Total Enrollment Research Articles

Imaging of solid tumors using 68Ga-FAP-2286.

3059 Background: Fibroblast Activation Protein (FAP) is a transmembrane protein overexpressed on cancer associated fibroblasts (CAFs), and is abundantly present in many epithelial cancers, suggesting FAP is an attractive imaging and therapeutic target. FAP-2286 is a cyclic peptide that binds to FAP and is currently being evaluated as a radioligand therapy to treat patients (pts) with FAP-positive solid tumors. The role of 68Ga-FAP-2286 as a diagnostic agent is unknown. We present an interim analysis of the ability of 68Ga-FAP-2286 to detect metastatic disease across multiple cancer types. Methods: This is a first in human Phase I/II study of 68Ga-FAP-2286 (NCT04621435) with a planned total enrollment of 65 pts across 3 cohorts: dosimetry cohort (n = 5), cohort with RECIST measurable disease (n = 30) and a cohort at risk for metastases without measurable disease (n = 30). By the cutoff date of February 12, 2022, 27 pts were enrolled (3 in cohort 1, 15 in cohort 2 and 9 in cohort 3). For each pt, the five largest lesions were included for analysis, and for each lesion, the maximum standardized uptake value (SUVmax) of the 68Ga-FAP-2286 and the size (short axis for lymph nodes) were documented. In pts who had an available FDG PET performed within 8 weeks of 68Ga-FAP-2286 PET, uptake on the two scans was compared. Results: Of the 27 enrolled pts, 9 had bladder cancer, 5 sarcoma, 4 head and neck squamous cell cancer (HNSCCA), 3 breast cancer (BC), and 3 castration resistant prostate cancer (CRPC). Most pts (89%, 24/27) had tumors positive for uptake on 68Ga-FAP-2286 PET, including 30 lesions < 1.5 cm, and 17 less than 1.0 cm. 16 pts had a paired FDG PET. In these pts, the average SUVmax on 68Ga-FAP-2286 PET was 244% higher than on FDG PET. Only two pts had higher uptake on FDG PET than on 68Ga-FAP-2286 PET (HNSCCA and DSRCT). The highest relative uptake was seen in 2 pts with BC (both 3.4 times higher on 68Ga-FAP-2286 PET); the average SUVmax in BC was 16.6. The lowest uptake on 68Ga-FAP-2286 PET was CRPC with an average SUVmax of 7.0. Sarcoma had variable uptake with one pt having an SUVmax of 4.5 (Ewing’s), while two pts had an SUVmax over 30 (both undifferentiated pleomorphic). Although sarcoma had high uptake on 68Ga-FAP-2286 PET, it was similar to FDG PET uptake across the 5 pts (ratio to FDG PET = 1.0). Conclusions: 68Ga-FAP-2286 is a promising imaging agent across cancers, although its benefit is not seen equally. BC had the highest absolute uptake and highest relative uptake compared to FDG PET; prostate cancer had the lowest uptake. Further work should be undertaken to define the settings where 68Ga-FAP-2286 PET may inform clinical decision making, and which pts may benefit from FAP-targeted radioligand therapy. Clinical trial information: NCT04621435.

Overall Survival in Phase 3 Clinical Trials and the Surveillance, Epidemiology, and End Results Database in Patients With Metastatic Colorectal Cancer, 1986-2016

