A comparison of the effects of two cooking methods on arsenic species and nutrient elements in rice

Rice is one of the major cereal crops in the world, contributing significantly towards the dietary energy and nutrition of more than half of the world's population. However, rice can also be a significant exposure route for inorganic arsenic (iAs). This risk is even greater if rice is cooked with iAs-contaminated water. Here, we quantified the effect of two cooking methods, excess water (EW) and parboiled and absorbed (PBA), on As species and essential nutrient elements (P, K, Mg, Fe, Zn, Mn, Cu, Se and Mo) in white, parboiled and brown rice cooked with As-safe (0.18 μg L-1) and As-spiked (10 and 50 μg L-1) tap water. Furthermore, we calculated the exposure risk using the margin of exposure (MOE) for both low (the UK) and high (Bangladesh) rice per capita consumption scenarios. The total micro and macronutrient content in cooked rice was measured using ICP-MS (Inductively Coupled Plasma Mass Spectrometry). An LC-ICP-MS (liquid chromatography-ICP-MS) method was used to quantify arsenic species. The results demonstrate that EW and PBA methods produced similar efficacy of iAs removal (54-58 %) for white and brown rice. However, the EW method was better at removing iAs from parboiled rice (∼50 %) than PBA (∼39 %). We found that cooked brown rice was superior to other rice types in many essential nutrient elements, and cooking methods significantly affected the loss of K, Fe, Cu and Mo. For both cooking methods, cooking with iAs-spiked water significantly increased iAs in all rice types: white > parboiled > brown. However, when using As-spiked water, the PBA method retained more iAs than EW. Our risk evaluations showed that cooking rice with 50 μg L-1 significantly raises the As-exposure of the Bangladesh population due to the high per capita rice consumption rate, reinforcing the importance of accessing As-safe water for cooking.

Disparities in Time to Diagnosis Among Patients With Multiple Myeloma

BACKGROUND

Multiple myeloma (MM) is one of the most diagnosed hematologic malignancies in the United States. Despite improvements in therapy, health disparities persist among patients with MM. Here, we aim to determine whether there are disparities in time to diagnosis (TTD) among MM patients with regard to income, race/ethnicity, and gender.

PATIENTS

Patients with a monoclonal protein detected in the serum and/or urine and a subsequent bone marrow biopsy confirmed diagnosis of MM were included in the study.

METHODS

We extracted data on patients with MM and assessed whether the predictor variables were associated with the primary outcome of TTD, which we define as the time between detection of a monoclonal protein in the serum or urine and bone marrow biopsy diagnosis of MM.

RESULTS

Compared to patients with commercial insurance, patients receiving Medicaid (HR: 0.408, 95% CI: 0.206-0.808; P = .010) and patients without insurance (HR: 0.428, 95% CI: 0.207-0.885; P = .022) were significantly more likely to have delayed TTD. TTD was also prolonged if the provider who ordered the testing for the detection of a monoclonal protein was not a hematologist (HR: 0.435, 95% CI: 0.284-0.668; P < .0001). No disparities were found with regard to race/ethnicity or gender.

CONCLUSION

This study suggests there may be socioeconomic disparities in TTD among patients with MM. Interventions such as patient navigation may be useful to reduce TTD among socioeconomically disadvantaged patient populations. Further studies need to be conducted to elucidate reasons for delays.

Clinical Outcomes and Immunotoxicity in People with HIV (PWH) after Definitive Chemoradiation (CRT) for Anal Squamous Cell Carcinoma

PURPOSE/OBJECTIVE(S)

Anal cancer disproportionately affects PWH despite antiretroviral therapy. Data on CRT outcomes are limited. Modern IMRT CRT decreases acute toxicity but may exacerbate immune dysregulation from chronic HIV. Although historical CRT has been associated with prolonged CD4 count suppression, little is known about late immunotoxicity in PWH after contemporary CRT. We report clinical outcomes and long term immunotoxicity.

MATERIALS/METHODS

Single-center retrospective review of all PWH confirmed on chart review with anal squamous cell carcinoma without prior pelvic irradiation treated with definitive IMRT CRT. Patient and CRT factors including HIV suppression (<200 copies/mL), mean CD4 count (cells/µL), and receipt of capecitabine (C) or 5-fluorouracil (F) +/- mitomycin (M) were summarized with n (%) or median (interquartile range). Progression-free and overall survival (PFS; OS) were estimated per Kaplan-Meier with 95% confidence intervals and compared with log-rank tests. Mean CD4 count and CD4:CD8 were compared by HIV suppression status (Welch's t-test); longitudinal changes in median CD4 count and CD4:CD8 were compared between baseline vs. nadir (within 6 months of CRT start) and 1-year follow-up for patients with complete data (Wilcoxon signed-rank test).

