Why secret detection tools are not enough: It's not just about false positives - An industrial case study.

Checked-in secrets in version-controlled software projects pose security risks to software and services. Secret detection tools can identify the presence of secrets in the code, commit changesets, and project version control history. As these tools can generate false positives, developers are provided with mechanisms to bypass the warnings generated from these tools. Providing this override mechanism can result in developers sometimes exposing secrets in software repositories. The goal of this article is to aid software security practitioners in understanding why' secrets are checked into repositories, despite being warned by tools, through an industrial case study of analysis of usage data of a secret detection tool and a survey of developers who bypassed the tool alert. In this case study, we analyzed the usage data of a checked-in secret detection tool used widely by a software company and we surveyed developers who bypassed the warnings generated by the tool. From the case study, we found that, despite developers classified 50% of the warning as false positive, developers also bypassed the warning due to time constraints, working with non-shipping projects, technical challenges of eliminating secrets completely from the version control history, technical debts, and perceptions that check-ins are low risk. We advocate practitioners and researchers to investigate the findings of our study further to improve secret detection tools and related development practices. We also advocate that organizations should insert secondary checks, as is done by the company we studied, to capture occasions where developers incorrectly bypass secret detection tools.

Methane Exhaust Measurements at Gathering Compressor Stations in the United States.

Unburned methane entrained in exhaust from natural gas-fired compressor engines ("combustion slip") can account for a substantial portion of station-level methane emissions. A novel in-stack, tracer gas method was coupled with Fourier transform infrared (FTIR) species measurements to quantify combustion slip from natural gas compressor engines at 67 gathering and boosting stations owned or managed by nine "study partner" operators in 11 U.S. states. The mean methane emission rate from 63 four-stroke, lean-burn (4SLB) compressor engines was 5.62 kg/h (95% CI = 5.15-6.17 kg/h) and ranged from 0.3 to 12.6 kg/h. The mean methane emission rate from 39 four-stroke, rich-burn (4SRB) compressor engines was 0.40 kg/h (95% CI = 0.37-0.42 kg/h) and ranged from 0.01 to 4.5 kg/h. Study results for 4SLB engines were lower than both the U.S. EPA compilation of air pollutant emission factors (AP-42) and Inventory of U.S. Greenhouse Gas Emissions and Sinks (GHGI) by 8 and 9%, respectively. Study results for 4SRB engines were 43% of the AP-42 emission factor and 8% of the GHGI emission factor, the latter of which does not distinguish between engine types. Total annual combustion slip from the U.S. natural gas gathering and boosting sector was modeled using measured emission rates and compressor unit counts from the U.S. EPA Greenhouse Gas Reporting Program. Modeled results [328 Gg/y (95% CI = 235-436 Gg/y) of unburned methane] would account for 24% (95% CI = 17-31%) of the 1391 Gg of methane emissions for "Gathering and Boosting Stations", or 6% of the net emissions for "Natural Gas Systems" (5598 Gg) as reported in the 2020 U.S. EPA GHGI. Gathering and boosting combustion slip emissions reported in the 2020 GHGI (374 Gg) fall within the uncertainty of this model.

Restaurant Date-Marking Practices Concerning Ready-to-Eat Food Requiring Time and Temperature Control for Safety.

Certain foods are more vulnerable to foodborne pathogen growth and formation of toxins than others. Lack of time and temperature control for these foods can result in the growth of pathogens, such as Listeria monocytogenes, and lead to foodborne outbreaks. The Food and Drug Administration's (FDA) Food Code classifies these foods as time/temperature control for safety (TCS) foods and details safe cooking, holding, and storing temperatures for these foods. The FDA Food Code also includes a date-marking provision for ready-to-eat TCS foods that are held for >24 h. The provision states that these foods should not be held in refrigeration for >7 days and should be marked with the date or day by which the food should be "consumed on the premises, sold, or discarded." To learn more about restaurants' date-marking practices, the Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted observations and manager interviews in 359 restaurants in 8 EHS-Net jurisdictions. Managers reported that they date marked ready-to-eat TCS foods more often than data collectors observed this practice (91% vs. 77%). Observation data showed almost a quarter of study restaurants did not date-mark ready-to-eat TCS foods. In addition, restaurants with an internal date-marking policy date marked 1.25 times more often than restaurants without such a policy and chain restaurants date marked 5.02 times more often than independently owned restaurants. These findings suggest that regulators and the retail food industry may improve food safety and lower the burden of foodborne illness in the United States if they target interventions to independent restaurants and encourage strong date-marking policies.