Phase 3 trials for patients with metastatic colorectal cancer (mCRC) have been conducted with varying designs and often with surrogate end points for overall survival (OS). To critically examine the factors associated with clinically relevant improvement in OS (defined as ≥2 months) in these trials and to evaluate their association with outcomes reflected in Surveillance, Epidemiology, and End Results (SEER) registry data. Medline, EMBASE, Cochrane, Web of Science, ClinicalTrials.gov, EU Clinical Trials Register, and the International Clinical Trials Registry Platform were searched for phase 3 trials of systemic therapy for patients with mCRC by decade (1986-1996, 1997-2006, and 2007-2016), excluding early or pilot studies, studies that did not involve an anticancer drug, studies on cancer screening and prevention, reports of pooled data from multiple trials, and studies with nonpharmaceutical approaches. The association of drug development with OS outside the clinical trial setting was evaluated using data from the SEER registry, including adult patients with a primary cancer site in the colon or rectum, including adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma; a distant stage; and receipt of chemotherapy as first-line therapy. Kaplan-Meier curves and log-rank tests were used to assess OS. The literature search identified 150 phase III clinical trials with 77 494 total enrollments, and 67 126 patients with mCRC were identified from the SEER database. Significant increases in survival were noted over time, best reflected in the experimental arm of first-line therapy (OS increased by 5.7 months per 10 years; 95% CI, 4.7-6.6 months; progression-free survival increased by 1.4 months per 10 years; 95% CI, 0.7-2.1 months). Although 69 of 148 trials (46.6%) met their predefined primary end point (including 20 of 44 trials [45.5%] with OS as the primary end point), only 35 of 132 trials (26.5%) resulted in improvement in OS by 2 months or more (including 13 of 42 trials [31.0%] with OS as the primary end point). Multivariable logistic regression showed that third-line therapies or later (odds ratio, 0.57; 95% CI, 0.51-0.63) and funding by pharmaceutical companies (odds ratio, 0.57; 95% CI, 0.54-0.60) were less often associated with improvement in OS. Furthermore, there was a decrease in the novelty of targets and agents over time, with trials that evaluated regimens composed entirely of previously approved drugs for mCRC increasing from 28% to 50%. Data from the SEER database showed that median OS increased from 12 months (95% CI, 12-13 months) (1986-1996) to 21 months (95% CI, 21-22 months) (2007-2015) (P < .001), but the 5-year OS continued to be low at 12.2% in 2011. In this systematic review, OS for patients with mCRC appeared to improve significantly in trials, translating into meaningful benefits outside the clinical trial setting; however, these advances, although significant cumulatively, are largely incremental individually. These data should be a call to aim for larger gains from future trials with novel drugs, building on the increasing understanding of the biology of mCRC and sophisticated translational research tools.

Segregation and success in Tasmanian primary school sport carnivals

ABSTRACT Australian schooling is one of the most segregated systems in the OECD, with much focus on the inequality between schools from poorer areas compared with those from wealthier suburbs. These inequalities have been explored in terms of infrastructure and funding, as well as their relative academic achievement. Previous research has also found that children from more disadvantaged backgrounds are more likely to have poorer health than their wealthier peers. To determine whether there is a connection between these findings, this study investigates the impact of social and educational advantage on participation and success in primary school sports carnivals in Tasmania. It examined the results of Tasmanian primary schools across interschool cross-country carnivals between 2009 and 2019 and found that structural segregation existed across all competitions. Multiple regression was used to see if the Index of Community Socio-Educational Advantage (ICSEA), total school enrolments and geographic location predicted school cross-country rank. It was found that school size, geographic region and ICSEA all played an independent role in determining the participation and success of schools. Implications of these findings are discussed.

Parental Occupation and Parental Involvement in Education Among Public Day Secondary Schools in Moyale Sub-County, Marsabit County, Kenya

Several obstacles have been proposed as potential roadblocks to parental involvement in schooling. This study sought to examine the influence of parental occupation on parental involvement in education among public day secondary schools in Moyale Sub-County, Marsabit County. This study used a descriptive cross-sectional design. The target population included 10 public day schools with a total enrollment of 1861 students. The sample size was 329 students, who were selected using simple random sampling. The findings indicated that parental occupation had a positive and significant relationship with parental involvement in education. The study concluded that parental occupation contributed significantly to parental involvement in education. The study recommended that school management should create awareness among parents about the role their occupation plays in their children’s education. Parents should be able to strike a balance between work and getting involved in the education of their children.

School-Level Predictors of Speech-Language Therapy Enrollment

Purpose: There are extensive concerns about the size of speech-language caseloads in schools. However, little empirical data exist regarding the patterns of speech-language services enrollment. We reviewed data from several hundred schools in a large state to explore the role of school-level factors in speech-language case enrollment. Method: Child count and enrollment data reports from a stratified sample of schools located within 12 Florida school districts ( N = 808) were drawn from the Florida Department of Education portal for the 2018–2019 school year. Three school districts were selected from each of several population sizes. To control for school population size, the raw numbers for each variable were converted into proportions. To examine the relations among variables, multiple correlational and regression analyses were conducted. Results: The results indicated that two school-level factors significantly predicted the total speech-language services enrollment and language therapy enrollment (e.g., proportion of students of low socioeconomic status [SES], passing the state reading assessment), whereas three school factors significantly predicted the speech therapy enrollment (e.g., proportion of low-SES students, passing the reading assessment, and enrolled in English as a second or other language services). Conclusions: The outcomes of this study suggested that school factors can predict speech-language service enrollment, which offers important implications for decision makers in schools. Implications for educational practices and further research are presented.

