Objective The purpose of the current scoping review is to explore knowledge and gaps in the literature on the preparedness of health care providers (HCPs) to deliver cancer care that addresses the needs of sexual and gender minority (SGM) adolescent and young adult (AYA) patients diagnosed with cancer between ages 15–39 years. Methods We conducted two comprehensive searches on OVID MEDLINE, PsycINFO, and CINAHL in February 2022 and June 2024; examined the empirical literature on HCPs who treat SGM AYA cancer patients; characterized existing research; and evaluated each contribution. Results A total of thirteen articles were included in the final review. The reviewed studies varied widely in sample sizes (n = 6 to n = 1253), reflecting different methodological approaches: quantitative cross-sectional (n = 3), qualitative (n = 4), and mixed methods (n = 6). Innovation The current scoping review piloted an innovative Quality Assessment (QA) Tool of Foundational Progress for SGM AYA Research to assess the quality of evidence, providing a new framework for evaluating and guiding future research. Conclusion The existing literature on provider preparedness to care for SGM AYA cancer patients is limited. Future studies are critically needed to improve providers' ability to holistically respond to the unique health care needs and concerns of this population.

Aims: To characterize Black, Indigenous and People of Color (BIPOC) adolescent and young adult (AYA) cancer patients' experiences of patient engagement in AYA oncology and derive best practices that are co-developed by BIPOC AYAs and oncology professionals. Materials & methods: Following a previous call to action from AYA oncology professionals, a panel of experts composed exclusively of BIPOC AYA cancer patients (n = 32) participated in an electronic Delphi study. Results: Emergent themes described BIPOC AYA cancer patients' direct experiences and consensus opinion on recommendations to advance antiracist patient engagement from BIPOC AYA cancer patients and oncology professionals. Conclusion: The findings reveal high-priority practices across all phases of research and are instructional for advancing health equity.

Background: Healthcare providers have an influential role in the experience of financial toxicity among their cancer patients, yet patients commonly report unmet needs and dissatisfaction regarding communication with their providers about financial concerns. Aims: The purpose of this study is to develop a novel financial navigation pathway that leverages existing patient financial services and resources with corresponding patient-centered, community-informed strategies, via study participants, that may be utilized in routine care to reduce financial hardship among cancer patients. Methods: We conducted in-depth interviews (n=50) with 34 cancer patients and 16 cancer care professionals at a National Cancer Institute designated comprehensive cancer center located in a dense urban area of the US between December 2022 to June 2023. Results: Content analyses resulted in emergent themes and representative quotations on experiences of financial hardship within the material, behavioral, and psychosocial domains. Investigators used emergent themes to develop financial strategies and construct a financial navigation pathway to screen patients for and intervene upon the financial toxicity of cancer in routine care. Conclusion: This study followed an innovative approach by constructing a financial navigation pathway tool that follows the oncological workflow at a National Cancer Institute designated comprehensive cancer center. Future research is needed to test the tool’s impact on financial toxicity, cancer outcomes, and other health-related outcomes, and to better understand how much patient navigation is needed to bring about meaningful change.

Background: Adolescent and young adult cancer patients (AYAs) who are sexual and gender minorities (SGM) are a rapidly increasing population that experiences unmet cancer-related needs. Despite emerging awareness, little is known about cancer care and outcomes for this vulnerable population. The purpose of this scoping review was to explore current knowledge and gaps in the literature on cancer care and outcomes for AYAs who identify as SGM. Methods: We reviewed empirical knowledge on SGM AYAs by identifying, describing, and critically appraising the literature to date. We conducted a comprehensive search on OVID MEDLINE, PsycINFO, and CINAHL in February 2022. Additionally, we developed and piloted a conceptual framework for appraising SGM AYA research. Results: A total of 37 articles were included in the final review. Most studies focused exclusively on SGM--related outcomes as the primary aim of the study (81.1%, n = 30), whereas others included some focus on SGM--related outcomes (18.9%, n = 7). The majority of studies included AYAs as part of a broader age range (86.0%, n = 32), and only a few studies examined exclusively AYA samples (14.0%, n = 5). Gaps in scientific evidence on SGM AYAs were seen across the cancer care continuum. Conclusion: Numerous gaps in knowledge of cancer care and outcomes exist for SGM AYAs diagnosed with cancer. Future efforts should fill this void with high-quality empirical studies that reveal unknown disparities in care and outcomes and are inclusive of the intersectionality of SGM AYAs with other minoritized experiences, thereby advancing health equity in meaningful ways.

12136 Background: In the thick of the ongoing global crises of the COVID-19 pandemic, uprisings against anti-Black racism and police brutality, and anti-Asian racism and violence, Black, indigenous, and people of color (BIPOC) adolescent and young adult (AYA) cancer patients may be particularly vulnerable and exploited. Whilst embroiled in sociopolitical complexity, BIPOC AYAs are increasingly called upon to contribute as patient advocates in AYA oncology research and advocacy. Researchers, clinicians, and advocates in AYA oncology must dismantle long-standing racism and create meaningful structural change. The purpose of this study is to derive vital best practices for implementing antiracist patient engagement in AYA oncology research and advocacy that are co-developed by BIPOC AYA cancer patients and oncology professionals. Methods: We utilized a modified Delphi technique with a panel of BIPOC AYA cancer patients (n = 32) to build consensus opinions on professional recommendations from a prior study ( Cheung et al., 2021 ), and to generate antiracist best practices in patient engagement. The Delphi study was comprised of three consecutive and iterative survey rounds over the course of 8 months in 2021; participants were BIPOC AYAs diagnosed with cancer between ages 15-36 years. Results: Results detail best practices for the implementation of antiracist patient engagement across all research activities within the Patient-Centered Outcomes Research Institute’s (PCORI) Framework for Patient Engagement. For example, BIPOC AYAs agreed with oncology professionals’ high priority recommendation for including BIPOC AYAs at the highest levels of decision making in research topic selection. As such, a best practice is for researchers to ensure that such representatives not only hold BIPOC AYA identity, but also hold direct experience with the particular oncology diagnosis, issue, or other outcome of interest. Additionally, BIPOC AYAs concurred with oncology professionals’ high priority for “transparency, honesty, and trust” as a core principle for best practices in patient engagement. They further explained that trustworthy relationships are especially important when collaborating with teens and young adults, who are developmentally just coming into their own. When describing successful experiences of inclusion, participants ranked “build collaborative relationships with BIPOC AYA communities and listen to patients not usually heard” and “recruit a diverse range of BIPOC patients and let them give actual input into the study” as the highest priority best practices. Conclusions: Findings from this study are instructional for AYA oncology researchers, clinicians, and advocates to prevent harmful tokenism and implement genuine antiracist inclusion to advance health equity. Future research should investigate best practices within unique clinical settings.

Purpose: The purpose of this study was to expand upon findings from a prior Delphi study of adolescent and young adults' (AYAs') preferences for cancer resources. Utilizing an embodied approach, this study intended to elucidate a deeper and nuanced understanding of the expressed benefits and risks of engaging in cancer-related online interactions. Methods: Using Gale et al.'s framework method for qualitative, multidisciplinary health research and Thanem and Knights's embodied research methods for the social sciences, an investigative team of embodied researchers (AYA cancer patients turned researchers) conducted semistructured in-depth interviews with AYA cancer patients (n = 10) diagnosed between ages 15 and 39 years. To generate themes, researchers identified commonalities and differences within the qualitative data, and indexed codes according to the agreed analytic framework. Furthermore, by fully engaging with personal reflexivity, bracketing, and analytic memos across data collection and analysis, the investigative team elucidated benefits and risks of embodied research. Results: Findings impart evidence on AYAs' needs for internet-based content at the time of cancer diagnosis, use of the internet to fulfill cancer-related needs, perception of gaps in online cancer resources, and advice to other AYA cancer patients accessing internet-based information and support. Content analysis of interview data on participants' descriptions of personal engagement with the internet revealed beneficial themes of empowerment and harmful themes of fear-inducing consequences. Conclusions: In our rapidly evolving context of postpandemic internet reliance, developers of online cancer content should prioritize and respond to the nuanced vulnerabilities of AYAs. Future research must include socioeconomically disadvantaged participants to better understand practical challenges and promote health equity.

