Mixed methods study of attitudes on location of gynaecological oncology outpatient care: a patient and healthcare professional questionnaire.

OBJECTIVE: Gynaecological oncology place of care is often based on evolution of services, along historical professional boundaries, rather than user needs or preferences. We aimed to assess existing evidence, gather views of patients in the UK on their preferred place of outpatient care for gynaecological malignancies and evaluate alignment with preferences of healthcare professionals (HCP). METHODS: We performed a mixed methods study, including a scoping review, a patient survey and a healthcare practitioner questionnaire. We collected quantitative and qualitative data, performing content analysis to determine current practice and impact on patients. RESULTS: No studies were identified in our scoping review. We received responses from 159 patients and 54 gynaecological oncology HCPs. There was a strong preference for a dedicated gynaecological oncology setting (89% somewhat or very happy) (p<0.0001). Fifty-three percent of patients were somewhat or very unhappy to have care colocated with general obstetrics and gynaecology services. Specifically, two key themes were identified through content analysis of qualitative data from patients: 'environment and getting this right is vital'; and 'our cancer should be the priority'. HCPs underestimated the strong patient preference to be seen in dedicated units. Of those who see patients within general obstetrics and gynaecology, only 50% said patients were seen at separate times/locations from obstetric patients. CONCLUSION: This study demonstrates the significant impact of place of care on gynaecological oncology patients, which may be underestimated by HCPs.

Pegylated liposomal doxorubicin for relapsed epithelial ovarian cancer.