Methane Emissions from Gathering Compressor Stations in the U.S.

Using results from a nationally representative measurement campaign at 180 gathering compressor stations conducted with nine industry partners, this study estimated emissions for the U.S. gathering sector, where sector-specific emission factors have not been previously available. The study drew from a partner station population of 1705 stations-a significantly larger pool than was available for prior studies. Data indicated that whole gas emission rates from components on gathering stations were comparable to or higher than emission factors utilized by the EPA's greenhouse gas reporting program (GHGRP) but less than emission factors used for similar components on transmission compressor stations. Field data also indicated that the national population of stations likely has a higher fraction of smaller stations, operating at lower throughput per station, than the data used to develop the per-station emission factor used in EPA's greenhouse gas inventory (GHGI). This was the first national study to incorporate extensive activity data reported to the GHGRP, including 319 basin-level reports, covering 15,895 reported compressors. Combining study emission data with 2017 GHGRP activity data, the study indicated statistically lower national emissions of 1290 [1246-1342] Gg methane per year or 66% [64-69%] of current GHGI estimates, despite estimating 17% [12-22%] more stations than the 2017 GHGI (95% confidence interval). Finally, we propose a replicable method that uses GHGRP activity data to annually update GHGI gathering and boost sector emissions.

Quantitative Risk Assessment of Norovirus Transmission in Food Establishments: Evaluating the Impact of Intervention Strategies and Food Employee Behavior on the Risk Associated with Norovirus in Foods.

We developed a quantitative risk assessment model using a discrete event framework to quantify and study the risk associated with norovirus transmission to consumers through food contaminated by infected food employees in a retail food setting. This study focused on the impact of ill food workers experiencing symptoms of diarrhea and vomiting and potential control measures for the transmission of norovirus to foods. The model examined the behavior of food employees regarding exclusion from work while ill and after symptom resolution and preventive measures limiting food contamination during preparation. The mean numbers of infected customers estimated for 21 scenarios were compared to the estimate for a baseline scenario representing current practices. Results show that prevention strategies examined could not prevent norovirus transmission to food when a symptomatic employee was present in the food establishment. Compliance with exclusion from work of symptomatic food employees is thus critical, with an estimated range of 75-226% of the baseline mean for full to no compliance, respectively. Results also suggest that efficient handwashing, handwashing frequency associated with gloving compliance, and elimination of contact between hands, faucets, and door handles in restrooms reduced the mean number of infected customers to 58%, 62%, and 75% of the baseline, respectively. This study provides quantitative data to evaluate the relative efficacy of policy and practices at retail to reduce norovirus illnesses and provides new insights into the interactions and interplay of prevention strategies and compliance in reducing transmission of foodborne norovirus.

Methane Emissions from United States Natural Gas Gathering and Processing.

New facility-level methane (CH4) emissions measurements obtained from 114 natural gas gathering facilities and 16 processing plants in 13 U.S. states were combined with facility counts obtained from state and national databases in a Monte Carlo simulation to estimate CH4 emissions from U.S. natural gas gathering and processing operations. Total annual CH4 emissions of 2421 (+245/-237) Gg were estimated for all U.S. gathering and processing operations, which represents a CH4 loss rate of 0.47% (±0.05%) when normalized by 2012 CH4 production. Over 90% of those emissions were attributed to normal operation of gathering facilities (1697 +189/-185 Gg) and processing plants (506 +55/-52 Gg), with the balance attributed to gathering pipelines and processing plant routine maintenance and upsets. The median CH4 emissions estimate for processing plants is a factor of 1.7 lower than the 2012 EPA Greenhouse Gas Inventory (GHGI) estimate, with the difference due largely to fewer reciprocating compressors, and a factor of 3.0 higher than that reported under the EPA Greenhouse Gas Reporting Program. Since gathering operations are currently embedded within the production segment of the EPA GHGI, direct comparison to our results is complicated. However, the study results suggest that CH4 emissions from gathering are substantially higher than the current EPA GHGI estimate and are equivalent to 30% of the total net CH4 emissions in the natural gas systems GHGI. Because CH4 emissions from most gathering facilities are not reported under the current rule and not all source categories are reported for processing plants, the total CH4 emissions from gathering and processing reported under the EPA GHGRP (180 Gg) represents only 14% of that tabulated in the EPA GHGI and 7% of that predicted from this study.

Methane Emissions from the Natural Gas Transmission and Storage System in the United States.

The recent growth in production and utilization of natural gas offers potential climate benefits, but those benefits depend on lifecycle emissions of methane, the primary component of natural gas and a potent greenhouse gas. This study estimates methane emissions from the transmission and storage (T&S) sector of the United States natural gas industry using new data collected during 2012, including 2,292 onsite measurements, additional emissions data from 677 facilities and activity data from 922 facilities. The largest emission sources were fugitive emissions from certain compressor-related equipment and "super-emitter" facilities. We estimate total methane emissions from the T&S sector at 1,503 [1,220 to 1,950] Gg/yr (95% confidence interval) compared to the 2012 Environmental Protection Agency's Greenhouse Gas Inventory (GHGI) estimate of 2,071 [1,680 to 2,690] Gg/yr. While the overlap in confidence intervals indicates that the difference is not statistically significant, this is the result of several significant, but offsetting, factors. Factors which reduce the study estimate include a lower estimated facility count, a shift away from engines toward lower-emitting turbine and electric compressor drivers, and reductions in the usage of gas-driven pneumatic devices. Factors that increase the study estimate relative to the GHGI include updated emission rates in certain emission categories and explicit treatment of skewed emissions at both component and facility levels. For T&S stations that are required to report to the EPA's Greenhouse Gas Reporting Program (GHGRP), this study estimates total emissions to be 260% [215% to 330%] of the reportable emissions for these stations, primarily due to the inclusion of emission sources that are not reported under the GHGRP rules, updated emission factors, and super-emitter emissions.

Methane emissions from natural gas compressor stations in the transmission and storage sector: measurements and comparisons with the EPA greenhouse gas reporting program protocol.

Equipment- and site-level methane emissions from 45 compressor stations in the transmission and storage (T&S) sector of the US natural gas system were measured, including 25 sites required to report under the EPA greenhouse gas reporting program (GHGRP). Direct measurements of fugitive and vented sources were combined with AP-42-based exhaust emission factors (for operating reciprocating engines and turbines) to produce a study onsite estimate. Site-level methane emissions were also concurrently measured with downwind-tracer-flux techniques. At most sites, these two independent estimates agreed within experimental uncertainty. Site-level methane emissions varied from 2-880 SCFM. Compressor vents, leaky isolation valves, reciprocating engine exhaust, and equipment leaks were major sources, and substantial emissions were observed at both operating and standby compressor stations. The site-level methane emission rates were highly skewed; the highest emitting 10% of sites (including two superemitters) contributed 50% of the aggregate methane emissions, while the lowest emitting 50% of sites contributed less than 10% of the aggregate emissions. Excluding the two superemitters, study-average methane emissions from compressor housings and noncompressor sources are comparable to or lower than the corresponding effective emission factors used in the EPA greenhouse gas inventory. If the two superemitters are included in the analysis, then the average emission factors based on this study could exceed the EPA greenhouse gas inventory emission factors, which highlights the potentially important contribution of superemitters to national emissions. However, quantification of their influence requires knowledge of the magnitude and frequency of superemitters across the entire T&S sector. Only 38% of the methane emissions measured by the comprehensive onsite measurements were reportable under the new EPA GHGRP because of a combination of inaccurate emission factors for leakers and exhaust methane, and various exclusions. The bias is even larger if one accounts for the superemitters, which were not captured by the onsite measurements. The magnitude of the bias varied from site to site by site type and operating state. Therefore, while the GHGRP is a valuable new source of emissions information, care must be taken when incorporating these data into emission inventories. The value of the GHGRP can be increased by requiring more direct measurements of emissions (as opposed to using counts and emission factors), eliminating exclusions such as rod-packing vents on pressurized reciprocating compressors in standby mode under Subpart-W, and using more appropriate emission factors for exhaust methane from reciprocating engines under Subpart-C.

Measurements of methane emissions from natural gas gathering facilities and processing plants: measurement results.

Facility-level methane emissions were measured at 114 gathering facilities and 16 processing plants in the United States natural gas system. At gathering facilities, the measured methane emission rates ranged from 0.7 to 700 kg per hour (kg/h) (0.6 to 600 standard cubic feet per minute (scfm)). Normalized emissions (as a % of total methane throughput) were less than 1% for 85 gathering facilities and 19 had normalized emissions less than 0.1%. The range of methane emissions rates for processing plants was 3 to 600 kg/h (3 to 524 scfm), corresponding to normalized methane emissions rates <1% in all cases. The distributions of methane emissions, particularly for gathering facilities, are skewed. For example, 30% of gathering facilities contribute 80% of the total emissions. Normalized emissions rates are negatively correlated with facility throughput. The variation in methane emissions also appears driven by differences between inlet and outlet pressure, as well as venting and leaking equipment. Substantial venting from liquids storage tanks was observed at 20% of gathering facilities. Emissions rates at these facilities were, on average, around four times the rates observed at similar facilities without substantial venting.

Long-term outcomes for primary glomerulonephritis: New Zealand Glomerulonephritis Study.

AIMS: Due to the paucity of studies focusing on primary glomerulonephritis, the second commonest cause of end-stage-kidney-disease in most of the developed world, we sought to review outcomes of these renal pathologies. METHODS: We reviewed renal outcomes and mortality for primary glomerulonephritis patients enrolled in the New Zealand Glomerulonephritis Study between 1972 and 1983. RESULTS: There were 765 patients with median follow-up of 30 years (range 0.1-42 years). They were predominantly New Zealand European, male and hypertensive. Poor renal outcomes and increased mortality were associated with hypertension, heavy proteinuria, impaired renal function and older age at diagnosis. Ethnicity was not significantly associated with progression to end-stage-kidney-disease although NZ Maori patients were at significantly increased risk of death. Patients with rapidly progressive glomerulonephritis had the highest risk of reaching end-stage-kidney-disease while the cumulative incidence of end-stage-kidney-disease was 20% and 30% for those with immunoglobulin-A nephropathy and membranous nephropathy respectively. Mortality risk was high for patients with rapidly progressive glomerulonephritis and anti-glomerular basement membrane disease. The era of diagnosis did not have much effect on outcomes except for patients with focal segmental glomerulosclerosis or immunoglobulin A nephropathy but this could be type II error. CONCLUSION: We report one of the longest follow-up studies on biopsy-proven glomerulonephritides. Age, hypertension, and severity of chronic kidney disease at diagnosis were strong predictors of the development of end-stage-kidney-disease and death. The specific renal pathology had a profound impact upon prognosis and therefore should continue to drive efforts to find targeted therapeutic options for these glomerulonephritides.

Evaluation of the Impact of Compliance with Mitigation Strategies and Frequency of Restaurant Surface Cleaning and Sanitizing on Control of Norovirus Transmission from Ill Food Employees Using an Existing Quantitative Risk Assessment Model.

