Long-term catheter management in the community: a population-based analysis of user characteristics, service utilisation and costs in England.

BACKGROUND: Long-term urinary catheters are problematic and burdensome for patients, carers and health services. Nursing practice to improve the management of long-term urinary catheters has been held back by a lack of evidence to support policy and practice. Little is known about who uses a catheter long term and the resources and costs needed for their management. Understanding these costs will help to target innovations to improve care. There have been no substantial innovations to urinary catheters or their management recently and no publications to characterise users and costs. AIM: To describe long-term catheter users and explore catheter-related service use and costs in England. METHODS: Descriptive information on the characteristics of catheter users and their use of services was obtained from: General Practice records (n = 607), district nursing records (n = 303), questionnaires to patients (n = 333) and triangulated, 2009-2012. Annual service costs (British pounds 2011) were computed. FINDINGS: Most catheter users (59.6%) were men, nearly three-quarters (71.2%) were over 70 years and 60.8% used a urethral catheter. Women tended to be younger than men and more likely to use a suprapubic catheter. The services used most frequently over 12 months were general practitioner (by 63.1%) and out of hours services (43.0%); 15.5% accessed Accident and Emergency services for urgent catheter-related care. Hospital use accounted for nearly half (48.9%) of total health service costs (mainly due to inpatient stays by 13.6% of participants); catheter supplies/medications were next most costly (25.7%). Half of all costs were accounted for by 14.2% of users. The median annual cost of services used was £6.38, IQR: £344-£1324; district nursing services added approximately a further £200 per annum. CONCLUSIONS: Finding better ways to reduce catheter problems (e.g. blockage, infection) that cause unplanned visits, urgent or hospital care should be a priority to improve quality of life for long-term catheter users and reduce health service expenditure.

Prevention of child sexual abuse in the United States: Scoping review of United States legislative policies.

BACKGROUND: States in the United States (US) have passed and enacted legislation for the purpose of preventing child sexual abuse (CSA) since 2000, but it is unknown whether these legislative policies reduce adult-perpetrated CSA. OBJECTIVE: Review the literature from 2000 to 2023 to understand which US CSA prevention policies have been evaluated, the effectiveness of these policies, study populations, and barriers and facilitators associated with the implementation of CSA prevention policies. METHODS: The study protocol was published prior to undertaking the review: PMC10603531. The review follows Joanna Briggs Institute methodology and is reported according to the PRISMA-ScR Checklist. We searched 27 databases, hand searched reference lists of included studies, and sent notice via listserv to other researchers in the field. Articles were included if the content focused on CSA prevention policies and the effects. No limits to methodology were applied. Methodological rigor was assessed. RESULTS: 2209 potentially relevant articles were identified; 20 articles advanced to full-text review, three satisfied the inclusion criteria. Three eligible studies focused on CSA prevention education policies, while the other focused on mandated reporting policies. Effects of these policies were mixed in relation to CSA reporting and substantiation rates. No study considered child demographics. CONCLUSIONS: Despite decades of legislative action for CSA prevention across the US, only a few studies have assessed the effects of these policies. These findings highlight the need for additional research to ensure that CSA prevention policies such as CSA prevention education in schools and mandated reporting practices are working as intended.

Healthcare professionals' experiences and views of providing continence support and advice to people living at home with dementia: "That's a carer's job".

BACKGROUND: People living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. This study aimed to understand more about healthcare professionals' experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home. METHODS: Semi-structured interviews were conducted with a range of healthcare professionals (n = 31) working in primary and community care in the South of England in 2023. Transcribed interviews were uploaded to NVivo 12, then analysed inductively and deductively using a thematic framework. RESULTS: Continence-related conversations were avoided by many healthcare professionals due to lack of dementia-continence specific knowledge. Many considered that continence problems of people living with dementia were largely outside their remit once a physical cause had been ruled out. This contributed to a lack of priority and proactivity in raising the subject of continence in their consultations. Challenges to providing support included limited consultation time and lack of access to specialist services with availability to support individuals. CONCLUSION: There is substantial scope to support primary and community-based healthcare professionals in their provision of continence-related support and advice to people living at home with dementia. This includes addressing knowledge deficits, enhancing confidence and instilling a sense of accomplishment.

