprogression, and 16% had induced oligometastatic disease. Most patients were treated to 1-3 sites (94%), which predominantly included bone (86%), and the median dose was 35 Gy/5F. Concurrent systemic therapy during SBRT was seen in 85% of patients, including (60.5% with new generation androgen receptor signaling inhibitors). Overall survival at 1-year and 2-years was 96.9% [95% CI, 88.2-99.2%] and 94.4% [95% CI, 83.2-98.2%]. Using univariable analysis, those who did not receive systemic treatment during SBRT had significantly shorter TTRP (HR 3.67, [95% CI, 1.62-8.32], p = 0.002), TTNT (HR 3.24, 95% CI [1.49-7.06], p = 0.003), and TTE (HR 3.05, [95% CI, 1.44-6.45], p = 0.004). Additionally, patients treated with SBRT for metachronous (HR 2.89, [95% CI 0.68-12.30]) and induced metastatic disease (HR 8.96, [95% CI 1.85-43.37]) had significantly shorter TTE compared to synchronous oligometastatic disease (p = 0.006).

CONCLUSION

Using a prospective registry cohort of men with Oligo PCa treated with SBRT, we identify an association of oligometastatic state and the use of concurrent systemic therapy with improved TTRP and TTNT. Further prospective studies are warranted.

School health systems under strain: an example of COVID-19 experiences & burnout among school health staff in Pima County, Arizona

BACKGROUND

School health staff lead and provide a variety of care for children in schools. As school districts have navigated the COVID-19 pandemic, school health staff have faced unprecedented challenges in protecting the health of students and school staff. Our objective was to qualitatively characterize these pandemic challenges and experiences of school health staff in Pima County, Arizona to identify gaps in school health staff support for improving future emergency preparedness.

METHODS

We conducted two focus group discussions (FGDs) with 48 school health staff in Pima County, Arizona in two school districts using a discussion guide including ten open-ended questions. The FGDs were audio recorded and transcribed verbatim. We used the socioecological model (SEM) to organize the thematic analysis and generate codes and themes; data were analyzed using Atlas.ti software.

FINDINGS

The pandemic has significantly challenged school health staff with new pandemic-related job tasks: managing isolation, vaccination, and developing/implementing new and evolving COVID-19 guidelines. School health staff also reported increased stress related to interactions with parents and school administration as well as frustrations with rapid changes to guidance from the health department and policy makers. A common issue was not having enough staff or resources to complete regular job responsibilities, such as providing care for students with non-COVID-19 related health issues.

CONCLUSIONS

Increased workload for school health staff resulted in physical burnout, mental distress, and disruption of core functions with long term implications for children's health. These focus groups highlight the need for improved emergency preparedness in schools during pandemics or infectious disease outbreaks. These include basic infrastructure changes (e.g., personnel support from health departments for tasks such as contact tracing to enable school nurses to continue core functions), and increased funding to allow for hazard pay and more school health personnel during emergency situations. In addition, basic school health infrastructure is lacking, and we should include a licensed school health nurse in every school.

Evidence of Antineutrinos from Distant Reactors Using Pure Water at SNO

The SNO+ Collaboration reports the first evidence of reactor antineutrinos in a Cherenkov detector. The nearest nuclear reactors are located 240 km away in Ontario, Canada. This analysis uses events with energies lower than in any previous analysis with a large water Cherenkov detector. Two analytical methods are used to distinguish reactor antineutrinos from background events in 190 days of data and yield consistent evidence for antineutrinos with a combined significance of 3.5σ.

Bifunctional g-C3N4/carbon nanotubes/WO3 ternary nanohybrids for photocatalytic energy and environmental applications

Ternary nanohybrids based on mesoporous graphitic carbon nitride (g-C3N4) were synthesized and presented for developing stable and efficient Hydrogen (H2) production system. Based on photocatalytic activity, optimization was performed in three different stages to develop carbon nanotubes (CNTs) and WO3 loaded g-C3N4 (CWG-3). Initially, the effect of exfoliation was investigated, and a maximum specific surface area of 100.77 m2/g was achieved. 2D-2D interface between WO3 and g-C3N4 was targeted and achieved, to construct a highly efficient direct Z-scheme heterojunction. Optimized binary composite holds the enhanced activity of about 2.6 folds of H2 generation rates than the thermally exfoliated g-C3N4. Further, CNT loading towards binary composite in an optimized weight ratio enhances the activity by 6.86 folds than the pristine g-C3N4. Notably, optimized ternary nanohybrid generates 15,918 μmol h-1. g-1cat of molecular H2, under natural solar light irradiation with 5 vol% TEOA as a sacrificial agent. Constructive enhancements deliver remarkable H2 production and dye degradation activities. Results evident that, the same system can be useful for pilot-scale energy generation and other photocatalytic applications as well.

