Racial, ethnic, and sex-based disparities among high-risk individuals undergoing pancreatic cancer surveillance

Background: The international, multi-center Pancreatic Cancer Early Detection (PRECEDE) Consortium enrolls high-risk individuals (HRIs) undergoing pancreatic ductal adenocarcinoma (PDAC) surveillance. Enrollment began in 2020, and despite challenges related to the COVID-19 pandemic, the PRECEDE Consortium rapidly accrued a large cohort of HRIs. The purpose of this study is to describe the characteristics of this cohort and assess racial, ethnic, and sex-based disparities. Method(s): The PRECEDE Consortium (NCT04970056) is a prospective, multicenter study focused on improving survival from PDAC through early detection. Data from all HRIs who met criteria for PDAC surveillance and enrolled between May 2020 - March 2022 were collected and included in the analysis. Result(s): During the study period, 1299 HRIs enrolled in PRECEDE at 32 centers. HRIs were excluded if enrollment data was incomplete or criteria for PDAC surveillance were not met. Of 1113 who were included, 47.2% met criteria for familial pancreatic cancer (FPC) and 45.4% had a family history of PDAC along with a PV in a PDAC-risk gene (BRCA1, BRCA2, PALB2, ATM, MLH1, MSH2, MSH6, PMS2, or EPCAM). The remainder had familial atypical mole melanoma syndrome (5.7%), Peutz- Jeghers syndrome (1.6%), or hereditary pancreatitis (0.2%). More females than males enrolled (65.9% vs. 33.5%). The distribution of HRIs by race and ethnicity is depicted;the majority identified as white (87.7%). Study participants were primarily from the US (82.7%), the median age was 61 (27-85) and 18.5% had Ashkenazi Jewish ancestry. Nearly all HRIs consented to allow access to imaging data (99.6%), collection of germline DNA (97.7%), and biosample collection (99.5%). There were no race, ethnicity, or sex-based differences in rates of consent for collection of imaging, DNA, or biosamples. Conclusion(s): Enrollment of HRIs in prospective studies of PDAC surveillance is essential for advancing early detection research in PDAC. A distinct advantage of the PRECEDE Consortium for examining enrollment disparities is that recruitment began in 2020, providing a unique and current snapshot of the international PDAC surveillance landscape. Despite the recent attention on addressing disparities in healthcare delivery, significant racial, ethnic, and sex-based disparities persisted in the cohort of HRIs enrolled in the PRECEDE Consortium. Ensuring that the diversity of participants in the PRECEDE Consortium mirrors the communities served by participating centers is crucial. Further examining and addressing the reasons for these disparities is a major focus of the PRECEDE Consortium moving forward.

The Frailty of the Invincible.

The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very "democratic", its consequences aren't. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and "financialisation". In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake.