Amidst the concurrent global crises of coronavirus disease 2019 (COVID-19), uprisings against Anti-Black racism and police brutality, as well as anti-Asian racism and violence, the field of medicine found itself simultaneously called upon to respond as essential workers in the public health devastation of COVID-19, and as representatives of healthcare institutions wrought with the impacts of systemic racism. Clinicians, researchers, and advocates in adolescent and young adult (AYA) oncology, must come together in authentic activism to begin the work of creating structural change to advance antiracist approaches to patient engagement in AYA oncology research and advocacy. Critical review of existing practices is needed to ensure that ethical and effective research methods are employed when engaging with racial and ethnic minority AYA patients with cancer, who may be particularly vulnerable and exploited in the current context.

Objective Examine whether an existing conceptual framework for understanding financial hardship following a cancer diagnosis captures experiences among military adolescent and young adult (AYA) patients. Methodological approach Investigators conducted focus groups and key informant interviews (n = 24) with active-duty military AYA cancer patients, their spouses, cancer care providers, and commanders at a military medical center and military post. Findings Content analysis and thematic abstraction revealed that military AYA cancer patients' experiences of financial hardship occur within material, psychosocial, and behavioral domains that are situated within the contextual influences of AYA development and military culture. Subsequently, investigators constructed an expanded conceptual framework for understanding the financial hardship of cancer to capture these contexts. Conclusion Differentiating experiences of financial hardship into material, psychosocial, and behavioral domains situated within life course development and occupational culture contexts, may inform development of interventions with aspects of financial hardship most impacted by cancer care.

Background: The number of persons aged sixty years and over is increasing worldwide. Oral health in the elderly is frequently under-appreciated. The aim of this narrative literature review is to highlight oral health problems affiliated with ageing and to bring about awareness of these conditions in the elderly. Results: Older individuals have poor oral health due to physiological age induced changes in teeth and oral mucosa, edentulism, dental caries, periodontal disease, xerostomia and oral cancer. Oral health problems in the elderly negatively impact their quality of life. Conclusion: Poor oral health in the elderly adversely impacts general health and quality of life. An integrated and multidisciplinary approach is important for preventing oral diseases and improving and maintaining oral health in the elderly.

Leaves, the most conspicuous part of the shoot system of most vascular plants, range greatly in size and shape between and also within individuals. Seedlings usually produce successively larger and more complex leaves and environmental factors influence mature leaf size and anatomy. Despite this diversity, leaves share certain features of construction and carry out the same primary function of photosynthesis. All leaves go through the same stages of leaf development, including initiation, morphogenesis, expansion, and histogenesis. Differences in leaf shape between different groups of plants arise early in leaf development, while environmental factors have their effects at later stages. Genes that regulate several important aspects of leaf development have been identified, making it possible to genetically manipulate leaf characters that contribute to photosynthetic efficiency.

WECC groups and vendors work closely together toward development of new tools and procedures to ensure consistency between the two major models used in WECC, (West-wide System Model (WSM) used by Reliability Coordinators and planning basecases used to perform operational and planning studies), This work includes program features that enable traditional software to read a node-breaker power flow snapshot from WSM, perform different types of system studies, link this model to the WECC dynamic model database and perform dynamic simulations from real-time snapshots and for historical system events to validate the model. Results are compared to actual measurements obtained from phasor measurement units (PMUs). This paper shows some of the results.

Fusarium oxysporum isolates collected from onions in the UK and other countries were characterized using sequences of the transfer elongation factor 1‐α (TEF) gene and compared with published sequence data for 10 other isolates. Isolates associated with diseased onion bulbs in the UK formed two clades. Isolates from both clades were selected for pathogenicity testing and to develop a rapid seedling assay to screen commercial onion cultivars for resistance to F. oxysporum f. sp. cepae (FOC), the cause of basal rot. Differences in the levels of aggressiveness between isolates were observed and isolates from both clades were pathogenic. Differences in resistance/susceptibility were also observed amongst 10 commercial onion cultivars, with cvs Ailsa Craig Prizewinner and White Lisbon showing the highest levels of resistance. The results from the seedling assay were supported by those from a subsequent onion bulb rot assay. Thus, this study reports the development of a rapid, simple and repeatable seedling assay that can be used to screen large numbers of onion cultivars for resistance to FOC and which is indicative of resistance at the bulb stage.

