Background: The association of atrial fibrillation (AF) with cancer and cancer types is inconclusive. Similarly, data regarding the association of AF with different cancer therapies are controversial.Objectives: To study the association of AF with cancer subtypes and cancer therapies.Methods: We studied all patients aged 18–89 years who presented to the Feist Weiller Cancer Center, with or without a diagnosis of cancer, between January 2011 and February 2016. Electronic health records were systematically queried for baseline demographics and ICD-9 and ICD-10 codes for specific co-morbidities. Patients with a diagnosis of AF were tabulated based on cross-validation with the ECG database and/or by recorded history. We assessed the prevalence and risk of AF based on cancer diagnosis, specific cancer type, and cancer therapy.Results: A total of 14,600 patients were analyzed. Compared to non-cancer patients (n = 6,801), cancer patients (n = 7,799) had a significantly higher prevalence of AF (4.3 vs. 3.1%; p < 0.001). However, following correction for covariates in a multivariable logistic regression model, malignancy was not found to be an independent risk factor for AF (p = 0.32). While patients with solid tumors had a numerically higher prevalence of AF than those with hematological malignancies (4.3 vs. 4.1%), tumor type was not independently associated with AF (p = 0.13). AF prevalence was higher in patients receiving chemotherapy (4.1%), radiation therapy (5.1%), or both (6.9%) when compared to patients not receiving any therapy (3.6%, p = 0.01). On multivariable logistic regression, radiation therapy remained an independent risk factor for AF for the entire study population (p = 0.03) as well as for the cancer population (p < 0.01).Conclusions: Radiation therapy for cancer is an independent risk factor for AF. The known association between cancer and AF may be mediated, at least in part, by the effects of radiation therapy.

Abstract Background: The purpose of this randomized trial was to examine the feasibility of using home self-sampling for HPV testing to screen for cervical cancer, as compared to HPV samples obtained by a physician or nurse practitioner during a clinical exam. Methods: Two LSU study sites were used, New Orleans and Shreveport, LA. Stratified, permuted blocks randomization was used to allocate patients to one of two methods of home sampling: a standard tampon inserted and worn for two hours, or an easy-to-use vaginal swab device (HerSwab®). All self- collected and clinical were tested for HPV 16 and 18 subtypes and other high-risk subtypes. Each self-collected sample was compared to the patient's clinical sample using McNemarâ' paired chi-squared test. Tampon and self-collected swab samples were compared using an unpaired chi-squared test. Results: A total of one hundred and seventy-four (174) eligible subjects were recruited. Ninety-five subjects were recruited from Shreveport and 79 from New Orleans. The age of the women subjects ranged from 21 to 69, with a mean age of 47 years. The predominant race was African American, 73%, with 22% white and 5% Asian, mixed race or unknown. Hispanic or Latino ethnicity was reported as 4%. Overall, 66% of home-collected specimens were returned for processing. The percent positive specimens was approximately the same, regardless of specimen source, e.g., clinical (13.5% positive), tampon (14.5% positive) or swab (15% positive). There was no statistical difference between the positive specimen rates of tampon and swab methods. By oversight, 11 clinical specimens were not collected for HPV testing. Six women had a positive self-test, but their clinical test results were not positive. All the clinical samples were sufficient for valid DNA analysis. Only one of the home swab specimens was insufficient, but 15 of the tampon specimens were insufficient. This difference is highly statistically significant, p< 0.0001 by Fisher's exact test. Also, as mentioned above, the return rate was better for the swab method. Fifty-five women answered the satisfaction questionnaire. Participants assigned to the tampon use complained about the procedure verbally to the study nurse, although the formal questionnaire did not reflect this. None reported problems with the swab method. Conclusion: The self-collected HPV specimens were not significantly different from the clinically collected specimens, although the tampon method had more unreturned specimens and significantly more specimens of insufficient quality for testing. Citation Format: Jerry McLarty, Donna Williams, Susan Loyd, Michael Hagensee. Cervical HPV testing with two home self-collection methods compared to a standard clinical-collection method [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B116.