Affirmative Action Bans and Enrollment of Students From Underrepresented Racial and Ethnic Groups in U.S. Public Medical Schools.

The percentage of U.S. physicians who identify as being from an underrepresented racial or ethnic group remains low relative to their proportion in the U.S. population. How this percentage may have been affected by state bans on affirmative action in public postsecondary institutions has received relatively little attention. To examine the association between state affirmative action bans and percentage of enrollment in U.S. public medical schools from underrepresented racial and ethnic groups. Event study comparing public medical schools in states that implemented affirmative action bans with those in states without bans. U.S. public medical schools. 21 public medical schools in 8 states with affirmative action bans matched to 32 public medical schools in 24 states without bans from 1985 to 2019. Percentage of total enrollment from racial and ethnic groups underrepresented in medicine (Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander). The percentage of enrollment from underrepresented racial and ethnic groups was 14.8% in U.S. public medical schools in the year before ban implementation in states with bans. The adjusted percentage of underrepresented students in ban schools decreased by 4.8 percentage points (95% CI, -6.3 to -3.2 percentage points) 5 years after ban implementation relative to the year before implementation, whereas the adjusted percentage in control schools increased by 0.7 percentage point (CI, -0.1 to 1.6 percentage points), for a relative difference, or difference-in-differences estimate, of -5.5 percentage points (CI, -7.1 to -3.9 percentage points). Inability to account for the effect of these bans on undergraduate enrollment. State affirmative action bans were associated with significant reductions in the percentage of students in U.S. public medical schools from underrepresented racial and ethnic groups. None.

ReducinG stroke by screening for UndiAgnosed atRial fibrillation in elderly inDividuals (GUARD-AF): Rationale and design of the GUARD-AF randomized trial of screening for atrial fibrillation with a 14-day patch-based continuous ECG monitor

BackgroundScreening for atrial fibrillation (AF) is attractive because AF independently raises the risk of ischemic stroke, this risk is largely reversible by long-term oral anticoagulant therapy (OAC), and many patients with AF remain undiagnosed and untreated. Recent trials of one-time brief screening for AF have not produced a significant increase in the proportion of patients diagnosed with AF. Trials of longer-term screening have demonstrated an increase in AF diagnoses, primarily paroxysmal AF. To date, however, no trials have demonstrated that screening for AF results in lower rates of stroke. Clinical practice guidelines conflict in their level of support for screening for AF. MethodsThe GUARD-AF individually randomized trial is designed to test whether screening for AF in individuals age 70 years or greater using a 2-week single-lead electrocardiographic patch monitor can identify patients with undiagnosed AF and lead to treatment with OAC, resulting in a reduced rate of stroke in the screened population. The trial's efficacy end point is hospitalization for stroke (either ischemic or hemorrhagic) and the trial's safety end point is hospitalization for a bleeding event. End points will be ascertained via Medicare claims or electronic health records at 2.5 years after study start. Enrollment is based in primary care practices and the OAC decision for screen-detected cases is left to the patient and their physician. The initial planned target sample size was 52,000, with 26,000 allocated to either screening or to usual care. ResultsTrial enrollment was severely hampered by the novel coronavirus disease 2019 (COVID-19) pandemic and stopped at a total enrollment of 11,931 participants. Of 5,965 randomized to the screening arm, 5,713 patients (96%) returned monitors with analyzable results. Incidence of screen-detected and clinically detected AF and associated stroke and bleeding outcomes will be ascertained. ConclusionsGUARD-AF is the largest AF screening randomized trial using a longer-term patch-based continuous electrocardiographic monitor. The results will contribute important information on the yield of patch-based AF screening, the “burden” of AF detected (percent time in AF, longest episode), and physicians’ OAC decisions as a function of AF burden. GUARD-AF's stroke and bleed results will contribute to pooled trial analyses of AF screening, thereby informing future studies and guidelines.

