Clinical Characteristics, Experiences, and Outcomes of Transgender Patients With Cancer.

IMPORTANCE: More than 1 million people in the US identify as transgender; however, few studies have examined the experiences and outcomes of transgender patients with cancer. OBJECTIVE: To examine clinical characteristics, experiences, and outcomes of transgender patients with cancer. DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series assessed transgender patients with at least 1 cancer diagnosis who were evaluated at Dana-Farber Cancer Institute or Brigham and Women's Hospital in Boston, Massachusetts, between January 1, 2005, and December 31, 2019. MAIN OUTCOMES AND MEASURES: Demographic, clinical, and treatment characteristics for all patients and documentation by oncologic practitioners of important aspects of providing gender-affirming care, including pronouns used by the patient, were recorded. RESULTS: A total of 37 transgender patients with cancer were assessed (mean [SD] age, 38.9 [21.8] years at first cancer diagnosis). Fifteen patients (40.5%) had hematologic malignant cancers, and 25 patients (67.6%) had solid malignant tumors. Sixteen patients (43.2%) initiated gender-affirming hormone therapy or surgery after their cancer diagnosis. Cancer treatment was frequently multimodal, with 24 patients (64.9%) receiving systemic therapy, 24 (64.9%) receiving surgery, and 20 (54.1%) receiving radiation therapy along with other cancer-directed treatment, such as cryoablation. Five patients (13.5%) had documentation from an oncologic practitioner that addressed a potential interaction between their gender-affirming care and their cancer treatment. Thirty-three patients had follow-up visits with oncologic practitioners after starting their transition. Of those patients, pronouns used were documented by a member of the oncologic team for 4 patients (12.1%). However, for 3 of the 4 patients, documentation did not consistently use patient-reported information. At the last follow-up, 5 patients (13.5%) had died of their disease, and 26 (70.3%) were living without disease. CONCLUSIONS AND RELEVANCE: This case series study found that transgender patients were diagnosed with diverse cancers, and many initiated gender-affirming hormone therapy or surgery after their diagnosis. Documentation by oncologic practitioners infrequently included pronouns used by the patient or discussion surrounding the interactions between cancer treatment and gender-affirming care, signifying that urgent improvements are needed in cancer care for transgender patients.

Experimental resource pulses influence social-network dynamics and the potential for information flow in tool-using crows.

Social-network dynamics have profound consequences for biological processes such as information flow, but are notoriously difficult to measure in the wild. We used novel transceiver technology to chart association patterns across 19 days in a wild population of the New Caledonian crow--a tool-using species that may socially learn, and culturally accumulate, tool-related information. To examine the causes and consequences of changing network topology, we manipulated the environmental availability of the crows' preferred tool-extracted prey, and simulated, in silico, the diffusion of information across field-recorded time-ordered networks. Here we show that network structure responds quickly to environmental change and that novel information can potentially spread rapidly within multi-family communities, especially when tool-use opportunities are plentiful. At the same time, we report surprisingly limited social contact between neighbouring crow communities. Such scale dependence in information-flow dynamics is likely to influence the evolution and maintenance of material cultures.

Calibrating animal-borne proximity loggers.

Growing interest in the structure and dynamics of animal social networks has stimulated efforts to develop automated tracking technologies that can reliably record encounters in free-ranging subjects. A particularly promising approach is the use of animal-attached 'proximity loggers', which collect data on the incidence, duration and proximity of spatial associations through inter-logger radio communication. While proximity logging is based on a straightforward physical principle - the attenuation of propagating radio waves with distance - calibrating systems for field deployment is challenging, since most study species roam across complex, heterogeneous environments.In this study, we calibrated a recently developed digital proximity-logging system ('Encounternet') for deployment on a wild population of New Caledonian crows Corvus moneduloides. Our principal objective was to establish a quantitative model that enables robust post hoc estimation of logger-to-logger (and, hence, crow-to-crow) distances from logger-recorded signal-strength values. To achieve an accurate description of the radio communication between crow-borne loggers, we conducted a calibration exercise that combines theoretical analyses, field experiments, statistical modelling, behavioural observations, and computer simulations.We show that, using signal-strength information only, it is possible to assign crow encounters reliably to predefined distance classes, enabling powerful analyses of social dynamics. For example, raw data sets from field-deployed loggers can be filtered at the analysis stage to include predominantly encounters where crows would have come to within a few metres of each other, and could therefore have socially learned new behaviours through direct observation. One of the main challenges for improving data classification further is the fact that crows - like most other study species - associate across a wide variety of habitats and behavioural contexts, with different signal-attenuation properties.Our study demonstrates that well-calibrated proximity-logging systems can be used to chart social associations of free-ranging animals over a range of biologically meaningful distances. At the same time, however, it highlights that considerable efforts are required to conduct study-specific system calibrations that adequately account for the biological and technological complexities of field deployments. Although we report results from a particular case study, the basic rationale of our multi-step calibration exercise applies to many other tracking systems and study species.

Readmission rates due to venous thromboembolism in cancer patients after abdominopelvic surgery, a retrospective chart review.

PURPOSE: Venous thromboembolism (VTE) is a known cause of morbidity in the oncology patient population. As hospital readmission rates are more frequently scrutinized, we sought to determine the most common causes of 30-day readmissions in the cancer patient following abdominopelvic surgery. Furthermore, due to the high risk of VTE, there have been guidelines established for prophylaxis. As guidelines are based on asymptomatic VTE, we studied the compliance rates of these guidelines in our institution and the rate of symptomatic VTE in the 30-day postoperative period. METHODS: We conducted a retrospective chart review at Pennsylvania Hospital of abdominopelvic surgeries between January 1, 2010 and December 31, 2012 in patients with abdominopelvic malignancies, totaling 263 patients. RESULTS: The median age of our patient population was 67 years and 51.3 % were female. The most common malignancy locations were colorectal (44 %) and pancreas (11 %). One patient did not receive perioperative anticoagulation; most received heparin subcutaneously three times daily, mean duration 5.5 days. Fourteen patients (5 %) received outpatient anticoagulation after discharge; only two had a primary intent of VTE prophylaxis. Thirty-five patients (13 %) were readmitted within 30 days of discharge, the most common reasons being abdominal symptoms and postoperative/surgical complications. There was one patient readmitted for a new, symptomatic VTE. CONCLUSIONS: Our study showed only one new, symptomatic VTE in the study population, despite 95 % of patients not receiving outpatient anticoagulation, which suggests that continued larger and multicenter trials may be needed to study anticoagulation benefits and risks in this patient population.

Monocular tool control, eye dominance, and laterality in New Caledonian crows.

Tool use, though rare, is taxonomically widespread, but morphological adaptations for tool use are virtually unknown. We focus on the New Caledonian crow (NCC, Corvus moneduloides), which displays some of the most innovative tool-related behavior among nonhumans. One of their major food sources is larvae extracted from burrows with sticks held diagonally in the bill, oriented with individual, but not species-wide, laterality. Among possible behavioral and anatomical adaptations for tool use, NCCs possess unusually wide binocular visual fields (up to 60°), suggesting that extreme binocular vision may facilitate tool use. Here, we establish that during natural extractions, tool tips can only be viewed by the contralateral eye. Thus, maintaining binocular view of tool tips is unlikely to have selected for wide binocular fields; the selective factor is more likely to have been to allow each eye to see far enough across the midsagittal line to view the tool's tip monocularly. Consequently, we tested the hypothesis that tool side preference follows eye preference and found that eye dominance does predict tool laterality across individuals. This contrasts with humans' species-wide motor laterality and uncorrelated motor-visual laterality, possibly because bill-held tools are viewed monocularly and move in concert with eyes, whereas hand-held tools are visible to both eyes and allow independent combinations of eye preference and handedness. This difference may affect other models of coordination between vision and mechanical control, not necessarily involving tools.