Abstract Introduction: The objective of this study was to perform an analysis of cytokines reported to be upregulated in cancer patients to determine differences that may exist between Caucasians and African-Americans. Cancer biomarkers aid in identifying therapeutic targets as well as providing information on the involved signaling pathways. As African-Americans are known to present with advanced disease and have poorer survival even in nonmetastatic head and neck cancer, findings may be indicative of a potential therapeutic target for this population. Methods: In this IRB approved study, we utilized a multiplex bead-based immunoassay by Millipore to compare serum levels of 13 cytokines (FGF-2, GM-CSF, GRO-α, IFNγ, IL-1β, IL-6, IL-8, IL-10, IL-13, IP-10, MIP-1β, TNFα and VEGF) in African-Americans and Caucasians at diagnosis of primary head and neck cancer. Cytokine expression was detected using Luminex xMAP technology with xPonent software, then analyzed using Milliplex Analyst. Results: Growth-related oncogene-alpha (GRO-α) was the only significantly different cytokine analyzed in regard to ethnicity, where African-Americans (n=36) exhibited higher serum levels in pg/ml compared to Caucasians (n=85) (1287±303.9 and 415.5±50.1, respectively; 95% CI 453.1 to 1290; p<0.0001). Conclusions: Systemic levels of GRO-α were higher in African-American compared to Caucasian head and neck cancer patients. There is accumulating evidence that GRO-α is overexpressed in human skin, breast, colorectal and hepatocellular cancers. GRO-α has been most notably implicated in cell proliferation, immune response, and as a regulator of tumor invasion and chemoresistance. With the present survival disparities in head and neck cancer patients, this striking overexpression warrants further study into a possible biomarker or targeted therapeutic agent for African-American patients. Citation Format: Tara Moore-Medlin, Eleni Mijalis, Xiaohui Ma, Jerry McLarty, Glenn Mills, Cherie-Ann Nathan. Racial disparity in systemic growth-related oncogene-alpha (GRO-α) expression in head and neck cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C037.

BACKGROUND:The purpose of this study was to compare the outcomes of 2 self-collection methods to detect cervical human papillomavirus (HPV) DNA with outcomes from a standard clinical method. The standard method samples were collected by a clinician at a routine pelvic examination. Self-samples were taken at home and mailed to the clinical laboratory.METHODS:The 2 self-collection methods were a tampon-based method and a swab-based method using a commercial device, an Eve Medical HerSwab. All HPV samples were processed by a clinical laboratory using the Food and Drugs Administration approved Roche Cobase HPV method, which specifically identifies HPV 16, HPV 18, and a set of 12 other high-risk subtypes. Patients were recruited from 2 cancer screening clinics 2015 to 2017. All patients signed an informed consent. Screening outcomes, such as prevalence, percent agreement with standard, sensitivity, and specificity, were calculated for each self-collection method. Measures of similarity between self and standard collection outcomes, Cohen's κ, percent concordance, McNemar equivalence, and others were tested statistically.RESULTS:One hundred seventy-four patients were randomized. The prevalence of 1 or more positive HPV high-risk subtypes from the standard clinical specimens was 13.5%. All clinical specimens were sufficient for valid HPV detection. For the tampon method, 15 (27%) of the specimens were insufficient quality. Only 1 (2%) swab specimen was insufficient. Only the swab self-collection method was found to be statistically noninferior to the clinical method. The tampon method had an unacceptably high rate of insufficient quality specimens and also failed the equivalency tests.CONCLUSIONS:The swab home collection samples were equivalent to the clinical samples, but the tampon method had an unacceptably high rate of specimens insufficient for HPV detection.