The current dental school admissions: An overview of the admission process and the geographical distribution of dental school enrollees in Taiwan

Background/purposeThere is no specific admission system for dentistry in Taiwan. The aims of this study were to describe and analyze the current admission processes for entry into dental schools through the university admission system and to compare the geographical distribution of dental school enrollees. Materials and methodsAll seven dental schools of general universities in Taiwan were included to analyze the admission protocols in 2019 and 2020. All data of dental enrollment quotas and dental school enrollees presented in this study were collected from information available to the public on the related websites. ResultsThe total dental enrollment quotas via the university admission system were 381 in 2019 and 397 in 2020. Those admitted via the special program for indigenous peoples and offshore island peoples were both 27 in 2019 and 2020, respectively. The main dental school admission way was individual application, and the main providers of dental enrollment quotas were northern dental schools and private dental schools. In addition, dental school enrollees were concentrated in the northern region, municipalities, and cities in Taiwan. ConclusionFurther advancement is needed to expand participation and broaden the sociodemographic profile of dental school applicants. The dental schools would benefit from a long-term prospective study about the correlation of admission methods with students’ performance in dental schools. The special program is impacting the equality of admission opportunities. It is necessary to track the practice dynamics of these dental school graduates who were enrolled via the special program as a basis for policy adjustment.

Population-level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design

BackgroundTo identify the population-level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home (CO@h)) in England on mortality and health service use.MethodsWe conducted a retrospective...

A Quasi-Experimental Investigation of Adult Student Enrollment Responses to the Tennessee Reconnect Grant

ABSTRACT In this study I deployed quasi-experimental methods to explore enrollment responses to a unique statewide college promise program for adult students attending college within the two-year public postsecondary education sector in Tennessee. State policymakers implemented Tennessee Reconnect in 2018 to encourage adult students without a college degree to enroll in college and pursue a postsecondary credential or degree. There is little research quantitatively exploring how promise programs affect adult student enrollment in contrast with nationwide trends. For this study, I used differences-in-differences to determine the effect of Tennessee Reconnect on total, part-time, full-time, male, and female adult student enrollment at public two-year postsecondary institutions in the first two years of the program. Findings revealed a significant increase in enrollment in response to the policy across all adult student categories in the first year. While overall adult student enrollment increased in the second year of the program, only part-time students and male students saw significant increases compared to the nationwide sample. Findings are encouraging regarding adult student responses to a free college program and how states can leverage policies to potentially increase enrollment among individuals who may not have otherwise pursued postsecondary education, such as adult students.

Instructor and Student Perceptions of Teacher Empathy in Higher Education

Empathy is recognized as the ability to relate emotionally to an experience or another person’s emotions. Evidence supports the notion that students learn better and have greater positive perceptions when instructors display empathetic values and seek more meaningful relationships with their students. The purpose of this study was to assess instructor self-reported empathy and students’ perceptions of instructor empathy, using the Toronto Empathy Questionnaire (TEQ) and a newly developed Instructor Empathy Practices questionnaire (IEP7), among a convenience sample from a public university. This convergent mixed-methods study consisted of a cross-sectional survey sent to both students and instructors and focus groups conducted with students. A total of 168 students and 68 faculty members completed the survey and 19 students participated in the focus groups. Contextual factors such as race (p = 0.036), classification (p = 0.003) and GPA (p = 0.028) played significant roles in student empathy scores. Among instructors, only total student enrollment (p = 0.028) had an association with teacher empathy. Focus groups revealed themes related to recognizing empathy including understanding its definition, instructional techniques, perception in relation to class motivation, and importance. This study was the first to employ a convergent study design to assess and better characterize empathy from both instructors’ and students’ perspectives.

Tobacco Surcharges Associated With Reduced ACA Marketplace Enrollment.

The Affordable Care Act (ACA) allows insurers to charge tobacco users who have nongroup coverage up to 50percent more than nonusers of tobacco. In this study we used 2014-19 administrative data on enrollees in the federally facilitated ACA Marketplace, HealthCare.gov, to examine the relationships among surcharge rates, total Marketplace enrollment, and enrollment by tobacco users. We found that the tobacco surcharge rate averaged approximately 14percent and that it was associated with lower total enrollment as well as a reduced share of total enrollees who reported any tobacco use. Our analysis also found that tobacco surcharges have a significantly larger effect on tobacco users' share of enrollment in rural areas than in urban areas, which may in turn contribute to urban-rural health disparities. Given that tobacco surcharges may decrease Marketplace enrollment overall and shift the composition of enrollment away from tobacco users, our findings suggest that reducing tobacco surcharges may increase total Marketplace enrollment.