RESULTS

A total of 23 PWH were treated between 2010-2022, median age 52, median 16 (13 - 19) years after HIV diagnosis; 4 had unsuppressed HIV; AJCC 8th stage I/II/III/IV 5/5/12/1. Radiation dose was median 54 Gy in 30 fractions over 42 (40 - 44) days. Most had C+M (57%); only 43% had 2×M with either C or F. One had neoadjuvant carboplatin/paclitaxel/pembrolizumab. With 2.9 (1.03 - 3.3) years follow-up, median OS was 6.6 (6.2 - unreached [UR]) years. With 2.2 (0.67 - 2.7) years follow-up, median PFS was UR. OS and PFS were similar regardless of HIV suppression status (both P ≥ 0.09). Overall baseline CD4 count was 458 (226 - 484), and CD4:CD8 was 0.54 (0.2 - 0.7). Nadir CD4 was 100 (59 - 126) and CD4:CD8 was 0.3 (0.2 - 0.4). Baseline and nadir CD4 count and CD4:CD8 were lower if HIV-unsuppressed (each P ≤ 0.04). One year after CRT, CD4 count was 252 (102 - 276), while CD4:CD8 was 0.5 (0.2 - 0.7). For 7 patients with repeated values the change in median from baseline to nadir, 6-, and 12-months post-CRT was -282, -549 (both P = 0.02), -480 (P = 0.9) for CD4 counts, and -0.7, -0.5, -0.4 (each P > 0.5) for CD4:CD8 ratios; none had unsuppressed HIV.

CONCLUSION

Definitive IMRT CRT with guideline-concordant doublet chemotherapy for anal cancer in PWH is effective despite unsuppressed HIV. Treatment leads to prolonged immunological changes that may increase the risk of HIV-related morbidity and mortality. Modifiable treatment-related causes of hematoimmunologic toxicity should be investigated further, and immune surveillance after CRT should be considered to better understand impact on quality of life.

Fungal Community Composition at the Last Remaining Wild Site of Yellow Early Marsh Orchid (Dactylorhiza incarnata ssp. ochroleuca)

The yellow early marsh orchid (Dactylorhiza incarnata ssp. ochroleuca) is a critically endangered terrestrial orchid in Britain. Previous attempts to translocate symbiotic seedlings to a site near the last remaining wild site demonstrated some success, with a 10% survival rate despite adverse weather conditions over a two-year period. However, to facilitate future reintroduction efforts or conservation translocations, a more comprehensive understanding of the fungal microbiome and abiotic soil characteristics at the final remaining wild site is required. Obtaining comprehensive information on both the fungal community and soil nutrient composition from wild sites has significant benefits and may prove critical for the success of future conservation translocations involving threatened orchids. This preliminary study, conducted at the last remaining wild site, revealed a significant correlation between the relative abundance of the orchid mycorrhizal fungal order Cantharellales and the concentrations of nitrate and phosphate in the soil. Another orchid mycorrhizal fungal group, Sebacinales, was found to be distributed extensively throughout the site. The composition of fungal communities across the entire site, orchid-hosting and non-orchid-hosting soils is discussed in relation to reinforcing the current population and preventing the extinction of this orchid.

Living with arsenic in the environment: An examination of current awareness of farmers in the Bengal basin using hybrid feature selection and machine learning

High levels of arsenic in drinking water and food materials continue to pose a global health challenge. Over 127 million people alone in Bangladesh (BD) and West Bengal (WB) state of India are exposed to elevated levels of arsenic in drinking water. Despite decades of research and outreach, arsenic awareness in communities continue to be low. Specifically, very few studies reported arsenic awareness among low-income farming communities. A comprehensive approach to assess arsenic awareness is a key step in identifying research and development priorities so that appropriate stakeholder engagement may be designed to tackle arsenic menace. In this study, we developed a comprehensive arsenic awareness index (CAAI) and identified key awareness drivers (KADs) of arsenic to help evaluate farmers' preferences in dealing with arsenic in the environment. The CAAI and KADs were developed using a questionnaire survey in conjunction with ten machine learning (ML) models coupled with a hybrid feature selection approach. Two questionnaire surveys comprising of 73 questions covering health, water and community, and food were conducted in arsenic-affected areas of WB and BD. Comparison of CAAIs showed that the BD farmers were generally more arsenic-aware (CAAI = 7.7) than WB farmers (CAAI = 6.8). Interestingly, the reverse was true for the awareness linked to arsenic in the food chain. Application of hybrid feature selection identified 15 KADs, which included factors related to stakeholder interventions and cropping practices instead of commonly perceived factors such as age, gender and income. Among ML algorithms, classification and regression trees and single C5.0 tree could estimate CAAIs with an average accuracy of 84%. Both communities agreed on policy changes on water testing and clean water supply. The CAAI and KADs combination revealed a contrasting arsenic awareness between the two farming communities, albeit their cultural similarities. Specifically, our study shows the need for increasing awareness of risks through the food chain in BD, whereas awareness campaigns should be strengthened to raise overall awareness in WB possibly through media channels as deemed effective in BD.

Breast cancer treatment: A phased approach to implementation

Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low- and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana.