Child Sexual Abuse in the United States: A Commentary on Current Policy Approaches to Prevention and Aspirations for the Future.

Child sexual abuse (CSA) is a significant threat to the health and well-being of children in the United States (US). Public policies are a key public health strategy for the primary prevention of violence, including CSA. In 2021, the Enough Abuse Campaign and Prevent Child Abuse America published a comprehensive report entitled A Call to Action for Policymakers and Advocates: Child Sexual Abuse Prevention Legislation in the States to encourage state leaders to create a comprehensive strategy to prevent CSA in the US. Findings from the report show that the nation has made some effort to address CSA, but more focus needs to be given to primary prevention strategies that stop it from occurring in the first place. The report also illustrates the variability of CSA prevention policies across the US and highlights critical gaps in current approaches that must be addressed. In the spirit of the special issue, the authors reflect on key policy issues in the field, including the lack of a federal policy framework for CSA prevention, dedicated funding for the prevention of CSA, and research on the effectiveness of policies intended to prevent CSA. Suggestions for future directions in relation to policy development provided in this commentary will be useful to a variety of stakeholders interested in the topic of CSA prevention policy.

In-Cell Association of a Bioorthogonal Tubulin.

Studies of proteins from one organism in another organism's cells have shown that such exogenous proteins stick more, pointing toward coevolution of the cytoplasm and protein surface to minimize stickiness. Here we flip this question around by asking whether exogenous proteins can assemble efficiently into their target complexes in a non-native cytoplasm. We use as our model system the assembly of BtubA and BtubB from Prosthecobacter hosted in human U-2 OS cells. BtubA and B evolved from eukaryotic tubulins after horizontal gene transfer, but they have low surface sequence identity with the homologous human tubulins and do not respond to tubulin drugs such as nocodazole. In U-2 OS cells, BtubA and B assemble efficiently into dimers compared to in vitro, and the wild-type BtubA and B proteins subsequently are able to form microtubules as well. We find that generic crowding effects (Ficoll 70 in vitro) contribute significantly to efficient dimer assembly when compared to sticking interactions (U-2 OS cell lysate in vitro), consistent with the notion that a generic mechanism such as crowding can be effective at driving assembly of exogenous proteins, even when protein-cytoplasm quinary structure and sticking have been modified in a non-native cytoplasm. A simple Monte Carlo model of in vitro and in-cell interactions, treating BtubA and B as sticky dipoles in a matrix of sticky or nonsticky crowders, rationalizes all the experimental trends with two adjustable parameters and reveals nucleation as the likely mechanism for the time-scale separation between dimer- and tubule formation in-cell and in vitro.

Disseminated Disease After Candidemia in Children and Young Adults: Epidemiology, Diagnostic Evaluation and Risk Factors.

BACKGROUND: Treatment of candidemia may be complicated by hematogenous dissemination. Limited data exist to guide decision-making regarding the evaluation for disseminated disease. We sought to describe the epidemiology of invasive disease after candidemia, report the diagnostic evaluations performed and identify risk factors for disseminated disease. METHODS: We performed a retrospective single-center study of candidemia from January 1, 2012 to December 31, 2022. Disseminated candidiasis was defined as radiologic findings consistent with end-organ disease, abnormal ophthalmologic exam or growth of Candida spp. from a sterile site after an episode of candidemia. A multilevel regression model was used to identify risk factors for dissemination. RESULTS: The cohort included 124 patients with 144 episodes of candidemia. Twelve patients died before an evaluation for dissemination occurred. Only 107/132 patients underwent evaluation for dissemination. Tests obtained included abdominal imaging (93/132), echocardiography (91/132), neuroimaging (45/132) and chest imaging (38/132). A retinal examination was performed in 90/132 patients. Overall, 27/107 patients (25%) had disseminated disease. Frequently identified sites of dissemination were lungs and abdominal organs. Regression modeling identified prematurity [adjusted odds ratio (aOR): 11.88; 95% confidence interval (CI): 1.72-81.90] and mitochondrial and genetic disease (aOR: 5.66; 95% CI: 1.06-30.17) as risk factors for disseminated candidiasis. Each additional day of candidemia increased the odds of dissemination (aOR: 1.36; 95% CI: 1.12-1.66). DISCUSSION: In a heterogeneous cohort of patients, disseminated candidiasis was common. Evaluation for disseminated disease was variable. Those with persistent candidemia had significantly increased risk of dissemination and should undergo a standardized evaluation for disseminated disease.