Abstract P2-11-04: Participation in a breast cancer prevention clinic before and after implementation of the Affordable Care Act

Abstract Background: Secondary prevention can serve to maintain patients’ long-term health and avoid the costs of chronic disease. At the Preventive Care Program for Women’s Cancer Clinic at UAB (UABPC), multidisciplinary staff provide women at increased risk for breast cancer specialized preventive care via comprehensive risk assessment with resultant recommendations for screening and management strategies. In 2011, several provisions of the Affordable Care Act (ACA) eliminated cost sharing of basic women’s preventive screening programs for patients with non-grandfathered health insurance plans. This increased affordability and accessibility of care for millions of Americans and increased awareness of racial disparities in preventive care. In this study, we examined the potential influence of these provisions on increasing total and minority patient participation in specialized preventive services in the UABPC. Methods: Patients seen in this clinic were consented and data was collected to understand use of preventative services. 2003-2011 was designated as the pre-ACA enactment period and 2011-2019 as the post-ACA enactment period. We further subdivided the patient's first participation in the clinic into 4-year periods to more closely assess trends in total and minority patient participation as a function of ACA implementation. Patients’ age, race, first clinic date, and socioeconomic status (SES) were considered for their impact on uptake of services pre- and post-ACA. Results: Between 2003 and 2019, 2,786 patients were entered into this database. The mean age at first visit was 46.28. 84.3% were White, 13.4% were Black and 2.3% were Asian, Hispanic, Native American, Unknown or of other racial origin. 623 (22.36%) patients were first seen during pre-ACA enactment and 2,163 (77.63%) patients were first seen during post-ACA enactment. From 2003-2011, minority patients comprised 6.4% of clinic patients and between 2011-2019 minority clinic patients nearly tripled to comprise 18.6% of all patients seen. We conducted an overall Chi- Square analysis of patients seen in this clinic by race pre- and post-ACA, demonstrating a significant increase in total and minority patients with a p value&amp;lt;.0001. An overall Chi-Square analysis of patients by race among the aforementioned 4-year time-periods also demonstrated a significant increase in patients between 2007-2011 and 2011-2015 with a p value&amp;lt;.0001. A two-sample t-test determined that the decrease in mean age seen between pre- and post-ACA enactment was not statistically significant. Conclusions: We demonstrate a change in overall uptake of our clinic’s preventive services and specifically changes to the racial makeup of the patient population following the implementation of the ACA. The resultant reduced cost sharing for women’s preventive screening and federal advancement of the Offices of Minority Health are plausible factors in the statistically significant increase in awareness of preventive services and increase in total and minority patient enrollment within the UABPC. These meaningful results underscore the value of federal programs focused on decreasing racial disparities in healthcare and increasing access to preventive care for women at increased risk of breast cancer. Future studies will be needed to determine the specific underlying causes and effects to ensure the greatest impact of future policy changes. Pre-ACA (N)Post-ACA (N)Race2003-20072007-20112011-20152015-2019White202381856904Black1424155181Asian, Hispanic, Native American, Unknown or Other022839 Citation Format: Jiliian Tinglin, Andrew Crouse, Helen Krontiras. Participation in a breast cancer prevention clinic before and after implementation of the Affordable Care Act [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-11-04.

Abstract OT2-01-02: First in human phase 1 dose escalation and expansion study of the safety and pharmacokinetics of the oral CDK7 inhibitor XL102 as a single-agent and in combination therapy in patients with inoperable locally advanced or metastatic solid tumors, including breast cancer