Fungal Diversity of Selected Habitat Specific Cynorkis Species (Orchidaceae) in the Central Highlands of Madagascar

About 90% of Cynorkis species are endemic to the biodiversity hotspot of Madagascar. This terrestrial habitat-specific genus received little study for fungal diversity to support conservation. We evaluated the diversity of culturable fungi of 11 species and soil characteristics from six sites spanning a >40 km radius in and along the region’s inselbergs. Peloton-forming fungi were grown in vitro from root/protocorm slices and positively identified using DNA sequencing. The fungal diversity was then correlated with soil pH, NO₃^-N, P, and K. All species harbored either putative mycorrhizal associates in the Rhizoctonia complex or Hypocreales fungi. Tulasnella Operational Taxonomic Units (OTUs) were most prevalent in all soil types while Serendipita OTUs were found in species inhabiting granite/rock outcrops in moist soil (seepage areas). Most Cynorkis species were present in soil with low NO₃^-N and P levels with diversity of mycorrhizal fungi inversely correlated to NO₃^-N levels. Of the different orchid life stages sampled, only one species (Cynorkis fastigiata) yielded putative mycorrhizal fungi from juvenile stages. As diversity of mycorrhizal fungi of Cynorkis spp. was negatively correlated with NO₃^-N, and majority of the studied taxa were found in soils with low NO₃^-N and P contents, reintroduction studies must include analysis of N and P in detail. For the first time, we showed that the assemblage of culturable fungi in the roots of habitat-specific species of Cynorkis (Orchidaceae) are intimately tied to specific soil characteristics.

Improved rice cooking approach to maximise arsenic removal while preserving nutrient elements

Inorganic arsenic (iAs) is a group 1 carcinogen, and consumption of rice can be a significant pathway of iAs exposure in the food chain. Although there are regulations in place to control iAs for marketed rice in some countries, additional measures are explored to remove arsenic from rice. Due to the surface-bound and soluble nature of iAs, previous studies have shown that it can be removed to a significant extent using different cooking methods. Towards this goal we modified and tested the absorption method in combination with four home-friendly cooking treatments (UA = unwashed and absorbed, WA = washed and absorbed, PSA = pre-soaked and absorbed, and PBA = parboiled and absorbed) using both brown and white rice (3 types each). The nutrient elements were measured using ICP-MS and arsenic speciation was carried out using LC-ICP-MS. Overall, our results show that PBA was the optimum approach assessed, removing 54% and 73% of inorganic arsenic (iAs) for brown and white rice respectively, raising the margin of exposure (MOE) by 3.7 for white rice and 2.2 times for brown rice, thus allowing the consumption of rice more safely for infants, children and adults. Other cooking treatments were effective in reducing the iAs concentration from white rice only. Here we also report changes in selected nutrient elements (P, K, Mg, Zn and Mn) which are relatively abundant in rice. In general, the treatments retained more nutrients in brown rice than white rice. No significant loss of Zn was observed from both rice types and the loss of other nutrients was similar or less than in comparison to reported losses from rice cooked in excess water in the literature. We conclude that PBA is a promising technique and further research is needed by including different regional rice types and water quality levels.

Acceptability and feasibility of a café-based sustainable food intervention in the UK

Dietary change is needed to improve health and reduce the environmental burden of food production and consumption. Using an Intervention Mapping approach, this study aimed to explore the views caterers and customers held towards point-of-choice interventions that promote healthy and environmentally friendly (EF) food and beverage choices at the University of Sheffield. Intervention options proposed during focus groups were devised using the Nuffield Bioethics ladder of intervention. Ten focus groups were held involving caterers (n = 16) and customers (n = 45). Thematic analysis was conducted on the transcripts of caterer and customer focus groups seperately, and then comparisons were made to identify concerns about the acceptability and feasibility of intervention options. Attitudes towards intervention options varied considerably amongst stakeholders, with the greatest disparity of opinion in the acceptability of interventions that restrict or limit personal choice, particularly with regards to meat consumption. Information provision was favoured as an acceptable intervention by both customers and caterers. However, labelling products in terms of their environmental impact was considered practically unfeasible. Social norms around eating also emerged as influencing the acceptability and feasibility of interventions with concerns raised about: shaming customers who chose meat, the exclusivity of vegan choices and the limited availability and appeal of meatless café options. Financial considerations were the main priority of caterers when discussing point-of-choice interventions. An acceptable and feasible café-based intervention ought to increase awareness and understanding of healthy and EF food choices, protect customer choice and avoid additional costs.

Should CD138 Immunohistochemistry be Standard Recommended Practice for Bone Marrow Evaluation of Plasma Cell Neoplasms?

Introduction/Objective

Myeloma diagnosis by a pathologist requires 10% plasma cells (PC) or a biopsy proven plasmacytoma in addition to myeloma defining events. PC% &gt; 60% is a biomarker of malignancy under this definition. WHO allows for assesment of plasma cell percentage either by aspirate count or by CD138 immunohistochemistry (IHC). There is lack of consensus on aspirate smear adequacy for PC% estimation. Uneven distribution of plasma cells, hemodilution and/or patchy infiltration can lead to gross underestimation. We compared PC% by aspirate count and CD138 IHC and established corelation with serum protein electrophoresis (SPEP) values.

Methods

67 myeloma cases were included after excluding cases with suboptimal or inadequate aspirate smears. Two hematopathologists evaluated the diagnostic marrow (therapy naive) for PC% by aspirate count and CD138 IHC on biopsy/clot section. Corresponding SPEP and Free light chain (FLC) values were obtained. Correlation coefficent was calculated using Pearson correlation coefficient (GraphPad Prism).

Results

The Ig subtypes included IgG (41/67) and IgA (17/67). 12 cases had available FLC values. Both average and median PC% by CD138 IHC was considerably higher (50%, 52%) compared to aspirate count (29%, 21%). However, PC% by aspirate smear count and CD138 IHC demonstrated a significant linear correlation (r=0.71, p60% by CD138 (and not by aspirate count).