Nanoparticle Size Influences the Self-Assembly of Gold Nanorods Using Flexible Streptavidin-Biotin Linkages.

The self-assembly of colloidal nanocrystals remains of robust interest due to its potential in creating hierarchical nanomaterials that have advanced function. For gold nanocrystals, junctions between nanoparticles yield large enhancements in local electric fields under resonant illumination, which is suitable for surface-enhanced spectroscopies for molecular sensors. Gold nanorods can provide such plasmonic fields at near-infrared wavelengths of light for longitudinal excitation. Through the use of careful concentration and stoichiometric control, a method is reported herein for selective biotinylation of the ends of gold nanorods for simple, consistent, and high-yielding self-assembly upon addition of the biotin-binding protein streptavidin. This method was applied to four different sized nanorods of similar aspect ratio and analyzed through UV-vis spectroscopy for qualitative confirmation of self-assembly and transmission electron microscopy to determine the degree of self-assembly in end-linked nanorods. The yield of end-linked assemblies approaches 90% for the largest nanorods and approaches 0% for the smallest nanorods. The number of nanorods linked in one chain also increases with an increased nanoparticle size. The results support the notion that the lower ligand density at the ends of the larger nanorods yields preferential substitution reactions at those ends and hence preferential end-to-end assembly, while the smallest nanorods have a relatively uniform ligand density across their surfaces, leading to spatially random substitution reactions.

Visualizing ultrafast photothermal dynamics with decoupled optical force nanoscopy.

The photothermal effect in nanomaterials, resulting from resonant optical absorption, finds wide applications in biomedicine, cancer therapy, and microscopy. Despite its prevalence, the photothermal effect in light-absorbing nanoparticles has typically been assessed using bulk measurements, neglecting near-field effects. Beyond standard imaging and therapeutic uses, nanosecond-transient photothermal effects have been harnessed for bacterial inactivation, neural stimulation, drug delivery, and chemical synthesis. While scanning probe microscopy and electron microscopy offer single-particle imaging of photothermal fields, their slow speed limits observations to milliseconds or seconds, preventing nanoscale dynamic investigations. Here, we introduce decoupled optical force nanoscopy (Dofn), enabling nanometer-scale mapping of photothermal forces by exploiting unique phase responses to temporal modulation. We employ the photothermal effect's back-action to distinguish various time frames within a modulation period. This allows us to capture the dynamic photothermal process of a single gold nanorod in the nanosecond range, providing insights into non-stationary thermal diffusion at the nanoscale.

Prevention of child sexual abuse in the USA: a scoping review protocol of US legislative policies.

INTRODUCTION: Child sexual abuse (CSA) poses a significant threat to the health and well-being of children in the USA and globally. Many states have introduced or implemented policies to address and prevent CSA, but little research has linked the effects of this legislation on the reduction of adult-perpetrated CSA. The objective of this scoping review is to identify US policies which aim to prevent CSA, explain the components of these types of legislation, review evidence of effectiveness, describe the populations included in the literature, and identify barriers and facilitators to the implementation of said policies. METHODS AND ANALYSIS: This scoping review will follow Joanna Briggs Institute methodology for scoping reviews and will use the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Sources of peer-reviewed evidence from January 2000 to July 2023 will be included. Relevant publications will first be searched in PubMed/MEDLINE database, then 25 other databases. The reference lists of included studies and high-yield journals will be hand searched. Articles which focus on the types of CSA prevention policies and their effects will be included. Studies must clearly demonstrate a connection between policies and CSA outcomes. Title, abstract, full-text screening and extraction will be completed by a team of three researchers. Critical appraisal of the included studies will be performed. Extracted data will be displayed in tabular form and a narrative summary will describe the results of the review. ETHICS AND DISSEMINATION: This scoping review will provide an extensive overview of legislative policies which aim to prevent CSA in the USA. Results of this review will inform future CSA prevention policies in the USA, particularly regarding policy development, evaluation and implementation. Results will be disseminated through a peer-reviewed publication.

