Treatment Sites Research Articles

Bait trapping of waterfowl increases the environmental contamination of avian influenza virus (AIV)

AbstractHighly pathogenic avian influenza virus (HPAIV) H5Nx clade 2.3.4.4b has circulated in North America since late 2021, resulting in higher rates of morbidity and mortality in wild birds than observed in this region before. The objective of this study was to determine whether baiting, which is widely conducted in Canada and the United States as part of waterfowl management practices (e.g., duck banding), influences the occurrence of avian influenza virus (AIV) in wetlands. We used a quasi‐experimental design, collecting superficial sediment samples (n = 336) and fecal samples (n = 242) from paired baited (treatment) and non‐baited (control) sites at 2 wetlands in Saskatchewan, Canada, between August and September 2022. We visited sampling sites 3 times during the sampling period: prior to the commencement of baiting activities (t0), approximately 14 days after t0 (t1), and 24 days after t0 (t2). We screened samples for AIV using real‐time reverse‐transcriptase polymerase chain reaction (rRT‐PCR) targeting the matrix gene and subjected the PCR‐positive samples to next‐generation sequencing. We used a mixed‐effects logistic regression model to estimate the effect of baiting on the odds of AIV positivity in sediment samples, while controlling for clustering by wetland. At control sites, we did not detect evidence for a difference in the odds of AIV detection in sediment at t1 or t2 versus t0; however, at baited sites, the odds of AIV detection at t1 were 5.43 (95% CI = 1.99, 14.79) times the odds at t0 and at t2 the odds of AIV detection were 8.73 (95% CI = 3.29, 23.18) times the odds at t0. We detected HPAIV clade 2.3.4.4b H5N1 in sediment at 1 treatment site following baiting. There was also a trend towards increased fecal AIV positivity and increased fecal and sediment AIV diversity in baited versus non‐baited sites; however, there was insufficient power to determine if these findings were statistically significant. Overall, our results indicate that baiting is associated with localized increases in AIV environmental contamination, with baiting potentially creating concentrated areas of AIV accumulation. As such, wetland baiting activities may pose a risk to wildlife population health through the propagation of AIV in wetlands and the waterfowl using those environments and efforts to replace, refine, or reduce this activity may be warranted depending on local ecosystem contexts and cost‐benefit analyses.

Proton arc therapy plan optimization with energy layer pre-selection driven by organ at risk sparing and delivery time

Objective.As proton arc therapy (PAT) approaches clinical implementation, optimizing treatment plans for this innovative delivery modality remains challenging, especially in addressing arc delivery time. Existing algorithms for minimizing delivery time are either optimal but computationally demanding or fast but at the expense of sacrificing many degrees of freedom. In this study, we introduce a flexible method for pre-selecting energy layers (EL) in PAT treatment planning before the actual robust spot weight optimization.Approach.Our EL pre-selection method employs metaheuristics to minimize a bi-objective function, considering a dynamic delivery time proxy and tumor geometrical coverage penalized as a function of selected organs-at-risk crossing. It is capable of parallelizing multiple instances of the problem. We evaluate the method using three different treatment sites, providing a comprehensive dosimetric analysis benchmarked against dynamic proton arc plans generated with early energy layer selection and spot assignment (ELSA) and IMPT plans in RayStation TPS.Result.The algorithm efficiently generates Pareto-optimal EL pre-selections in approximately 5 min. Subsequent PAT treatment plans derived from these selections and optimized within the TPS, demonstrate high-quality target coverage, achieving a high conformity index, and effective sparing of organs at risk. These plans meet clinical goals while achieving a 20%-40% reduction in delivery time compared to ELSA plans.Significance.The proposed algorithm offers speed and efficiency, producing high-quality PAT plans by placing proton arc sectors to efficiently reduce delivery time while maintaining good target coverage and healthy tissues sparing.

Colorectal cancer care disparities in an urban diverse population: A tale of two hospitals in the nation’s capital.

38 Background: Colorectal cancer (CRC) disparities by race and ethnicity are well-documented nationally. In the District of Columbia (DC), Black Americans have an 18% higher incidence and 46% higher mortality rate compared to overall rates among all races/ethnicities. These disparities often stem from long-standing inequities in the social determinants of health, which affect access to cancer prevention, early detection, and treatment. MedStar Georgetown serves a large, urban, diverse population at 2 hospitals: the MedStar Georgetown University Hospital (MGUH) and the MedStar Washington Hospital Center (MWHC). MWHC serves a higher proportion of minoritized patients (pts) with multiple social determinant barriers to care, including those without private health insurance. We hypothesized that disparities would be found in CRC pt care and outcomes when comparing MWHC with MGUH. Methods: We conducted a retrospective study of all CRC pts treated during the 2021-2023 period at MGUH and MWHC using the COTA real-world database. Pt demographics, insurance status, and selected clinical data, including but not limited to treatment site, disease stage, tumor molecular testing, and pt survival, were abstracted for analysis. Descriptive, bivariate, and multivariate analyses focused on gender, race/ethnicity, insurance status, receipt of tumor testing, and the interval between diagnosis and therapy initiation and explored survival by these factors in addition to the site of care (MGUH versus MWHC). Results: Of the 379 CRC pts receiving care at the Lombardi Comprehensive Cancer Center during the study period, 53% were treated at MGUH and 47% at MWHC. CRC pts at MWHC were more likely than CRC pts at MGUH to be Black Americans (65% vs. 28%, p<0.001) and have 3 or more comorbidities (16% vs. 8%, p=0.22) but were less likely to have early onset CRC (p<0.01) and be on private insurance (36% vs. 23%, p=0.01). Pts treated at advanced stages (stages 3-4) were similar between the two hospitals (64%). In spite of these differences, we did not find any differences between MWHC and MGUH in molecular tumor testing (83% vs. 86%, p=0.41), median time (days) to treatment initiation (28 vs. 26 days, p=0.18), or short-term survival (90% vs. 91%, p=0.95). In analyses comparing care/treatment-related factors with race/ethnicity and insurance status across the 2 hospitals, we did not find any statistically significant differences. Conclusions: Contrary to our expectations of finding significant cancer care disparities, we did not observe any differences in molecular tumor testing rates, time to initiation of therapy, or short-term survival by treatment site or race/ethnicity status. Our results suggest that integrated, specialized, guideline-concordant care in comprehensive cancer centers has the potential to eliminate CRC outcome disparities among pts diagnosed at these centers.

Intra-arterial gemcitabine versus intravenous gemcitabine: Pharmacokinetic sub-study of the TIGeR-PaC phase 3 clinical trial.

719 Background: Localized, dual balloon catheter-mediated, intra-arterial delivery of gemcitabine (IAG) targeted to tumors/tissue can provide higher local drug potency (1). Furthermore, IAG may result in a decreased systemic drug concentration and associated side effects. In patients with locally advanced pancreatic cancer (LAPC), this approach is currently being tested in the TIGeR-PaC Phase 3 clinical trial. Herein we report the results of a 19-patient pharmacokinetics (PK) sub-study analysis within TIGeR-PaC. Methods: PK analyses were performed for a total of 19 participants across 6 TIGeR-PaC study sites; 11 participants received IAG with the RenovoCath dual balloon catheter at 1000 mg/m 2 over 20 minutes and 8 participants received intravenous gemcitabine (IVG) (5 at 1000 mg/m 2 , 2 at 800 mg/m 2 , 1 at 500 mg/m 2 ) over 30 minutes. IAG target treatment arteries were either the superior mesenteric artery (SMA) (n=5) or branches of the celiac axis (n=6). At T = -5, 10, 15, 20, 30, 40, 60, and 90 minutes from the onset of infusion, 2 mL of blood was collected in heparinized tubing containing 25 mcg/mL of tetrahydrouridine. Plasma from each sample was frozen and shipped to a reference lab for gemcitabine assays. Maximum plasma drug concentration (C max ) and the area under the drug plasma concentration curve (AUC) based on the terminal phase were compared between the two groups; for these dose-dependent parameters, only participants who received 1000 mg/m 2 gemcitabine (IAG, N=11; IVG, N=5) were included in the comparison analysis. Results: As shown in the table, AUC was significantly lower with IAG (4.99) compared to IVG (9.97) ( P = 0.019). Peak plasma gemcitabine concentrations were also lower with IAG (12.9 mcg/mL) vs. IVG (14.6 mcg/mL) despite a 50% higher drug concentration during IAG vs. IVG (1000 mg/m 2 infused over 20 minutes vs. 30 minutes, respectively). There was no difference in plasma levels between IAG treatment sites (SMA vs. celiac axis). Conclusions: In this analysis, localized, dual-balloon catheter-mediated IAG resulted in decreased systemic levels of gemcitabine compared to IVG. Thus, in addition to providing increased local potency, the IAG approach may also be beneficial in decreasing gemcitabine-related systemic side effects. 1. Farsad K, et al. 2024. JVIR 35:1043-48 e3. Clinical trial information: NCT03257033 . Effects of treatment mode on mean pharmacokinetic parameters for gemcitabine. PK parameter IAG Group(N=11) IVG Group(N=5) C max (mcg/mL), Mean (SE) 12.9 (±2.4) 14.6 (±1.2) AUC (hr ⋅ mcg/mL), Mean (SE) 4.99 (±0.96) 9.97 (±1.9) AUC = area under the curve; C max = maximum serum concentration; IAG = intra-arterial gemcitabine; IVG = intravenous gemcitabine; PK = pharmacokinetic; SE = standard error.

