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The aim of this study was to investigate 60 SNPs pertaining to drug metabolism and pharmacodynamics in the Burmese refugee population in the Fort Wayne, Indiana area to better inform patient care. Sixty-two self-identified Burmese refugees were genotyped for 60 common SNPs pertaining to pharmacokinetic and pharmacodynamic pharmacogenes. The resulting allelic frequencies were compared with Ensembl's database for surrounding populations to Myanmar and America. The frequency of , , , and were approximately 20% different in the Burmese refugee population as compared with the Ensembl populations. Our study demonstrates that genetic differences are expected to affect drug efficacy in patients with a Burmese background.

Background Endocrinopathies are well recognised immune-related adverse events associated with immunotherapy. Incidence rates of hypophysitis and thyroid dysfunction are widely variable in the literature. Hypophysitis has been reported in between 0.4% and 27% in patients treated with CTLA-4 inhibitors such as ipilimumab (1) while the incidence of thyroid dysfunction varies between 8% and 20% in patients treated with PD-1 inhibitors such as nivolumab and pembrolizumab (1). Aims Our aim was to determine real world rates of thyroid and pituitary dysfunction in patients treated with immunotherapy. We also sought to evaluate the characteristics of same-e.g. time to onset of adverse events and presence of autoantibodies. Methods A retrospective cohort study was performed in 347 patients who received treatment with PD-1 inhibitors nivolumab and pembrolizumab, anti-CD52 antibody alemtuzumab and CTLA-4 inhibitor ipilimumab between January 2013 and December 2017 at a tertiary referral metropolitan hospital in Melbourne, Australia. Patients were identified from pharmacy records and assessment of the clinical and biochemical records pertaining to thyroid function (TFT) and serum cortisol was performed. Results 45 patients (12.9%) had evidence of thyroid or pituitary dysfunction from the therapies. 34 of the 267 (12.7%) patients on PD-1 inhibitors developed thyroid dysfunction, 15 (5.6%) of whom had a clear thyroiditis picture-i.e. thyrotoxic phase with subsequent hypothyroidism. 3 of the 34 (8.8%) patients who received CTLA-4 inhibitor ipilimumab developed hypophysitis, all of whom were on combined treatment with a PD-1 inhibitor. Median time to onset of adverse effects was 30days. 12 out of 27 patients with thyroid dysfunction had positive anti-thyroid peroxidase antibodies. 25 of the 45 (55.6%) patients were reviewed in endocrine outpatient clinics. Only 2 of the 45 endocrinopathies were recorded in the hospital’s adverse drug reactions database. Conclusions In our tertiary centre, endocrinopathies are common in patients treated with immunotherapies; however reportage to the adverse drug reaction database is low and endocrinology services appear underutilised. Current guidelines suggest TFT monitoring every 4-6weeks on therapy (2) with baseline monitoring of early morning ACTH and cortisol concentrations to be considered in patients treated with CTLA-4 inhibitors. Greater clinician awareness and adherence to guidelines is needed for optimal patient care. References: 1. The Current Understanding of the Endocrine Effects from Immune Checkpoint Inhibitors and Recommendations for Management. Girotra et al. JNCI Cancer Spectrum. July 2018. 2. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology. Feb 2018. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

This study examines the figure of the female killer and the monstrous gaze within contemporary Hollywood Cinema: the action heroine; the serial killer; the Slasher killer; the rape revenge heroine; the femme fatale, the 'Bitch from Hell' and the witch. The theoretical aim of this study is to locate a form of visual pleasure for female spectators within these images which is active, sadistic and subjective, and yet remains figuratively feminine.