Biologically Representative Lipid-Coated Gold Nanoparticles and Phospholipid Vesicles for the Study of Alpha-Synuclein/Membrane Interactions.

Alpha-synuclein is an intrinsically disordered protein whose formation of beta-sheet-rich protein aggregates in the brain is implicated in the development of Parkinson's disease. Due to its believed role in synaptic vesicle trafficking and neurotransmission, many studies have employed simple, synthetic model systems to investigate alpha-synuclein/membrane interactions in an attempt to gain a better understanding of the protein's native and pathogenic functions. Interestingly, these studies seem to suggest that alpha-synuclein interacts differently with rigid vesicle mimics in comparison to malleable vesicle mimics. However, the use of different mimic sizes and surface chemistries across existing studies makes it challenging to directly compare the effects of membrane mechanical properties on protein behavior observed thus far. In this work, we developed a synaptic vesicle mimic library comprising a range of both malleable and rigid synaptic vesicle mimics possessing the same size and biologically representative lipid surface chemistry. Limited proteolysis mass spectrometry experiments revealed distinct fragmentation patterns between rigid and malleable synaptic vesicle mimics. The N-terminal and C-terminal regions of alpha-synuclein were found to become less solvent-accessible upon binding to all synaptic vesicle mimics. Nevertheless, minor variations in digestion pattern were observed in the central region of the protein dependent upon mimic size, rigidity, and lipid composition. Higher binding affinities were observed for alpha-synuclein binding to rigid synaptic vesicle mimics compared to malleable synaptic vesicle mimics. Additionally, the binding affinity of alpha-synuclein toward small lipid vesicles and small lipid-coated gold nanoparticles without cholesterol was found to be lower than that of their respective malleable and rigid counterparts. Interestingly, the binding curves for the rigid synaptic vesicle mimics demonstrated a nontraditional peak and dip shape believed to arise from differences in alpha-synuclein orientation on the particle surface at different protein-to-particle incubation ratios.

Adsorption and Molecular Display of a Redox-Active Protein on Gold Nanoparticle Surfaces.

Engineered gold nanoparticles (AuNPs) have great potential in many applications due to their tunable optical properties, facile synthesis, and surface functionalization via thiol chemistry. When exposed to a biological environment, NPs are coated with a protein corona that can alter the NPs' biological identity but can also affect the proteins' structures and functions. Protein disulfide isomerase (PDI) is an abundant protein responsible for the disulfide formation and isomerization that contribute to overall cell redox homeostasis and signaling. Given that AuNPs are widely employed in nanomedicine and PDI plays a functional role in various diseases, the interactions between oxidized (oPDI) and reduced (rPDI) with 50 nm citrate-coated AuNPs (AuNPs) are examined in this study using various techniques. Upon incubation, PDI adsorbs to the AuNP surface, which leads to a reduction in its enzymatic activity despite limited changes in secondary structures. Partial enzymatic digestion followed by mass spectrometry analysis shows that orientation of PDI on the NP surface is dependent on both its oxidation state and the PDI:AuNP incubation ratios.

Nanoscale goldbeating: Solid-state transformation of 0D and 1D gold nanoparticles to anisotropic 2D morphologies.

Goldbeating is the ancient craft of thinning bulk gold (Au) into gossamer leaves. Pioneered by ancient Egyptian craftsmen, modern mechanized iterations of this technique can fabricate sheets as thin as ∼100 nm. We take inspiration from this millennia-old craft and adapt it to the nanoscale regime, using colloidally synthesized 0D/1D Au nanoparticles (AuNPs) as highly ductile and malleable nanoscopic Au ingots and subjecting them to solid-state, uniaxial compression. The applied stress induces anisotropic morphological transformation of AuNPs into 2D leaf form and elucidates insights into metal nanocrystal deformation at the extreme length scales. The induced 2D morphology is found to be dependent on the precursor 0D/1D NP morphology, size (0D nanosphere diameter and 1D nanorod diameter and length), and their on-substrate arrangement (e.g., interparticle separation and packing order) prior to compression. Overall, this versatile and generalizable solid-state compression technique enables new pathways to synthesize and investigate the anisotropic morphological transformation of arbitrary NPs and their resultant emergent phenomena.

