Philadelphia Fight

A two-parameter environmental (measured in CO2eq—CO2 is used in this paper to represent the carbon dioxide molecule as opposed to the chemical formula CO2 as is common practice in LCA studies; CO2eq is an abbreviation for CO2 equivalent and may be written as CO2e in the literature) and economic (measured in USD) analysis using life cycle analysis (LCA) and techno-economic analysis (TEA) of repurposed wind turbine blades for structural use in recreational trail bridges (e.g., on hiking trails and golf courses) is described in this paper. The US Department of Energy’s TECHTEST TEA/LCA software (v1.0) platform was used to compare three commercially available trail bridges (a steel truss bridge, an FRP pultruded truss bridge, and a glulam stringer bridge) with a bridge made from retired wind turbine blades (known as a BladeBridge). All bridges had a 50 ft (15.24 m) long by 6 ft (1.83 m) wide deck and were designed for a 90 psf (4.3 kN/m2) live load. The LCA functional unit was the assembled bridge, which was made ready to be shipped from the fabricator. Cradle-to-gate (A1–A3, i.e., raw material extraction, transportation, and manufacturing) system boundaries were used. For the BladeBridge, no embodied carbon was attributed to the blade itself (cut-off system allocation). For the TEA, a USD 660/tonne credit was attributed to the blade. The raw materials for each bridge were determined from detailed construction documents. Manufacturing and transportation energy were determined based on the equipment used for fabrication and geographical location. Direct labor for fabrication was calculated based on a weighted average of salaries taken from the US Bureau of Labor Statistics. The results indicate that raw materials had the biggest effect on embodied CO2eq and that labor had the largest impact on cost for all bridges. The results indicate that the BladeBridge is significantly less expensive to produce and releases less CO2eq into the environment (less Global Warming Potential (GWP)) than the three commercially available bridges. Additional TEA metrics for the BladeBridge, including Technology Readiness Level (TRL) and future market potential, were also evaluated and found to be positive for the BladeBridge technology.

Abstract Background People with HIV (PWH) are at an increased risk of cardiovascular disease (CVD), even after accounting for traditional risk factors like diabetes and dyslipidemia. Metabolic syndrome, a component of which is central adiposity, is also increasingly prevalent in PWH. Yet, there are few data on the contribution of excess visceral abdominal fat (EVAF) to increased CVD risk in PWH in the modern ART era. Methods We used the Visceral Adiposity Measurement and Observation Study (VAMOS) to investigate how EVAF impacts traditional CVD risk factors and overall CV risk in PWH. VAMOS is a cross-sectional, multi-center observational study in PWH, virologically suppressed for ≥1 year, with BMI ranging from 20 to 40 kg/m2. Participants completed study visits, labs, and an abdominal computed tomography scan in the overnight fasting state. Visceral fat was quantified by a single slice at L4-L5. Growth hormone (GH) levels, HOMA-IR and triglyceride:high-density lipoprotein (TG:HDL) ratios (an alternative measure of insulin resistance, IR) were also analyzed. Relationships with EVAF were assessed by Spearman correlation coefficients and Wilcoxon Two-Sample Tests (EVAF defined as ≥130 cm2). Results Of the 170 participants studied, the majority were white and male with an average age of 54 years. Median visceral fat area was 148 cm2 (94, 218) with an EVAF prevalence of 58%. Participants with EVAF had higher HOMA-IR values (p≤.0001) and higher TG:HDL ratios (p=0.0013) than those without EVAF. There was also a positive correlation between EVAF and HOMA-IR (ρ=0.43, p≤0.0001) and TG:HDL ratio (ρ=0.33, p≤0.0001). Importantly, greater visceral fat area was associated with higher 10-year ASCVD risk (p< 0.0001). To understand a potential driver behind this relationship between EVAF and CV risk, GH levels were explored. Increasing visceral fat surface area was inversely correlated with GH levels (ρ=-0.17, p=0.03); moreover, there were lower GH levels in subjects with EVAF (p=0.05). Conclusion Increased levels of visceral fat relate to increased CV risk scores, as well as the traditional risk factors of IR and lipid levels, which contributes to the heightened risk of CVD in PWH on modern ART regimens. The dynamics between decreased GH levels and EVAF found here support targeting EVAF reduction via the GH axis. Disclosures Karam Mounzer, MD, Epividian: Board Member|Epividian: Honoraria|GS: Advisor/Consultant|GS: Grant/Research Support|GS: Honoraria|Merck: Advisor/Consultant|THERA Technologies: Grant/Research Support|ViiV healthcare: Advisor/Consultant|ViiV healthcare: Grant/Research Support|ViiV healthcare: Honoraria John R. Koethe, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Merck & Co.: Advisor/Consultant|Merck & Co.: Grant/Research Support Jordan Lake, MD, Merck: Advisor/Consultant|Theratechnologies: Advisor/Consultant Mohammed Zogheib, PharmD, MPH, Theratechnologies: Employee Colleen McGary, PhD, Theratechnologies: Employee R Brandon Cash, PharmD, Theratechnologies: Employee