BACKGROUND: Cancer of ovarian, fallopian tube and peritoneal origin, referred to collectively as ovarian cancer, is the eighth most common cancer in women and is often diagnosed at an advanced stage. Women with relapsed epithelial ovarian cancer (EOC) are less well and have a limited life expectancy, therefore maintaining quality of life with effective symptom control is an important aim of treatment. However, the unwanted effects of chemotherapy agents may be severe, and optimal treatment regimens are unclear. Pegylated liposomal doxorubicin (PLD), which contains a cytotoxic drug called doxorubicin hydrochloride, is one of several treatment modalities that may be considered for treatment of relapsed EOCs. This is an update of the original Cochrane Review which was published in Issue 7, 2013. OBJECTIVES: To evaluate the efficacy and safety of PLD, with or without other anti-cancer drugs, in women with relapsed high grade epithelial ovarian cancer (EOC). SEARCH METHODS: We searched CENTRAL, MEDLINE (via Ovid) and Embase (via Ovid) from 1990 to January 2022. We also searched online registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated PLD in women diagnosed with relapsed epithelial ovarian cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data to a pre-designed data collection form and assessed the risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Where possible, we pooled collected data in meta-analyses. MAIN RESULTS: This is an update of a previous review with 12 additional studies, so this updated review includes a total of 26 RCTs with 8277 participants that evaluated the effects of PLD alone or in combination with other drugs in recurrent EOC: seven in platinum-sensitive disease (2872 participants); 11 in platinum-resistant disease (3246 participants); and eight that recruited individuals regardless of platinum sensitivity status (2079 participants). The certainty of the evidence was assessed for the three most clinically relevant comparisons out of eight comparisons identified in the included RCTs. Recurrent platinum-sensitive EOC PLD with conventional chemotherapy agent compared to alternative combination chemotherapy likely results in little to no difference in overall survival (OS) (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.83 to 1.04; 5 studies, 2006 participants; moderate-certainty evidence) but likely increases progression-free survival (PFS) (HR 0.81, 95% CI 0.74 to 0.89; 5 studies, 2006 participants; moderate-certainty evidence). The combination may slightly improve quality of life at three months post-randomisation, measured using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (mean difference 4.80, 95% CI 0.92 to 8.68; 1 study, 608 participants; low-certainty evidence), but this may not represent a clinically meaningful difference. PLD in combination with another chemotherapy agent compared to alternative combination chemotherapy likely results in little to no difference in the rate of overall severe adverse events (grade ≥ 3) (risk ratio (RR) 1.11, 95% CI 0.95 to 1.30; 2 studies, 834 participants; moderate-certainty evidence). PLD with chemotherapy likely increases anaemia (grade ≥ 3) (RR 1.37, 95% CI 1.02 to 1.85; 5 studies, 1961 participants; moderate-certainty evidence). The evidence is very uncertain about the effect of PLD with conventional chemotherapy on hand-foot syndrome (HFS)(grade ≥ 3) (RR 4.01, 95% CI 1.00 to 16.01; 2 studies, 1028 participants; very low-certainty evidence) and neurological events (grade ≥ 3) (RR 0.38, 95% CI 0.20 to 0.74; 4 studies, 1900 participants; very low-certainty evidence). Recurrent platinum-resistant EOC PLD alone compared to another conventional chemotherapy likely results in little to no difference in OS (HR 0.96, 95% CI 0.77 to 1.19; 6 studies, 1995 participants; moderate-certainty evidence). The evidence is very uncertain about the effect of PLD on PFS (HR 0.94, 95% CI 0.85 to 1.04; 4 studies, 1803 participants; very low-certainty evidence), overall severe adverse events (grade ≥ 3) (RR ranged from 0.61 to 0.97; 2 studies, 964 participants; very low-certainty evidence), anaemia (grade ≥ 3) (RR ranged from 0.19 to 0.82; 5 studies, 1968 participants; very low-certainty evidence), HFS (grade ≥ 3) (RR ranged from 15.19 to 109.15; 6 studies, 2184 participants; very low-certainty evidence), and the rate of neurological events (grade ≥ 3)(RR ranged from 0.08 to 3.09; 3 studies, 1222 participants; very low-certainty evidence). PLD with conventional chemotherapy compared to PLD alone likely results in little to no difference in OS (HR 0.92, 95% CI 0.70 to 1.21; 1 study, 242 participants; moderate-certainty evidence) and it may result in little to no difference in PFS (HR 0.94, 95% CI 0.73 to 1.22; 2 studies, 353 participants; low-certainty evidence). The combination likely increases overall severe adverse events (grade ≥ 3) (RR 2.48, 95% CI 1.98 to 3.09; 1 study, 663 participants; moderate-certainty evidence) and anaemia (grade ≥ 3) (RR 2.38, 95% CI 1.46 to 3.87; 2 studies, 785 participants; moderate-certainty evidence), but likely results in a large reduction in HFS (grade ≥ 3) (RR 0.24, 95% CI 0.14 to 0.40; 2 studies, 785 participants; moderate-certainty evidence). It may result in little to no difference in neurological events (grade ≥ 3) (RR 1.40, 95% CI 0.85 to 2.31; 1 study, 663 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: In platinum-sensitive relapsed EOC, including PLD in a combination chemotherapy regimen probably makes little to no difference in OS compared to other combinations, but likely improves PFS. Choice of chemotherapy will therefore be guided by symptoms from previous chemotherapy and other patient considerations. Single-agent PLD remains a useful agent for platinum-resistant relapsed EOC and choice of agent at relapse will depend on patient factors, e.g. degree of bone marrow suppression or neurotoxicity from previous treatments. Adding another agent to PLD likely increases overall grade ≥ 3 adverse events with little to no improvement in survival outcomes. The limited evidence relating to PLD in combination with other agents in platinum-resistant relapsed EOC does not indicate a benefit, but there is some evidence of increased side effects.

Ultrafast Exciton Dynamics in Silicon Nanowires.

Ultrafast exciton dynamics in one-dimensional (1D) silicon nanowires (SiNWs) have been investigated using femtosecond transient absorption techniques. A strong transient bleach feature was observed from 500 to 770 nm following excitation at 470 nm. The bleach recovery was dominated by an extremely fast feature that can be fit to a triple exponential with time constants of 0.3, 5.4, and ∼75 ps, which are independent of probe wavelength. The amplitude and lifetime of the fast component were excitation intensity-dependent, with the amplitude increasing more than linearly and the lifetime decreasing with increasing excitation intensity. The fast decay is attributed to exciton-exciton annihilation upon trap state saturation. The threshold for observing this nonlinear process is sensitive to the porosity and surface properties of the sample. To help gain insight into the relaxation pathways, a four-state kinetic model was developed to explain the main features of the experimental dynamics data. The model suggests that after initial photoexcitation, conduction band (CB) electrons become trapped in the shallow trap (ST) states within 0.5 ps and are further trapped into deep trap (DT) states within 4 ps. The DT electrons finally recombine with the hole with a time constant of ∼500 ps, confirming the photophysical processes to which we assigned the decays.