The Landscape of Gold Nanocrystal Surface Chemistry.

ConspectusGold nanoparticles (AuNPs) exhibit unique size- and shape-dependent properties not obtainable at the macroscale. Gold nanorods (AuNRs), with their morphology-dependent optical properties, ability to convert light to heat, and high surface-to-volume ratios, are of great interest for biosensing, medicine, and catalysis. While the gold core provides many fascinating properties, this Account focuses on AuNP soft surface coatings, which govern the interactions of nanoparticles with the local environments. Postmodification of AuNP surface chemistry can greatly alter NP colloidal stability, nano-bio interactions, and functionality. Polyelectrolyte coatings provide controllable surface-coating thickness and charge, which impact the composition of the acquired corona in biological settings. Covalent modification, in which covalently bound ligands replace the original capping layer, is often performed with thiols and disulfides due to their ability to replace native coatings. N-heterocyclic carbenes and looped peptides expand the possible functionalities of the ligand layer.The characterization of surface ligands bound to AuNPs, in terms of ligand density and dynamics, remains a challenge. Nuclear magnetic resonance (NMR) spectroscopy is a powerful tool for understanding molecular structures and dynamics. Our recent NMR work on AuNPs demonstrated that NMR data were obtainable for ligands on NPs with diameters up to 25 nm for the first time. This was facilitated by the strong proton NMR signals of the trimethylammonium headgroup, which are present in a distinct regime from other ligand protons' signals. Ligand density analyses showed that the smallest AuNPs (below 4 nm) had the largest ligand densities, yet spin-spin T2 measurements revealed that these smallest NPs also had the most mobile ligand headgroups. Molecular dynamics simulations were able to reconcile these seemingly contradictory results.While NMR spectroscopy provides ligand information averaged over many NPs, the ligand distribution on individual particles' surfaces must also be probed to fully understand the surface coating. Taking advantage of improvements in electron energy loss spectroscopy (EELS) detectors employed with scanning transmission electron microscopy (STEM), a single-layer graphene substrate was used to calibrate the carbon K-edge EELS signal, allowing quantitative imaging of the carbon atom densities on AuNRs with sub-nanometer spatial resolution. In collaboration with others, we revealed that the mean value for surfactant-bilayer-coated AuNRs had 10-30% reduced ligand density at the ends of the rods compared to the sides, confirming prior indirect evidence for spatially distinct ligand densities.Recent work has found that surface ligands on nanoparticles can, somewhat surprisingly, enhance the selectivity and efficiency of the electrocatalytic reduction of CO2 by controlling access to the active site, tuning its electronic and chemical environment, or denying entry to impurities that poison the nanoparticle surface to facilitate reduction. Looking to the future, while NMR and EELS are powerful and complementary techniques for investigating surface coatings on AuNPs, the frontier of this field includes the development of methods to probe the surface ligands of individual NPs in a high-throughput manner, to monitor nano-bio interactions within complex matrices, and to study structure-property relationships of AuNPs in biological systems.

Immunoglobulin adsorption and film formation on mechanically wrinkled and crumpled surfaces at submonolayer coverage.