Background Despite continuing advancements in treatments for opioid use disorder (OUD), continued high rates of relapse indicate the need for more effective approaches, including novel pharmacological interventions. Glucagon-like peptide 1 receptor agonists (GLP-1RA) provide a promising avenue as a non-opioid medication for the treatment of OUD. Whereas GLP-1RAs have shown promise as a treatment for alcohol and nicotine use disorders, to date, no controlled clinical trials have been conducted to determine if a GLP-1RA can reduce craving in individuals with OUD. The purpose of the current protocol was to evaluate the potential for a GLP-1RA, liraglutide, to safely and effectively reduce craving in an OUD population in residential treatment. Method This preliminary study was a randomized, double-blinded, placebo-controlled clinical trial designed to test the safety and efficacy of the GLP-1RA, liraglutide, in 40 participants in residential treatment for OUD. Along with taking a range of safety measures, efficacy for cue-induced craving was evaluated prior to (Day 1) and following (Day 19) treatment using a Visual Analogue Scale (VAS) in response to a cue reactivity task during functional near-infrared spectroscopy (fNIRS) and for craving. Efficacy of treatment for ambient craving was assessed using Ecological Momentary Assessment (EMA) prior to (Study Day 1), across (Study Days 2–19), and following (Study Days 20–21) residential treatment. Discussion This manuscript describes a protocol to collect clinical data on the safety and efficacy of a GLP-1RA, liraglutide, during residential treatment of persons with OUD, laying the groundwork for further evaluation in a larger, outpatient OUD population. Improved understanding of innovative, non-opioid based treatments for OUD will have the potential to inform community-based interventions and health policy, assist physicians and health care professionals in the treatment of persons with OUD, and to support individuals with OUD in their effort to live a healthy life. Trial registration: ClinicalTrials.gov: NCT04199728. Registered 16 December 2019, https://clinicaltrials.gov/study/NCT04199728?term=NCT04199728 . Protocol Version 10 May 2023

Purpose This study describes financial toxicity (FT) reported by people with metastatic cancer, characteristics associated with FT, and associations between FT and compensatory strategies to offset costs. Methods Cancer Support Community’s Cancer Experience Registry data was used to identify respondents with a solid tumor metastatic cancer who completed the Functional Assessment of Chronic Illness Therapy COmprehensive Score for Financial Toxicity (FACIT-COST) measure. Multivariable logistic regression analyses examined associations between respondent characteristics and FT, and FT and postponing medical visits, nonadherence to medications, and postponing supportive and/or psychosocial care. Results 484 individuals were included in the analysis; the most common cancers included metastatic breast (31%), lung (13%), gynecologic (10%), and colorectal (9%). Approximately half of participants (50.2%) reported some degree of FT. Those who were non-Hispanic White, Hispanic, or multiple races (compared to non-Hispanic Black), and who reported lower income, less education, and being less than one year since their cancer diagnosis had greater odds of reporting FT. Individuals with any level of FT were also more likely to report postponing medical visits (Adjusted Odds Ratio [OR] 2.58; 95% Confidence Interval [CI] 1.45–4.58), suboptimal medication adherence (Adjusted OR 5.05; 95% CI 2.77–9.20) and postponing supportive care and/or psychosocial support services (Adjusted OR 4.16; 95% CI 2.53–6.85) compared to those without FT. Conclusions With increases in the number of people living longer with metastatic cancer and the rising costs of therapy, there will continue to be a need to systematically screen and intervene to prevent and mitigate FT for these survivors.

To the Editor: Starmer and colleagues (Nov. 6 issue) 1 found an impressive reduction in medical errors with their patient-handoff intervention. In the past, similar impressive interventions have been oversimplified. 2 We hope that others do not oversimplify this work and implement the I-PASS mnemonic (illness severity, patient summary, action items, situation awareness and contingency plans, and synthesis by receiver) alone without the other important elements in the bundle. We believe that the bundle worked because medical errors were detected by means of collaborative cross-checks among peers. 3 , 4 Elements of the handoff program support effective cross-checks in multiple ways: conveying that polite, . . .

Nonmedical use of prescription opioid medication (NMPO) in the United States is a public health crisis, resulting in high rates of emergency room visits, morbidity, and mortality. The purpose of this study was to explore prevalence estimates and correlates of NMPO among a convenience sample of college students in the northeast and southeast regions of the US to help generate directions for future research. Motivations for misuse, age of onset, access, concomitant substance use, and individual factors were investigated among a sample of undergraduate students from two universities. Participants (N = 847) completed a battery of various self-report measures. Findings revealed that 7.7% (Southeastern University) and 12.8% of students (Northeastern University) reported lifetime NMPO, whereas past-month NMPO was reported by 0.8% and 0.9% of participants, respectively. Lifetime history of regularly using alcohol, nonmedical use of benzodiazepine medication, nonmedical use of prescription stimulants, symptoms of depression and anxiety, and executive functioning (i.e., metacognition and behavioral regulation) were significantly related to lifetime history of NMPO in this college sample. These findings offer several potential subsequent lines of investigation regarding the associations between various demographic and psychological factors and NMPO. Future research is needed to help identify college students who are at risk of NMPO.