Objectives/HypothesisHead and neck squamous cell carcinoma represents the sixth most common cancer. As a result of field cancerization, second primaries and recurrences are high. Hence, research has focused on chemoprevention. Curcumin, a polyphenol compound with anticarcinogenic properties, is one such promising nutraceutical. As poor bioavailability limits curcumin's use, a novel gum formulation was tested allowing for direct mucosal absorption into the bloodstream. This preliminary study validates curcumin gum efficacy by assessing release and transmucosal absorption, along with measuring its effects on serum cytokine levels.Study DesignClinical trial.MethodsProtocols consisting of initial chew (chewing gum for 30 minutes) and revised chew (alternating chewing and parking gum against buccal mucosa for 30 minutes) were tested in healthy volunteers. High‐performance liquid chromatography measured remnant curcumin in chewed gum, serum, and saliva. Serum levels were assayed for 15 proinflammatory cytokines via multiplex analysis.ResultsRevised chew samples demonstrated significantly higher curcumin release and absorption (P = .0078). Curcumin serum levels were significantly higher at 4 hours in samples > 2.0 g of curcumin release (P = .01). As saliva levels decreased, a concurrent increase in serum levels was observed, with no significance in the inverse relationship (P = .1423). When evaluating differences between gender, race, and age, the Asian population showed significantly lower curcumin release and serum levels (P = .009). CXCL1 (GRO‐α) and TNF‐α were significantly decreased in serum after chewing the gum (P = .036, P < .001, respectively).ConclusionsEnhanced mucosal contact appears critical in improving curcumin release and absorption. CXCL1 and TNF‐α both represent potential biomarkers for the future study of curcumin chemoprevention.Level of Evidence2bLaryngoscope, 129:1597–1603, 2019

In this article, we introduced basic concepts of statistics, type of distributions, and descriptive statistics. A few examples were also provided. The basic concepts presented herein are only a fraction of the concepts related to descriptive statistics. Also, there are many commonly used distributions not presented herein, such as Poisson distributions for rare events and exponential distributions, F distributions, and logistic distributions. More information can be found in many statistics books and publications.

Abstract Purpose: The purpose of this report is to compare screening outcomes in an underserved population in North Louisiana with two different imaging techniques: digital breast tomosynthesis and standard digital mammography. Digital breast tomosynthesis (DBT) is a relatively new technology that images the breast in 3-D which is thought to overcome limitations of standard (2-D) digital mammography (DM). The outcome measures for this report are: 1) recalls for further mammography and evaluation and 2) breast cancers confirmed by biopsy. Background: The LSU Feist-Weiller Cancer Center has operated a free cancer screening clinic for uninsured and under-insured women since 1999. We started with one clinic in a fixed location in the LSU hospital in Shreveport, Louisiana. Since 2009 cancer screens are also routinely performed by 2 mobile units in 28 rural, underserved locations in 24 parishes in North Louisiana. Permanent mammography facilities are not available in 40% of the parishes we serve. For this population, in the remote rural areas, or the working poor in the non-rural areas, recalls are a significant extra burden on the patients. Methods: In 2009 we started mobile mammography screening with a Hologic Selenia Digital mammogram machine onboard. In 2014 we obtained another vehicle which was especially designed for the Hologic Dimension Tomographic mammography machine. DBT in a mobile setting is rare, with very few implementations in the U.S. In Louisiana, we have the only mobile DBT unit, statewide. This presents an unique opportunity to evaluate this new technology, in a mobile screening program in a high-risk population with multiple disparities. The subjects used in this presentation are those seen on one of the two mobile screening vehicles between April 1, 2009 and December 31, 2015. All patients screened qualified as either uninsured or under-insured and their mammograms were paid for by one of a multiple number of grants. All cancer screens were performed according to American Cancer Society guidelines by technologists certified in mammography. All mammographic images were digital. Images were read by one of two board certified radiologists, specialists in mammography and both trained to read DBT images. Of special interest to this presentation is the number of patients who are called recalled for additional views or other follow-up and the results of those recalls visits. Results: Results of screening for only the mobile vehicles are presented below, with emphasis on comparing results from tomosynthesis mammography (DBT) to those from standard digital mammography (DM). Chi-Squared tests were used to calculate p values. For the meeting presentation the numbers will be updated to include more patients screened and demographics and area health measures will be included. 4,619 patients were given mammograms with the DM machine, and (since it is new and has not long been in service) 2,731 with DBT. The number of recalls for additional study was 713 (15.4%) with DM and 131 (4.8%), with DBT. DBT resulted in significantly fewer recalls, p<0.0001. The number of cancers detected by DM was 20 (2.8% of recalls) and by DBT was 15 (11.5% of recalls). Again this is highly significant, p<0.0002. Conclusion: tomosynthesis mammograpy is significantly better at reducing unnecessary recalls, and at dectecting breast cancer than usual digital mammography. Recall visits are an especially serious burden on underserved populations with many access to care issues. Tomosynthesis mammography requires a more expensive machine, but its value, especially in minority underserved populations which are hard to reach and have major access to cancer care issues is undeniable. Citation Format: Jerry W. McLarty, Jennifer Lance, Towanno Collins, Sharon Grubbs, Stacey Massey, Nelson Luraguiz. Screening outcomes of digital Breast tomosynthesis versus digital mammography in an underserved population with multiple disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C74.