The Changing Job of School Nurses during the COVID-19 Pandemic: A Media Content Analysis of Contributions to Stress

School nurses and unlicensed assistive personnel (UAPs) are essential to the health and wellness of school children. However, most US schools do not have a full-time licensed nurse. During the COVID-19 pandemic, school nurses and UAPs have been integral in ensuring that the health needs of students were met. They have seen a marked increase in their responsibilities included implementing COVID-19 mitigation strategies, screening for symptoms, testing students and staff, conducting contact tracing and data collection, and ensuring the implementation of rapidly changing COVID-19 guidelines and protocols for schools. The objective of this study was to explore COVID-19 occupational changes and their contributions to stress among school nurses and UAPs through a content analysis of local and national media articles. A Google search of articles published between February 2020 and September 2021 was conducted using the following search terms: 'school nurse', 'COVID-19', 'health aide', 'stress', and 'experiences'. A search was also conducted in Nexis Uni. Articles were included if the topic discussed school nurses or UAPs and COVID-19. All articles that examined nurses in other settings were excluded from the review. We examined topics and themes temporally (from February 2020 to September 2021) and spatially (i.e. the frequency by US state). Overall, 496 media articles discussing school nurses and COVID-19 were included in our review. The highest volume of articles was from September 2021 (22%, 111/496). Other months with relatively high volume of articles included August 2020 (9%, 43/496), January 2021 (10%, 47/496), February 2021 (9%, 44/496), and August 2021 (8%, 39/496). These larger article volumes coincided with notable COVID-19 events, including returning to school in the fall (August 2020 and August 2021), school nurses assisting with vaccine rollouts among adults in the USA (January/February 2021), concerns regarding the delta variant (August/September 2021), and vaccine rollouts for children ages 12-15 (September 2021). The representation of articles spatially (national, state, regional, or local) was 66 (13%) articles at national level, 217 (44%) state level, 25 (5%) regional level, and 188 (38%) local news at the city and/or village level. Pennsylvania had the highest frequency of articles, but when standardized to the state population, Alaska had the highest rate of media per 100 000 people. Three major themes were identified in our analysis: (i) safety; (ii) pandemic-related fatigue/stress; and (iii) nursing shortage/budget. The most represented theme for articles before September 2021 was that of safety. Over time, the themes of pandemic-related fatigue/stress and nursing shortage/budget increased with the most notable increase being in September 2021. The COVID-19 pandemic has resulted in new occupational risks, burdens, and stressors experienced by school nurses and UAPs. School nurses play a critical role in disease surveillance, disaster preparedness, wellness and chronic disease prevention interventions, immunizations, mental health screening, and chronic disease education. Furthermore, they provide a safety net for our most vulnerable children. Given that school nurses were already over-burdened and under-resourced prior to the pandemic, characterization of these new burdens and stressors will inform emergency preparedness resources for school health personnel during future pandemics or outbreaks.

Advanced virtual mentoring of dentists in oral cancer screening and tobacco cessation - An interventional study

Context

Oral cancer is the third common cancer in India. Its mortality can be reduced through early detection and tobacco cessation ideally by dentists owing to their forte of work.

Aim

This study was conducted to discuss effectiveness of an advanced tele-mentoring programme in oral cancer screening and tobacco cessation for dentists across India.

Settings and Design

Online, interventional study.

Methods and Material

The 14-week long training programme with 52 participants/spokes from across India had weekly hour-long online sessions comprising of an expert-led didactic and case discussions by spokes. Online evaluation (pre- and post-training, post-session), weekly and post-one-year feedback were conducted. Successful spokes attended a hands-on workshop subsequently.

Statistical Analysis Used

One and independent sample t-tests determined the significance of the evaluation scores of the participants. Findings on attitudes and practice-related questions are presented as simple percentages.

Results

A notable increase in the overall and per-session mean knowledge score, and confidence in oral cancer screening was observed. Many participants started these services at their clinics, thereby reducing further referrals, and were also motivated to spread community awareness about the same.

Conclusion

This tele-mentoring programme, based on the novel Extension for Community Healthcare Outcomes model, is the first oral cancer screening training programme for dentists. This model-comprising of expert didacts, case discussions, and significant spoke-expert interaction-is a promising best-practices tool for reducing the disparity in knowledge and skills regarding oral cancer prevention among dentists across different locations. This would enable these most appropriate healthcare providers to contribute toward the overall goal of oral cancer prevention.

Effectiveness of topical fluorides in prevention of radiation caries in adults: A systematic review and meta- analysis

BACKGROUND

Topical fluoride is used for prevention of dental caries. However, its effectiveness and more specifically its formulation and frequency of application in patients undergoing head and neck radiotherapy are still debatable. The aim of this systematic review was to pool the evidence of effectiveness of various topical fluorides in preventing radiation caries or change in bacterial growth in adult patients of head and neck cancer.

METHODS

Three databases (PubMed and Google Scholar and Cochrane) were searched for randomized controlled or uncontrolled trials or quasi randomised trials published till February 2021. Two independent reviewers screened 346 abstracts finally 14 articles were included in the current systematic review. Primary outcome evaluated was the prevention of radiation caries or change in bacterial growth in saliva. Meta-analysis was performed for the sub groups formed on the basis of fluoride formulations and adjuncts used with it.