RationaleAllergen exposure in sensitized asthmatics has been associated with pulmonary eosinophil infiltration; however, whether there is a systemic inflammatory response is unclear.Methods21 stable asthmatics who were non-smokers (18-50 y) were skin prick tested (SPT) and underwent environmental mouse allergen challenge (EMAC) in a controlled environmental chamber. A positive challenge was defined as a 15% drop in FEV1. Peripheral blood eosinophils and superoxide anion (O2-) production by peripheral white blood cells were measured before and 24 hours after EMAC. O2- was measured by a luminol chemiluminescence assay. Outcomes for participants who were mouse sensitized (3mm+ net wheal to mouse epithelial extract) and had a positive challenge (sens/chall+) were compared to outcomes for participants who were non-sensitized and had a negative challenge (sens/chall-).ResultsThe median blood eosinophil percentages were 3.5% and 5.1% at baseline and 24hr, respectively (p=0.04), among sens/chall+ subjects. The median lymphocyte O2- was 911,615 relative luminescence units (RLU) at baseline and 3,544,645 RLU at 24hr (p= 0.12) among sens/chall+ subjects. Eosinophil% and lymphocyte O2- remained stable among sens/chall- subjects (p=0.11, p=0.45, respectively). Neither lymphocyte nor neutrophil percentage increased in (sens/chall+) subjects 24hr post challenge.ConclusionsAsthmatic responses to mouse allergen exposure may be associated with the development of a systemic inflammatory response characterized by increased blood eosinophils and lymphocyte activation 24 hours following exposure. These findings suggest that the respiratory allergic response results in systemic inflammatory changes. RationaleAllergen exposure in sensitized asthmatics has been associated with pulmonary eosinophil infiltration; however, whether there is a systemic inflammatory response is unclear. Allergen exposure in sensitized asthmatics has been associated with pulmonary eosinophil infiltration; however, whether there is a systemic inflammatory response is unclear. Methods21 stable asthmatics who were non-smokers (18-50 y) were skin prick tested (SPT) and underwent environmental mouse allergen challenge (EMAC) in a controlled environmental chamber. A positive challenge was defined as a 15% drop in FEV1. Peripheral blood eosinophils and superoxide anion (O2-) production by peripheral white blood cells were measured before and 24 hours after EMAC. O2- was measured by a luminol chemiluminescence assay. Outcomes for participants who were mouse sensitized (3mm+ net wheal to mouse epithelial extract) and had a positive challenge (sens/chall+) were compared to outcomes for participants who were non-sensitized and had a negative challenge (sens/chall-). 21 stable asthmatics who were non-smokers (18-50 y) were skin prick tested (SPT) and underwent environmental mouse allergen challenge (EMAC) in a controlled environmental chamber. A positive challenge was defined as a 15% drop in FEV1. Peripheral blood eosinophils and superoxide anion (O2-) production by peripheral white blood cells were measured before and 24 hours after EMAC. O2- was measured by a luminol chemiluminescence assay. Outcomes for participants who were mouse sensitized (3mm+ net wheal to mouse epithelial extract) and had a positive challenge (sens/chall+) were compared to outcomes for participants who were non-sensitized and had a negative challenge (sens/chall-). ResultsThe median blood eosinophil percentages were 3.5% and 5.1% at baseline and 24hr, respectively (p=0.04), among sens/chall+ subjects. The median lymphocyte O2- was 911,615 relative luminescence units (RLU) at baseline and 3,544,645 RLU at 24hr (p= 0.12) among sens/chall+ subjects. Eosinophil% and lymphocyte O2- remained stable among sens/chall- subjects (p=0.11, p=0.45, respectively). Neither lymphocyte nor neutrophil percentage increased in (sens/chall+) subjects 24hr post challenge. The median blood eosinophil percentages were 3.5% and 5.1% at baseline and 24hr, respectively (p=0.04), among sens/chall+ subjects. The median lymphocyte O2- was 911,615 relative luminescence units (RLU) at baseline and 3,544,645 RLU at 24hr (p= 0.12) among sens/chall+ subjects. Eosinophil% and lymphocyte O2- remained stable among sens/chall- subjects (p=0.11, p=0.45, respectively). Neither lymphocyte nor neutrophil percentage increased in (sens/chall+) subjects 24hr post challenge. ConclusionsAsthmatic responses to mouse allergen exposure may be associated with the development of a systemic inflammatory response characterized by increased blood eosinophils and lymphocyte activation 24 hours following exposure. These findings suggest that the respiratory allergic response results in systemic inflammatory changes. Asthmatic responses to mouse allergen exposure may be associated with the development of a systemic inflammatory response characterized by increased blood eosinophils and lymphocyte activation 24 hours following exposure. These findings suggest that the respiratory allergic response results in systemic inflammatory changes.