The Tyler asbestos plant produced pipe insulation from 1954 to 1972 and exclusively used amosite asbestos. There were 1130 former workers of this plant during the period of operation. A death certificate mortality analysis was published regarding this plant in 1998 for the period through 1993. This study represents an update of the mortality analysis with additional certificates collected for deaths occurring through 2011.Searches of the National Death Index database were conducted in 2004 and again in 2013. At the time of the latter search, only deaths occurring through 2011 were available. In total, 265 distinct additional death certificates were secured and added to 304 available from the original study. After the new certificates were coded (ICD-9), data were analyzed using the Centers for Disease Control and Prevention Life Table Analysis System (LTAS) and standard mortality ratios (SMR) generated with 95% confidence limits (CL). LTAS constructs cause-specific mortality rates by age, gender, race, and person-time at risk, and compares observed rates with a referent population in order to derive SMR. A significant excess number of deaths due to nonmalignant respiratory disease (asbestosis) and from select malignant neoplasms were identified. There were in total 23 mesothelioma deaths (4% of deaths), with 16 pleural and 7 peritoneal. The SMR for malignant neoplasms of the trachea, bronchus, and lung was 244 (with 95% CL 196, 300), suggesting that exposed workers from this cohort were nearly 2.5-fold (244 %) more likely to die from this cause as the general referent population. The analysis also showed that exposures of short duration (<6 mo) produced significantly elevated SMR for all respiratory cancers, lung cancer, and pleural mesothelioma. There was a significant difference in median duration of exposure for mesothelioma types, confirming association of peritoneal mesothelioma with longer duration of exposure. Deaths due to intestinal cancer (predominantly colon; not including rectum) were also found in excess. The mortality experience of the Tyler cohort continues to be followed with great interest, given the exclusivity of exposure to amosite. Data confirm the inherent pathogenicity of this fiber type for nonmalignant disease as well as select cancers, particularly relevant given the importance of this amphibole's use in the United States.

1572 Background: Preclinical, epidemiological and prior clinical trial data suggest that green tea catechins may reduce prostate cancer (PCa) risk. Methods: We, therefore, conducted a placebo-controlled, randomized clinical trial of one year of Polyphenon E (PolyE), a proprietary mixture of green tea catechins containing 400 mgs of epigallocatechin-3-gallate (EGCG) per day, in 97 men with high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferstion (ASAP) on prostate biopsy. The primary study endpoint was the total number of PCa diagnoses on the PolyE versus placebo arm at one year. Results: No differences in prostate cancer rates were observed in the two groups (4/49 PolyE vs 6/48 placebo, P = 0.25). A prespecified analysis comparing the combined rates of PCa + ASAP in the subgroup of men with HGPIN-only at baseline, showed a decrease in this composite endpoint (3/26 PolyE vs 10/25 placebo, P < 0.024). This was largely driven by a reduction in ASAP (0/26 PolyE vs 5/25 placebo). In another prespecified analysis, a decrease in serum PSA was observed the PolyE arm.(-0.90 ng/mL; 95% CI:-1.67, -0.12; P < 0.05). Adverse events related to the study agent did not significantly differ between the two study groups. Conclusions: Daily intake of a standardized, decaffeinated catechin mixture containing 400 mgs EGCG per day for 1 year accumulated in plasma and was well tolerated, but did not reduce the likelihood of a subsequent PCa diagnosis in men with baseline HGPIN or ASAP over this period of time. Clinical trial information: NCT00596011.