RESULTS

Studies included were highly heterogeneous. Majority of studies found different fluoride formulations to be effective in controlling radiation caries to a variable extent up to 70% depending upon the intervention, patient compliance, rate of attrition and follow up period. Sodium fluoride was the most commonly used caries preventive agent. Meta-analysis showed no significant difference between sodium fluoride formulations and other fluoride agents. Fluoride treatment when incorporated with re-mineralising agent had no significant effect on caries prevention CONCLUSION: Fluoride prevents radiation caries. However, to delineate its exact formulation, dosage or frequency, there is need for more well conducted randomised controlled trials.

Evaluation of Perceptions of Tobacco Cessation among the Individuals Attending a Tertiary Care Dental Hospital - A Mixed Methods Design

Introduction:

In India every year, an estimated 1 million people die from tobacco-related illnesses, which could have been avoided by stopping tobacco use. This study aimed to determine the tobacco dependence and perceptions about tobacco cessation among the patients attending a tertiary care dental hospital.

Methods:

A mixed-methods study was conducted among the individuals visiting the dental hospital. Self-administered questionnaires were used to record quantitative data on the current and past tobacco history, tobacco dependence, and quit attempts. Face-to-face interviews were conducted to collect qualitative data on the perceptions on tobacco quitting.

Results:

About 52% of participants had made an attempt to quit tobacco in the past. The majority of the smokers (82.7%), smokeless tobacco (SLT) users (71.3%), and dual users (83.1%) reported being in the contemplation phase of quitting tobacco. SLT users (12.3%) reported to have taken action in the past to quit tobacco compared to 9.6% smokers, and 1.4% of dual users. Doctors advise, motivation from family and friends motivated the participants to quit tobacco. The risk perception of tobacco use was reported as death, cancer, dental diseases, systemic diseases like chest congestion, cough, tuberculosis, lung cancer, and general body weakness. However, some of the participants were unaware of the methods to quit tobacco, some had misconceptions that shifting to other forms of tobacco and alcohol could help in quitting, and considered SLT to be less harmful than smoking forms.

Conclusion:

Majority of the participants were willing to quit tobacco and had taken measures to quit in the past. There is a need to increase the awareness among the tobacco users about the health risk of tobacco use, and motivate them to utilize the existing cessation services available.

Effectiveness of an oral health training program for nursing professionals in India: An interventional study

OBJECTIVES

Nursing professionals form the first line of contact and are in a unique place to provide appropriate oral advice to patients. The study assessed the effectiveness of oral health training program for nurses.

DESIGN

The effectiveness of the program was evaluated by a pre and post questionnaire assessment on 50 nurses.

RESULTS

Nursing professionals had a significant increase (p < .003) in post-training knowledge scores compared to pre-training scores.

CONCLUSION

Improvement in oral health knowledge of nursing professionals has the potential for translation into practice for oral health promotion of patients and the general population.

The effect of energy and fat content labeling on food consumption pattern: a systematic review and meta-analysis

CONTEXT

Consumption of high-energy food has increased globally, thereby leading to an increase in many diseases. One strategy for addressing this is to make people aware of their energy intake through energy and fat labels. However, the effectiveness of this remains debatable.

OBJECTIVE

This review aims to pool the mixed outcomes of recent studies assessing the effect of energy and fat content labeling on food consumption pattern.

DATA SOURCES

Google Scholar, MEDLINE, and Cochrane Library databases were searched. Randomized controlled and quasi-experimental controlled trials published from 2014 to 2019 were included.

DATA EXTRACTION

Two reviewers screened 413 abstracts independently. Qualitative and quantitative data was extracted from 10 articles; meta-analysis was carried out on 6 of those studies.

RESULTS

The majority of the included papers were conducted in the regions of America, the Western Pacific, and Europe. Overall, the 6 studies claimed that labeling did not reduce the consumption of energy or fat. However, meta-analysis showed that fat and energy content labeling of food had a statistically significant effect on consumption. Subgroup analysis showed no difference with respect to types of labels, ie, context labeling vs traffic-light labeling, but energy content labels seemed to be more effective than fat content labels in influencing healthy food choices.

CONCLUSION

Energy and fat content labeling were shown to reduce the consumption of each significantly. However, the outcome was influenced by the study setting and the population concerned. There is a need for research in other regions in order to assess the global effectiveness of nutrition labels on food consumption.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020172675.

Effectiveness of a web-based learning module on oral health promotion for nursing and allied health professionals

Background Nursing and allied health professionals are helping hands for healthcare and are important in the training cascade. We aimed to develop and validate the effectiveness of a web-based learning module on oral health promotion among nursing and allied health professionals. Methods We developed and validated an oral health module focused on prevention and promotion for a web-based intervention among nurses and allied health professionals. Pre- and post-test assessment was conducted to evaluate the effectiveness of the programme. Results Of a total of 347 participants, 170 (48.9%) had a good knowledge score in the pre-test, and after attending the oral health module their number increased to 267 (76.9%). The mean difference between the pre-test and post-test scores was statistically significant (p<0.005). Conclusions Training of nurses and allied health professionals on oral health through a web-based module showed improvement in oral health literacy.

Abstract 87: Virtual Mentoring of Dentists in Oral Cancer Screening and Tobacco Cessation: An Advanced Level Program

Purpose: Oral cancer is the third common cancer in India, the mortality of which can be reduced by early detection. Dentists are ideal for this task and tobacco cessation owing to their forte of work. This paper discusses findings of a Project ECHO (Extension for Community Health Outcome)-based advanced telementoring program in these areas for dentists across India.

Methods: The 14-week long training program in 2018, with weekly, hour-long sessions conducted by our Organization (hub) on Zoom app, had 52 participants (spokes) from across India. Each session comprised of an expert-led didactic, and case discussions by spokes. Participants were evaluated through online, pre- and post-training, and weekly post-session quizzes, along with weekly and post-one-year feedback. Successful spokes attended a hands-on workshop at our organization subsequently.

Results: A notable increase in the overall and per-session mean knowledge score, and confidence in oral cancer screening was seen among the spokes. Many started such services at their respective clinics (and continued till even a year later) and reduced referrals to other healthcare facilities for confirmation of their diagnosis. They also felt motivated to spread community awareness about oral cancer prevention.

Conclusion: The ECHO telementoring model comprising of expert didactics, case discussions by spokes, along with significant interaction between the spokes and experts, is a promising best-practice tool to reduce knowledge and skills disparity regarding oral cancer prevention among dentists situated across different locations. This in turn would enable these most appropriate healthcare providers to contribute towards the overall goal of oral cancer prevention.

Citation Format: Suzanne Nethan, Amrita John, Priyanka Ravi, Vipin Kumar, Kavitha Dhanasekaran, Roshni Babu, Roopa Hariprasad. Virtual Mentoring of Dentists in Oral Cancer Screening and Tobacco Cessation: An Advanced Level Program [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 87.

An economic analysis comparing health care resource use and cost of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin versus gemcitabine and cisplatin as neoadjuvant therapy for muscle invasive bladder cancer

PURPOSE

To compare healthcare resource utilization (HRU) and costs associated with dose-dense methotrexate, vinblastine, doxorubicin, cisplatin (ddMVAC) and gemcitabine, cisplatin (GC) as neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC).

METHODS

Patient treated at Dana-Farber Cancer Institute from 2010 to 2019 were identified. HRU data on chemotherapy administered, supportive medications, patient monitoring, clinic, infusion, emergency department (ED) visits and hospitalization were collected retrospectively. Unit costs for HRU components were obtained from the Centers for Medicare and Medicaid Website and HRU was compared between groups using quantile regression analysis.

RESULTS

137 patients were included; 51 received ddMVAC and 86 GC. Baseline characteristics were similar, except lower mean age (P < 0.001) and higher proportion of ECOG-PS = 0 (P < 0.001) for ddMVAC. ddMVAC required more granulocyte-colony stimulating factor support (P < 0.001), central line placement (P = 0.017), cardiac imaging (P < 0.001), and infusion visits (P < 0.001), whereas GC required more clinic visits. ED visits were higher for ddMVAC (P = 0.048), while chemotherapy cycle delays and hospitalization days were higher for GC (P = 0.008). After adjusting for ECOG-PS and age, the cost per patient was approximately 41% lower (95%CI: 28% to 52%; P < 0.001) for GC vs. ddMVAC, which translated to a median adjusted cost savings of $7,410 (95%CI: $5,474-$9,347) per patient.

CONCLUSIONS

Although excess HRU did not clearly favor one regimen, adjusting for PS and age indicated lower costs with GC vs. ddMVAC. Given the similar cumulative cisplatin delivery with both regimens, the associated values and costs supports the preferential selection of GC in the neoadjuvant setting of MIBC.

The construction of a dual direct Z-scheme NiAl LDH/g-C3N4/Ag3PO4 nanocomposite for enhanced photocatalytic oxygen and hydrogen evolution

Dual direct Z-scheme photocatalysts for overall water decomposition have demonstrated strong redox abilities and the efficient separation of photogenerated electron-hole pairs. Overall water splitting utilizing NiAl-LDH-based binary and ternary nanocomposites has been extensively investigated. The synthesized binary and ternary nanocomposites were characterized via XRD, FTIR, SEM, HRTEM, XPS, UV-DRS, and photoelectrochemical measurements. The surface wettability properties of the prepared nanocomposites were measured via contact angle measurements. The application of the NiAl-LDH/g-C3N4/Ag3PO4 ternary nanocomposite was investigated for photocatalytic overall water splitting under light irradiation. In this work, we found that in the presence of Ag3PO4, the evolution of H2 and O2 is high over LCN30, and 2.8- fold (O2) and 1.4-fold (H2) activity increases can be obtained compared with the use of LCN30 alone. It is proposed that Ag3PO4 is involved in the O2 evolution reaction during water oxidation and g-C3N4 is involved in overall water splitting. Our work not only reports overall water splitting using NiAl-LDH-based nanocomposites but it also provides experimental evidence for understanding the possible reaction process and the mechanism of photocatalytic water splitting. Photoelectrochemical measurements confirmed the better H2 and O2 evolution abilities of NiAl-LDH/g-C3N4/Ag3PO4 in comparison with NiAl LDH, g-C3N4, Ag3PO4, and LCN30. The observed improvement in the gas evolution properties of NiAl LDH in the presence of Ag3PO4 is due to the formation of a dual direct Z-scheme, which allows for the easier and faster separation of charge carriers. More importantly, the LCNAP5 heterostructure shows high levels of H2 and O2 evolution, which are significantly enhanced compared with LCN30 and pure NiAl LDH.