Abstract Background: XL102 is an orally bioavailable, selective, and covalent small-molecule inhibitor of cyclin-dependent kinase 7 (CDK7). CDK7 is a serine/threonine kinase which controls cell cycle progression via the phosphorylation of CDKs (1, 2, 4 &amp; 6) and regulates transcription through phosphorylation of RNA polymerase II. CDK7 overexpression has been reported in multiple tumor types including hormone receptor positive (HR+) breast cancer (BC) and triple negative breast cancer (TNBC). XL102 induced cell death in a number of cancer cell lines and caused tumor regression in murine xenograft models of multiple tumor types including HR+ BC and TNBC. Here, we present the study design of an ongoing phase 1 trial in solid tumors which includes cohorts with advanced HR+ BC, TNBC, epithelial ovarian cancer (EOC), and metastatic castration-resistant prostate cancer (mCRPC). Trial Design and Statistical Methods: This phase 1, open-label trial will assess the safety, tolerability, pharmacokinetics, anti-tumor activity and effect on biomarkers of XL102 administered orally alone and in combination regimens in selected tumor types (NCT04726332). The study consists of dose-escalation stages and disease-specific cohort expansion stages. In the dose-escalation stages (modified interval 3+3 design), a maximum tolerated (MTD) and/or recommended XL102 dose (RD) for use alone and in combination therapy with standard dose fulvestrant (HR+BC) or abiraterone/prednisone (mCRPC) will be established in independent strata. Upon reaching the MTD/RD, the expansion stage will enroll according to Simon’s Two-Stage Minimax design, assuming a power of 80% and one-sided α of 15%, for single agent XL102 (HR+BC, TNBC, EOC, and mCRPC) and XL102 in combination therapy (HR+BC and mCRPC). Eligibility criteria: All patients must have adequate organ function and be able to take oral medications. Patients with CNS disease are eligible if treated and stable, provided they meet the other inclusion and exclusion criteria. Patients enrolled in expansion cohorts must have measurable disease. Patients in HR+ BC expansion cohorts must have received ≥ 1 prior endocrine anticancer therapy and 1 prior CDK4/6 inhibitor therapy either sequentially or concurrently and may have received ≤ 2 additional prior lines of systemic anticancer therapy for locally advanced or metastatic disease. Patients in TNBC and EOC expansion cohorts must have received ≥ 1 line but &amp;lt; 3 lines of prior systemic anticancer therapy for locally advanced or metastatic disease or platinum-resistant ovarian cancer (eg, cytotoxic therapy, targeted therapy, immunotherapy), respectively. Patients in EOC expansion cohort may include primary peritoneal cancer and fallopian tube cancer who have platinum-resistant disease following treatment with a platinum-containing chemotherapy. Patients with ovarian borderline epithelial tumors and platinum-refractory disease are ineligible. Study objectives: The primary objective of the expansion stage is the objective response rate of XL102 alone and in combination therapy as assessed by the investigator per RECIST 1.1. The secondary objectives are to evaluate safety, tolerability, and pharmacokinetics. Exploratory objectives include duration of response, progression-free survival, overall survival, and correlation of tumor and blood biomarkers with response. Accrual: The study began enrolling patients in February 2021 and is ongoing. Total enrollment estimated to be up to 298 subjects. Citation Format: Amita Patnaik, Minal Barve, Manali Bhave, Vivek Subbiah, Sumandeep Atwal, Keerti Sharma, Christian Scheffold, Cynthia Wetmore, Geoffrey Shapiro. First in human phase 1 dose escalation and expansion study of the safety and pharmacokinetics of the oral CDK7 inhibitor XL102 as a single-agent and in combination therapy in patients with inoperable locally advanced or metastatic solid tumors, including breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-01-02.

Abstract P5-19-05: Successful participation of veterans affairs patients in precision medicine research through passive recruitment efforts

Abstract Background Access to clinical trials and other research opportunities is important to discovering new disease treatments and better ways to detect, diagnose, and reduce disease risk. The WISDOM (Women Informed to Screen Depending on Measures of risk) Study is a multi-site, pragmatic trial with web-based participation based at the University of California at San Francisco (UCSF) that aims to move breast cancer screening away from its current one-size-fits-all approach to one that is personalized based on each woman’s individual risk. We sought to evaluate passive recruitment efforts of Veterans Affairs (VA) patients into a precision medicine research program. Methods We created a hub and spoke recruitment model with the San Francisco VA Medical Center (SFVAMC) serving as the central hub of passive recruitment activities and eligible VA facilities that agreed to participate serving as the spoke recruitment sites. Eligible facilities had at least 3,000 women patients, VA clinical genetic services available, a site lead from the VA Women’s Health-Practice-Based Research Network, and mammography on site. Site participation involved permission for the research team to email eligible patients (women age 40-74 without a prior breast cancer diagnosis) about the WISDOM Study. We evaluated the effectiveness of the recruitment by assessing trends in enrollment and monitoring participation of VA patients in the WISDOM Study. The participating sites were determined to be non-engaged in human subjects research. Results Between May 24th, 2021 and June 30th, 2021, we emailed 29,470 eligible VA patients from seven participating VA facilities. Prior to the VA emailing, 2% of the total WISDOM Study population had served or was currently serving in active duty in any of the United States Armed Forces. After the first month of emails, this percentage increased to 50%. The month following VA emailing was one of the highest accruing months for the study with 2175 women registering, doubling the average of the prior three months, with VA participation accounting for over 50% of total enrollment that month. VA enrollment population was racial and ethnically diverse and changed the demographics of study enrollment. Prior to the VA emailing, the WISDOM Study population (n= 32,3278) included women who are 79% non-Hispanic White, 3% Black/African American and 9% Hispanic/Latina. Between the May 24th, 2021 and June 30th, 2021 emailing period, of the 1665 women enrolled, 64% of which were non-Hispanic White, 16% Black/African American and 12% Hispanic/Latina. Most women veterans enrolled in the study were between the ages of 40-50 (45%), which represented a younger population than the general WISDOM Study population (28%, aged 40-50). Both the VA population and general WISDOM Study population had similar levels education: 72% of the VA population had obtained a college graduate degree compared to 76% of the WISDOM study population with a college graduate degree. Conclusions The VA has recently approved email contact as a method for passively recruiting research participants. Our results demonstrate that there is substantial interest among female veterans in the WISDOM Study, and that emailing VA patients was not only feasible but an effective approach to increased study recruitment and diversity of participants. This data provides a unique opportunity for future trials to engage women veterans as precision medicine becomes a growing area of research in the VA and at academic affiliates. Citation Format: Maren Scheuner, Paloma Sales, Susan M. Frayne, Marcelo Palmieri, Rashna Soonavala, Allison Stover Fiscalini, WISDOM Study/Athena Investigators, Advocate Partners, Laura Esserman. Successful participation of veterans affairs patients in precision medicine research through passive recruitment efforts [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-19-05.