628. Geographic distribution of hospitalized severe malaria cases in the United States, 2012–2018

Abstract Background Between 200–300 severe malaria cases are diagnosed annually in the U.S. Intravenous artesunate (IVAS), the FDA-approved 1st-line therapy for severe malaria since 2020, is commercially available but at high cost. Uncertainty regarding where people with severe malaria will seek medical care poses supply chain challenges. We identified hospitals where people with severe malaria were treated and mapped proximity to Level 1 trauma centers as a proxy for hospitals that provide complex clinical care, which could assist with planning for IVAS distribution. Location identification and manual adjudication process for hospitals that hospitalized people with severe malaria as reported to CDC from 2012–2018. Of the original 1,912 cases of severe malaria reported to the CDC from 2012-2018, we excluded 379 cases that were not admitted or were admitted but missing a hospital name. Of the remaining 1,533 severe malaria cases that were eligible for adjudication, 1,237 were an exact match with an existing hospital location. Of the 296 cases that were not an exact match, we manually adjudicated 229 cases by clarifying a hospital name that was abbreviated, incomplete, or had a change in name; only 49 cases could not be identified given multiple possible sites with the same name, and 18 cases with no name that matched a hospital site. Six additional cases were excluded because of occurring at a site with no Level 1 trauma center within driving distance (i.e., Alaska and US Virgin Islands). Methods Using 2012–2018 data reported to the Centers for Disease Control and Prevention (CDC), we analyzed free text of U.S. hospital names where people were treated as inpatients for severe malaria. We identified these hospitals using Google Maps Geocoding Application Programming Interface (API) followed by manual adjudication. We excluded cases when data were incomplete or ambiguous or if a Level 1 trauma center was inaccessible (e.g., Alaska or U.S. Virgin Islands). We then mapped hospitals to U.S. counties and estimated travel times between hospitals and the nearest Level 1 trauma center as per 2014–2016, using Google Maps Distance Matrix API. Average numbers of severe malaria cases at identified hospitals per US county annually as reported to the CDC during 2012–2018. Panel A shows the geographic distribution and average number of severe malaria cases at identified hospitals per year by county reported to CDC during 2012–2018; darker color shows counties with more severe malaria cases reported. Panel B shows that the distribution is highly skewed to 2 counties that reported more than 10 inpatient cases annually; 2,824 counties (pale peach) reported no cases of severe malaria admitted to an identified hospital during 2012–2018. Results After excluding 379 cases with no recorded hospital name from 1,912 severe malaria cases, we successfully adjudicated hospitals for 1,460/1,533 cases (Fig 1). Two counties reported >10 inpatient cases per year (Bronx County, NY and New York County, NY), and 2,824 counties never reported a hospitalized severe malaria case (Fig 2). Almost 35% of inpatient cases occurred at Level 1 trauma centers (508/1,460 [34.8%]) (Fig 3). Of the 952/1,460 (65.2%) inpatient cases not at Level 1 trauma centers, 891/952 (93.5%) were at hospitals located < 2h estimated driving time of a Level 1 trauma center. Only 61/1,460 (4.2%) cases were at locations >2h from a Level 1 trauma center. Limitations include that the analysis did not consider the original site of clinical presentation with malaria or locations of people with severe malaria not hospitalized. Histogram of modeled travel times between each severe malaria case at an identified hospital and the nearest Level 1 trauma center. Of severe malaria cases reported to CDC in 2012–2018 and hospitalized at an identified hospital, 34.8% were treated at Level 1 trauma centers (red bar); for severe malaria cases that were not at Level 1 trauma centers, we found that modeled transit times between treatment site and Level 1 trauma center were less than 2 hours except in 4.2% of severe malaria cases at an identified hospital (right of black dashed vertical line). Conclusion More than 95% of people admitted for severe malaria at identified hospitals reported to the CDC in 2012–2018 were at or within 2h estimated driving time of a Level 1 trauma center, which may suggest priorities for implementing IVAS distribution. Disclosures Alison Ridpath, MD, MPH, Abbvie Inc.: Stocks/Bonds (Public Company)|Amarin Corperation PLC: Stocks/Bonds (Public Company)|Amgen Inc: Stocks/Bonds (Public Company)|BioNTech: Stocks/Bonds (Public Company)|Immunic Inc: Stocks/Bonds (Public Company)|infinity Pharmaceutical Companies: Stocks/Bonds (Public Company)|IQVIA Holdings Inc: Stocks/Bonds (Public Company)|Johnson and Johnson: Stocks/Bonds (Public Company)|Merck and Co inc: Stocks/Bonds (Public Company)|Pfizer Inc.: Stocks/Bonds (Public Company)|Protagonist Therapeutics: Stocks/Bonds (Public Company)

Microbial community structure and functional characteristics in a membrane bioreactor used for real rural wastewater treatment.