Licorice-induced apparent mineralocorticoid excess causing persistent hypertension and hypokalemia

Chronic ingestion of licorice is known to cause numerous metabolic and electrolyte disturbances. Severe hyponatremia, hypertension, and hypokalemia as well as metabolic alkalosis are amongst the most common consequences of chronic ingestion resulting in an apparent mineralocorticoid excess (AME). Treatment predominantly consists of cessation of licorice ingestion, potassium replenishment and aldosterone antagonists. Given the potentially lethal effects of chronic licorice ingestion, clinicians should be made aware of the presentation of AME and the proper management. We present the rare case of a 62-year-old male with licorice-induced apparent mineralocorticoid excess secondary to excessive licorice tea intake. Initial presentation included severe hypokalemia of 2.2mmol/L and hypertension of 180/110mmHg, while eunatremic (Na, 144meq/L).

Empowering AYUSH health professionals on oral health promotion in a tertiary care dental hospital in India: An interventional study

BACKGROUND

The extensive reach of AYUSH health professionals allows them to provide profound quality care to the unreachable. These professionals from the traditional system of medicine form fundamental part of the health care system. If adequately trained on oral health they can play a remarkable role in oral health promotion and prevention of oral diseases.

OBJECTIVE

A training strategy was thus chalked out and this study was conducted to assess the knowledge of AYUSH health professionals on oral health and the impact of this training intervention in improving their knowledge.

MATERIALS AND METHODS

An interventional study via self structured pre and post questionnaire on 49 participants assessed the knowledge of participants on oral health promotion. The needs assessment revealed that all the AYUSH health practitioners felt the need to participate in oral health promotion training.

RESULTS

A significant increase in mean knowledge scores from 12.56 ± 2.26 to 15.26 ± 1.40 of AYUSH professionals was seen after a one day training programme.

CONCLUSION

The study concluded that the utilization of AYUSH health professionals for oral health promotion and education can aid as a valuable tool for population based oral health promotion approaches.

Tuning the type of nitrogen on N-RGO supported on N-TiO2 under ultrasonication/hydrothermal treatment for efficient hydrogen evolution - A mechanistic overview

Efficient hydrogen production through water splitting has been the challenging task to be achieved in the present context of energy crisis. Among the various catalysts employed, nitrogen doped Titanium dioxide/Reduced graphene oxide (N-TiO₂/RGO) nanocomposite has been established to be a promising photocatalytic material for this purpose. However, nuances of doping nitrogen on TiO₂ and the type of nitrogen (pyridinic, pyrrolic and graphitic) stabilized on RGO responsible for facilitating the H₂ production has not yet been addressed mechanistically. In the present investigation, an attempt has been made to synthesise N-Titanium dioxide/N-Reduced graphene oxide (NTNG) nanocomposite under ultrasonication followed by hydrothermal treatment. A stainlesssteel ultrasonic bath, of 6.5 L tank size (LxBxH) 300 × 150 × 150 mm, was used for ultrasonic treatments. The transducers located at the bottom of the ultrasonic bath generate a frequency of 40 kHz with maximum power of 200 W. A mechanism has been proposed including the nuances of formation and the stabilisation of each type of nitrogen on N-RGO as a function of ultrasonication time. The present work supports the stabilization of a given type of nitrogen on RGO through keto enol tautomerism. XPS and FTIR studies have been undertaken to identify the different types of nitrogen doping and the presence of functional groups respectively. XRD, UV-Vis DRS and PL investigations have been made to establish morphological profile and band gap structure of the nanocomposite. It was observed that pyrrolic type nitrogen stabilized on N-RGO augments the efficiency of photocatalytic activity through hydrogen production by water splitting.

Effectiveness of an oral health training program for school teachers in India: An interventional study

INTRODUCTION

Schools are a valuable platform for promoting oral health through oral health education as the children spend most of their active time in schools. Training school teachers on oral health promotion will help to inculcate healthy oral habits in children during their formative years of life.

OBJECTIVES

The objective of this study was to assess the knowledge, attitude, approach, and action change of school teachers toward oral health and the impact of this training intervention in improving their knowledge.

MATERIALS AND METHODS

An interventional study was conducted among 50 primary school teachers across the country selected by the Ministry of Human Resource Development. A self-administered, 28-item questionnaire in Google document format was developed to evaluate the knowledge and practice of teachers toward oral hygiene before and after the teachers' training program. The training was done using a validated training manual on oral health promotion for school teachers developed by the Ministry of Health and Family Welfare. Needs assessment for training was conducted 1 week before this training program.

STATISTICAL ANALYSIS

Wilcoxon signed-rank test and Mc Nemar tests were used to assess the difference between the scores before and after oral health education.

RESULTS

The needs assessment revealed that majority of the teachers felt the need to participate in oral health promotion training. A significant increase (P < 0.001) in mean knowledge scores of school teachers was seen after a 1-day training program.