BACKGROUND:The overall prognosis of multiple myeloma has improved significantly over the last 15 years. We wondered whether the overall improvement would also be seen in unselected patients in an academic center in Northwest Louisiana with a high proportion of minority patients, and if second malignant neoplasms are relevant for our patients.MATERIALS AND METHODS:Between 1998 and 2009, 215 patients were treated for multiple myeloma at our center and had complete follow-up until May 2013.RESULTS:The mean survival of patients with multiple myeloma increased from 3.25 to 5.34 years, which is comparable to patients treated at larger centers. No prognostic difference was observed in the subgroups of myeloma patients. Among 215 patients followed for the development of secondary cancers, 16 already had a preexisting or concomitant malignancy (7.4%) and 10 developed secondary cancers. Our data indicate a significant background of histologically unrelated cancers and a cumulative incidence of new cancers of about 20% after 10 years of follow-up. Based on SEER data, preexisting or secondary cancers were not statistically increased in our population.CONCLUSIONS:The use of autologous transplantation and the introduction of new agents resulted in a significant improvement in the prognosis of multiple myeloma. Other cancers are not statistically increased before or after multiple myeloma is diagnosed and are not prognostically relevant.

Breast cancer outcomes are influenced by multiple factors including access to care, and payer status is a recognized barrier to treatment access. To further define the influence of payer status on outcome, the National Cancer Data Base data from 1998–2006 was analyzed.

Abstract Importance: In recent years, several studies have suggested effectiveness of green tea catechins in prostate cancer (PCa) chemoprevention. With the exception of one trial from Italy, this has not been further tested in a randomized trial setting in high-risk men with atypical small acinar proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN). Objective: To determine whether the daily consumption of a standardized formulation of green tea catechins (Polyphenon E) supplement for 1 year reduces the rate of progression to PCa in men, diagnosed with HGPIN or ASAP. Additional objectives were to evaluate tolerance, lower urinary tract symptoms (LUTS) and quality of life (QOL). Design, setting and participants: A randomized, double-blinded trial was conducted from September 2008 to March 2014 at medical centers in the US targeting 97 men diagnosed HGPIN or ASAP, randomized to treatment (n=49) or control arm (n=48). Supplement or placebo was initiated within 3 months of initial biopsy and continued for 1 year. Intervention: Participants were block randomized by baseline diagnosis and study site to receive Polyphenon E (PolyE), a decaffeinated, standardized green tea catechin mixture, the main component of which is (−)-epigallocatechin-3-gallate (EGCG) at a dose of 400 mgs EGCG per day (200 mgs twice a day [BID]), or placebo. Main outcomes and measures: Rate of progression to PCa at one year in men treated with PolyE or placebo following diagnosis of HGPIN or ASAP; evaluation of tolerance, LUTS and QOL. Results: Overall, we did not observe a difference in the number of men who progressed to PCa in one year in the Poly E (4/49) arm compared to placebo arm(6/48). Secondary analyses of patients reaching a definitive endpoint revealed that among men with baseline diagnosis of HGPIN, a greater number progressed to ASAP or PCa in the placebo arm (10/25) compared to the PolyE arm (3/26; P<0.05). Interestingly, this result was largely driven by the fact that a significantly greater number of subjects with baseline HGPIN progressed to ASAP in the placebo arm (5/25) compared to men in the PolyE arm (0/26; P <0.05). In men with baseline diagnosis of ASAP, the rate of cancer diagnosis at the end of intervention were similar in both study arms. Men in the PolyE group treated for one year demonstrated a significant decrease in serum tPSA compared to those in the placebo group (-0.90 ng/mL;(95%CI:-1.67, -0.12; P<0.05). No significant differences in tolerance, LUTS or QOL were observed between the two groups. Conclusions and Relevance: Daily intake of a standardized, decaffeinated catechin mixture containing 400 mgs EGCG (200 mgs BID) for 1 year is well tolerated and appears to produce chemoprevention effects in the early stages (HGPIN to ASAP) of prostate carcinogenesis. These findings should be confirmed in a phase III clinical trial prior to recommending use in clinical settings. Trial Registration: Clinical Trials.gov Identifier: NCT00596011 Acknowledgement: The research study was funded by the National Institute of Health- National Cancer Institute R01 CA12060-01A1. We acknowledge the contributions of Anthony M. Neuger, Domenico Coppola, Binglin Yue, (Moffitt Cancer Center); Kyle Anderson (Minneapolis VA Medical Center, Minneapolis, MN); Eduard Trabulsi (Jefferson Medical College, Philadelphia, PA); Tajammul Fazili (Overton Brooks VA, Shreveport, LA); Edward Giovanucci (Harvard University); Gregory Zagaja (University of Chicago, Chicago, IL); Shahnjayla Connors (University of Washington, St. Louis, MO); Folake Odedina (University of Florida). External Data Monitoring Board: Omer Kucuk, (Emory University), Phyllis Bowen (Retired), and Steven Clinton (Ohio State University). Citation Format: Nagi B. Kumar, Julio Pow-Sang, Kathleen M. Egan, Philippe A. Spiess, Shohreh Dickinson, Raoul Salup, Mohamed Helal, Jerry McLarty, Christopher R. Williams, Fred Schreiber, Said Sebti, Aslam Kazi, Loveleen Kang, Gwen Quinn, Tiffany Smith, Karen Diaz, Ganna Chornokur, Theresa Crocker, Michael J. Schell. Effect of polyphenon E on progression to prostate cancer after diagnosis of high grade prostatic intraepithelial neoplasia. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr PR06.