Rodent sensitization and exposure is associated with asthma severity in urban children, but whether these are risk factors for asthma severity in adults with asthma is unclear. 63 non-smoking urban asthmatic adults (18-50y) underwent skin prick testing (SPT) to 14 common aeroallergens, including mouse and rat epithelia; pulmonary functioning testing; and completed questionnaires. Rodent sensitization was defined as a +SPT to either mouse or rat. A +SPT was defined as a ≥3mm net wheal. Outcomes were compared between rodent sensitized and non-rodent-sensitized subjects. Regression models were adjusted for gender, race, and number of +SPTs aside from mouse and rat. 38 (60%) were female, 49 (78%) were African American, and 21(33%) were rodent SPT+. 14(22%) were sensitized to rat, 13(20%) were sensitized to mouse and 8(13%) were sensitized to mouse and rat. Rodent sensitization was associated with low FEV1 (OR [95%CI]: 9.6 [2.0-45.2]), independent of race, gender, and number of +SPTs. Rodent sensitization was also associated with having been hospitalized for asthma, independent of race, gender, and number of +SPTs (OR [95%CI]: 3.6 [1.0-13.8]). Rodent sensitized and non-sensitized subjects had similar prevalences of symptoms in the past 2 weeks (OR [95%CI]: 1.6 [0.4-5.6]). Rat and mouse sensitization alone had similar relationships with these outcomes as being either rat or mouse sensitized. Rodent sensitization is associated with worse lung function in a community-based population of adults with asthma.

RATIONALE: Particulate matter (PM) may cause asthma symptoms by induction of eosinophilic inflammation. METHODS: 16 non-smoking adults (18-50y) with atopic asthma underwent one nasal challenge to saline and one nasal challenge to 3.6mg PM collected from Baltimore City homes in a crossover study. Nasal lavage fluid (NLF) and blood samples were collected before and after challenges (4 and 24hr post challenge) for quantification of eosinophils. Atopy was defined as at least one positive skin test on a panel of 14 aeroallergens. Differences in pre- and post-challenge eosinophils were calculated (post-challenge - pre-challenge) and compared between saline and PM challenge groups using non-parametric tests. RESULTS: 13(81%) were female, 14(82%) were African American, and 11(68%) reported rescue inhaler use within 2 weeks of baseline visit. Baseline absolute eosinophil counts in blood were: median[IQR]: 105[60-220] and percent eosinophils in blood were: median[IQR]: 1.85[1.3-4.2]. Baseline percent eosinophils in NLF were: median[IQR]: 0[0-0.59]. At 24hrs, there were no significant changes in eosinophils following either PM or saline challenge (PM: difference in blood eosinophils (median[IQR]: -10[-60-30]); difference in percent blood eosinophils (0.2[-0.4-1.1]); difference in percent NLF eosinophils (0.0[-1.21-0.40]), SALINE: difference in blood eosinophils (median[IQR]: 10[-10-30]); difference in percent blood eosinophils (0.25[-1.35-0.65]); difference in percent NLF eosinophils (0[-0.75-1.34])). Similarly, there were no significant changes in eosinophils at 4h post PM challenge or between PM and saline challenge groups. CONCLUSIONS: In a human nasal challenge model, indoor PM did not lead to local or systemic eosinophilia in adults with atopic asthma. Indoor PM may cause asthma symptoms through non-eosinophilic inflammatory pathways.