CONCLUSION

The training improved the knowledge of school teachers on oral health which indicates that the adopted method of oral health education was well received by the participants from all over the country.

Oral Health Status and Treatment Needs of Government Employees in New Delhi

Oral diseases, including dental caries, periodontitis, and edentulism (toothlessness), affect about 3.5 billion people worldwide. A cross-sectional study was conducted to assess the oral health status and treatment needs of government employees employed at an organization in New Delhi. Oral health information was recorded using the standard World Health Organization’s (WHO) Oral Health Assessment Tool. A total of 476 employees at various levels of administration were screened at their worksite. Dental caries and periodontal disease were present in more than half of the participants. Around 56% had decayed teeth, 20% had missing teeth, and 16% had filled teeth. Bleeding from gums was seen in 71% and periodontitis in 59% of participants. Preventive treatment and oral health promotion was required in at least 41% of the screened individuals. Annual workplace oral examinations may help in decreasing the oral disease burden and create awareness on the oral health among employees.

Sustainable hydrogen production for the greener environment by quantum dots-based efficient photocatalysts: A review

Nano-size photocatalysts exhibit multifunctional properties that opened the door for improved efficiency in energy, environment, and health care applications. Among the diversity of catalyst Quantum dots are a class of nanomaterials having a particle size between 2 and 10 nm, showing unique optoelectrical properties that are limited to some of the metal, metal oxide, metal chalcogenides, and carbon-based nanostructures. These unique characteristics arise from either pristine or binary/ternary composites where noble metal/metal oxide/metal chalcogenide/carbon quantum dots are anchored on the surface of semiconductor photocatalyst. It emphasized that properties, as well as performance of photocatalytic materials, are greatly influenced by the choice of synthesis methods and experimental conditions. Among the chemical methods, photo-deposition, precipitation, and chemical reduction, are the three most influential synthesis approaches. Further, two types of quantum dots namely metal based and carbon-based materials have been highlighted. Based on the optical, electrical and surface properties, quantum dots based photocatalysts have been divided into three categories namely (a) photocatalyst (b) co-catalyst and (c) photo-sensitizer. They showed enhanced photocatalytic performance for hydrogen production under visible/UV-visible light irradiation. Often, pristine metal chalcogenides as well as metal/metal oxide/carbon quantum dots attached to a semiconductor particle exhibit enhanced the photocatalytic activity for hydrogen production through absorption of visible light. Alternatively, noble metal quantum dots, which provide plenty of defects/active sites facilitate continuous hydrogen production. For instance, production of hydrogen in the presence of sacrificial agents using metal chalcogenides, metal oxides, and coinage metals based catalysts such as CdS/MoS₂ (99,000 μmol h^-1g^-1) TiO₂-Ni(OH)₂ (47,195 μmol h^-1g^-1) and Cu/Ag-TiO₂ nanotubes (56,167 μmol h^-1g^-1) have been reported. Among the carbon-based nanostructures, graphitic C₃N₄ and carbon quantum dots composites displayed enhanced hydrogen gas (116.1 μmol h^-1) production via overall water splitting. This review accounts recent findings on various chemical approaches used for quantum dots synthesis and their improved materials properties leading to enhanced hydrogen production particularly under visible light irradiation. Finally, the avenue to improve quantum efficiency further is proposed.

Ultrasonically aided selective stabilization of pyrrolic type nitrogen by one pot nitrogen doped and hydrothermally reduced Graphene oxide/Titania nanocomposite (N-TiO2/N-RGO) for H2 production

Herein, we report the simultaneous doping of nitrogen on TiO₂ and reduced graphene oxide (N-TiO₂/N-RGO) with exclusive stabilization of pyrrolic type nitrogen on RGO network by ultrasonic conditions followed by hydrothermal method for efficient photocatalytic H₂ production. Interestingly, during synthesis of N-TiO₂/N-RGO composite, pyrrolic type nitrogen in RGO has been exclusively stabilized as confirmed by XPS analysis. The exclusive stabilization of pyrrolic nitrogen changed the optical and electronic properties of N-TiO₂/N-RGO nanocomposites by giving two π-electrons to the system for extended conjugation, which enhanced the optical absorption and charge carrier separation efficiency as confirmed by UV-Vis DRS and PL studies. Notably, N-TiO₂/N-RGO nanocomposite demonstrated. This enhanced photocatalytic activity can be ascribed to synergetic action of N-TiO₂ and N-RGO in optical and photogenerated charge carrier separation. Moreover, the plausible mechanism for exclusive stabilization of pyrrolic type nitrogen and enhanced photocatalytic activity were also proposed.

A revisit at 16 years for individuals from peri-urban New Delhi for tobacco use and associated oral lesions

Objectives:

India has a high incidence of oral cancer due to multifarious tobacco use. The objective of this study was to assess the status of tobacco-related oral lesions over 16 years, in a screen-detected population.

Methods:

This cross-sectional study involved home visits of 2000 Delhi residents, previously screened for oral potentially malignant disorders/oral cancer and counseled for tobacco cessation. Their basic demographics and tobacco/alcohol history were noted followed by oral visual examination for any related mucosal abnormalities. The data thus obtained were statistically analyzed.