ABSTRACT: Reduction of foodborne illness caused by norovirus (NoV) continues to be a focus for the food safety community. Using a previously published quantitative risk assessment model, we evaluated more than 60 scenarios examining the impact of implementation of and compliance with risk management strategies identified in the U.S. Food and Drug Administration Food Code for (a) surface cleaning and sanitizing, (b) hand hygiene, (c) exclusion, or (d) restriction of ill employees. Implementation of and compliance with hand hygiene and ill food employee exclusion strategies had the largest impact on the predicted number of highly contaminated food servings and associated consumer illnesses. In scenarios in which gloves were always worn and hand washing compliance was 90%, the model estimated reductions in the number of highly contaminated food servings and ill consumers to 39 and 43% of baseline estimates (i.e., typical practice), respectively. Reductions were smaller when gloves were never worn. Hand washing compliance after using the restroom strongly impacted predicted numbers of highly contaminated servings and consumer illnesses. Ten percent compliance with removing or excluding ill food employees was predicted to increase the number of highly contaminated food servings and ill consumers to 221 and 213% of baseline estimates, respectively. Ninety-four percent compliance with exclusion of ill food employees was predicted to decrease these numbers to 69 and 71% of baseline estimates, respectively. Surface cleaning in food establishments had a relatively small impact on these measures. Restriction of food employees (removed from contact with food and food contact equipment and utensils) was not effective for reducing NoV illness unless this restriction included additional provisions. The results from this study can help risk managers prioritize mitigation strategies and their implementation for controlling the transmission of NoV and subsequent consumer foodborne illness.

Patient-centered communication in cancer care: the role of the NCI's Cancer Information Service.

While patient-centered care and the reduction of suffering due to cancer are primary goals of the NCI, improvement in the delivery of patient-centered communication has been identified as a key NCI research priority. As research on patient-centered communication evolves, the potential contributions of programs such as the National Cancer Institute's (NCI) Cancer Information Service (CIS) cannot be overlooked. The purpose of this paper is to describe how the six core functions of patient-clinician communication described in the literature (fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions and enabling patient-self management) are embedded in the work of the CIS. The communication process used by the CIS to extend the patient-centered communication role of the clinician will be discussed. CIS training and quality management systems will be described. Lastly, suggestions for the role of CIS in future health information delivery and research will be explored.

Assessing Employee Health Policies for Reporting and Excluding Ill Food Employees in Restaurants within the United States.

ABSTRACT: Preventing ill food employees from spreading pathogens to food and food contact surfaces remains an important objective of retail food safety policy in the United States. Since 2005, the U.S. Food and Drug Administration (FDA) has recommended food establishments implement employee health policies that include requirements for the exclusion or restriction of ill food employees and reporting, to the person in charge, symptoms or diagnosis of certain diseases transmitted by food. However, the incorporation of this recommendation has not been widely studied. The purpose of this exploratory study was to assess the presence and prevalence of employee health policies at fast-food and full-service restaurants in the United States. More than 50% of fast-food and full-service restaurants were found to have nonexistent employee health policies for each of the five recommended components specified in the FDA Food Code. Results showed 17.41% of fast-food restaurants and 12.88% of full-service restaurants had all five recommended components. Moreover, most restaurants with all five recommended employee health policy components were part of a multiple-unit operation and were found to have more developed food safety management systems than restaurants with none of the recommended components. Further attention and research into the impediments associated with developing and implementing employee health policies in restaurants is warranted.

Allergen Removal and Transfer with Wiping and Cleaning Methods Used in Retail and Food Service Establishments.

ABSTRACT: Preventing the transfer of allergens from one food to another via food contact surfaces in retail food environments is an important aspect of retail food safety. Existing recommendations for wiping and cleaning food contact surfaces is mainly focused on preventing microorganisms, such as bacteria and viruses, from contaminating foods. The effectiveness of these wiping and cleaning recommendations for preventing the transfer of food allergens in retail and food service establishments remains unclear. This project investigated (i) allergen removal from surfaces by wiping with paper wipes, terry cloth, and alcohol quaternary ammonium chloride (quat) sanitizing wipes; (ii) cleaning of allergen-contaminated surfaces by using a wash-rinse-sanitize-air dry procedure; and (iii) allergen transfer from contaminated wipes to multiple surfaces. Food contact surfaces (stainless steel, textured plastic, and maple wood) were contaminated with peanut-, milk- and egg-containing foods and subjected to various wiping and cleaning procedures. For transfer experiments, dry paper wipes or wet cloths contaminated with allergenic foods were wiped on four surfaces of the same composition. Allergen-specific lateral flow devices were used to detect the presence of allergen residues on wiped or cleaned surfaces. Although dry wipes and cloths were not effective for removing allergenic foods, terry cloth presoaked in water or sanitizer solution, use of multiple quat wipes, and the wash-rinse-sanitize-air dry procedure were effective in allergen removal from surfaces. Allergens present on dry wipes were transferred to wiped surfaces. In contrast, minimal or no allergen transfer to surfaces was found when allergen-contaminated terry cloth was submerged in sanitizer solution prior to wiping surfaces. The full cleaning method (wash-rinse-sanitize-air dry) and soaking the terry cloth in sanitizer solution prior to wiping were effective at allergen removal and minimizing allergen transfer.

Evaluation of a Mobile Health Intervention to Improve Wellness Outcomes for Breast Cancer Survivors.

PURPOSE: Breast cancer survivors are at increased risk of cancer recurrence, second malignancies, and other comorbid conditions. This study examined if use of a convenient, commercially available, $65 per month app that gives breast cancer survivors access to a health and wellness coach is more effective than a self-guided toolkit and one-time health education session at achieving the following goals: 1) improving adherence to a plant-based diet, 2) increasing physical activity, 3) assisting with weight loss and reduction in body mass index, 4) reducing elevated depression and fatigue scores, and 5) leading to sustained adherence to lifestyle and wellness plan at and beyond 6 months. METHODS: A nonrandomized 2-group control study design with pre-post repeated measures (N=127 subjects) was utilized. Women 18 years of age or older, with curative-intent breast cancer, were included in the study. App users received a survivorship care plan and enrolled in a 6-month subscription to the health app. A control group received the same information but, instead of access to the app, were given a self-guided toolkit. RESULTS: At 6 months, more patients in the app group experienced weight loss and had a significantly greater reduction in overall body mass index (P<0.01). The app group also demonstrated statistically significant improvements in "strenuous" physical activity (P=0.04) and had significant improvement in their dietary patterns (P<0.001), as compared to the self-guided group. The app group had greater reduction in fatigue and improvement in depression, but these changes were not statistically significant. At 12 months, none of the app users were still using the app, but many were still following their wellness plan and had maintained their weight loss. Outliers in both groups and low rate of response made evaluation of results difficult. CONCLUSIONS: The results of this advanced practice provider-led study demonstrated that a live health coaching app that provides wellness coaching can offer motivated breast cancer survivors and cancer programs a modality that offers convenient, effective support at a reasonable cost.

Food Safety Management Systems, Certified Food Protection Managers, and Compliance with Food Safety Practices Associated with the Control of Listeria monocytogenes in Foods at Restaurants.

HIGHLIGHTS: Proper cold holding and date marking practices help control Lm growth in foods. Most restaurants had ≥1 instance of improper cold holding. Less than 50% of all cold holding observations were found to be out of compliance. Restaurants in areas requiring date marking of food were more likely to date mark. CFPM did not predict out-of-compliance observations when FSMS effects were considered.

AVURT: aspirin versus placebo for the treatment of venous leg ulcers - a Phase II pilot randomised controlled trial.

