Ralph Lauren Center for Cancer Care and Prevention

ABSTRACT We document widespread changes to the historical I/B/E/S analyst stock recommendations database. Across seven I/B/E/S downloads, obtained between 2000 and 2007, we find that between 6,580 (1.6%) and 97,582 (21.7%) of matched observations are different from one download to the next. The changes include alterations of recommendations, additions and deletions of records, and removal of analyst names. These changes are nonrandom, clustering by analyst reputation, broker size and status, and recommendation boldness, and affect trading signal classifications and back‐tests of three stylized facts: profitability of trading signals, profitability of consensus recommendation changes, and persistence in individual analyst stock‐picking ability.

BACKGROUND: Patient navigation is an intervention developed to reduce disparities in cancer care that is being widely replicated and receiving considerable support for demonstration projects and research to test its effectiveness. In the current study, the authors present an in-depth descriptive analysis of the original patient navigation programs to inform current and future program development. METHODS: A qualitative multistakeholder case study using interviews and site visits of the first patient navigation site and 2 sites subsequently developed by the leadership of the original site were evaluated. RESULTS: At these sites, patient navigation is a system, as opposed to a person, comprised primarily of navigators and directors that work together to remove barriers and facilitate access in a well-defined course of care; navigators were from the community or were culturally similar to the patient population served but were also paid employees of the clinical care site with detailed knowledge of the clinical course patients must traverse to complete care plans. Directors had administrative authority over the clinical facility and social capital across institutions, and communicated regularly and openly with navigators to implement system level changes to remove barriers to care. Contextual factors such as policies supporting breast cancer care also influenced the implementation of these programs. CONCLUSIONS: The first patient navigation programs combined community and culturally sensitive care-coordination with aspects of disease management programs to reduce racial, ethnic, and poverty-driven disparities in care. Future efforts to replicate and evaluate patient navigation should take into account these unique aspects of the original patient navigation programs.

Hypertension is a typical example of long-term disease posing formidable challenges to health care. One goal of antihypertensive therapy is to achieve optimal blood pressure (BP) control and reduce co-occurring chronic conditions (multimorbidity). This study aimed to assess the influence of multimorbidity on medication adherence, and to explore the association between poor BP control and multimorbidity, with implications for hypertension management.A cross-sectional design with multistage sampling was adopted to recruit Chinese hypertensive patients attending general out-patient clinics from 3 geographic regions in Hong Kong. A modified systemic sampling methodology with 1 patient as a sampling unit was used to recruit consecutive samples in each general out-patient clinic. Data were collected by face-to-face interviews using a standardized protocol. Poor BP control was defined as having systolic BP/diastolic BP ≥130/80 mm Hg for those with diabetes or chronic kidney disease; and ≥140/90 mm Hg for others. Medication adherence was assessed by a validated Chinese version of the Morisky Medication Adherence Scale. A simple unweighted enumeration was adopted to measure the combinations of coexisting long-term conditions. Binary logistic regression analysis was conducted with medication adherence and multimorbidity as outcome variables, respectively, after controlling for effects of patient-level covariates.The prevalence of multimorbidity was 47.4% (95% confidence interval [CI] 45.4%-49.4%) among a total of 2445 hypertensive patients. The proportion of subjects having 0, 1, and ≥2 additional long-term conditions was 52.6%, 29.1%, and 18.3%, respectively. The overall rate of poor adherence to medication was 46.6%, whereas the rate of suboptimal BP control was 48.7%. Albeit the influence of multimorbidity on medication adherence was not found to be statistically significant, patients with poorly controlled BP were more likely to have multimorbidity (adjusted odds ratio 2.07, 95% CI 1.70-2.53, P < 0.001). Diabetes was the most prevalent concomitant long-term condition among hypertensive patients with poor BP control (38.6%, 95% CI 35.8-41.4 vs 19.7%, 95% CI 17.5-21.9 for patients with good BP control, P < 0.001).Multimorbidity was common among hypertensive patients, and was associated with poor BP control. Subjects with coexisting diabetes, heart disease, or chronic kidney disorder should receive more clinical attention to achieve better clinical outcomes.

Quite recently, I had a personal experience that underscored why we must constantly revisit the issue of race in America. I went to the University of North Carolina at Chapel Hill in search of information about my great-great grandfather. I knew he was a slave in Raleigh, North Carolina who bought

Cardinal events in atherogenesis are the retention of apolipoprotein B-containing lipoproteins in the arterial wall and the reaction of macrophages to these particles. My laboratory has been interested in both the cell biological events producing apolipoprotein B-containing lipoproteins, as well as in the reversal of the damage they cause in the plaques formed in the arterial wall. In the 2013 George Lyman Duff Memorial Lecture, as summarized in this review, I covered 3 areas of my past, present, and future interests, namely, the regulation of hepatic very low density lipoprotein production by the degradation of apolipoprotein B100, the dynamic changes in macrophages in the regression of atherosclerosis, and the application of nanoparticles to both image and treat atherosclerotic plaques.

Testing for BRCA1 mutation has important clinical implications such as identifying risk of second primary cancers and risk of cancer in the family. This study seeks to quantify the risk of having BRCA1 mutation in female breast cancer patients with triple-negative phenotype compared with those with other phenotypes. We undertook a search of MEDLINE and EMBASE databases for relevant studies through 10 May 2013. Outcomes were calculated and reported as risk ratio and risk difference. 12 studies comprising 2533 breast cancer patients were included in the analysis. It was found that almost all eligible studies were performed on high-risk population with breast cancer. By analyzing the incidence rates of BRCA1 mutation in patients with triple-negative breast cancer (TNBC) and non-TNBC, our meta-analysis provides a relative risk of 5.65 [95% confidence interval (CI), 4.15-7.69] and risk difference of 0.22 (95% CI, 0.15-0.29). This implies that, in selected population with high-risk features, women with TNBC are approximately five and a half times more likely to have BRCA1 mutation compared with non-TNBC phenotype, and approximately two in nine women with TNBC harbor BRCA1 mutation. Triple-negative phenotype significantly increases the risk of having BRCA1 mutation in high-risk breast cancer patients compared with non-TNBC.

PURPOSE: Digital breast tomosynthesis (DBT) in conjunction with digital mammography (DM) is becoming the preferred imaging modality for breast cancer screening compared with DM alone, on the basis of improved recall rates (RR) and cancer detection rates (CDRs). The aim of this study was to investigate racial differences in the utilization and performance of screening modality. METHODS: Retrospective data from 63 US breast imaging facilities from 2015 to 2019 were reviewed. Screening outcomes were linked to cancer registries. RR, CDR per 1,000 examinations, and positive predictive value for recall (cancers/recalled patients) were compared. RESULTS: A total of 385,503 women contributed 542,945 DBT and 261,359 DM screens. A lower proportion of screenings for Black women were performed using DBT plus DM (referred to as DBT) (44% for Black, 48% for other, 63% for Asian, and 61% for White). Non-White women were less likely to undergo more than one mammographic examination. RRs were lower for DBT among all women (8.74 versus 10.06, P < .05) and lower across all races and within age categories. RRs were significantly higher for women with only one mammogram. CDRs were similar or higher in women undergoing DBT compared with DM, overall (4.73 versus 4.60, adjusted P = .0005) and by age and race. Positive predictive value for recall was greater for DBT overall (5.29 versus 4.45, adjusted P < .0001) and by age, race, and screening frequency. CONCLUSIONS: All racial groups had improved outcomes with DBT screening, but disparities were observed in DBT utilization. These data suggest that reducing inequities in DBT utilization may improve the effectiveness of breast cancer screening.

To assess the effectiveness of breast support previous studies monitored breast kinematics and kinetics, subjective feedback, muscle activity (EMG), ground reaction forces (GRFs) and physiological measures in isolation. Comparing these variables within one study will establish the key performance variables that distinguish between breast supports during activities such as running. This study investigates the effects of changes in breast support on biomechanical, physiological and subjective measures during running. Ten females (34D) ran for 10 min in high and low breast supports, and for 2 min bare breasted (2.8 m·s−1). Breast and body kinematics, EMG, expired air and heart rate were recorded. GRFs were recorded during 10 m overground runs (2.8 m·s−1) and subjective feedback obtained after each condition. Of the 62 variables measured, 22 kinematic and subjective variables were influenced by changes in breast support. Willingness to exercise, time lag and superio-inferior breast velocity were most affected. GRFs, EMG and physiological variables were unaffected by breast support changes during running. Breast displacement reduction, although previously advocated, was not the most sensitive variable to breast support changes during running. Instead breast support products should be assessed using a battery of performance indicators, including the key kinematic and subjective variables identified here.