Conclusion

CD138 IHC based PC% is consistently higher, nevertheless, statistically significant linear corelation is observed between aspirate count PC% and CD138 IHC. A significant linear correlation is observed between CD138 IHC and SPEP (IgG and IgA), however, no such correlation is observed with aspirate count. More cases were diagnosed as myeloma (11%) and higher propotion of cases (35%) had biomarker of malignancy i.e. PC% &gt;60% by CD138 IHC. Based on these findings, we propose estimation of PC% by CD138 immunostain be a recommended standard practice for better clinicopathologic and biologic correlation.

Do arsenic levels in rice pose a health risk to the UK population?

Consumption of rice and rice products can be a significant exposure pathway to inorganic arsenic (iAs), which is a group 1 carcinogen to humans. The UK follows the current European Commission regulations so that iAs concentrations must be < 0.20 mg kg^-1 in white (polished) rice and <0.25 mg kg^-1 in brown (unpolished) rice. However, iAs concentration in rice used for infant food production or direct consumption has been set at a maximum of 0.1 mg kg^-1. In this context, this study aimed to evaluate iAs concentrations in different types of rice sold in the UK and to quantify the health risks to the UK population. Here, we evaluated 55 different types of rice purchased from a range of retail outlets. First, we analysed all rice types for total As (tAs) concentration from which 42 rice samples with tAs > 0.1 mg kg^-1 were selected for As speciation using HPLC-ICP-MS. Based on the average concentration of iAs of our samples, we calculated values for the Lifetime Cancer Risk (LCR), Target Hazard Quotient (THQ) and Margin of Exposure (MoE). We found a statistically significant difference between organically and non-organically grown rice. We also found that brown rice contained a significantly higher concentration of iAs compared to white or wild rice. Notably, 28 rice samples exceeded the iAs maximum limit stipulated by the EU (0.1 mg kg^-1) with an average iAs concentration of 0.13 mg kg^-1; therefore consumption of these rice types could be riskier for infants than adults. Based on the MoE, it was found that infants up to 1 year must be restricted to a maximum of 20 g per day for the 28 rice types to avoid carcinogenic risks. We believe that consumers could be better informed whether the marketed product is fit for infants and young children, via appropriate product labelling containing information about iAs concentration.

ER, PR, and HER2 expression in Ugandan breast cancer patients: An evaluation of in-country RT-PCR compared to IHC

e19009

Background: Breast cancer, the most common cancer in sub-Saharan Africa (SSA), is characterized by poor survival. An accurate assessment of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 receptor (HER2) status, typically via immunohistochemistry (IHC), is considered essential to provide prognostic data and guide therapeutic decision-making. However, due to inaccessible IHC services, these data are often unavailable in many parts of SSA; alternate methods need to be explored. Given the lab infrastructure developed in response to the HIV pandemic, RT-PCR testing is more readily accessible and feasible in SSA. Here we assess the potential of RT-PCR in evaluating the receptor status of women with breast cancer in Uganda. Methods: We enrolled women with a new diagnosis of invasive breast cancer at the Uganda Cancer Institute. Demographic and clinical data were obtained. A formalin-fixed paraffin embedded (FFPE) specimen was utilized for quantitative RT-PCR, using a validated assay for the detection of the ER, PR and HER2. Receptor expression levels were expressed as relative quantity (RQ) compared to housekeeping genes (CALM2). HER2 IHC results were categorized as negative (score 0 or 1+) or positive (3+); 2+ results (n=6) were excluded as FISH testing was not performed. Unstained slides were sent to the Fred Hutchinson Cancer Research Center for IHC. Receiver operating characteristic (ROC) analysis was applied to compare RT-PCR to IHC (gold standard). Results: We analyzed interim data (anticipated N=100 of an ongoing study) from 32 women aged 35 to 56 years. The majority of women (25, 78%) presented with advanced stage disease. Of the 32 cancers, 18 were ER+ (56%), 10 were PR+ (31%), 9 were HER2+ (28%) and 8 were triple negative (25%) by IHC. From ROC analysis, the AUC were 0.94, 0.95, and 0.81 for ER, PR, and HER2 respectively with high sensitivity and specificity (Table). Conclusions: Despite the tremendous need, the ability to detect the ER, PR, and HER2 via IHC in SSA is limited. Here we demonstrate the favorable test characteristics of RT-PCR when compared to IHC. Given the relatively wide accessibility of RT-PCR and endocrine therapy for breast cancer, as well as the recent inclusion of trastuzumab in the WHO’s Essential Medicines List, the results of this study have both direct diagnostic and therapeutic implications. Clinical trial information: NCT03518242 . [Table: see text]

A review on biochar modulated soil condition improvements and nutrient dynamics concerning crop yields: Pathways to climate change mitigation and global food security