Membrane bioreactors (MBRs) have been widely used in the field of wastewater treatment because of their small footprint and high treatment efficiency. In this research, 10 rural wastewater treatment sites in China that employ the MBR process were systematically studied. Specifically, treatment of actual domestic wastewater using MBRs was examined by high-throughput 16S rRNA gene sequencing to explore the microbial community composition and perform function prediction. The data of water quality parameters revealed high removal rates of chemical oxygen demand and NH4+-N in all the sites. Proteobacteria were absolutely dominant in all the sites. Thauera, Nitrospira, Ferribacterium, and Dechloromonas were the main functional genera responsible for nitrogen and phosphorus removal at the tested sites. Nitrospira includes conventional nitrite-oxidizing bacteria and complete ammonia-oxidizing bacteria. Among them, 26 genes related to nitrogen metabolism were retrieved according to gene prediction, which verified the good NH4+-N removal efficiency at the tested sites. This study focuses on the analysis of microbial community structure and functional characteristics of MBR-based treatment systems for rural wastewater treatment, thereby providing a microbial basis for improving rural wastewater treatment processes.

Abstract B003: Landscape of chemoradiation plus immunotherapy trials across multiple locally advanced cancer types: The more, the better?

Abstract Purpose: Checkpoint inhibitors (ICIs) are being added to standard-of-care chemoradiotherapy in multiple clinical trials. The optimal sequencing of immunotherapy and chemoradiotherapy remains widely debated. Therefore, we compiled available trials and reviewed various aspects that may be associated with outcomes. Methods: We conducted a systematic literature review of randomized controlled Phase 3 trials (RCTs) in PubMed, ClinicalTrials.gov and Google scholar from 1/1/2018 to 11/8/2024. We included all available seminal randomized controlled trials with matured data, encompassing locally advanced non–small and small cell lung carcinomas, head and neck, endometrial and cervical cancers treated with chemoradiotherapy plus ICI. Performance of these trials with different ICI timing was analyzed in a high level and stratified by radiation treatment sites, oncovirus driven histology, anti PD1/PD-L1 agents and treatment discontinuation rate. Results: Eleven seminal randomized clinical trials across 6 different cancer types with 7891 patients were included. Among 5 trials with thoracic RT, 2 trials(PACIFIC and ADRIATIC) with only consolidative design proved PFS superiority over placebo, while PACIFIC-2 and LU-005 with concurrent and maintenance design did not. Moreover, CheckMate-73L failed to prove the superiority of concurrent and maintenance ICI over consolidative ICI. Among 3 head & neck trials all with induction + concurrent + maintenance design, only CONTINUUM trial treating nasopharyngeal cancer with 3 cycles of induction ICI proved EFS superiority. Among 3 gynecological trials all with concurrent + maintenance design, only anti PD-1 agent showed PFS superiority in cervical cancer (KEYNOTE-A18) and dMMR endometrial cancer (KEYNOTE-B21) in pre-planned analysis. The trials with concurrent ICI approaches failed in all non-viral driven cancers (NSCLC, SCLC and overall endometrial), but succeeded in EBV-rich Asian nasopharyngeal cancer (CONTINUUM) and HPV-driven cervical cancer (KEYNOTE-A18 and CALLA post hoc analysis of PD-L1 TAP ≥20%). However, this success was not found in HPV-driven head & neck squamous cell cancer (HPV subgroup of either KEYNOTE-412 or JAVELIN). For consolidative ICI trials in thorax, the treatment discontinuation rate was significantly lower in experimental arm compared to control arm (population weighted p=0.0003), mainly due to less tumor progression. For the trials with concurrent ICI, the treatment discontinuation rate was significantly higher in experimental arm (population weighted p=0.001), mainly due to more adverse events. Conclusion: Despite multifactorial heterogeneity, this review provides insights for designing future trials in locally advanced cancers. Consolidative ICI approaches generally showed superiority in thoracic cancers, while concurrent ICI approaches often failed in non-viral-driven cancers likely due to higher adverse events and discontinuation rates but showed efficacy in EBV-rich nasopharyngeal and HPV-driven cervical cancers. As more trial data matures, the existing trends will be further tested. Citation Format: Bin Gui, Bhupesh Parashar. Landscape of chemoradiation plus immunotherapy trials across multiple locally advanced cancer types: The more, the better? [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr B003.

Radiometric assessment of the sewage treatment site at Ahmadu Bello University, Zaria

Radiometric assessment of the sewage treatment site at Ahmadu Bello University, Zaria

Separation Surgery Followed by Conformal Postoperative Spine Stereotactic Body Radiation Therapy Does Not Increase Risk of Adjacent Spine Level Progression in the Management of Spine Metastases.

