Sociocultural Impacts on Cancer Control in The U.S. Affiliated Pacific Island Jurisdictions

Large disparities in cancer services and cancer outcomes exist between the United States and the United States Associated Pacific Island Jurisdictions (USAPIJ) [Commonwealth of the Northern Marianas, Guam, American Samoa, Republic of the Marshall Islands, Republic of Palau, Federated States of Micronesia] The USAPIJ have systematically advocated through disparity networks,. developed a regional cancer council, organized jurisdiction cancer coalitions, written individual and regional strategic comprehensive cancer control, plans, and are now implementing those plans. The USAPIJ have leveraged their assets to now have Federally funded projects that will allow the development of a Pacific Regional Cancer Registry and will sustain the Cancer Coalitions. The Pacific region has received a CDC designation as a Center for Excellence t

A New Era for Real-World Evidence

This presentation will use cancer therapeutic development as a use case for exploring the emerging role of real-world evidence. The current availability of electronic health records with rich information about patients gathered during their routine care is rapidly changing the landscape of evidence generation in medicine. Recent advances have accelerated the introduction of new diagnostics and treatments into clinical practice. Learning Objectives: Understand potential sources of real-world data for use in evidence generation to guide drug development and patient care. Describe the opportunities and limitations of observational research using real-world data derived from electronic health records. Review examples of real-world data use in oncology drug development

Recruiting and Retaining Individuals with Serious Mental Illness and Diabetes in Clinical Research: Lessons Learned from a Randomized, Controlled Trial.

Abstract: Recruitment and retention of individuals with serious mental illness (SMI) and comorbid diabetes mellitus (DM) in research studies can be challenging with major impediments being difficulties reaching participants via telephone contact, logistic difficulties due to lack of transportation, ongoing psychiatric symptoms, and significant medical complications. Research staff directly involved in recruitment and retention processes of this study reviewed their experiences. The largest barriers at the macro, mediator, and micro levels identified in this study were inclement weather, transportation difficulties, and intermittent and inaccessible telephone contact. Barrier work-around practices included using the health system’s EHR to obtain current phone numbers, providing transportation assistance (bus passes or parking reimbursement), and flexible scheduling of appointments. Suggestions are intended to assist in planning for recruitment and retention strategies

COVID-19 Vaccine Hesitancy Resources in Northern New York

COVID-19 continues to be a significant health threat and has caused significant disease and mortality in the fall 2021 wave largely driven by the Delta Variant and complicated by unvaccinated patients. In the state of NY, approximately 40 patients died per day (7 day moving average) from serious COVID-19 illness during this time period. During this time, approximately 35% of Clinton County’s population is not vaccinated for COVID-19 and is subsequently unprotected from serious COVID-19 illness. This work discusses reasons for non-vaccination and strategies to combat vaccine hesitancy. Additionally, it includes a pamphlet for local distribution as well as a dot phrase to be utilized for patients seen in the outpatient setting to serve as a personalized reminder on the importance of receiving vaccination against COVID-19 and to answer questions identified as concerns for vaccine hesitancy.https://scholarworks.uvm.edu/fmclerk/1837/thumbnail.jp

Surgery Poster - 2019

Surgery Poster - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1016/thumbnail.jp

New interleukin-15 superagonist (IL-15SA) significantly enhances graft-versus-tumor activity.

Interleukin-15 (IL-15) is a potent cytokine that increases CD8+ T and NK cell numbers and function in experimental models. However, obstacles remain in using IL-15 therapeutically, specifically its low potency and short in vivo half-life. To help overcome this, a new IL-15 superagonist complex comprised of an IL-15N72D mutation and IL-15RαSu/Fc fusion (IL-15SA, also known as ALT-803) was developed. IL-15SA exhibits a significantly longer serum half-life and increased in vivo activity against various tumors. Herein, we evaluated the effects of IL-15SA in recipients of allogeneic hematopoietic stem cell transplantation. Weekly administration of IL-15SA to transplant recipients significantly increased the number of CD8+ T cells (specifically CD44+ memory/activated phenotype) and NK cells. Intracellular IFN-γ and TNF-α secretion by CD8+ T cells increased in the IL-15SA-treated group. IL-15SA also upregulated NKG2D expression on CD8+ T cells. Moreover, IL-15SA enhanced proliferation and cytokine secretion of adoptively transferred CFSE-labeled T cells in syngeneic and allogeneic models by specifically stimulating the slowly proliferative and nonproliferative cells into actively proliferating cells.We then evaluated IL-15SA\u27s effects on anti-tumor activity against murine mastocytoma (P815) and murine B cell lymphoma (A20). IL-15SA enhanced graft-versus-tumor (GVT) activity in these tumors following T cell infusion. Interestingly, IL-15 SA administration provided GVT activity against A20 lymphoma cells in the murine donor leukocyte infusion (DLI) model without increasing graft versus host disease. In conclusion, IL-15SA could be a highly potent T- cell lymphoid growth factor and novel immunotherapeutic agent to complement stem cell transplantation and adoptive immunotherapy