Yellowstone Volcano Observatory 2021 Annual Report

The Yellowstone Volcano Observatory (YVO) monitors volcanic and hydrothermal activity associated with the Yellowstone magmatic system, carries out research into magmatic processes occurring beneath Yellowstone Caldera, and issues timely warnings and guidance related to potential future geologic hazards (see sidebar on volcanic hazards on p. 2). YVO is a collaborative consortium made up of the U.S. Geological Survey (USGS), Yellowstone National Park, University of Utah, University of Wyoming, Montana State University, UNAVCO, Wyoming State Geological Survey, Montana Bureau of Mines and Geology, and Idaho Geological Survey (see sidebar on YVO on p. 3). The USGS arm of YVO also has the operational responsibility for monitoring volcanic activity in the Intermountain West of the United States, including Arizona, New Mexico, Utah, and Colorado. Despite the decrease in activity compared to the previous 3 years, Steamboat Geyser continued to impress visitors with 20 major water eruptions in 2021. This episodic activity is typical of many geysers in Yellowstone National Park, as demonstrated once again in 2021, when Sawmill Geyser returned to its usual pattern of multiple eruptions per day after about 4.5 years of quiescence. Monitoring measurements indicate background levels of seismicity, deformation, and thermal emissions. The number of located earthquakes (2,773) was the most since 2017, when 3,427 earthquakes were located, but the 2021 value was still not significantly different from the average number of annual located events. GPS measurements indicated no significant deformation at Norris Geyser Basin throughout the year, and Yellowstone Caldera continued to subside at rates of a few centimeters (about 1 inch) per year, as it has since 2015. One noteworthy change in deformation style was detected by satellite radar, which documented about 1 centimeter (0.4 inch) of uplift centered on the north side of the caldera, south of Norris Geyser Basin, between late 2020 and late 2021. The deformation strongly resembles that which occurred during 1996-2004 but is yet too small to be strongly apparent in nearby continuous GPS stations. Heat flux estimates from both satellite imagery and river chemistry indicate no major changes with respect to previous years. The COVID-19 pandemic limited field work in 2021, although critical equipment maintenance and deployments and several scientific studies were still carried out. Temporary deployments of seismometers in Norris and Upper Geyser Basins collected information that will be used to better understand geyser plumbing systems, and a new continuous gas-monitoring station-the first of its kind in Yellowstone National Park-was deployed near Mud Volcano in July. Geologic investigations focused on better understanding the age and history of hydrothermal explosion craters in the Lower Geyser Basin, revising geologic maps in the areas around Mount Everts and the Sour Creek resurgent dome, improving age constraints on post-caldera rhyolite lava flows, and investigating the sources of hydrothermal travertine within Yellowstone Caldera. Additional sedimentary cores were collected from Yellowstone Lake to better constrain the characteristics and extent of lake-bottom hydrothermal activity and triggers for hydrothermal explosions. New research results will be highlighted in future editions of YVO's weekly series of online articles, Yellowstone Caldera Chronicles, which can be accessed at https://www.usgs.gov/volcanoes/yellowstone/caldera-chronicles, as well as in annual reports, monthly updates and videos, and public presentations. © 2021 US Geological Survey. All Rights Reserved.

The promise and pitfalls of environmental DNA and RNA approaches for the monitoring of human and animal pathogens from aquatic sources

Novel forensics-inspired molecular approaches have revolutionized species detection in the wild and are particularly useful for tracing endangered or invasive species. These new environmental DNA or RNA (eDNA or eRNA)-based techniques are now being applied to human and animal pathogen surveillance, particularly in aquatic environments. They allow better disease monitoring (presence or absence and geographical spread) and understanding of pathogen occurrence and transmission, benefitting species conservation and, more recently, our understanding of the COVID-19 global human pandemic. In the present article, we summarize the benefits of eDNA-based monitoring, highlighted by two case studies: The first is a fibropapillomatosis tumor-associated herpesvirus (chelonid herpesvirus 5) driving a sea turtle panzootic, and the second relates to eRNA-based detection of the SARS-CoV-2 coronavirus driving the COVID-19 human pandemic. The limitations of eDNA- or eRNA-based approaches are also summarized, and future directions and recommendations of the field are discussed. Continuous eDNA- or eRNA-based monitoring programs can potentially improve human and animal health by predicting disease outbreaks in advance, facilitating proactive rather than reactive responses.