OBJECTIVE: The objective of this study was to investigate the relationships between motor symptoms of Parkinson disease (PD) and activity limitations in persons with PD. DESIGN/METHODS: This is a cross-sectional study of persons with mild to moderate PD (N = 90). Associations among axial motor features, limb motor signs, the Physical Activity Scale for the Elderly, the ability to perform Activities of Daily Living (ADLs), and level of ADL dependency were studied. A composite score of axial motor features included the following Unified Parkinson Disease Rating Scale items: speech, rigidity of the neck, arising from chair, posture, gait, and postural stability. A composite score of limb motor signs included the following Unified Parkinson Disease Rating Scale items: tremor at rest of all extremities, action tremor, rigidity of all extremities, finger taps, hand movement, rapid alternating hand movements, and foot tapping. RESULTS: Axial motor features of PD were significantly correlated with physical inactivity (P < 0.001), decreased ADL (P < 0.001), and increase in ADL dependency (P < 0.001). Limb motor signs significantly correlated with decreased ADL (P < 0.001) and level of ADL dependency (P = 0.035) but did not correlate with physical inactivity. After controlling for age, sex, disease duration, and comorbidity, axial motor features contributed significantly to physical inactivity, decreased ADL, and increase in ADL dependency, whereas the limb motor signs did not. CONCLUSIONS: Axial motor impairment contributed to physical inactivity and decreased ability to perform ADLs in persons with PD.

During the past decade, the National Cancer Institute has made significant progress in bringing to and addressing the health and other issues related to poor and medically underserved populations, racial and ethnic minorities, and residents of rural areas. A key to the institute's achievements was the development of the Special Populations Networks (SPN) program which from 2000–2005, established a deeper involvement in reducing cancer disparities than had been previously undertaken by increasing cancer awareness and creating opportunities for conducting community-based research.

BACKGROUND: Colorectal cancer screening (CRCS) in the United States is inadequate in minority communities and particularly among those who lack insurance. Finding ways to increase screenings in these minorities presents a healthcare challenge. The authors sought to determine whether offering CRCS at the time of mammography is an effective way to increase CRCS among minority women. METHODS: This study was offered to women attending the Breast Examination Center of Harlem (BECH), a community outreach program of Memorial Sloan-Kettering serving the primarily black and Hispanic Harlem Community. Screening was explained, medical fitness was determined, and colonoscopies were performed. Barriers to screening and ways to overcome them were ascertained. Participants had to be at least 50 years of age without a history of colorectal cancer or screening within the last 10 years. RESULTS: There were 2616 women eligible for CRCS, of these women 2005 (77%) refused to participate in the study, and 611 (23%) women were enrolled. There was a high interest in CRCS including among those who declined to participate in the study. The major barrier was lack of medical insurance, which was partially overcome by alternative funding. Of the 611 women enrolled, 337 (55%) went on to have screening colonoscopy. Forty-nine (15%) women had adenomatous polyps. CONCLUSIONS: Offering CRCS to minority women at the time of mammography and without a physician's referral is an effective way to expand screening. Screening colonoscopy findings are similar to those in the general population. Alternatives to traditional medical insurance are needed for the uninsured.

A need exists for a breast cancer risk identification paradigm that utilizes relevant demographic, clinical, and other readily obtainable patient-specific data in order to provide individualized cancer risk assessment, direct screening efforts, and detect breast cancer at an early disease stage in historically underserved populations, such as younger women (under age 40) and minority populations, who represent a disproportionate number of military beneficiaries. Recognizing this unique need for military beneficiaries, a consensus panel was convened by the USA TATRC to review available evidence for individualized breast cancer risk assessment and screening in young (< 40), ethnically diverse women with an overall goal of improving care for military beneficiaries. In the process of review and discussion, it was determined to publish our findings as the panel believes that our recommendations have the potential to reduce health disparities in risk assessment, health promotion, disease prevention, and early cancer detection within and in other underserved populations outside of the military. This paper aims to provide clinicians with an overview of the clinical factors, evidence and recommendations that are being used to advance risk assessment and screening for breast cancer in the military.

