Outcomes of Incidental Fallopian Tube High-Grade Serous Carcinoma and Serous Tubal Intraepithelial Carcinoma in Women at Low Risk of Hereditary Breast and Ovarian Cancer.

OBJECTIVES: The natural history and optimal management of serous tubal intraepithelial carcinoma (STIC), regardless of BRCA status, is unknown. We report the follow-up findings of a series of incidental fallopian tube high-grade serous carcinomas (HGSCs) and STICs identified in women at low risk for hereditary breast and ovarian cancer (HBOC), undergoing surgery for other indications. MATERIALS AND METHODS: Cases of incidental STIC and HGSC were identified from 2008. Patients with known BRCA1 or BRCA2 mutations, or a family history of ovarian or breast cancer before the diagnosis of STIC or HGSC were excluded. A retrospective chart review was conducted to obtain clinical data. RESULTS: Eighteen cases were identified with a median follow-up of 25 months (range, 4-88 months). Twelve of 18 patients had a diagnosis of STIC with no associated invasive HGSC and 6 had STIC associated with other invasive malignancies. Completion staging surgery was performed on 7 of the 18 patients, including 5 of 12 in which there was STIC only identified on primary surgery; 3 cases were upstaged from STIC only to HGSC based on the staging surgery. Recurrence of HGSC occurred in 2 of the 18 patients. BRCA testing was performed on 3 patients, 1 of whom tested positive for a pathogenic BRCA1 mutation. CONCLUSIONS: Our study suggests that completion staging surgery for incidental STICs in non-BRCA patients may be considered. These patients should be offered hereditary testing. The Pelvic-Ovarian cancer INTerception (POINT) Project is an international registry set up to add to our understanding of STICs.

Informal inter-island poultry movement in Indonesia: does it pose a risk to HPAI H5N1 transmission?

Informal movement of domesticated poultry and wild birds is considered a major threat in terms of highly pathogenic avian influenza (HPAI) H5N1 transmission between birds and from birds to humans. However, the risk of transmission from informal illegal poultry movement has received little attention in Indonesia where human fatalities are the highest in the world. This research investigated the illegal movement of adult poultry between the islands of Java, Bali and Lombok to determine the potential risk of HPAI H5N1 transmission. The aim was to determine known origins and destinations of poultry, estimated quantity and types of birds, people involved and the drivers of illegal movement. Transportation and handling methods and views on how to minimise illegal movement were also investigated. In-depth interviews were carried out with 71 key informants in Bali and Lombok in 2009. East Java was the main origin of poultry entering Bali, followed by Central Java and Lombok. Interviewees estimated that over 10,000 village chickens, 500 ducks and 50 fighting cocks were brought into Bali per month from all origins. However, there were significant discrepancies with quarantine records indicating that the majority of birds imported illegally are not detected. We conclude that although informal illegal movement of poultry in Indonesia poses a potentially high risk for potential HPAI H5N1 transmission if birds are infected, much can be done to increase surveillance, encourage reporting of sick birds, educate traders about the risks and provide effective quarantine within an appropriate cultural framework.

Factors affecting community-agency trust before, during and after a wildfire: an Australian case study.

Trust has been identified as a critical relationship component in contexts of high uncertainty and complexity such as wildfire management, and as a primary factor in public support for wildland fire management strategies. However, little attention has been paid to identifying and comparing factors across fire management stages (i.e. before, during, after a fire) that may influence trust between community members and fire management agencies. This paper attempts to address this gap by exploring factors affecting community-agency trusting relationships before, during and after a wildfire event. We draw upon 26 semi-structured interviews with 38 residents of a community directly impacted by fires in December 2006 and January 2007 in Victoria, Australia. Communication, cooperation, trustworthiness, and integration of local concerns and knowledge influenced trust in more than one fire management stage. Institutional structures and reduction of uncertainty were particularly strong influences during a fire. After a fire, resolving negative outcomes and immediately meeting perceived needs arising from the fire were factors unique to this stage.

Exercise Interventions for Women with Ovarian Cancer: A Realist Review.