Home spo2 monitoring of patients with covid-19: The mater cvc project

Background: The COVID19 pandemic has necessitated innovative ways to provide safe healthcare remotely for large numbers of infected patients. We implemented a COVID Virtual Clinic (CVC) in a tertiary referral centre allowing such patients to be monitored in the community. This study describes the CVC's remote monitoring experience and explores the predictors of need for specialist intervention. Methods: We included all patients enrolled in the CVC at the Mater Misericordiae University Hospital, Dublin between March 1st and June 1st 2020. Patients received a Bluetooth-enabled pulse oximeter and smartphone application (Patient-M-Power®) and uploaded twice-daily SpO2 readings, heart rate and dyspnoea score (1-10). A team of 2-14 healthcare providers monitored results. Abnormal or absent data triggered calls from the CVC, with assessments and/or admission as required. We collected data on demographics, calls received from/made to patients, outcomes and readmissions. Descriptive analysis of the CVC was performed as well as simple logistic regression to explore factors associated with the likelihood of readmission. Results: 502 patients were included (179 (36.4%) male, median age 39 (IQR 50-3) years, 360 (73.2%) staff). Outcomes are illustrated in Figure 1. Median time in CVC was 12 days (IQR 13-10). 1902 calls were made to patients by CVC staff prompted by abnormal data: dyspnoea (41 patients, 8.2%), low SpO2 (133, 26.5%), tachycardia, (99, 19.7%), technical issues (81, 16.1%), absent results (255, 50.1%). This resulted in 45 (9%) patients requiring re-assessment and 42 (8.4%) being readmitted. Of those readmitted, 3 (7%) required critical care admission. Median length of stay was 2 (IQR 6.75-1) days. Those readmitted were more likely to be older (odds ratio [OR] per year older 1.03 (1.01, 1.05), P=0.0050, have an abnormal SpO2 (<94%, OR 5.43 [2.93, 11.1], P<0.001), a high dyspnoea score (>7, OR 4.33 (2.04, 9.3), P<0.001) and be staff (OR 6.08 (3.11, 11.87), P<0.001). Neither gender nor abnormal HR were associated with higher likelihood of readmission. 22.2% of presenting patients were hypoxic in the absence of dyspnoea, of which 70% required admission and one patient required intensive care. Conclusion: We describe the largest remotely monitored cohort of COVID19 patients to date. The low frequency of readmissions and value of SpO2 monitoring and dyspnoea scores as predictors of readmission highlights the value of this model in providing safe care whilst minimising unnecessary admissions.

COVID-19 related pancreatic cancer surveillance disruptions amongst high-risk individuals

BACKGROUND: COVID-19 pandemic-related disruptions to EUS-based pancreatic cancer surveillance in high-risk individuals remain uncertain. METHODS: Analysis of enrolled participants in the CAPS5 Study, a prospective multicenter study of pancreatic cancer surveillance in high-risk individuals. RESULTS: Amongst 693 enrolled high-risk individuals under active surveillance, 108 (16%) had an EUS scheduled during the COVID-19 pandemic-related shutdown (median length of 78 days) in the spring of 2020, with 97% of these procedures being canceled. Of these canceled surveillance EUSs, 83% were rescheduled in a median of 4.1 months, however 17% were not rescheduled after 6 months follow-up. Prior history of cancer was associated with increased likelihood of rescheduling. To date no pancreatic cancer has been diagnosed among those whose surveillance was delayed. CONCLUSIONS: COVID-19 delayed pancreatic cancer surveillance with no adverse outcomes in efficiently rescheduled individuals. However, 1 in 6 high-risk individuals had not rescheduled surveillance, indicating the need for vigilance to ensure timely surveillance rescheduling.

Immersive Interactive Technology: A Case Study of a Wine Farm

Immersive technologies have paved a unique way of performing agricultural activities as well as learning and interacting with 3D content, among others. Moreover, the current situation from the COVID-19 pandemic has further created the need to develop solutions that can help the agriculture industry to stay relevant and ahead of potential post-COVID-19 challenges. This paper presents an immersive virtual reality application using a wine farm as a case study. The developed farm marketing application used participatory design and SCRUM methodology to showcase a wine farm and the wine production process. The application provides a virtual walk-through of the vineyards (lookout point), the lodge, the community garden, the conference facilities, as well as the cellar in 3D 360-degree rendering. Current basic 360-degree exploration applications exist but none have incorporated 3D 360-degree exploration as presented in the current research. The immersive experience provides a more realistic experience and feel of what is available on the farm. Results and feedback confirm that the farm marketing application shows promise in promoting wine farm marketing and other farm offerings. © 2020 ITU.

The Frailty of the Invincible.

The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very "democratic", its consequences aren't. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and "financialisation". In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake.