Improving Routine Human Immunodeficiency Virus Screening in a Primary Care Setting

According to the Centers for Disease Control and Prevention, in 2017, over 38,700 people receive an human immunodeficiency virus (HIV) diagnosis in the US. The United States Preventive Services Task Force (USPSTF) published recommendations in 2013 for routine HIV screening of patients ages 15 to 65 years old. Primary care providers who offer routine HIV screening can identify patients with a positive result and promptly connect them to care to decrease transmission of HIV. This process improvement project targeted health care providers and staff, using evidence-based interventions, 2013 USPSTF recommendations, and the Chronic Care Model, to improve HIV screening at a primary care site. Information sessions were held with health care providers and staff pre- and post-intervention. Participants were given a pre-survey (n=28) and post-survey (n=25) questionnaires, information on the electronic medical record screening reminder and educational materials about routine HIV screening. Monthly visits were made to the clinic by the primary investigator who conducted semi-structured interviews with participants. A retrospective chart review evaluated HIV screening data during the months of September, October, and November for 2017, (baseline year), compared to September - November 2018, intervention months. The pre- and post-intervention surveys were confidential and paired by the number assigned to each provider participant (n=6). The results were analyzed using descriptive statistics and paired t-tests to determine if perspectives on HIV screening changed from pre- to post-survey. There were no statistically significant findings from the survey questionnaire results, however, the mean Likert scores improved in the post-survey in most topics. Twenty-five percent of encounters during the 2017 baseline months and 2018 intervention months had an HIV test ordered. During the 2018 intervention year, September had a 3.5% increase and October had a 1.0% increase in percentage of tests ordered when compared to 2017; however, November 2018 had a 5.8% decrease from November 2017. This project piloted interventions to increase provider and clinic staff’s knowledge on routine HIV screening practices to help further reduce HIV transmissions among patients with an unknown serostatus. Further work is needed to identify ways to improve screening rates, such as clinic staff-initiated screening and rapid screening.Doctor of Nursing Practic

Limitations in the Use of Archived Vent Mussel Samples to Assess Genetic Connectivity Among Seafloor Massive Sulfide Deposits: A Case Study with Implications for Environmental Management

Genetic connectivity studies can inform the design of mitigation strategies used in environmental management. However, the expense of developing species-specific molecular markers and collecting samples at appropriate spatial and temporal scales can be prohibitive. Using archived material and existing molecular markers may provide a cost-effective way to assess population connectivity. Genetic connectivity studies are increasingly in demand in the deep sea in response to mounting anthropogenic pressures, including seafloor massive sulfide (SMS) mining. The feasibility of using archived material was assessed using the New Zealand-endemic vent mussel Gigantidas gladius, which inhabits areas licensed for the prospecting phase of SMS mining. Four molecular markers were tested, but only one (mitochondrial COI) provided suitable sequences. Of 942 specimens, only 150 individuals were informative, largely due to poor tissue quality of archived samples. Seven populations spanning the distributional range of G. gladius were assessed. The results indicate that G. gladius has high levels of gene flow among sites 10s to 100s km apart and limited genetic structure. Haplotypic diversity was not equally distributed among populations, with lower diversity for the Macauley Volcano population at the northern extent of the species distribution and greater diversity within central populations. Migrant exchange was also greatest between central populations, with one population at Rumble V Seamount appearing important in terms of maintaining genetic diversity within the Kermadec Volcanic Arc region. However, interpretation of the results should be viewed with caution as small sample sizes may have limited the ability to detect genetic structure. Despite these limitations, mitigation strategies that protect areas of seabed from mining activities should consider the genetic vulnerability of the population at the northern edge of the species’ distribution and the significance of certain central populations

1999-2000 Tribute - Music by Women Composers

This concert is presented by Palm Beach County Music Teacher\u27s Association.https://spiral.lynn.edu/conservatory_otherseasonalconcerts/1109/thumbnail.jp

NUTMEG: A randomized phase II study of nivolumab and temozolomide versus temozolomide alone in newly diagnosed older patients with glioblastoma.

BACKGROUND: There is an immunologic rationale to evaluate immunotherapy in the older glioblastoma population, who have been underrepresented in prior trials. The NUTMEG study evaluated the combination of nivolumab and temozolomide in patients with glioblastoma aged 65 years and older. METHODS: NUTMEG was a multicenter 2:1 randomized phase II trial for patients with newly diagnosed glioblastoma aged 65 years and older. The experimental arm consisted of hypofractionated chemoradiation with temozolomide, then adjuvant nivolumab and temozolomide. The standard arm consisted of hypofractionated chemoradiation with temozolomide, then adjuvant temozolomide. The primary objective was to improve overall survival (OS) in the experimental arm. RESULTS: A total of 103 participants were randomized, with 69 in the experimental arm and 34 in the standard arm. The median (range) age was 73 (65-88) years. After 37 months of follow-up, the median OS was 11.6 months (95% CI, 9.7-13.4) in the experimental arm and 11.8 months (95% CI, 8.3-14.8) in the standard arm. For the experimental arm relative to the standard arm, the OS hazard ratio was 0.85 (95% CI, 0.54-1.33). In the experimental arm, there were three grade 3 immune-related adverse events which resolved, with no unexpected serious adverse events. CONCLUSIONS: Due to insufficient evidence of benefit with nivolumab, the decision was made not to transition to a phase III trial. No new safety signals were identified with nivolumab. This complements the existing series of immunotherapy trials. Research is needed to identify biomarkers and new strategies including combinations

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment

Learning together for and with the Martuwarra Fitzroy River

Co-production across scientific and Indigenous knowledge systems has become a cornerstone of research to enhance knowledge, practice, ethics, and foster sustainability transformations. However, the profound differences in world views and the complex and contested histories of nation-state colonisation on Indigenous territories, highlight both opportunities and risks for Indigenous people when engaging with knowledge co-production. This paper investigates the conditions under which knowledge co-production can lead to improved Indigenous adaptive environmental planning and management among remote land-attached Indigenous peoples through a case study with ten Traditional Owner groups in the Martuwarra (Fitzroy River) Catchment in Western Australia’s Kimberley region. The research team built a 3D map of the river and used it, together with an interactive table-top projector, to bring together both scientific and Indigenous spatial knowledge. Participatory influence mapping, aligned with Traditional Owner priorities to achieve cultural governance and management planning goals set out in the Fitzroy River Declaration, investigated power relations. An analytical framework, examining underlying mechanisms of social learning, knowledge promotion and enhancing influence, based on different theories of change, was applied to unpack the immediate outcomes from these activities. The analysis identified that knowledge co-production activities improved the accessibility of the knowledge, the experiences of the knowledge users, strengthened collective identity and partnerships, and strengthened Indigenous-led institutions. The focus on cultural governance and management planning goals in the Fitzroy River Declaration enabled the activities to directly affect key drivers of Indigenous adaptive environmental planning and management—the Indigenous-led institutions. The nation-state arrangements also gave some support to local learning and decision-making through a key Indigenous institution, Martuwarra Fitzroy River Council. Knowledge co-production with remote land-attached Indigenous peoples can improve adaptive environmental planning and management where it fosters learning together, is grounded in the Indigenous-led institutions and addresses their priorities