To determine if piecemeal separation surgery, in conjunction with smaller treatment volumes utilized with spine stereotactic radiation therapy (S-SBRT), increased the risk of adjacent level progression (ALP). We performed a retrospective analysis of a prospectively maintained database of adult spine oncologic patients who underwent SBRT to the spine at University of Michigan from 2010 to 2021. We compared ALP in patients undergoing SBRT who had pretreatment surgery with those who did not. Four hundred and ninety-eight treatment sites were identified in 417 patients. Of these, 366 (73.5%) were treated with SBRT alone and 132 (26.5%) were treated with surgery followed by S-SBRT. Patients treated with SBRT alone were significantly older (63.3y) compared with the surgery plus SBRT group (60.2y; P=0.02). More radiosensitive histologies were treated with SBRT alone (34%) compared with 11% for the surgery plus SBRT group (P<0.001). Lesions treated in the surgery plus SBRT group had significantly more severe metastatic epidural spinal cord compression (65%) compared with the SBRT only group (8%) (P<0.001). Both infield progression (9.3% vs. 7.6%; P=0.43) and ALP (21.3% vs. 18.9%; P=0.37) were not significantly different between groups. Spine oncology patients treated with surgery followed by conformal postoperative S-SBRT had similar infield and ALP compared with patients receiving SBRT alone, suggesting that piecemeal separation surgery does not locally spread tumor cells, leading to an increased risk of ALP failure, and supporting the use of conformal postoperative S-SBRT.

Fluoxetine and fractures after stroke: an individual patient data meta-analysis of three large randomised controlled trials of fluoxetine for stroke recovery.

Observational studies have shown that selective serotonin reuptake inhibitors are associated with an increased risk of bone fractures, but the association can be confounded by indication and other sources of systematic bias that can be minimised in randomised controlled trials (RCTs). Our aim was to report the rate, site, context, and predictors of fractures after stroke, and whether the fractures modified the effect of fluoxetine on modified Rankin score (mRS) at six months in an individual patient data meta-analysis of 5907 patients enrolled in three RCTs of fluoxetine (20mg for six months) for stroke recovery. We classified fractures by treatment allocation, site (and thus likelihood of osteoporosis) and context, then performed multivariable analyses to explore independent predictors of fractures. We explored whether the trend towards a poorer mRS at 6 months was explained by a fracture excess. Risk of bias was assessed using GRADE. Among 5907 patients randomised at a mean of 6.6 days (SD3.6) post-stroke onset and followed for six months, the number with fractures at 6 months was 93 (3.15%) in the fluoxetine group vs 41 (1.39%) in the control group (difference 1.76%, 95% CI 0.10 to 2.51%). 128 patients with fractures were suitable for further analyses. Of these 102 (80%) were in sites typically affected by osteoporosis; 115 (90%) were associated with falls and one (1%) with a seizure. Independent fracture risk factors were female sex (hazard ratio (HR) 1.96; 95% CI 1.37 to 2.81, p=0.0002), age>70 years (HR 2.30, 95% CI 1.52 to 3.49, p<0.001), previous fractures (HR 0.63 for no previous fractures, 95% CI 0.42 to 0.94, p=0.0227), and randomised treatment (fluoxetine) (HR 2.39; 95% CI 1.64 to 3.49, p<0.001). The common odds ratio for the effect of fluoxetine on mRS at 6 months was unchanged after excluding fracture patients. Risk of bias was high for imprecision. Fractures were more common in the fluoxetine group but the absolute risk of fractures was small and risk estimates were imprecise. Most fractures occurred with a fall, and in osteoporotic locations. Fractures did not modify the effect of fluoxetine on functional outcome.

Response of Hard-Bottom Macro-Zoobenthos to the Transition of a Mediterranean Mariculture Fish Plant (Mar Grande of Taranto, Ionian Sea) into an Integrated Multi-Trophic Aquaculture (IMTA) System

: This study investigates the effects on hard-bottom macro-zoobenthic communities of converting a mariculture plant into an Integrated Multi-Trophic Aquaculture (IMTA) system. This study was conducted from 2018 to 2021 in the semi-enclosed Mar Grande basin of Taranto (northern Ionian Sea), on a facility located 600 m off the coastline, with a production capacity of 100 tons per year of seabass (Dicentrarchus labrax) and seabream (Sparus aurata). The results from seasonal sampling performed in a treatment site, where bioremediators (filter-feeding invertebrates such as sponges, polychaetes, mussels, and macroalgae) were deployed, and a control site without bioremediators were compared. Before the IMTA installation, the hard substrates under the cages were sparsely inhabited, with significant sediment coverage. By 2021, the treatment site exhibited revitalized and more diverse macro-zoobenthic communities, with species richness increasing from 83 taxa in 2018 to 104 taxa, including notable growth in sponges, annelids, mollusks, and bryozoans. In contrast, the control site showed no substantial changes in biodiversity over the same period. Biodiversity indices, including Shannon and Margalef indices, improved significantly at the treatment site, particularly during summer months, highlighting a more resilient and balanced benthic environment. Taxonomic distinctness (delta+) and multivariate analyses (PERMANOVA, PCO) confirmed significant spatial and temporal shifts in community structure at the treatment site, driven by IMTA implementation. SIMPER analysis identified key taxa contributing to these changes, which played a pivotal role in structuring the community. The emergence of filter feeders, predators, and omnivores at the treatment site suggests enhanced nutrient cycling and trophic complexity, while the decline in opportunistic species further supports improved environmental conditions. These findings demonstrate the potential of IMTA to promote recovery and sustainable mariculture practices, also offering a comprehensive understanding of its positive effects on hard-bottom benthic community dynamics.