Indonesien gilt aufgrund seiner vielen Vulkane als einer der Hotspots fur Geothermie. Doch Salz und Hitze setzen den Geothermie‐Anlagen zu und gefahrden ihre Sicherheit und Wirtschaftlichkeit. Ein Team an der BAM hat gunstigen, lokal verfugbaren Baustahl jetzt so beschichtet, dass ein nachhaltiger und sicherer Betrieb der Geothermie‐Kraftwerke moglich ist ‐ auch unter Extrembedingungen. Das BAM‐Team will das Beschichtungssystem nun den Anwendern in Indonesien zur Verfugung stellen, damit es unter Realbedingungen in einem Geothermie‐Kraftwerk getestet werden kann. Der Schutz vor Korrosion ist mitentscheidend, weil sie die Lebensdauer dieser Kraftwerke bestimmt. Unsere Arbeit konnte die Effizienz der Energieproduktion mit Geothermie wesentlich verbessern.

INTRODUCTION: Urological chronic pelvic pain syndrome (UCPPS) represents a group of pain symptoms relating to patients with pelvic pain for which treatment is largely unsatisfactory. The objective of this study is to analyze the effects of a novel treatment strategy in males suffering from UCPPS. METHODS: This retrospective, institutional review board-approved study analyzed eight male patients aged 24 to 61 with UCPPS. All the patients had a trial of antibiotic therapy, NSAIDs, and pelvic floor physical therapy before the study. The Visual Analog scale (VAS) and Functional Pelvic Pain scale (FPPS) were collected pretreatment. While continuing physical therapy, patients underwent weekly ultrasound-guided pelvic floor trigger point injections to the iliococcygeus, pubococcygeus, and puborectalis with lidocaine 1%. Concomitantly, patients received peripheral nerve hydrodissection performed on the pudendal nerve and the posterior femoral cutaneous nerve. The first two injections combined 1% lidocaine with dexamethasone, while the next four injections consisted of 1% lidocaine with traumeel (a homeopathic, plant-derived anti-inflammatory medication). At the 6-week follow-up, each patient retook the VAS and FPPS. RESULTS: The mean age of our patients was 31.8 years and the average duration of symptoms of the UCPPS was 21 months. Pretreatment, the mean VAS was 3.3 (STD 1.7) and the mean VAS posttreatment was 1.8 (STD 1.4); P < .05; 95% CI, 0.73 to 2.27. The mean FPPS pretreatment was 11.0 (STD 8.0) and the mean FPPS posttreatment was 6.3 (STD 5.3); P < .05; 95% CI, 0.03 to 9.22. CONCLUSION: Our results show promise for a novel, nonopioid-based treatment for UCPPS.

This chapter contains sections titled: Introduction History Physical examination Laboratory evaluation General management Treatment References

Tests on 1-gpm and 0.5-gpm hydroclones showed them to be unnecessary. Solvent-aqueous phase separation, although effective when optimized, was infrequently required. The 1-gpm hydroclone produced better water separation than the 0.5-gpm hydroclone for similar control parameters. Decontamination factors for widely varying flow conditions ranged from 1 to 3. Introduction of water into the hydroclone feed stream had no effect on decontamination or particle removal. (auth)

Spinal muscular atrophy (SMA) type 4 is a rare, adult-onset motor neuron disorder characterized by slowly progressive proximal weakness with preserved ambulation. Its indolent clinical course and nonspecific early manifestations frequently result in prolonged diagnostic delays. We present the complete diagnostic evaluation of a 33-year-old male patient with a multi-year history of painless, progressive lower extremity weakness. Initial laboratory testing revealed an isolated elevation of creatine kinase (CK) and vitamin D deficiency, with otherwise normal metabolic, endocrine, and inflammatory studies. Persistent CK elevation despite vitamin repletion prompted a neuromuscular referral. Electrodiagnostic testing demonstrated normal nerve conduction studies with electromyographic evidence of widespread chronic active denervation and, critically, normal paraspinal musculature. This pattern strongly supported the localization of the pathology to the anterior horn cells. Subsequent genetic testing confirmed a homozygous deletion of exon 7 in the SMN1 gene, establishing the definitive diagnosis of SMA type 4. This case underscores the importance of a systematic diagnostic approach integrating serial CK monitoring, electrodiagnostic localization, and genetic confirmation in evaluating adult-onset proximal weakness, particularly in the current era of disease-modifying therapies.