Preclinical, epidemiologic, and prior clinical trial data suggest that green tea catechins (GTC) may reduce prostate cancer risk. We conducted a placebo-controlled, randomized clinical trial of Polyphenon E (PolyE), a proprietary mixture of GTCs, containing 400 mg (−)-epigallocatechin-3-gallate (EGCG) per day, in 97 men with high-grade prostatic intraepithelial neoplasia (HGPIN) and/or atypical small acinar proliferation (ASAP). The primary study endpoint was a comparison of the cumulative one-year prostate cancer rates on the two study arms. No differences in the number of prostate cancer cases were observed: 5 of 49 (PolyE) versus 9 of 48 (placebo), P = 0.25. A secondary endpoint comparing the cumulative rate of prostate cancer plus ASAP among men with HGPIN without ASAP at baseline, revealed a decrease in this composite endpoint: 3 of 26 (PolyE) versus 10 of 25 (placebo), P < 0.024. This finding was driven by a decrease in ASAP diagnoses on the Poly E (0/26) compared with the placebo arm (5/25). A decrease in serum prostate-specific antigen (PSA) was observed on the PolyE arm [−0.87 ng/mL; 95% confidence intervals (CI), −1.66 to −0.09]. Adverse events related to the study agent did not significantly differ between the two study groups. Daily intake of a standardized, decaffeinated catechin mixture containing 400 mg EGCG per day for 1 year accumulated in plasma and was well tolerated but did not reduce the likelihood of prostate cancer in men with baseline HGPIN or ASAP. Cancer Prev Res; 8(10); 879–87. ©2015 AACR.

Breast cancer survival is affected both by endogenous factors and exogenous factors such as socioeconomic status. This study explored the relationship between insurance status and overall survival of 987 female breast cancer patients in a population served by a public hospital. All patients were offered the same level of care regardless of ability to pay. Of the 987 breast cancer patients investigated, 54.6% were African-American. 54.1% of patients were insured (commercial insurance or Medicare), 27.1% with Medicaid, and 18.8% who were uninsured. Overall median survival was 15.5 years and was not statistically significant between Caucasian and African-American women. Median survival times were 15.8, 11.3, and 8.2 years for insured, Medicaid, and uninsured groups, respectively. Uninsured patients had worse overall survival rates compared with insured patients (p < 0.05). Adjusting for other factors (e.g., stage, age, race, body mass index, and income), insurance was a significant factor affecting survival with hazard ratios of 2.24 and 3.22 for Medicaid and uninsured patients, respectively, compared with insured patients. Even in a public hospital, after adjusting for potential risk factors, insurance status still proved to be an important factor in the survival of breast cancer patients. Further research is necessary to identify causal factors related to the survival disparities associated with insurance status.

The Fourth-year Academic Clinical Training and Teaching Selective (FACTTS) is a course taught by medical and library faculty on the practice of evidence-based medicine and critical appraisal of the medical literature. This study assesses the impact of the course on students' understanding of the subject matter by examining three years of pre- and post-test data and addresses whether the number of sessions in the course affects the knowledge gained by the students. The data show an improvement in the students' understanding of course material, but no benefit was found in having two versus three sessions.