Immobilisation of arsenic and simultaneous degradation of polycyclic aromatic hydrocarbons in soil in situ by modified electrooxidation.

Improper management of wood impregnation chemicals and treated wood has led to soil contamination at many wood treatment sites, particularly with toxic substances like creosote oil and chromated copper arsenate (CCA). The simultaneous presence of these pollutants complicates the choice of soil remediation technologies, especially if they are to be applied in situ. In this laboratory study, we attempted to immobilise arsenic (As) and simultaneously degrade polycyclic aromatic hydrocarbons (PAHs) (constituents of creosote oil) by applying a modified electrochemical oxidation method. The supply of iron (Fe) amendments in contaminated soil was done using corroding Fe electrodes as an Fe source and applying an alternating polarity electrical current. Soil with a large fraction of organic matter (25%) and containing 505mgkg-1 As and 5160 mgkg-1 16-PAHs was placed in Plexiglas cells equipped with porewater samplers and an iron electrode pair connected to a power supply unit. The porewater and percolating solution were periodically sampled and analysed over an 8-week period. The modified electrochemical soil treatment led to a decrease in the total concentration of 16-PAHs in soil by 56-68%. The amount of poorly crystalline Fe oxides in the soil substantially increased, especially close to the electrodes, enabling 76-89% of As to be bound to this most reactive Fe fraction. Nevertheless, over 10% of soil As remained in the most soluble and available fraction (exchangeable), most likely due to the decline in soil redox potential over time. This study suggests that electrochemical oxidation of organic soil with mixed contaminants could be used for in situ soil remediation but needs further improvement to achieve more efficient As immobilisation.

Young, Empowered & strong (YES): a study protocol paper for a randomized controlled trial of an mHealth symptom monitoring and self-management intervention for adolescent and young adult (AYA) breast cancer survivors

BackgroundCompared to older adults with breast cancer (BC), adolescents and young adults (AYAs) develop more aggressive disease necessitating more intensive therapy with curative intent, which is disruptive to planned life trajectories. The burden of unmet needs among AYA BC survivors exists in two domains: (1) symptoms (e.g., sexual problems, anxiety, fatigue, stress, hot flashes) and (2) AYA concerns (e.g., fertility, genetics, relationships, economic attainment). Improved attention to concerns and symptoms may improve symptom management and quality of life. The Young, Empowered and Strong (YES) trial tests the efficacy of a 9-month, multicomponent digital health intervention that includes monthly assessments of prevalent symptoms, a chat room, and journal to engage and support AYAs with BC by providing tailored information, resources, and support outside of the clinical setting.MethodsYES is a multicenter, randomized controlled trial across three academic institutions in the United States with 400 participants randomized to either the YES intervention or usual care arm. Inclusion criteria include biologically female; 15–39 years of age at diagnosis of stage 0-III BC; within 3 years of diagnosis; no known evidence of recurrence; no prior history of new malignancy since initial BC diagnosis; and ability to access medical records from treatment site. All participants complete REDCap surveys at baseline, and at 3, 6, and 9 months post-enrollment. The primary outcome is quality of life as measured by the Quality of Life in Adult Cancer Survivors Scale (QLACS), with changes from baseline to 6-months in QLACS scores, compared by arm. Secondary outcomes include patient reported AYA concerns/needs, emotional symptoms, general health, physical symptoms, and health behaviors,DiscussionStudy findings will provide valuable insight into the ability of the YES digital health intervention to address symptoms and concerns of AYA BC survivors and assist them to track and self-manage their own symptoms, concerns, and needs related to their cancer outside of the clinic.Trial registrationClinicaltrials.gov, NCT04906200, registered May 13, 2021.

Diagnosis and treatment of pediatric arterial stenosis associated with neurofibromatosis type 1

BackgroundNeurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder affecting multiple systems. However, arterial stenosis is a rare manifestation in patients with NF1. Since the symptoms of arterial stenosis caused by NF1 are often atypical and have a high under-diagnosis rate, this can lead to serious complications such as hypertension, ischemic stroke, or even death. The aim of our research is to analyse the clinical characteristics of arterial stenosis in pediatric patients with NF1 and to summarise its diagnosis, treatment and prognosis.MethodsWe conducted a retrospective review of data from patients with NF1 treated at Beijing Children’s Hospital from 2016 to 2020. Patients diagnosed with arterial stenosis, identified through clinical symptoms, physical examination, arterial ultrasonography, or imaging studies, were included in this study. These patients received symptomatic drug and/or surgical treatments and were followed up regularly. We summarized demographic characteristics, sites of arterial stenosis, clinical manifestations, and treatment outcomes.ResultAmong the 258 patients with NF1 treated at our hospital, 12 (4.7%) had arterial stenosis, comprising 9 males and 3 females with a median age of 7 years (range: 1–14 years). Renal artery stenosis was diagnosed in 7 patients (58.3%), while internal carotid artery (ICA) stenosis was diagnosed in 5 patients (41.7%). The predominant symptoms of renal artery and ICA stenosis were renal hypertension and convulsions, respectively. Antihypertensive drugs were effective in 5 patients with renal hypertension; 2 patients required balloon dilatation of the renal artery due to inadequate response to medication. Oral antiepileptic treatment was effective in 3 patients with ICA stenosis, and encephaloduroarteriosynangiosis was effective in the remaining 2 cases. The follow-up period ranged from 2 to 6 years, with a median duration of 3 years. No deterioration or mortality was observed during the follow-up period.ConclusionsArterial stenosis was present in approximately 4.7% of patients with NF1, predominantly affecting the renal artery and ICA. Renal hypertension and convulsions were the primary symptoms of renal artery and ICA stenosis, respectively. Early diagnosis and intervention can substantially improve the prognosis of these patients.

Efficacy and Safety of UVA1 Phototherapy Adjunct Treatment for Acute Cutaneous Inflammations and Neuralgia of Herpes Zoster: A Prospective, Randomized, Open-Label, Blinded End-Point Study.

Background: Previous case reports hint ultraviolet A1 (UVA1) phototherapy as a novel adjunct treatment for acute cutaneous inflammations and neuralgia of herpes zoster, but its clinical effectiveness and safety in this condition are not yet proven by clinical trials. Objectives: To determine the efficacy and safety of UVA1 phototherapy as an adjunct treatment for acute inflammation and neuralgia in herpes zoster. Methods: A total of 60 patients with moderate-to-severe acute herpes zoster were randomly divided into two parallel groups. Group I received regular treatment and UVA1, and Group II received regular treatment alone. Time of blister crusting and acute erythema subside, assessment of pain, sleep, anxiety, and quality of life were recorded accordingly. Results: In Groups I and II, 28 and 29 patients completed the treatment and follow-up, respectively, with no significant demographic or baseline differences. UVA1 therapy notably reduced blister crusting time and acute erythema subside time and achieved more rapid pain relief within the first 2 weeks. However, it did not significantly alter the rate of postherpetic neuralgia occurrence. Additionally, UVA1 therapy significantly improved anxiety and quality of life scores at the 2-week mark. The primary adverse effects were mild burning and hyperpigmentation at the treatment site. Conclusions: UVA1 phototherapy as an adjunct treatment can expedite the resolution of acute inflammatory cutaneous lesions and neuralgia associated with herpes zoster, providing swifter relief from anxiety and enhancing patient quality of life during the acute phase, with demonstrated good tolerability and safety.

Complete genome of a fluorescent Pseudomonas sp. isolated from a PFAS groundwater treatment site.

Pseudomonas sp. CBR-F is a bacterial species isolated from a water treatment plant targeting for per- and poly-fluoroalkyl substances, a difficult-to-degrade family of anthropogenic compounds. Here, we report a complete genome for Pseudomonas sp. CBR-F, sequenced with Oxford Nanopore Technology. The genome consists of one 6.91 Mbp chromosome.

MR-guided Transrectal Focal Laser Ablation for Localized Low- and Intermediate Risk Prostate Cancer: Initial Outcomes Using an Integrated Laser Ablation System.

To investigate the feasibility and safety of MRI-guided focal laser ablation (FLA) in localized, International Society of Urological Pathology (ISUP) grade 1-3, prostate cancer (PCa) using an integrated system. Ten consecutive males (mean age: 66±7 years) with low-to-intermediate risk PCa were prospectively included (April 2022-May 2023) and treated with MRI-guided FLA using an integrated system for laser energy control and MR thermometry monitoring. Primary endpoints were technical success, procedure-related adverse events (AEs) following SIR (Society of Interventional Radiology) classification, and 12-months local tumor progression-free survival (LTPFS), defined as no evident residual/ recurrent disease on follow-up imaging or histopathology at the treatment site. Secondary endpoints included MRI-derived percentual volumetric tumor coverage, prostate-specific antigen (PSA), sexual and urinary function response measured by the International Prostate Symptom Score index and Sexual Health Inventory for Men (SHIM) questionnaires. Technical success was achieved in 10/10 (100%) patients (ISUP grade 1 (n=1), 2 (n=8) and 3 (n=1)). Three AEs were observed: urinary tract infection (n=2; SIR grade B) and acute urinary retention (n=1; SIR grade D). Cumulative 12-month LTPFS was 80% (8/10 patients). Median tumor coverage was 100% (IQR: 95-100%). Compared to baseline, the mean PSA level decreased, but did not reach statistical significance (6.6 vs. 4.4 ng/mL; p=0.06), and mean urinary (8.6 vs. 7.3; p=0.60) and sexual function (11.3 vs. 10.5; p=1.00) scores were non-significantly altered at 12 months follow-up. MRI-guided FLA in patients with low-to-intermediate risk PCa using an integrated system was feasible and safe and indicates promising short-term oncological and functional outcomes.