The beneficial role of biochar on improvement of soil quality, C sequestration, and enhancing crop yield is widely reported. As such there is not much consolidated information available linking biochar modulated soil condition improvement and soil nutrient availability on crop yields. The present review paper addresses the above issues by compilation of world literature on biochar and a new dimension is introduced in this review by performing a meta-analysis of published data by using multivariate statistical analysis. Hence this review is a new in its kind and is useful to the broad spectrum of readers. Generally, alkalinity in biochar increases with increase in pyrolysis temperature and majority of the biochar is alkaline in nature except a few which are acidic. The N content in many biochar was reported to be more than 4% as well as less than 0.5%. Poultry litter biochar is a rich source of P (3.12%) and K (7.40%), while paper mill sludge biochar is higher in Ca content (31.1%) and swine solids biochar in Zn (49810 mg kg^-1), and Fe (74800 mg kg^-1) contents. The effect of biochar on enhancing soil pH was higher in Alfisol, Ferrosol and Acrisol. Soil application of biochar could on an average increase (78%), decrease (16%), or show no effect on crop yields under different soil types. Biochar produced at a lower pyrolysis temperature could deliver greater soil nutrient availabilities than that prepared at higher temperature. Principal component analysis (PCA) of available data shows an inverse relationship between [pyrolysis temperature and soil pH], and [biochar application rate and soil cation exchange capacity]. The PCA also suggests that the original soil properties and application rate strongly control crop yield stimulations via biochar amendments. Finally, biochar application shows net soil C gains while also serving for increased plant biomass production that strongly recommends biochar as a useful soil amendment. Therefore, the application of biochar to soils emerges as a 'win-win strategy' for sustainable waste management, climate change mitigation and food security.

Assessment of potentially toxic trace element contamination in urban allotment soils and their uptake by onions: A preliminary case study from Sheffield, England

Toxic trace element (TTE) contamination in urban soils may pose potential health risks, especially in cities with previous industrial activities. This study aimed to investigate soil contamination in urban allotments in Sheffield, the uptake of TTEs in autumn and spring sown onions (Allium cepa), and their potential risks on human health via consumption of the crops. Paired soil and plant samples were taken in triplicates from four private allotments to assess potentially elevated levels of lead (Pb), zinc (Zn), copper (Cu), arsenic (As), and chromium (Cr). These elements in soils exceeded the ambient background levels for England. Both Pb and As exceeded some UK and EU soil tolerable limits. Concentration factors (CF) were calculated as the ratio of trace element in the plant as compared to that in the soil, and uptake rates were in the order Zn>Cu>Cr>Pb>As. Concentrations were higher for most TTEs in spring sown onions (SSO), and had significantly higher CF (p < 0.05) for Pb and Cr than autumn sown onions (ASO), whereas the opposite was true for As. Toxic elements in plants did not exceed FAO/WHO intake limits when considering TTE content per plant and consumption rates. Human health risk assessment calculations using target hazard quotients (THQ) and hazard indexes (HI) indicated that consuming onions alone did not pose an immediate health risk.

Talent Management and Employee Retention: An Integrative Research Framework

The differential value created by talented employees and their contribution to organizations in the hypercompetitive and complex global economy has made talent management a strategic priority for organizations. Talent management has been advocated as an important strategy to retain talented employees, but academic studies exploring their relationship are limited. Building on the Resource-Based View (RBV) theory and Social Exchange Theory (SET), the present article studies the relationship between talent management and employee retention. In addition, a conceptual model explaining the role of talent perception congruence and organizational justice in the relationship between talent management and employee retention is developed by incorporating the Perceived Organizational Justice Theory and Congruence Theory in talent management context. This article may assist in setting the direction for future research in the area of talent management and help managers understand the significant roles of talent perception congruence and organizational justice in determining the talent management outcomes.

Pathology-Based Research in Africa

The process of conducting pathology research in Africa can be challenging. But the rewards in terms of knowledge gained, quality of collaborations, and impact on communities affected by infectious disease and cancer are great. This report reviews 3 different research efforts: fatal malaria in Malawi, mucosal immunity to HIV in South Africa, and cancer research in Uganda. What unifies them is the use of pathology-based approaches to answer vital questions, such as physiology, pathogenesis, predictors of clinical course, and diagnostic testing schemes.

Utilization of pelvic lymph node dissection in patients undergoing robot-assisted radical prostatectomy in India versus the United States - A Vattikuti Collective Quality Initiative database analysis

BACKGROUND

The utilization and extent of pelvic lymph node dissection (PLND) varies depending on the disease and practice patterns.

AIMS

This study compares practice patterns in utilization of PLND between Indian and United States (US) practices.

SETTINGS AND DESIGN

We focused on 415 patients (204 India; 211 US) prostate cancer patients treated with robot-assisted radical prostatectomy, between 2015 and 2016, within the Vattikuti Collective Quality Initiative database.

SUBJECTS AND METHODS

Utilization of PLND and number of nodes removed were evaluated for the entire cohort, and after stratifying for Country of treatment and D'Amico risk groups. Logistic regression tested the relationship between PLND and country of treatment, after adjusting for disease risk.

RESULTS

Indian patients had a higher risk distribution (D'Amico high-risk 53.4% in India vs. 27% in the US; P< 0.001) compared to their US counterparts. Overall, 193/204 (94.6%) Indian patients underwent PLND versus 181/211 (85.8%) US patients (P = 0.003). When stratified based on disease risk, PLND was performed more frequently in Indian patients with low-risk disease (81.0% vs. 41.4%,P= 0.008), but not in those with intermediate and high-risk disease. On multivariable analysis, Indian patients had a 2.57-fold higher probability of undergoing PLND than their US counterparts (P = 0.02). The analysis of the number of lymph nodes removed showed similar trends.

CONCLUSIONS

Indian patients are more likely to undergo PLND than US patients. This is, especially true for patients with low-risk disease, who are unlikely to benefit from this procedure. Efforts should focus on optimizing the utilization of PLND, and deliver it only when there is clinical indication.

Whom to treat? Factors associated with chemotherapy recommendations and outcomes among patients with NHL at the Uganda Cancer Institute

Introduction

Cancer treatment options in sub-Saharan Africa are scarce despite an increasing burden of disease. Identification of those cancer patients who would benefit most from the limited resources available would allow broader and more effective therapy.

Methods

We conducted a retrospective analysis of patients over the age of 18 at the time of a pathologic diagnosis of NHL between 2003 and 2010 who were residents of Kyandondo County (Uganda) and presented to the Uganda Cancer Institute for care.

Results

A total of 128 patients were included in this analysis. Chemotherapy was recommended to 117 (91.4%) of the patients; the odds of recommending chemotherapy decreased for each additional month of reported symptoms prior to diagnosis.

Of the 117 patients to whom chemotherapy was recommended, 111 (86.7%) patients received at least 1 cycle of chemotherapy; HIV infected patients, as well as those with a lower hemoglobin and advanced disease at the time of diagnosis were significantly less likely to complete therapy. Among the patients who initiated chemotherapy, twenty patients died prior to treatment completion (including nine who died within 30 days). Hemoglobin level at the time of presentation was the only variable associated with early mortality in the adjusted model.

Conclusion

In resource-poor areas, it is essential to align health care expenditures with interventions likely to provide benefit to affected populations. Targeting cancer therapy to those with a favorable chance of responding will not only save limited resources, but will also prevent harm in those patients unlikely to realize an effect of cancer-directed therapy.

End-of-Life Palliative Care Practices and Referrals in Uganda

BACKGROUND

While early involvement and integration of palliative care with oncology can positively impact quality of life and survival of patients with advanced cancer, there is a dearth of information regarding this integration in sub-Saharan Africa.

OBJECTIVE

We sought to describe the rate and factors predicting specialist palliative referrals among cancer patients in Uganda.

DESIGN

We examined the rate of referrals of cancer patients to palliative specialists via a chart review, while also surveying and interviewing doctors at the Uganda Cancer Institute (UCI) about their approaches to palliative care.

SETTING

All adult patients at the UCI who died in a 20-month interval from 2014 to 2015. All UCI doctors were approached for the survey and 25 (96%) participated. Seven of these doctors were also individually interviewed.

MEASUREMENTS

Number of referrals to palliative specialists and qualitative responses to questions about end-of-life care management.

RESULTS

Sixty-six (11.1%) of 595 patients were referred to palliative care specialists. Patients with worse ECOG performance statuses were more likely to be referred to palliative specialists (odds ratio 2.23, p = 0.03); no other factors were predictive of a referral. Median number of days lived after referral was 5 days (interquartile range 2-13). Doctors explained the low referral rate and short life expectancy after referral by limited palliative resources and a reticence to have end-of-life management conversations with patients due to cultural taboos.

CONCLUSION

Despite recognized benefits of palliative collaboration, doctors at the UCI seldom refer patients to palliative care specialists due to limited staffing, cultural barriers, and difficult interservice communication.

Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality

BACKGROUND

A critical appraisal of the benefits of minimally invasive surgery (MIS) is needed, but is lacking. This study examined the associations between MIS and 30-day postoperative outcomes including complications graded according to the Clavien-Dindo classification, unplanned readmissions, hospital stay and mortality for five common surgical procedures.

METHODS

Patients undergoing appendicectomy, colectomy, inguinal hernia repair, hysterectomy and prostatectomy were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Non-parsimonious propensity score methods were used to construct procedure-specific matched-pair cohorts that reduced baseline differences between patients who underwent MIS and those who did not. Bonferroni correction for multiple comparisons was applied and P < 0·006 was considered significant.

RESULTS

Of the 532 287 patients identified, 53·8 per cent underwent MIS. Propensity score matching yielded an overall sample of 327 736 patients (appendicectomy 46 688, colectomy 152 114, inguinal hernia repair 59 066, hysterectomy 59 066, prostatectomy 10 802). Within the procedure-specific matched pairs, MIS was associated with significantly lower odds of Clavien-Dindo grade I-II, III and IV complications (P ≤ 0·004), unplanned readmissions (P < 0·001) and reduced hospital stay (P < 0·001) in four of the five procedures studied, with the exception of inguinal hernia repair. The odds of death were lower in patients undergoing MIS colectomy (P < 0·001), hysterectomy (P = 0·002) and appendicectomy (P = 0·002).

CONCLUSION

MIS was associated with significantly fewer 30-day postoperative complications, unplanned readmissions and deaths, as well as shorter hospital stay, in patients undergoing colectomy, prostatectomy, hysterectomy or appendicectomy. No benefits were noted for inguinal hernia repair.

Infusion-Compatible Antibiotic Formulations for Rapid Administration to Improve Outcomes in Cancer Outpatients With Severe Sepsis and Septic Shock: The Sepsis STAT Pack

Background: Patients with cancer are at high risk for severe sepsis and septic shock (SS/SSh), and a delay in receiving effective antibiotics is strongly associated with mortality. Delays are due to logistics of clinic flow and drug delivery. In an era of increasing antimicrobial resistance, combination therapy may be superior to monotherapy for patients with SS/SSh. Patients and Methods: At the Seattle Cancer Care Alliance, we implemented the Sepsis STAT Pack (SSP) program to simplify timely and effective provision of empiric antibiotics and other resuscitative care to outpatients with cancer with suspected SS/SSh before hospitalization. Over a 49-month period from January 1, 2008, through January 31, 2012, a total of 162 outpatients with cancer received the intervention. A retrospective cohort study was conducted to determine outcomes, including mortality and adverse events associated with the use of a novel care bundle designed for compatibility of broad-spectrum antibiotics and other supportive care administered concurrently via rapid infusion at fixed doses. Results: Of 162 sequential patients with cancer and suspected SS/SSh who received the SSP, 71 (44%) were diagnosed with SS/SSh. Median age was 53 years and 65% were men; 141 (87%) had hematologic malignancies, 77 (48%) were transplant recipients, and 80 (49%) were neutropenic. Median time to completion of antibiotics was 111 minutes (interquartile range, 60-178 minutes). A total of 71 patients (44%) had bacteremia and 17% of 93 isolates were multidrug-resistant. Possibly related nephrotoxicity occurred in 7 patients, and 30-day mortality occured in 6 of 160 patients (4%), including 3 of 71 (4%) with SS/SSh. Risk of developing SSh or death within 30 days increased 18% (95% CI, 4%-34%) for each hour delay to completion of antibiotics (P=.01). Conclusions: Rapidly administered combination antibiotics and supportive care delivered emergently to ambulatory patients with cancer with suspected SS/SSh was well-tolerated and associated with excellent short-term survival.

Correlates of cervical cancer screening from four Sub-Saharan African (SSA) countries: Results from the Demographic Health Survey (DHS)—2013-2015

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Background: Widespread cervical cancer screening has led to a dramatic reduction in cervical-cancer related mortality in resource-rich regions. However, cervical cancer remains a leading cause of cancer-related death in SSA due in part to a lack of accessible screening and treatment options. Methods: The DHS is a nationally representative household survey designed by ICF International and typically implemented every 5 years. In addition to demographic characteristics, select surveys collect data on cervical cancer awareness and screening. We included women aged ≥21 years from Côte d'Ivoire, Kenya, Namibia, and Zimbabwe who participated in the DHS. After sample weights were applied, we used logistic regression to examine associations of demographics and national cervical cancer incidence (as per the International Agency on Research on Cancer) with cervical cancer screening. Factors with p < 0.20 in bivariate analyses were included in a multivariate model. Results: We analyzed data from 45,947 women aged 21 to 49 years (mean = 32.2); 69% were married with an average of 3 children. Nearly half had completed secondary education (47%), 73% were literate, and 48% belonged to the highest two wealth quintiles. Over 70% of women were aware of cervical cancer; 24% of all women reported a previous screening exam with variation by country. Namibia, with the highest rates of screening (46%), had the lowest incidence. In multivariate analyses, cervical cancer screening was associated with increasing age (OR = 1.06; CI = 1.05, 1.07), education (OR = 1.48; CI = 1.30, 1.69), literacy (OR = 1.80; CI = 1.53, 2.13), and wealth (OR = 1.14; CI = 1.09, 1.20). Higher cervical cancer incidence at the national level (OR = .980; CI = .976, .983) and rural residence (OR = .839; CI = .738, .953) were inversely associated with odds of cervical cancer screening. Conclusions: Based on DHS data from four SSA countries, awareness of cervical cancer is high, but receipt of cervical cancer screening is low and may be associated with reductions in cervical cancer incidence. Targeted efforts to increase utilization of cervical cancer screening in SSA are warranted to reduce the preventable burden of cervical cancer.

Chemotherapy Use at the End of Life in Uganda

Purpose Avoiding chemotherapy during the last 30 days of life has become a goal of cancer care in the United States and Europe, yet end-of-life chemotherapy administration remains a common practice worldwide. The purpose of this study was to determine the frequency of and factors predicting end-of-life chemotherapy administration in Uganda. Methods Retrospective chart review and surveys and interviews of providers were performed at the Uganda Cancer Institute (UCI), the only comprehensive cancer center in the area, which serves a catchment area of greater than 100 million people. All adult patients at the UCI with reported cancer deaths between January 1, 2014, and August 31, 2015 were included. All UCI physicians were offered a survey, and a subset of physicians were also individually interviewed. Results Three hundred ninety-two patients (65.9%) received chemotherapy. Age less than 55 years (odds ratio [OR], 2.30; P = .004), a cancer diagnosis greater than 60 days before death (OR, 9.13; P < .001), and a presenting Eastern Cooperative Oncology Group performance status of 0 to 2 (OR, 2.47; P = .001) were associated with the administration of chemotherapy. More than 45% of patients received chemotherapy in the last 30 days of life. No clinical factors were predictive of chemotherapy use in the last 30 days of life, although doctors reported using performance status, cancer stage, and tumor chemotherapy sensitivity to determine when to administer chemotherapy. Patient expectations and a lack of outcomes data were important nonclinical factors influencing chemotherapy administration. Conclusion Chemotherapy is administered to a high proportion of patients with terminal cancer in Uganda, raising concern about efficacy. Late presentation of cancer in Uganda complicates end-of-life chemotherapy recommendations, necessitating guidelines specific to sub-Saharan Africa.