O Pathf inder, um estudo baseado em um projeto de investigação, utiliza uma abordagem metodológica para mapear etapas e indicadores-chave, apoiar na identificação de obstáculos e soluções, capturar e compartilhar ferramentas e métodos adotados pelo projeto. A Pesquisa Vacina Maré foi selecionada para Pathfinder como um exemplo bem-sucedido, com impactos significativos na saúde coletiva e na comunidade, além de abordar questões comunitárias e científicas de maneira colaborativa. O mapeamento da pesquisa permitiu a identificação de desafios e soluções, com aprendizados valiosos, também para outros projetos.

Pathfinder, a study based on a research project, uses a methodological approach that maps key stages and indicators, supports the identification of obstacles and solutions, and captures and shares tools and methods adopted by the project. The Vacina Maré Research was selected for Pathfinder as a successful example, with significant impacts on collective health and the community, as well as addressing community and scientific issues collaboratively. Mapping the research allowed challenges and solutions to be identified, with valuable lessons for other projects as well.

IntroductionColorectal cancer (CRC) screening utilization is low among low-income, uninsured, and minority populations that receive care in community health centers (CHCs). There is a need for evidence-based interventions to increase screening and follow-up care in these settings. MethodsA multilevel, multi-component pragmatic cluster randomized controlled trial is being conducted at 8 CHCs in two metropolitan areas (Boston and Los Angeles), with two arms: (1) Mailed FIT outreach with text reminders, and (2) Mailed FIT-DNA with patient support. We also include an additional CHC in Rapid City (South Dakota) that follows a parallel protocol for FIT-DNA but is not randomized due to lack of a comparison group. Eligible individuals in participating clinics are primary care patients ages 45–75, at average-risk for CRC, and overdue for CRC screening. Participants with abnormal screening results are offered navigation for follow-up colonoscopy and CRC risk assessment. ResultsThe primary outcome is the completion rate of CRC screening at 90 days. Secondary outcomes include the screening completion rate at 180 days and the rate of colonoscopy completion within 6 months among participants with an abnormal result. Additional goals are to enhance our understanding of facilitators and barriers to CRC risk assessment in CHC settings. ConclusionsThis study assesses the effectiveness of two multilevel interventions to increase screening participation and follow-up after abnormal screening in under-resourced clinical settings, informing future efforts to address CRC disparities. Trial RegistrationNCT05714644

1564 Background: Physical function (PF) is a core outcome in cancer trials that can inform treatment tolerability. PF can be assessed across modalities including by patient (pt) report, clinician (clin) report, performance tests and digital sensors. The optimal approach for PF measurement has not been defined. Methods: In4M is a prospective observational study evaluating PF in pts initiating chemotherapy for breast cancer or lymphoma followed over 9 months. We used an electronic platform (Hugo) to aggregate serially assessed pt-reported PF, clin- and pt-reported ECOG performance status (PS), 6-minute walk test (6MWT) and wearable (Fitbit) data. We evaluated feasibility in all pts; associations among PF measures and the ability of PF measures to detect change were evaluated in pts with both baseline (BL) and 3-month (3M) data. We used Pearson correlations to assess the relationship of average daily steps with measures of PF. To assess change, we compared each PF measure from BL to 3M using a 2-sided α=.05 paired t-test. Results: Of the208 pts enrolled, 193 (93%) and 159 (76%) completed surveys, and 121 (58%) and 124 (60%) provided wearable data (evaluable: ≥1 day data) at BL and 3M, respectively. When requiring a stringent BL with 4+ days of data with ≥1 weekend day to be evaluable, 88 (42%) and 120 (58%) provided wearable data at BL and 3M. At both BL and 3M, pt-reported PF was generally more highly correlated with wearable-derived daily steps than clin-reported PF and 6MWT were (Table). Significant declines in PF were observed for pt- and clin-reported PF (all p<0.05), but not other modalities. Conclusions: Longitudinalassessment of multi-modal PF data including pragmatic wearable data collection was feasible in pts receiving chemotherapy. Pt-reported PF was the only modality that was both correlated with step count and able to detect change. Additional wearable metrics, correlations among PF measurements and outcomes, and clinically meaningful change scores will be reported. Optimal PF measurement may improve future reporting of treatment tolerability. Clinical trial information: NCT05214144 . [Table: see text]