Portuguese Fascism’s Genocidal Strategy in Mozambique: the Zambezi River South Bank in the Early-Mid 1970s

An exceptional combination of circumstances would make the Wiriyamu massacre of December 1972 the most documented operation of the total war waged against the populations by Portuguese fascism along the southern bank of the Zambezi river from the early 1970s. The representation of Wiriyamu by present-day Portuguese intelligentsia oscillates between the acknowledgement of an “episodic” case and a sort of relativistic denial. Both representations explicitly deny the carnage as a moment of a vaster genocidal strategy meant to prevent African guerrillas from crossing the critical border of the Zambezi river, which would signify a direct threat to the main bastions of apartheid. Since African troops constituted more then one half of the Portuguese army’s total enrolment, denial positions are based on the rhetorical assumption that the imperial war was a sort of “civil war”. This mystification is directly linked to the fact that the mass-killings in the Wiriyamu area were carried out mainly by African commando units. In this essay a parallel is made with the 1920s’ colonial literary accounts of the genocidal processes which took place in Mozambique in the 1910s. Like in the 1920s, the argument of today’s Portuguese elites is that savagery is the work of savages and the Portuguese, with their scant resources, had to rely on what was available. A general contextual view is presented, particularly attentive to the developments of the last months of Portuguese rule around Inhaminga, where regular mass-killings were carried out mainly by Portuguese soldiers and settlers. This essay aims to contribute to the understanding of their moral distress, but at the same time their determination, as a community self-represented by ideas of “race” and nation, to “exterminate all the brutes”. Moreover, it seeks to promote the discussion on the connection between present-day denial rhetoric and racist or culturalist hierarchical representations.

Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin

After the federal public health emergency was declared in March 2020, states could qualify for increased federal Medicaid funding if they agreed to maintenance of eligibility (MOE) provisions, including a continuous coverage provision. The implications of MOE provisions for total Medicaid enrollment are unknown. To examine observed increases in Medicaid enrollment and identify the underlying roots of that growth during the first 7 months of the COVID-19 public health emergency in Wisconsin. This population-based cohort study compared changes in Wisconsin Medicaid enrollment from March through September 2020 with predicted changes based on previous enrollment patterns (January 2015-September 2019) and early pandemic employment shocks. The participants included enrollees in full-benefit Medicaid programs for nonelderly, nondisabled beneficiaries in Wisconsin from March through September 2020. Individuals were followed up monthly as they enrolled in, continued in, and disenrolled from Medicaid. Participants were considered to be newly enrolled if they enrolled in the program after being not enrolled for at least 1 month, and they were considered disenrolled if they left and were not reenrolled within the next month. Continuous coverage provision beginning in March 2020; economic disruption from pandemic between first and second quarters of 2020. Actual vs predicted Medicaid enrollment, new enrollment, disenrollment, and reenrollment. Three models were created (Medicaid enrollment with no pandemic, Medicaid enrollment with pandemic economic circumstances, and longer Medicaid enrollment with a pandemic-induced recession), and a 95% prediction interval was used to express uncertainty in enrollment predictions. The study estimated ongoing Medicaid enrollment in March 2020 for 792 777 enrollees (mean [SD] age, 20.6 [16.5] years; 431 054 [54.4%] women; 213 904 [27.0%] experiencing an employment shock) and compared that estimate with actual enrollment totals. Compared with a model of enrollment based on past data and incorporating the role of recent employment shocks, most ongoing excess enrollment was associated with MOE provisions rather than enrollment of newly eligible beneficiaries owing to employment shocks. After 7 months, overall enrollment had increased to 894 619, 11.1% higher than predicted (predicted enrollment 805 130; 95% prediction interval 767 991-843 086). Decomposing higher-than-predicted retention, most enrollment was among beneficiaries who, before the pandemic, likely would have disenrolled within 6 months, although a substantial fraction (30.4%) was from reduced short-term disenrollment. In this cohort study, observed increases in Medicaid enrollment were largely associated with MOE rather than new enrollment after employment shocks. Expiration of MOE may leave many beneficiaries without insurance coverage.