Understanding protein adsorption behavior on rough and wrinkled surfaces is vital to applications including biosensors and flexible biomedical devices. Despite this, there is a dearth of study on protein interaction with regularly undulating surface topographies, particularly in regions of negative curvature. Here we report nanoscale adsorption behavior of immunoglobulin M (IgM) and immunoglobulin G (IgG) on wrinkled and crumpled surfaces via atomic force microscopy (AFM). Hydrophilic plasma treated poly(dimethylsiloxane) (PDMS) wrinkles with varying dimensions exhibit higher surface coverage of IgM on wrinkle peaks over valleys. Negative curvature in the valleys is determined to reduce protein surface coverage based both on an increase in geometric hindrance on concave surfaces, and reduced binding energy as calculated in coarse-grained molecular dynamics simulations. The smaller IgG molecule in contrast shows no observable effects on coverage from this degree of curvature. The same wrinkles with an overlayer of monolayer graphene show hydrophobic spreading and network formation, and inhomogeneous coverage across wrinkle peaks and valleys attributed to filament wetting and drying effects in the valleys. Additionally, adsorption onto uniaxial buckle delaminated graphene shows that when wrinkle features are on the length scale of the protein diameter, hydrophobic deformation and spreading do not occur and both IgM and IgG molecules retain their dimensions. These results demonstrate that undulating wrinkled surfaces characteristic of flexible substrates can have significant effects on protein surface distribution with potential implications for design of materials for biological applications.

Society for Immunotherapy of Cancer (SITC) consensus definitions for immune checkpoint inhibitor-associated immune-related adverse events (irAEs) terminology.

Immune-related adverse events (irAEs) associated with immune checkpoint inhibitor (ICI) therapy may vary substantially in their clinical presentation, including natural history, outcomes to treatment, and patterns. The application of clinical guidelines for irAE management can be challenging for practitioners due to a lack of common or consistently applied terminology. Furthermore, given the growing body of clinical experience and published data on irAEs, there is a greater appreciation for the heterogeneous natural histories, responses to treatment, and patterns of these toxicities, which is not currently reflected in irAE guidelines. Furthermore, there are no prospective trial data to inform the management of the distinct presentations of irAEs. Recognizing a need for uniform terminology for the natural history, response to treatment, and patterns of irAEs, the Society for Immunotherapy of Cancer (SITC) convened a consensus panel composed of leading international experts from academic medicine, industry, and regulatory agencies. Using a modified Delphi consensus process, the expert panel developed clinical definitions for irAE terminology used in the literature, encompassing terms related to irAE natural history (ie, re-emergent, chronic active, chronic inactive, delayed/late onset), response to treatment (ie, steroid unresponsive, steroid dependent), and patterns (ie, multisystem irAEs). SITC developed these definitions to support the adoption of a standardized vocabulary for irAEs, which will have implications for the uniform application of irAE clinical practice guidelines and to enable future irAE clinical trials.

Cytotoxicity of mini gold nanorods: intersection with extracellular vesicles.

It is well-known that there are size- and shape-dependencies to nanoparticle uptake and processing by living cells. Small gold nanorods have shown to exhibit low toxicity and high clearance rates when compared to larger ones, making smaller particles more desirable for biomedical applications. In this study gold mini-rods (approximately 9.5 × 23, 8 × 26, and 6 × 26 nm, corresponding to aspect ratios 2.5, 3.2 and 4.1) and gold nanospheres (15.6 nm average diameter) were synthesized, and wrapped with cationic and anionic polyelectrolytes. This library of colloidally stable nanomaterials was exposed to human dermal fibroblasts at the relatively low concentration of 1 nM for each nanoparticle type. The cytotoxic profile of these nanoparticles and their influence on the small extracellular vesicles released by the cells was assessed. It was observed that although the nanoparticles were found in vesicles inside the cells, the cell viability, the mitochondrial membrane potential and levels of reactive oxygen species were not markedly affected by the mini gold nanorods. The production of extracellular vesicles by the cells was unaffected by gold nanoparticle exposure; moreover, no gold nanoparticles were observed in extracellular vesicles in the exosomal size range. Taken together, these results suggest that these mini gold nanorods are suitable for a wide range of cellular applications for relatively short-term studies.

Lactobacillus-dominance and rapid stabilization of vaginal microbiota in combined oral contraceptive pill users examined through a longitudinal cohort study with frequent vaginal sampling over two years.