11021 Background: ASCO and Friends of Cancer Research established a task force to evaluate trial mitigation strategies allowed by US regulators during the COVID-19 pandemic, including the use of telemedicine and remote monitoring. We report the results of a meta-analysis quantifying the impact of these strategies on quality metrics and the recovery time to pre-COVID levels. Methods: We invited 41 sponsors with active US cancer treatment trials from January 2015-May 2022 to contribute deidentified trial-level aggregate data on major protocol deviations (PDs), dropouts, severe or worse toxicity (CTCAE Grade 3-5), and enrollment. We examined outcomes as proportions of participants at-risk during the pre-COVID, initial wave (IW), initial recovery (IR), and secondary recovery (SR) assessment times (Table). Multi-level beta-regression analyses were adjusted for trial phase (“early”, phases I, II, or I/II, vs. “late”, phase III) with study and sponsor as random effects. Indicator variables were used for post-COVID time periods with pre-COVID as the reference. Results: Ten sponsors (9 industry and 1 NCI Cooperative Group) contributed 82 evaluable studies: 63 early and 19 late phase trials. Among the 15,679 participants, enrollment odds decreased 64% in the IW and 45% in the IR but recovered to approximately pre-COVID levels by the SR (Table). Major PDs, dropouts, and severe or worse toxicity all had lower incidence in the IW compared to pre-COVID; these outcomes were also less frequent in IR (p<.05 for each), but not in the SR (p>.05 for each) compared to pre-COVID. Conclusions: Large declines in enrollment rates during the IW rebounded to pre-COVID levels by 2021-2022. We found steep reductions in the rates of reported occurrence of major PDs, dropouts, and severe or worse toxicity during the initial outbreak, which also recovered to pre-COVID levels by 2021-2022. Findings suggest pandemic-related procedural flexibility did not lead to increased reporting of PDs or dropouts and highlight how use of mitigation strategies likely corresponded with the temporary disruption to trial conduct during the pandemic’s peak. Sponsors could consider broader adaptation of trial flexibilities moving forward. [Table: see text]

In Brief Nurse Leader Development Programs (NLDPs) improve leadership abilities and the quality of patient care, but the programs aren't widely available. This article provides a framework and methodology that institutions can follow when developing NLDPs.

Health-care-related transportation insecurity is common in the United States. Patients with cancer are especially vulnerable because cancer care is episodic in nature, occurs over a prolonged period, is marked by frequent clinical encounters, requires intense treatments, and results in substantial financial hardship. As a result of transportation insecurity, patients with cancer may forego, miss, delay, alter, and/or prematurely terminate necessary care. Limited data suggest that these alterations in care have the potential to increase the rates of cancer recurrence and mortality and exacerbate disparities in cancer incidence, severity, and outcomes. Transportation insecurity also negatively impacts at the informal caregiver, provider, health system, and societal levels. Recognizing that transportation is a critical determinant of outcomes for patients with cancer, there are ongoing efforts to develop evidence-based protocols to identify at-risk patients and address transportation insecurity at federal policy, health system, not-for-profit, and industry levels. In 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing key social determinants of health including food, housing, and transportation among patients with cancer. This commentary summarizes the formal presentations and discussions related to transportation insecurity and will 1) discuss the heterogeneous nature of transportation insecurity among patients with cancer; 2) characterize its prevalence along the cancer continuum; 3) examine its multilevel consequences; 4) discuss measurement and screening tools; 5) highlight ongoing efforts to address transportation insecurity; 6) suggest policy levers; and 7) outline a research agenda to address critical knowledge gaps.