BACKGROUND: Venous leg ulcers (VLUs) are the most common cause of leg ulceration, affecting 1 in 100 adults. VLUs may take many months to heal (25% fail to heal). Estimated prevalence is between 1% and 3% of the elderly population. Compression is the mainstay of treatment and few additional therapies exist to improve healing. Two previous trials have indicated that low-dose aspirin, as an adjunct to standard care, may improve healing time, but these trials were insufficiently robust. Aspirin is an inexpensive, widely used medication but its safety and efficacy in the treatment of VLUs remains to be established. OBJECTIVES: Primary objective - to assess the effects of 300 mg of aspirin (daily) versus placebo on the time to healing of the reference VLU. Secondary objectives - to assess the feasibility of leading into a larger pragmatic Phase III trial and the safety of aspirin in this population. DESIGN: A multicentred, pilot, Phase II randomised double-blind, parallel-group, placebo-controlled efficacy trial. SETTING: Community leg ulcer clinics or services, hospital outpatient clinics, leg ulcer clinics, tissue viability clinics and wound clinics in England, Wales and Scotland. PARTICIPANTS: Patients aged ≥ 18 years with a chronic VLU (i.e. the VLU is > 6 weeks in duration or the patient has a history of VLU) and who are not regularly taking aspirin. INTERVENTIONS: 300 mg of daily oral aspirin versus placebo. All patients were offered care in accordance with Scottish Intercollegiate Guidelines Network (SIGN) guidance with multicomponent compression therapy aiming to deliver 40 mmHg at the ankle when possible. RANDOMISATION: Participants were allocated in a 1 : 1 (aspirin : placebo) ratio by the Research Pharmacy, St George's University Hospitals NHS Foundation Trust, using a randomisation schedule generated in advance by the investigational medicinal product manufacturer. Randomisation was stratified according to ulcer size (≤ 5cm2 or > 5cm2). MAIN OUTCOME MEASURE: The primary outcome was time to healing of the largest eligible ulcer (reference ulcer). FEASIBILITY RESULTS ­ RECRUITMENT: 27 patients were recruited from eight sites over a period of 8 months. The target of 100 patients was not achieved and two sites did not recruit. Barriers to recruitment included a short recruitment window and a large proportion of participants failing to meet the eligibility criteria. RESULTS: The average age of the 27 randomised participants (placebo, n = 13; aspirin, n = 14) was 62 years (standard deviation 13 years), and two-thirds were male (n = 18). Participants had their reference ulcer for a median of 15 months, and the median size of ulcer was 17.1 cm2. There was no evidence of a difference in time to healing of the reference ulcer between groups in an adjusted analysis for log-ulcer area and duration (hazard ratio 0.58, 95% confidence interval 0.18 to 1.85; p = 0.357). One expected, related serious adverse event was recorded for a participant in the aspirin group. LIMITATIONS: The trial under-recruited because many patients did not meet the eligibility criteria. CONCLUSIONS: There was no evidence that aspirin was efficacious in hastening the healing of chronic VLUs. It can be concluded that a larger Phase III (effectiveness) trial would not be feasible. TRIAL REGISTRATION: Clinical Trials.gov NCT02333123; European Clinical Trials Database (EudraCT) 2014-003979-39. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 55. See the NIHR Journals Library website for further project information.

Practice Model for Advanced Practice Providers in Oncology.

According to ASCO, the number of practicing oncologists has remained stable despite growth demands, leading to an overall shortage in many areas of the country. Nurse practitioners and physician assistants are advanced practice providers (APPs) who can assist in the provision of support and care to patients with cancer, but the role of the APP in the oncology setting has not been well defined. There exists a variety of different practice patterns for APPs who work in oncology, and the lack of role definition and absence of an established practice model are considered leading causes of APP attrition. According to the American Academy of Nurse Practitioners, it has been well demonstrated that, when nurse practitioners are allowed to work to the full scope of their education and preparation, there are notable cost reductions and quality improvements in patient care. The focus of APP education and training is on health promotion, disease prevention, and primary care medical management, but most APPs have limited exposure to management of cancer in patients. With this in mind, Aurora Cancer Care developed a practice model for APPs who work in oncology. The goal of the model is to enhance the quality of care delivered to patients and provide a stimulating work environment that fosters excellent collaborative relationships with oncologist colleagues, supports professional growth, and allows APPs to practice to the full extent of their licensure.