Characterization of LIPUS Parameters Suitable for Hip Bone Fracture.

To investigate the effects of ultrasound treatment on the healing of hip bone fractures using frequencies of 0.5 MHz and 1.5 MHz with constant intensity (30 mW/cm2) at the fractured site. For the ex vivo experiments, acoustic attenuations of 0.5 MHz and 1.5 MHz ultrasound were measured and compared using different thicknesses of human cadaver and porcine tissues in a hydrophone system. For the in vivo experiments, 20 hip-fractured rabbits were divided into four groups, namely: control, 1.5 MHz with unchangeable intensity (positive control), 0.5 MHz with changeable intensity, and 1.5 MHz with changeable intensity. For the 0.5 and 1.5 MHz groups with changeable intensity, a constant intensity of 30 mW/cm2 at the fracture site was achieved using a compensation method for power transmission with reference to the acoustic attenuation. The effective intensity measured using a hydrophone was substantially reduced to 6.16 mW/cm2 from 30 mW/cm2 in the positive control device after propagating soft tissues with a thickness of 5.0 cm, with an attenuation of approximately 6.0 dB. Meanwhile, for the 0.5 and 1.5 MHz groups, the ultrasound intensity was consistently controlled at 30 mW/cm2 after passing through tissues with different thicknesses using the compensation method. In the in vivo study using a newly established hip fracture rabbit model, the best results in bone histomorphometry, mechanical properties, and histological evaluation were consistently found in the 0.5 MHz group, while the 1.5 MHz group exhibited relatively better bone healing than the positive control group. The results suggest a LIPUS frequency of 0.5 MHz together with the consistent intensity of 30 mW/cm2 at the fracture site for more effective treatment of hip bone fractures.

Study protocol for a multi-center stepped-wedge cluster randomized trial to explore the usability and outcomes among young people living with HIV in Kiambu and Kirinyaga counties of Kenya, using an online health portal.

While the incidence of Human Immunodeficiency Virus (HIV) infection is decreasing in most age groups worldwide, it is rising among adolescents and young adults, who also face a higher rate of HIV-related deaths. This tech-savvy demographic may benefit from an online patient portal designed to enhance patient activation-empowering them to manage their health independently. However, the effectiveness of such digital health interventions on young HIV patients in Kenya remains uncertain. We will conduct a 12-month stepped wedge cluster randomized trial involving 15-24-year-old HIV patients with smartphone access. The primary outcome will be patient activation, with secondary outcomes including self-reported adherence, social engagement and viral suppression. We will also evaluate the portal's functionality, usability, fidelity, and costs. Participants will be recruited from 47 antiretroviral treatment (ART) sites with electronic medical records (EMR), forming 16 clusters of 30 participants each. Clusters will be randomized into three sequences for intervention every three months. Baseline measurements (patient activation, adherence, social engagement and viral suppression) will be collected over two weeks, followed by checks at 3, 6, and 12 months. Data will be analyzed using generalized linear mixed models and adjusted for cluster effects and potential confounders. Results will be disseminated through stakeholder forums, scientific conferences, peer-reviewed publications, and the media.

ASSISTED LIVING STAFF VIEWS OF FAMILY INVOLVEMENT IN PALLIATIVE CARE FOR RESIDENTS WITH DEMENTIA

Abstract Of the close to 300,000 residents in assisted living (AL) living with dementia, an estimated 40% will die there and be in need of end-of-life care. Family of residents living with dementia are an important part of the care convoy in AL. This qualitative study aimed to understand staff perspectives about family involvement in end-of-life care. The Palliative Care Education in Assisted Living for Dementia Care Providers intervention study (2019-21) included a sample of 17 AL staff from six treatment sites in Florida who completed four homework assignments. Two of the assignments were writing assignments that 1) asked about a good death for residents and 2) asked staff specifically to identify one resident with dementia who they could do one thing to make them comfortable. A priori codes were used based on the physical, emotional, social and spiritual care domains of palliative care asked about in the homework assignments. The data was coded using Atlas.ti version 23. Family was involved in all four domains of palliative care. Social and emotional aspects of care were the most prominent (e.g., playing music, visits, care coordination, delivery of food) followed by spiritual care (e.g., pray together, attend religious services). Physical care tasks by family were reported less often. Less physically demanding care tasks were performed by the family (e.g., grooming, dressing) with family reliance on direct care staff and hospice providers for more physically demanding care (bathing, transfers), and for pain management. We will discuss the role family play in AL care provision.