BACKGROUND: Despite evidence indicating the benefits of exercise interventions for women with ovarian cancer both during and following treatment, uptake is poor. There is limited research exploring the implementation of such interventions for this cohort of women. The purpose of this review was to identify implementation theories in relation to exercise interventions for women with stages I-IV ovarian cancer, both during and following treatment; to explain positive and negative contextual factors, which may help or hinder implementation; and to develop a theory on how exercise interventions for women with ovarian cancer may be implemented. METHODS: This realist review sourced literature from five electronic databases: CINAHL plus, Medline, Embase, PsycINFO and Google Scholar. Methodological rigour was assessed using the relevant critical appraisal skills programme tools. RESULTS: Nine papers were included. Two intervention stages were identified: first, optimising uptake by providing education to patients on the benefits of exercise, approaching patients when symptoms are adequately managed and offering a personalised exercise programme; second, adherence and retention are influenced by the provision of an "autoregulated" exercise programme with additional supportive infrastructure, individualised goal setting and symptom management support where required. CONCLUSION: Women with ovarian cancer are reluctant to engage in exercise interventions, despite the supporting evidence in terms of positive clinical outcomes. This realist review elucidates underlying mechanisms and important contextual factors that will support and guide the implementation of exercise interventions for this cohort of women.

Community engagement strengthens pig disease knowledge and passive surveillance in Timor-Leste.

Smallholder pig production in Timor-Leste is culturally and economically important for most households. However, regular and ongoing disease surveillance and pig husbandry training for farmers are limited. This article describes collaborative social and diagnostic research followed by a pilot community engagement program to improve farmer and technician knowledge, skills, and working relationships. There were three phases: (1) A qualitative study in 2020 to explore the experiences and knowledge of 133 pig farmers, 6 village leaders, and 16 district veterinary technicians on pig diseases and reporting, treatment methods, and access to information or assistance. (2) A pilot community engagement program in 3 villages in 2021 with the diagnostic investigation with samples analyzed from 27 dead pigs, and (3) Evaluation of community engagement and training outcomes. Results of the qualitative study revealed limited reporting of sick or dead pigs by farmers to veterinary technicians due to a lack of trust in the veterinary diagnostic system. Most technicians lacked experience with sampling or post-mortems so diagnostic training was undertaken for the pilot disease investigation. Evaluation results showed improved knowledge, motivation, and confidence of government staff and farmers. The credibility of veterinary technicians improved and gave them more confidence to work with communities. Farmers felt supported because all aspects of pig husbandry were addressed, and they were more willing to report dead or sick pigs. The project indicates that improved passive disease surveillance can be achieved by engaging communities in smallholder pig farming in Timor-Leste. Further research and testing of the approach in other districts and countries is recommended.

Safety and Efficacy of Antiviral Therapy for Prevention of Cytomegalovirus Reactivation in Immunocompetent Critically Ill Patients: A Randomized Clinical Trial.

Importance: Latent cytomegalovirus (CMV) infection is present in more than half the adult population, and a viral reactivation (ie, when the virus becomes measurable in body fluids such as blood) can occur in up to one-third of these individuals during episodes of critical illness. Objective: To determine whether antiviral therapy is safe and effective for preventing CMV reactivation in a general population of critically ill patients. Design, Setting, and Participants: A single-center, open-label, randomized, controlled clinical trial recruited 124 CMV-seropositive patients undergoing mechanical ventilation for at least 24 hours in the intensive care unit between January 1, 2012, and January 31, 2014. The mean baseline Acute Physiology and Chronic Health Evaluation II score of all patients was 17.6. Interventions: Patients were randomized to receive anti-CMV prophylaxis with valacyclovir hydrochloride (n = 34) or low-dose valganciclovir hydrochloride (n = 46) for up to 28 days to suppress viral reactivation, or to a control group with no intervention (n = 44). Main Outcomes and Measures: Time to first CMV reactivation in blood within the 28-day follow-up period following initiation of the study drug. Results: Among the 124 patients in the study (46 women and 78 men; mean [SD] age, 56.9 [16.9] years), viral reactivation in the blood occurred in 12 patients in the control group, compared with 1 patient in the valganciclovir group and 2 patients in the valacyclovir group (combined treatment groups vs control: hazard ratio, 0.14; 95% CI 0.04-0.50). Although this trial was not powered to assess clinical end points, the valacyclovir arm was halted prematurely because of higher mortality; 14 of 34 patients (41.2%) had died by 28 days, compared with 5 of 37 (13.5%) patients in the control arm at the point of the decision to halt this arm. Other safety end points showed similar outcomes between groups. Conclusions and Relevance: Antiviral prophylaxis with valacyclovir or low-dose valganciclovir suppresses CMV reactivation in patients with critical illness. However, given the higher mortality, a large-scale trial would be needed to determine the clinical efficacy and safety of CMV suppression. Trial Registration: clinicaltrials.gov Identifier: NCT01503918.

Knowledge and Perceptions of Highly Pathogenic Avian Influenza (HPAI) among Poultry Traders in Live Bird Markets in Bali and Lombok, Indonesia.

Highly Pathogenic Avian Influenza (HPAI) has been prevalent in Indonesia since 2003 causing major losses to poultry production and human deaths. Live bird markets are considered high risk areas due to the density of large numbers of mixed poultry species of unknown disease status. Understanding trader knowledge and perceptions of HPAI and biosecurity is critical to reducing transmission risk and controlling the disease. An interview-administered survey was conducted at 17 live bird markets on the islands of Bali and Lombok in 2008 and 2009. A total of 413 live poultry traders were interviewed. Respondents were mostly male (89%) with a mean age of 45 years (range: 19-81). The main source of AI information was TV (78%), although personal communication was also identified to be an important source, particularly among female traders (60%) and respondents from Bali (43%). More than half (58%) of live poultry traders interviewed knew that infected birds can transmit HPAI viruses but were generally unaware that viruses can be introduced to markets by fomites. Cleaning cages and disposing of sick and dead birds were recognized as the most important steps to prevent the spread of disease by respondents. Two thirds (n = 277) of respondents were unwilling to report sudden or suspicious bird deaths to authorities. Bali vendors perceive biosecurity to be of higher importance than Lombok vendors and are more willing to improve biosecurity within markets than traders in Lombok. Collectors and traders selling large numbers (>214) of poultry, or selling both chickens and ducks, have better knowledge of HPAI transmission and prevention than vendors or traders selling smaller quantities or only one species of poultry. Education was strongly associated with better knowledge but did not influence positive reporting behavior. Our study reveals that most live poultry traders have limited knowledge of HPAI transmission and prevention and are generally reluctant to report bird deaths. Greater efforts are needed to engage local government, market managers and traders in education and awareness programs, regulatory measures and incentive mechanisms. Understanding and evaluating the social responses to such an integrated approach could lead to more effective HPAI prevention and control.

Randomized controlled trial of different models of care for nursing home residents with dementia complicated by depression or psychosis.

OBJECTIVE: To compare the outcomes of 3 interventions for the management of dementia complicated by depression or psychosis: psychogeriatric case management, general practitioners with specialist psychogeriatric consultation, and standard care for nursing home residents. METHOD: The sample for this 12-week randomized controlled trial consisted of 86 subjects with dementia from 11 Sydney, Australia, nursing homes, of whom 34 had depression, 33 had depression and psychosis, and 19 had psychosis. All participants received full psychiatric assessments and physical examinations. Information was obtained from the residents' families and nursing home staff. Depression measures included the Even Briefer Assessment Scale for Depression, Hamilton Rating Scale for Depression, Cornell Scale for Depression in Dementia, and Geriatric Depression Scale. Psychosis measures included the Behavioral Pathology in Alzheimer's Disease Rating Scale, Neuropsychiatric Inventory, and Scale for the Assessment of Positive Symptoms. Data were obtained from nursing home records on prescription of psychotropic medication and demographic information. Management plans were formulated by a multidisciplinary team before random assignment to interventions. RESULTS: All 3 groups improved from pretreatment to posttreatment on depression scales for depression groups and psychosis scales for psychosis groups. Mode of management appeared to make no difference in rate or amount of improvement; neither of the treatment group-by-time interactions were significant. Neither use of antidepressants nor use of antipsychotics predicted depression or psychosis outcomes. CONCLUSION: Participation in the study was associated with improvement in depression and psychosis, perhaps because of the presence of a psychogeriatric team, the increased attention focused on residents, or the generalization of active intervention techniques to control subjects. A formula-driven psychogeriatric team case management approach was not significantly more effective than a consultative approach or standard care. This study demonstrates the difficulties and feasibility of conducting service-oriented research in nursing homes.

