CLINICAL APPLICABILITY OF PROPOSED ALGORITHM FOR IDENTIFYING INDIVIDUALS AT RISK FOR HEREDITARY HEMATOLOGIC MALIGNANCIES

Over the past decade, more than 12 genes have been identified to cause hereditary predispositions to hematologic malignancies. These syndromes are characterized by an increased risk to develop myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), or aplastic anemia (AA) at young ages, with various phenotypic features including peripheral cytopenias, immune dysfunction and skeletal defects. In 2013, Churpek et al. proposed a referral algorithm which consists of certain criteria for identifying leukemia patients who may benefit from genetic assessment for these hereditary syndromes. These criteria assess personal history of cytopenias, skin or nail abnormalities, immune deficiencies/atypical infections, and other associated clinical characteristics. The algorithm also assesses family history of leukemia and personal/family history of other malignancies. Our study aimed to assess the applicability of these criteria on an unselected population of adults with leukemia by retrospective chart review at The University of Texas M.D. Anderson Cancer Center. These patients presented for initial consultation from March 1, 2014 to December 31, 2014. Six-hundred and eight individuals diagnosed with MDS/AML/AA were included in this study. Key demographic information was obtained from a clinical database maintained by the Department of Leukemia. The median age at diagnosis was 67 years, 387 (64%) were male, and at the time of data collection, 315 (51.8%) individuals were alive. Of the 608 individuals in this study, 334 (54.9%) were diagnosed with AML, 199 (32.7%) with MDS, 59 (9.7%) with MDS/MPD, and 16 (2.6%) with AA. Regarding clinical/medical record documentation of referral criteria, three hundred and sixty-four (59.9%) individuals reported at least one first or second-degree relative with cancer. Thirty-one (5.1%) individuals reported a family history of leukemia, which was also the most consistently reported criteria in the medical record (n=580, 95.4%). Overall, 406 individuals (66.8%) had insufficient documentation to determine whether any criteria were met. Two hundred and two (33.2%) individuals met at least one of the proposed criteria for genetic counseling referral; however, only nine received a referral (4.5%) to genetic counseling. Increased documentation of the presence or absence of phenotypic features associated with these hereditary syndromes is necessary to better assess the applicability of these criteria, and to ensure that individuals receive appropriate referral for cancer genetics risk assessment

Improving Climate Literacy within Extension by Understanding Diverse Climate-Related Informational Needs

Increasing literacy among Extension professionals in every sector regarding potential regional impacts and adaptation strategies related to climate change is key to producing high-quality relevant programs addressing climate-related risks. Professionals in the forestry, agriculture, livestock, and coastal resources sectors attended the Southeast Region Extension Climate Academy in fall 2014. Participant surveys and interviews suggested that some of the agents most confused about climate change gained the most from the workshop. Further, focusing on region- and sector-specific information made climate change relevant to participants who were initially uninterested in addressing the topic

'It's learned on the job and it depends who you're with.':An observational qualitative study of how internal jugular cannulation is taught and learned

Internal jugular cannulation may lead to serious complications. Ultrasound guidance is advocated; however, procedural complications remain a concern. Inconsistent education may be in part responsible for this. This study examined how internal jugular cannulation is taught and learned. An ethnographic approach was used in two acute hospitals. Methods comprised interviews, observations and focus groups. An inductive thematic analysis was undertaken. Three themes were identified: apprenticeship, trust and reciprocity. In apprenticeship, a new form of apprenticeship learning, necessitated by the structure of training is described. In trust the strategies by which trainers assess trainees' competence in order to allow them to gain experience is explored. In reciprocity the beneficial influence of trainees is illustrated. This study demonstrates how high-stakes procedures are learned. It provides insights into under-investigated topics such as the use of 'permitted mistakes' to stimulate reflection and the role played by trainees in promoting good practice

Correlates of a good death and the impact of hospice involvement: findings from the national survey of households affected by cancer

Knowing how to improve the dying experience for patients with end-stage cancer is essential for cancer professionals. However, there is little evidence on the relationship between clinically relevant factors and quality of death. Also, while hospice has been linked with improved outcomes, our understanding of factors that contribute to a “good death” when hospice is involved remains limited. This study (1) identified correlates of a good death; and, (2) provided evidence on the impact of hospice on quality of death

Validation of the Quality of Dying-Hospice Scale

Measuring the quality of the dying experience is important for hospice providers. However, few instruments exist that assess the quality of one’s dying; and those that do, have not been well validated in hospice

From moral hazard to risk-response feedback

The Intergovernmental Panel on Climate Change assessments (IPCC) Special Report on 1.5 °C of global warming is clear. Nearly all pathways that hold global warming well below 2 °C involve carbon removal (IPCC, 2015). In addition, solar geoengineering is being considered as a potential tool to offset warming, especially to limit temperature until negative emissions technologies are sufficiently matured (MacMartin et al., 2018). Despite this, there has been a reluctance to embrace carbon removal and solar geoengineering, partly due to the perception that these technologies represent what is widely termed a “moral hazard”: that geoengineering will prevent people from developing the will to change their personal consumption and push for changes in infrastructure (Robock et al., 2010), erode political will for emissions cuts (Keith, 2007), or otherwise stimulate increased carbon emissions at the social-system level of analysis (Bunzl, 2008). These debates over carbon removal and geoengineering echo earlier ones over climate adaptation. We argue that debates over “moral hazard” in many areas of climate policy are unhelpful and misleading. We also propose an alternative framework for dealing with the tradeoffs that motivate the appeal to “moral hazard,” which we call “risk-response feedback.

Molecular Heterogeneity and Response to Neoadjuvant Human Epidermal Growth Factor Receptor 2 Targeting in CALGB 40601, a Randomized Phase III Trial of Paclitaxel Plus Trastuzumab With or Without Lapatinib

Dual human epidermal growth factor receptor 2 (HER2) targeting can increase pathologic complete response rates (pCRs) to neoadjuvant therapy and improve progression-free survival in metastatic disease. CALGB 40601 examined the impact of dual HER2 blockade consisting of trastuzumab and lapatinib added to paclitaxel, considering tumor and microenvironment molecular features

Concert recording 2016-04-03

[Track 01]. Fanfare pour précéder \u27La Péri\u27 / Paul Dukas -- [Track 02]. French dances revisted. I ; [Track 03]. II ; [Track 04]. III ; [Track 05]. IV ; [Track 06]. V ; [Track 07]. VI / Adam Gorb -- [Track 08]. Danses sacrée et profane / Claude Debussy -- [Track 09]. Dance mix / Rob Smith

Concert recording 2017-05-04b

[Track 1]. Fanfare for the common man / Aaron Copland -- [Track 2]. Bach Buch / J.S. Bach translated by Pann -- [Track 3]. Highway musings / Ryan Key -- [Track 4]. Serenade in D minor / Antonín Dvorák