BACKGROUND: Bacterial vaginosis (BV), a condition in which vaginal Lactobacillus spp. are in low abundance, is associated with vulvovaginal symptoms, obstetric outcomes and urogenital infections. Recurrent BV is difficult to manage, and emerging data indicate a reduced risk of BV with the use of hormonal contraception (HC). Despite widespread use, little longitudinal data is available on whether, and in what timeframe, combined oral contraceptive pills (COCs) may act to affect vaginal microbiota stability and Lactobacillus dominance. METHODS: We compared the vaginal microbiota of reproductive-age cisgender women during intervals on combined estrogen and progestin COCs with non-use intervals in a 2-year observational study. Vaginal microbiota were characterized by 16S rRNA gene amplicon sequencing. FINDINGS: COC users were more likely to have Lactobacillus-dominated microbiota and more stable microbiota over time. Stability increased and then plateaued four weeks after COC initiation. The associations between COCs and Lactobacillus spp. dominance, and microbiota stability, were statistically significant for White, but not African American women; however sample size was limited for African American participants. Findings were similar for other forms of HC and when excluding samples collected during menses. INTERPRETATION: Our study provides a methodologic framework to evaluate observational longitudinal microbiota data with exposure crossovers. We found COCs are associated with vaginal microbiota stability and a Lactobacillus-dominated state. COCs appear to impact stability within a month of initiation. Our findings have clinical implications for how soon benefits can be expected in (at least White) patients initiating COCs, and support the need for larger prospective trials to verify our results in ethnically diverse populations. FUNDING: R01-AI089878.

Evaluation of miRNA Expression in 3D In Vitro Scaffold-Based Cancer Models.

Accumulating experimental evidence suggests that 3D in vitro cancer models strengthen our understanding of vital processes in the tumor microenvironment (TME) and accelerate the drug discovery pipeline. Previous studies examining the effects of specific miRNAs on cancer cells in vitro have involved ectopic expression of miRNA mimics in 2D in vitro culture. Assessment of cell viability and gene expression ensures that upregulation of the chosen miRNA and repression of its target genes have been achieved. However, this 2D culture is overly simplified and lacks the complex cell to extracellular matrix (ECM) interactions observed in the native TME, yielding results often not reproduced when progressed to in vivo studies. Hence, this chapter describes a novel method of overexpressing the miRNA mimic in cells cultured on 3D collagen-based scaffolds adapted from tissue engineering techniques. Cell growth on scaffolds is sequentially monitored via a DNA quantification assay, and overexpression of the miRNA mimic and repression of its target gene is assessed via reverse transcription quantitative PCR (RT-qPCR).

A permanent legacy of the pandemic? Outcomes of and staff views on the introduction of virtual clinics to an Irish oncology service.

BACKGROUND: Virtual clinics were introduced to our practice in March 2020. We aimed to assess outcomes from virtual clinics and to assess staff views on them and their barriers to implementation nationally. METHODS: We prospectively assessed outcomes from 53 planned virtual consultations in a cancer centre oncology outpatient department (April-July 2020). Thirty-two oncologists completed an online survey. RESULTS: Visit durations ranged from < 5 min (n = 2, 4%) to 30 + min/patient (n = 9, 20%) (median: 18 min (range 4-141, IQR 10-30 min)). Median time spent preparing for patients who did not attend (n = 6, 11%) was 15 min (range 9-15 min). Most patients were scheduled for routine follow-up (n = 41, 87%), with some planned for an early in-person visit (n = 3) or investigation (n = 3). Where bloods had been requested (n = 25), samples had often not been taken (n = 20, 80%) or results were unavailable (n = 3, 12%). Different plans may have been agreed with two patients (4%) had they attended in-person. Virtual visits were perceived as faster by most doctors in the online survey (n = 26, 84%), with some (n = 5, 16%) reporting a difference of 10 min per patient. Many (n = 13, 42%) arranged earlier follow-up appointments. Low satisfaction was associated with difficulty with patient assessment (81%) or communication (63%), resource limitation (48%), or poor access to results of investigations (40%). The majority (n = 21, 67%) do not feel their virtual clinic quality is as good as in-person. CONCLUSIONS: If virtual clinics are to play a long-term role in oncology, it is essential to monitor clinic quality and plan visits proactively.