Results:

Two hundred and sixty-five individuals (13.2%) could be traced after 16 years. The status of oral lesions varied across the participants, mainly in terms of their location, type, number, and/or presence/absence; no oral malignancies were noted. Most individuals had either a decreased use (34%, p < 0.001) or had quit tobacco (25.7%, p < 0.001); 8.3% individuals from the former and 5.7% from the latter group showed complete lesion(s) regression. The overall change in the tobacco use and oral lesions showed a highly significant positive association ( p < 0.05).

Conclusion:

A direct relationship exists between tobacco use and oral lesions. Repeated, tobacco cessation counseling provided by health-care professionals is effective. Oral screening of high-risk individuals, along with tobacco cessation, is thus essential.

Population trends in prenatal detection of transposition of great arteries: impact of obstetric screening ultrasound guidelines

OBJECTIVES

Dextro-transposition of the great arteries (d-TGA) is one of the most common critical neonatal heart defects, with a low detection rate antenatally. We sought to evaluate trends in the prenatal detection of d-TGA with or without ventricular septal defect (VSD) in Alberta over the past 13 years, examining the potential impact of ultrasound guidelines incorporating screening of cardiac outflow tracts, updated in 2009-2010 and in 2013, and factors affecting detection of the condition.

METHODS

All fetuses and neonates with d-TGA, with or without VSD, encountered between 2003 and 2015 in the province of Alberta, were identified retrospectively. Clinical records including obstetric ultrasound reports were reviewed. Pregnancy outcome, common referral indications and associated maternal and fetal pathology in affected pregnancies were assessed.

RESULTS

From 2003 to 2015, 127 cases with d-TGA were encountered in Alberta, of which 47 (37%) were detected prenatally. Prenatal detection improved over the study period, from 14% in 2003-2010, to 50% in 2011-2013, and to 77% in 2014-2015. Of the 47 fetuses with a prenatal diagnosis of d-TGA, an indication for fetal echocardiography included abnormal or poorly visualized cardiac outflows with normal four-chamber view in 46 (98%). Comorbidities were identified in 12 mothers, only five of which represented an additional reason for fetal echocardiography referral, and four fetuses had extracardiac pathology.

CONCLUSION

Substantial improvement in the prenatal detection of d-TGA has been observed in Alberta over the past few years, owing to improved screening of cardiac outflow tracts on routine obstetric ultrasound examination in otherwise healthy pregnancies, and has been temporally associated with updated obstetric ultrasound guidelines suggesting that these contributed to optimized screening of affected pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck - a systematic review of literature

Radiation therapy for the treatment of head and neck cancer can injure normal tissues and have devastating side effects. Hyperbaric oxygen (HBO) is known to reduce the severity of radiation-induced injury by promoting wound healing. While most of the research in literature has focused on its efficacy in osteonecrosis, HBO has other proven benefits as well. The aim of this review was to identify the various benefits of hyperbaric oxygen therapy in patients who have undergone radiation for head and neck cancer. An electronic database search was carried out to identify relevant articles and selected articles were reviewed in detail. The quality of evidence for each benefit, including preserving salivary gland function, preventing osteonecrosis, dental implant success, and overall quality of life, was evaluated. Evidence showed that HBO was effective in improving subjective symptoms of xerostomia, swallowing, speech and overall quality of life. There was no conclusive evidence to show that HBO improved implant survival, prevented osteonecrosis, or improved salivary gland function. The high costs and accessibility of HBO therapy must be weighed against the potential benefits to each patient.

Changes in uninvolved immunoglobulins during induction therapy for newly diagnosed multiple myeloma

Little is known about the impact of multiple myeloma (MM) treatment on uninvolved immunoglobulins (Ig). We identified 448 patients who received high-dose dexamethasone (HD-DEX), lenalidomide and dexamethasone (RD), bortezomib and dexamethasone (VD), bortezomib, cyclophosphamide and dexamethasone (VCD) or bortezomib, lenalidomide and dexamethasone (VRD) for newly diagnosed MM at our institution between 2000 and 2013, and who had available data on absolute lymphocyte count (ALC) and quantitative uninvolved Ig at baseline and at the end of four cycles of therapy. Changes in ALC and uninvolved Ig were significantly different across treatments, with VCD and HD-DEX producing reductions in uninvolved Ig, and RD, VD and VRD leading to increases in uninvolved Ig. In addition, treatment with RD, VD and VRD was independently associated with higher odds of achieving a ⩾25% increase in or normalization of the primary uninvolved Ig on multivariate analysis. Although achievement of a humoral response in the primary uninvolved Ig was associated with a higher odds of achieving VGPR or better after four cycles of therapy, it was not associated with improved overall survival. These data highlight the different mechanisms of action of MM drugs and point toward a possible role for the use of VCD in treating antibody-mediated autoimmune disease.