LE02-01 Race is perhaps single most defining issue in history of American society. This nation9s unique history overwhelmingly provides background on which concept of race is based. Popular conceptualizations of race date back several centuries and in particular are rooted in 19th and 20th century scientific thought. The presumption that visible traits produced measure of all other internal traits in an individual or population has pervaded our national history and is a basis on which we see, value and behave toward one another. American classifications of race came out of this history in which people were categorized by external visible traits (skin color, hair type, facial features etc) and treated differently. Furthermore, science has been a major force in establishing and reinforcing such classifications. Past and current United States Census categories reflect this history of classification by race. For example, Office of Management of Budget (OMB) Directive number 15 sets forth and ethnic categories used in census. This Directive goes on to say that the collection of information and use of these categories is required for that meets National Institutes of Health definition of clinical research At same time OMB states that racial and ethnic categories are social-political constructs and should not be interpreted as being scientific in nature.
 >Against this background, both American society and science operate. To illustrate, in both science and society, race is often used as a proxy for poverty, class, education, discriminatory experiences and certain behaviors, among other factors. But recent studies based on an understanding of human genome, population genetics and physical anthropology now lead to conclusion that categories as used in US census are not biologically determined.
 >We conclude that at this time in American society, race does exist from a social perspective. To extent that people are racially categorized and treated differently, race is real.
 >However, races as used in US census do not exist as biological categories from a scientific perspective.
 >Given fact that human populations do differ, and that race is not basis for those variations, scientists face challenge of elucidating how populations really differ.
 >Moreover, in concert with our increasing scientific understanding of populations there is a need to augment our understanding of social, economic and cultural determinants of population differences.
 >In conclusion, everything we know about population genetics, human genome and physical anthropology makes it clear that classification has no scientific basis. Race is a social construct determined primarily by how one group perceives, values and behaves toward another group.
 >The power of science can be used to eliminate false perceptions of meaning of race and could prove pivotal in moving our society toward justice and reconciliation. Physicians and scientists must be leaders in promoting this evolution in understanding.

BACKGROUND: Sleep disruption, a common symptom among patients requiring cardiovascular surgery, is a potential risk factor for the development of postoperative delirium. Postoperative delirium is a disorder of acute disturbances in cognition associated with prolonged hospitalization, cognitive decline, and mortality. OBJECTIVE: The aim of this study was to evaluate the feasibility and acceptability of using polysomnography (PSG) to capture sleep in patients with scheduled cardiothoracic surgery. METHODS: Wireless limited PSG assessed sleep at baseline (presurgery at home), postoperatively in the intensive care unit, and at home post hospital discharge. Primary outcomes were quality and completeness of PSG signals, and acceptability by participants and nursing staff. RESULTS: Among 15 patients, PSG data were of high quality, and mean percentage of unscorable data was 5.5% ± 11.1%, 3.7% ± 5.4%, and 3.7% ± 8.4% for baseline, intensive care unit, and posthospitalization measurements, respectively. Nurses and patients found the PSG monitor acceptable. CONCLUSIONS: Wireless, limited PSG to capture sleep across the surgical continuum was feasible, and data were of high quality. Authors of future studies will evaluate associations of sleep indices and development of postoperative delirium in this high-risk population.

OBJECTIVE: Culturally targeted narrative education is a promising approach to cancer prevention and control. This study evaluates the uptake of genetic counseling and testing (GCT) in Latinas at risk for hereditary breast and ovarian cancers (HBOC) after watching a culturally targeted narrative video and being navigated to GCT services. METHODS: Latina women at increased risk for HBOC were recruited through community-based organizations. Participants responded to surveys before and after watching Spanish-language telenovela-style video. Surveys measured sociodemographic and clinical variables, HBOC and GCT knowledge, transportation with the story, identification with characters, and emotions elicited by the video. After watching video, participants were offered patient navigation services to free or low-cost GCT and completed a 3-month follow-up phone survey to assess GCT uptake. RESULTS: Participants (N = 40) were 47.35 years old on average (SD = 9.48); all were born outside the United States. At the 3-month follow-up (N = 37), 27 (72.9%) and 26 (70.27%) participants had attended genetic counseling and genetic testing, respectively. U Mann Whitney tests found statistically significant differences between women who attended counseling versus those who did not at baseline knowledge (U = 216.00, p = 0.000) and distress elicited by the video (U = 73.5, p = 0.03). A logistic regression with distress elicited by the video as a predictive variable reached statististical significance (β = -0.27, p = 0.037, CI 95% 0.58-0.98). CONCLUSIONS: GCT uptake was promising, supporting a role for culturally targeted narrative video education along with a patient navigation component in increasing interest in cancer prevention and reducing healthcare disparities in HBOC genetic services. TRIAL REGISTRATION: NCT03075540 (Initial release 2/22/2017).