Quarterly Program Progress Report April 1, 2002-June 30, 2002

DOE B188 DOE/PHRI Special Medical Care Program in the Republic of the Marshall Islands (RMI)Quarterly Program Progress Report The DOE/PHRI Special Medical Care Program continues to provide, on a year round basis, a broad spectrum of medical care to the DOE patient population. During the fourth quarter of Year 4, the following medical services were provided: (1) Annual medical examinations for the DOE patient population (see Exhibit 1 for details). (2) Medications for the DOE patient population. (3) Preventive and primary medical care to the DOE patient population in the RMI as time and resources permit. (4) Additional manpower for the outpatient clinics at Ebeye and Majuro Hospitals (see Exhibit 2 for details). (5) Ancillary services such as labs, radiology and pharmacy in coordination with Kwajalein Hospital, Majuro Hospital and the 177 Health Care Program (177 HCP). (6) Referrals to Ebeye Hospital, Majuro Hospital and Kwajalein Hospital as necessary. (7) Referrals to Straub Clinic and Hospital in Honolulu as necessary (for details see Exhibit 1). (8) Monitored and adjusted monthly annual examination schedules based on equipment failure at Kwajalein. In addition to the above, the program was also involved in the following activities during this quarter: (1) Organized and conducted continuing medical education (CME) talks for the program's RMI staff and other RMI healthcare workers. (2) Held meetings with RMI government officials and Local Atoll government officials. (3) Input past medical records into the Electronic Medical Record (EMR) system. (4) Made adjustments to and created more templates for the EMR system. (5) Coordinated with the Public Health Departments on Majuro and Ebeye. (6) Met with PEACESAT to discuss possible collaboration on high speed Internet access. (7) Looked for opportunities to expand the program's telehealth capabilities. (8) Participated in the DOE-RMI Meeting in Honolulu. (9) Finalized the agreement with the RMI Ministry of Health and Environment (MOHE) and Majuro Hospital to hire Dr. Marie Lanwi on a part-time basis. (10) Held a Community Advisory Group (CAG) Meeting and Community Meeting on Majuro. (11) Negotiated with Kwajalein with regards to the increase in laboratory and procedure costs and continuing Mammography services for the DOE patient population. (12) Met with DOE in Honolulu to discuss the next year's program and budget. (13) Trained new residents in the use of the electronic medical record system. (14) Conducted electronic medical record audits. (15) Participated in a training session for the appointment scheduler module by Physician Micro System, Inc. on the EMR system. (16) Worked on the Year 5 Continuation Application and Budget. (17) Finalized the Memorandum of Understanding (MOU) with 177. (18) Worked with DOE and Bechtel Nevada (BN) to reduce PHRI program costs to meet an increase in referral costs paid by Bechtel. This report details the additions and changes to the program for the April 1, 2002-June 30, 2002 period

Annual Program Progress Report under DOE/PHRI Cooperative Agreement: (July 1, 2001-June 30, 2002)

OAK B188 DOE/PHRI Special Medical Care Program in the Republic of the Marshall Islands (RMI)Annual Program Progress Report. The DOE Marshall Islands Medical Program continued, in this it's 48th year, to provide medical surveillance for the exposed population from Rongelap and Utrik and the additional DOE patients. The program was inaugurated in 1954 by the Atomic Energy Commission following the exposure of Marshallese to fallout from a nuclear test (Castle Bravo) at Bikini Atoll. This year marks the fourth year in which the program has been carried out by PHRI under a cooperative agreement with DOE. The DOERHRI Special Medical Care Program, awarded the cooperative agreement on August 28, 1998, commenced its health care program on January 15, 1999, on Kwajalein and January 22, 1999, on Majuro. This report details the program for the July 1, 2001, through the June 30, 2002, period. The program provides year-round, on-site medical care to the DOE patient population residing in the Republic of the Marshall Islands (RMI) and annual examinations to those patients living in Hawaii and on the Continental U.S

Hips Can Lie: Impact of Excluding Isolated Hip Fractures on External Benchmarking of Trauma Center Performance

BACKGROUND: Trauma centers (TCs) vary in the inclusion of patients with isolated hip fractures (IHFs) in their registries. This inconsistent case ascertainment may have significant implications on the assessment of TC performance and external benchmarking efforts. METHODS: Data were derived from the National Trauma Data Bank (2007-8.1). We included patients (aged 16 years or older) with Injury Severity Score value ≥ 9 who were admitted to Level I and II TCs. To ensure data quality, we limited the study to TC that routinely reported comorbidities and Abbreviated Injury Scale codes. IHF were defined as patients, aged 65 years or older, injured as a result of falls, with Abbreviated Injury Scale codes for hip fracture and without other significant injuries. TCs were stratified according to their reported inclusion of IHF in their registry. Observed-to-expected mortality ratios were used to rank TC performance first with and then, without the inclusion of patients with IHF. RESULTS: In total, 91,152 patients in 132 TCs were identified; 5% (n = 4,448) were IHF. The proportion of IHF per TC varied significantly, ranging from 0% to 31%. When risk-adjusted mortality was evaluated, excluding patients with IHF had significant effects: 37% (n = 49) of TCs changed their performance rank by ≥ 3 (range, 1-25) and 12% of centers changed their performance quintile. The greatest change in rank performance was evident in centers that routinely include IHF in their registries. CONCLUSIONS: Given the fact that IHFs in the elderly significantly influence risk-adjusted outcomes and are variably reported by TCs, these patients should be excluded from subsequent benchmarking efforts