Effect of vehicular traffic on wild animals in Sigur Plateau, Tamil Nadu, India

The construction of a road, directly and indirectly, impacts on the ecosystems where the road is built.  Highways passing through national reserves/wildlife sanctuaries have an adverse impact on wild animals.  The present survey was conducted to estimate the road kills on the state highways passing through the Nilgiri north territorial forest division (19km) and Mudumalai Tiger Reserve (15km) in Sigur Plateau, Tamil Nadu, India.  The road kills were monitored three times a month between July 2013 and December 2013 (six months) and a total of 176 road kills belonging to 30 species were recorded.  Reptiles were the most affected taxa (39%), followed by mammals (33%) and birds (21%).  Amphibians were least affected by vehicular traffic and comprised 7% of the total kills.  According to road stretch category, the overall road kill was N=135 in the forested area and N=41 in human habitations.  A total of 812 food materials were encounterd  612km with average of  1.32 food materials / km. Conservation and management implications are essential to prevent the local extinction of wildlife. 

Evolving changes in disease biomarkers and risk of early progression in smoldering multiple myeloma

We studied 190 patients with smoldering multiple myeloma (SMM) at our institution between 1973 and 2014. Evolving change in monoclonal protein level (eMP) was defined as ⩾10% increase in serum monoclonal protein (M) and/or immunoglobulin (Ig) (M/Ig) within the first 6 months of diagnosis (only if M-protein ⩾3 g/dl) and/or ⩾25% increase in M/Ig within the first 12 months, with a minimum required increase of 0.5 g/dl in M-protein and/or 500 mg/dl in Ig. Evolving change in hemoglobin (eHb) was defined as ⩾0.5 g/dl decrease within 12 months of diagnosis. A total of 134 patients (70.5%) progressed to MM over a median follow-up of 10.4 years. On multivariable analysis adjusting for factors known to predict for progression to MM, bone marrow plasma cells ⩾20% (odds ratio (OR)=3.37 (1.30-8.77), P=0.013), eMP (OR=8.20 (3.19-21.05), P<0.001) and eHb (OR=5.86 (2.12-16.21), P=0.001) were independent predictors of progression within 2 years of SMM diagnosis. A risk model comprising these variables was constructed, with median time to progression of 12.3, 5.1, 2.0 and 1.0 years among patients with 0-3 risk factors respectively. The 2-year progression risk was 81.5% in individuals who demonstrated both eMP and eHb, and 90.5% in those with all three risk factors.

Model free isoconversional procedure for evaluating the effective activation energy values of thermally stimulated processes in dinitroimidazoles

The decomposition kinetics of 1,4-dinitroimidazole, 2,4-dinitroimidazole, and N-methyl-2,4-dinitroimidazole have been investigated using thermogravimetry-differential thermal analysis technique under N2 atmosphere at the flow rate 100 cm(3)/min. The Flynn-Wall-Ozawa method and the Friedman method were used for the estimation of the effective activation energy values. These model free isoconversional kinetic methods showed variation in the calculated values due to the approximation of temperature integral used in the derivations of the kinetic equations. The model compounds were decomposed by multi-step kinetics evident from the nonlinear relationship of the effective activation energy values with the conversion rate. Three different reaction pathways namely NO2 elimination, NO elimination, and HONO elimination are expected to play crucial role in the decomposition of nitroimidazoles. The model dinitroimidazoles represent different decomposition kinetics, and the reaction pathways the NO2 elimination, and NO elimination compete with each other for the decomposition mechanism. The present study is certainly helpful in understanding the decomposition kinetics, and dynamics of substituted nitroimidazoles to be used for fuel, and explosive applications.

Vitamin B12 levels are not affected by radioiodine ablation of the thyroid

OBJECTIVE

Radioiodine administered for the treatment of hyperthyroidism and thyroid cancer can be taken up by many non-thyroid tissues which express sodium iodide symporter. Though gastric mucosa takes up radioiodine, its impact on parietal cell has not been evaluated. The aim of the present study was to compare vitamin B12 and homocysteine concentrations in patients with thyroid disorders treated by radioiodine ablation with those in control population without radioiodine exposure.

METHODS

Patients with Graves' disease, toxic multinodular goiter (TMNG), toxic adenoma (TA) or differentiated thyroid cancer (DTC) who had received 131I were included as "patients". Healthy persons and patients having Graves' disease but without exposure to radioiodine were recruited as "controls". A total of 35 patients and 35 controls were included. Patients were divided into Graves' disease and non-Graves' disease (TMNG, TA, DTC) groups. Graves' disease patients were compared with Graves' disease controls while non-Graves' disease patients were compared with healthy controls.

RESULTS

In the Graves' disease group, median vitamin B12 concentration was 240 pg/ml (IQR: 148 - 371) in patients (n=23) and 195 pg/ml (IQR: 140 - 291 pg/ml) (p=0.13, ns) in controls (n=24). In the non-Graves' disease group, median serum vitamin B12 concentration was 147 pg/ml (IQR: 124 - 325pg/ml) in patients (n=12) and 190 pg/ml (IQR: 157 - 373 pg/ml) (p=0.34, ns) in healthy controls (n=11). Homocysteine concentrations were also similar in compared groups of patients and controls.

CONCLUSIONS

Radioiodine ablation does not cause vitamin B12 deficiency. However, a prospective study with a larger number of patients is required to confirm this finding.