Emergence of CA125 immunoreactivity in recurrent or metastatic primary ovarian mucinous neoplasms of the intestinal type.

Primary ovarian mucinous carcinomas are uncommon and usually present as unilateral stage 1 neoplasms. The vast majority are of the so-called intestinal or enteric type and arise from a preexisting intestinal-type mucinous borderline neoplasm. The overall prognosis is good. However, a minor proportion recurs or metastasizes, and this is associated with a poor prognosis. The vast majority of primary ovarian intestinal-type mucinous carcinomas and borderline tumors exhibit a variable degree of positivity with enteric markers and are CA125 negative. The primary purpose of this study was to describe the unusual phenomenon of CA125 immunoreactivity in 8 of 10 metastatic mucinous carcinomas arising after a diagnosis of primary ovarian mucinous carcinoma (n=3) or mucinous borderline tumor of the intestinal type (n=7) in which the primary neoplasms were mostly negative. The reasons underlying this emergent CA125 positivity are not clear, but we speculate it may be because while intestinal type mucinous borderline neoplasms and mucinous carcinomas exhibiting so-called expansile invasion are usually CA125 negative, focal positivity may be seen in areas of infiltrative stromal invasion, which may preferentially metastasize. CA125 positivity in the metastatic neoplasm may result in the pathologist considering an alternative primary site; however, this should not be the case. In our study, we found a 4.2% risk of malignant progression after a diagnosis of primary ovarian mucinous borderline tumor of the intestinal type. In light of this, we favor retaining the term "mucinous borderline tumor," because of this small, but not insignificant, risk of malignant transformation, which in most cases is likely secondary to a focus of invasion being unsampled at the time of reporting the primary neoplasms.

Genomic analysis reveals the molecular heterogeneity of ovarian clear cell carcinomas.

PURPOSE: Ovarian clear cell carcinomas (OCCC) are a drug-resistant and aggressive type of epithelial ovarian cancer. We analyzed the molecular genetic profiles of OCCCs to determine whether distinct genomic subgroups of OCCCs exist. EXPERIMENTAL DESIGN: Fifty pure primary OCCCs were subjected to high-resolution microarray-based comparative genomic hybridization (aCGH). Unsupervised hierarchical clustering using Ward's linkage analysis was performed to identify genomic subgroups of OCCCs. Survival analysis was performed using Kaplan-Meier method and log-rank test. Cox-regression analysis was used to identify independent predictors of outcome. Differentially amplified regions between genomic subgroups of OCCCs were identified using a multi-Fisher's exact test. RESULTS: Hierarchical cluster analysis revealed two distinct clusters of OCCCs with different clinical outcomes. Patients from cluster-1 had a significantly shorter median progression-free survival (PFS) than those from cluster-2 (11 vs. 65 months, P = 0.009), although estimates for ovarian cancer-specific survival (OCS) did not reach statistical significance (P = 0.065). In multivariate analysis, suboptimal debulking surgery and genomic cluster were independently prognostic for PFS. Recurrently amplified genomic regions with a significantly higher prevalence in cluster-1 than cluster-2 OCCCs were identified and validated. HER2 gene amplification and protein overexpression was observed in 14% of OCCCs, suggesting that this may constitute a potential therapeutic target for a subgroup of these tumors. CONCLUSIONS: OCCCs constitute a heterogeneous disease at the genomic level despite having similar histological features. The pattern of genomic aberrations in subgroups of OCCCs is of clinical significance. We have identified recurrently amplified regions that may harbor potential therapeutic targets for subgroups of OCCCs.