Renal Squamous Cell Carcinoma of a Native Kidney After Renal Transplant: A Case Report

BACKGROUND

Renal squamous cell carcinoma is a rare primary tumor of the kidney that rapidly invades local structures and has a poor prognosis. Presentation is usually nonspecific and is associated with renal stone disease and chronic infection. Immunosuppressed renal transplant recipients are more likely to develop a malignancy than the general population. Squamous cell carcinoma of the kidney in the context of a renal transplant and long-term immunosuppression has not previously been described in the literature.

CASE REPORT

A 46-year-old white man with previous renal stones and recurrent urinary infections underwent a right nephrectomy and subsequent renal transplantation owing to failure of the remaining kidney. Five years posttransplant, an abdominal ultrasound scan was performed owing to recurrent urinary infections and ongoing pyuria. This was reported as normal, but he later developed a discharging sinus in his left flank. A computed tomography (CT) scan revealed a tracking perinephric abscess with an associated cystic lesion of the left kidney. A left nephrectomy was performed and histologic examination suggested an invasive squamous cell carcinoma of the renal pelvis. The patient later required major surgery for chronic infection, and further imaging revealed metastatic disease, resulting in the decision to manage palliatively.

CONCLUSION

Given the nonspecific nature of the symptoms and the poor prognosis, health care professionals should have a lower threshold for diagnostic imaging in these patients. Abdominal ultrasonography was unhelpful and only a later CT scan revealed the underlying malignancy. This should be expedited if there is a persistent abnormality on urinalysis. Once diagnosed, a change in immunosuppressant regime to include sirolimus should be considered.

Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

PURPOSE

Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth.

METHODS

A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure.

RESULTS

The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups.

CONCLUSIONS

When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic III.

Tele-Oncology: A Joint Web-Based Clinical Conference Between the Uganda Cancer Institute and the Fred Hutch Cancer Research Center

Abstract 47

Background:

The increasing incidence of cancer in sub-Saharan Africa (SSA) has highlighted gaps in access to quality cancer care and subsequent poor outcomes. Two of the factors responsible for this disparity are the limited availability of diagnostic methods and the lack of trained oncologists. Tele-oncology, the application of web-based medical communications, has the potential to bridge the healthcare gap. Here we describe our 3-year experience linking resources between the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle, WA and the Uganda Cancer Institute (UCI) Kampala, Uganda, via a monthly conference.

Methods:

We created a monthly teleconference, each focused on a specific disease group, to provide a clinical treatment and research forum between the UCI and FHCRC. Guided by patients seen at the UCI, clinicians in Uganda present clinical, laboratory, and radiographic data. Case presentations and supporting documents are provided and loaded on a central site. Faculty members from the FHCRC (medical oncology, radiation oncology, surgery, pathology, and radiology, as applicable) are identified in advance and serve as discussants and assist in interpreting data, as well as provide guidance on clinical decision-making. Web conferencing is performed utilizing the Cisco WebEx platform.

Results:

To date, we have held 36 case conferences and have discussed the following malignancies: Leukemia (including myelodysplasia) (6), gastrointestinal (5), head/neck/lung (5), genitourinary (3), gynecologic (3), lymphoma (2), breast (2), plasma cell dyscrasia (1), soft tissue sarcoma (1), central nervous system (1) and other (5). Two conferences have focused specifically on palliative care. Two locally-relevant treatment guidelines, co-authored by colleagues from Uganda and Seattle, have been published for HIV-associated non-Hodgkin lymphoma and cutaneous T-cell lymphoma as a direct result of these conferences.

Conclusions:

The monthly teleconference has enhanced education, clinical practice, and collaboration between colleagues in Uganda and Seattle. Future opportunities include the initiation of a core oncology training curriculum, as well as video conferencing capabilities. Similar twinning programs between institutions in resource-rich and resource-limited countries are recommended.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:

Fred Okuku No relationship to disclose Manoj Menon No relationship to disclose Rachel Kansiime No relationship to disclose Jason Barrett No relationship to disclose Warren Phipps No relationship to disclose Nixon Niyonzima No relationship to disclose Matthew Ulrickson Speakers' Bureau: Incyte Jackson Orem No relationship to disclose Corey Casper Leadership: Temptime Corporation Consulting or Advisory Role: Janssen Pharmaceuticals Research Funding: Janssen Pharmaceuticals Travel, Accommodations, Expenses: Glaxo Smith Kline, Temptime Corporation

ZnO gap engineering by doping with III-V compounds

Gap engineering of ZnO by codoping it with III-V materials is investigated using model and ab initio calculation. Our results show that the codoped materials (ZnO)1-x (III-V)x , where (III-V) stands for GaN, AlN, AlP, BN, BP exhibit energy band gaps that get smaller as the dopant concentrations x is increased. Even at a very small dopant concentration the obtained band gaps are found to be much smaller than that of ZnO making the studied (ZnO)1-x(III-V)x materials promising candidates for photoelectrochemical water splitting.