High-sensitivity molecular sensing using hollow-core photonic crystal fiber and surface-enhanced Raman scattering.

A high-sensitivity molecular sensor using a hollow-core photonic crystal fiber (HCPCF) based on surface-enhanced Raman scattering (SERS) has been experimentally demonstrated and theoretically analyzed. A factor of 100 in sensitivity enhancement is shown in comparison to direct sampling under the same conditions. With a silver nanoparticle colloid as the SERS substrate and Rhodamine 6G as a test molecule, the lowest detectable concentration is 10(-10) M with a liquid-core photonic crystal fiber (LCPCF) probe, and 10(-8) M for direct sampling. The high sensitivity provided by the LCPCF SERS probe is promising for molecular detection in various sensing applications.

Portable fiber sensors based on surface-enhanced Raman scattering.

Two portable molecular sensing systems based on surface-enhanced Raman scattering (SERS) have been experimentally demonstrated using either a tip-coated multimode fiber (TCMMF) or a liquid core photonic crystal fiber (LCPCF) as the SERS probe. With Rhodamine 6G as a test molecule, the TCMMF-portable SERS system achieved 2-3 times better sensitivity than direct sampling (focusing the laser light directly into the sample without the fiber probe), and a highly sensitive LCPCF-portable SERS system reached a sensitivity up to 59 times that of direct sampling, comparable to the sensitivity enhancement achieved using fiber probes in the bulky Renishaw system. These fiber SERS probes integrated with a portable Raman spectrometer provide a promising scheme for a compact and flexible molecular sensing system with high sensitivity and portability.

Bonnie's Bus--cancer disparities in West Virginia, philanthropy and opportunities to build lasting partnerships.

The State of West Virginia (WV) has significant cancer health disparities, substantiated by the fourth highest cancer mortality rate in the nation. In October 2007, Jo and Ben Statler donated $5 million dollars to the Mary Babb Randolph Cancer Center to establish a mobile mammography program (Bonnie's Bus) and endowed research positions at West Virginia University. This opportunity paved the way for an additional $2.5 million dollars of funding through a match program afforded the by WV Eminent Scholars Program and $700,000 of private foundation (Susan G. Komen for the Cure and Claude Worthington Benedum) support to begin to craft a statewide clinical trials network linked to Bonnie's Bus to provide new access to state-of-the-art clinical trials for residents of WV. Philanthropic gifts, as illustrated by the Statler gift, provide momentum for academic research and health care programs and new opportunities await through another legislative initiative--the WV Research Trust Fund. The Mary Babb Randolph Cancer Center is working to address cancer health disparities in the state of WV.

Simultaneous quantification of amphetamine and methamphetamine in meconium using ISOLUTE HM-N-supported liquid extraction columns and GC-MS.

A procedure is described for the rapid extraction and quantification of amphetamine and methamphetamine from meconium using ISOLUTE HM-N-supported liquid extraction columns and gas chromatography-mass spectrometry (GC-MS). Because of the matrix complexity of meconium samples, extraction and sample preparation prior to instrumental analysis can prove difficult and time-consuming. The present study introduces a novel sample preparation technique for the simultaneous quantification of amphetamine and methamphetamine in meconium using GC-MS. Extraction of both analytes was achieved using ISOLUTE HM-N-supported liquid extraction columns containing a modified form of diatomaceous earth. Limits of detection for both analytes were 30 ng/g and the lower limit of quantitation was 75 ng/g. Linearity was achieved over the range 75-3000 ng/g. The methodology showed excellent intrarun precision with %CV values ranging from 2 to 8% for both analytes. Interrun precision experiments produced %CV values between 7 and 10% for both analytes. The reported methodology proved suitable for the accurate quantification of amphetamine and methamphetamine in meconium samples and greatly reduced the sample preparation time normally required for traditional solid-phase extraction. The development and validation of such analytical methodologies will prove beneficial for the identification of prenatal substance abuse, which is an ongoing concern across socioeconomic lines.