Self-proctored mechanism for online high-stake assessments in university courses

The aim of the study was to develop a cost-effective form of online proctoring mechanism that can serve as a scalable and secure solution to cater to high-stake assessments in institutions, with a particular focus on attaining high levels of flexibility and user-friendliness. With reference to existing systems, a self-proctored mechanism is proposed to conduct proctoring online assessment with a convenient setup by students. Students were guided to record and submit recordings from their webcam and captured from their computer screens. The recording submission compliance level and statistics were evaluated to gauge the effectiveness of the mechanism. The devised mechanism was deemed reliable across various student groups tested in two lower-division undergraduate courses with total enrolment of over 600 students. With the advantages and potential improvements in conducting assessments online identified, the devised mechanism can provide a satisfactory baseline for the future development of large-scale high-stake assessment.

War and Schooling in South Sudan, 2013-2016

South Sudan was embroiled in a civil war from mid-December 2013 to mid-September 2018. Nearly 400,000 people died, and several million were displaced. The economy nearly collapsed as the nation's output was severely reduced, causing inflation to soar. While prior research on the immediate humanitarian crisis in South Sudan has focused on forced displacement and food insecurity, there is little information available about the long-term impact the war had on human capital accumulation in this context. This analysis exploits spatial variation in exposure to violence to estimate the causal impact of the recent civil war on primary school enrollment as a proxy for measuring human capital accumulation. Results based on the difference-in-differences methodology indicate a statistically significant relationship between school enrollment and the war. The study shows that schools located in the South Sudanese war zones lost 85 children per year on average, or 18.5 percent of total enrollment. The diminishing trends in girls' enrollment are unrelated to the war, which is not surprising; social barriers, including gendered domestic roles, early marriage, and out-of-wedlock pregnancies, have long impeded female educational opportunities in South Sudan. These effects are robust to a number of specifications, including holding constant school-level fixed effects and adjusting for the standard errors. The article presents important policy implications for education and the labor market, both locally and internationally.

Exploring the relationships between socio-economic indicators and student enrollment in higher education institutions of Pakistan.

Higher education is considered as the engine of the economic development of a country due to its role in cultivating human capital. The provision of higher education is regarded as a productive investment in human capital for improving nation’s productive capacity. However, there is a large gap in enrollment between students of different socioeconomic statuses. The ever-widening socio-economic inequalities between individuals from disadvantaged and advantaged backgrounds make the government’s efforts to enroll a higher number of students to pursue higher education challenging in developing countries, as the students’ socioeconomic status plays a decisive role in their priority to attain higher education. This study anticipated quantifying the impact of socio-economic indicators and underlying situations on students’ enrollment in higher education in Pakistan. A descriptive study, involving correlation, principal component analysis (PCA), clustering, and stepwise regression using 15-years data of enrollment and socio-economic indicators was conducted. The correlation between different socio-economic indicators and students’ enrollment was positive and highly significant (0.73 to 0.99), except for the unemployment rate (- 0.39 to -0.57). PCA showed that the first two components were the most influential with 93.85% of the total variation. Enrollment (total and male) showed significant relationships with general government expenditure and unemployment rate, while female enrollment showed a significant relationship with general government expenditure. Findings revealed that socio-economic factors can serve as a significant predictor of students’ enrollment in higher education. The minimum values of correlation coefficient (R) and adjusted R2 for enrollment were ranged from 0.875 to 0.748 (female enrollment), while maximum values (0.987 to 0.993 and 0.973 to 0.983), respectively were observed for total enrollment. The findings will assist educationists, social scientists, and policymakers to better understand the association between socio-economic indicators and student enrollment in higher education for formulating future education policies for enhancing enrollment in higher education.