OBJECTIVE:As skin cancer incidence increases, research has focused on novel chemopreventive agents that inhibit tumor formation. In prior experimentation, curcumin, a naturally occurring food substance and anticarcinogenic agent, inhibited cutaneous squamous cell carcinoma xenograft growth. We hypothesize curcumin will inhibit UVB radiation-induced skin cancer growth in mice, approximating a human chemopreventive model. STUDY DESIGN:Randomized experimental animal and laboratory study. SETTING:Louisiana State University Health Sciences Center-Shreveport, Louisiana. SUBJECTS AND METHODS:SKH-1 mice were pretreated with oral or topical curcumin or oral or topical control (n = 11/group) for 14 days. Mice received UVB radiation 3 times weekly for 24 weeks or were not radiated. Number of tumors formed and time to tumor onset for each mouse were recorded through tumor harvest after week 24. Tumor multiplicity and time to tumor onset were compared. RESULTS:Time to tumor onset was significantly shorter in control mice compared to mice receiving either oral (P = .025) or topical (P = .015) curcumin. A significant difference in the average number of tumors formed per mouse was seen, as fewer tumors were formed in the oral curcumin (P = .01) and topical curcumin (P = .01) groups, compared with respective controls. No significant difference in average number of tumors per mouse was seen between oral and topical curcumin (P = .56), suggesting that both routes were equally effective. CONCLUSION:Curcumin appears to inhibit skin cancer formation and prolong time to tumor onset when administered by either an oral or topical route. These data suggest that curcumin may have chemopreventive potential against skin cancer, necessitating future experimentation with human subjects.

Objective: The research sought to determine the effect of a clinical medical librarian (CML) on outcomes of in-patients on the internal medicine service.Methods: A prospective study was performed with two internal medicine in-patient teams.Team 1 included a CML who accompanied the team on daily rounds.The CML answered questions posed at the point of care immediately or in emails post-rounds.Patients on Team 2, which did not include a CML, as well as patients who did not require consultation by the CML on Team 1, served as the control population.Numerous clinical and library metrics were gathered on each question.Results: Patients on Team 1 who required an answer to a clinical question were more ill and had a longer length of stay, higher costs, and higher readmission rates compared to those in the control group.Using a matched pair analysis, we showed no difference in clinical outcomes between the intervention group and the control group.Conclusions: This study is the largest attempt to prospectively measure changes in patient outcomes when physicians were accompanied by a CML on rounds.This approach may serve as a model for further studies to define when and how CMLs are most effective.

Objectives/HypothesisTo determine if the intravascular delivery of mesenchymal stem cells improves wound healing and blood perfusion to postischemic cutaneous flap tissues.Study DesignRandomized controlled study.MethodsA murine model of a cutaneous flap was created based on the inferior epigastric vessels. Mice (n = 14) underwent 3.5 hours of ischemia followed by reperfusion. Bone marrow stromal cells (BMSCs) 1 × 106 were injected intravenously. Wound healing was then assessed measuring percent flap necrosis, flap perfusion, and tensile strength of the flap after a period of 14 days. Localization of BMSCs was determined with radiolabeled and fluorescent labeled BMSCs.ResultsPostischemic cutaneous flap tissues treated with BMSCs demonstrated significantly less necrosis than control flaps (P <0.01). Beginning on postoperative day 5, BMSC‐treated flaps demonstrated greater blood perfusion than untreated flaps (P <0.01). Tensile strength of BMSC‐treated cutaneous flaps was significantly higher (P <0.01), with a mean strength of 283.4 ± 28.4 N/m than control flaps with a mean of 122.4 ± 23.5 N/m. Radiolabeled BMSCs localized to postischemic flaps compared to untreated tissues (P = 0.001). Fluorescent microscopy revealed incorporation of BMSCs into endothelial and epithelial tissues of postischemic flaps.ConclusionsThis study demonstrates that the intravascular delivery of BMSCs increases wound healing and promotes flap survival following ischemia‐reperfusion injury of cutaneous tissue flaps. Laryngoscope, 124:642–648, 2014