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Purpose: Previous studies have demonstrated that many healthcare workers in low- and middle-income countries (LMICs) lack the appropriate training and knowledge to recognize and diagnose breast cancer at an early stage. As a result, women in LMICs are frequently diagnosed with late-stage breast cancer (Stage III/IV) with a poor prognosis.Materials and Methods: We hosted a 1-day breast cancer educational conference directed towards healthcare workers in Honduras. We conducted pre- and postcourse (1–2 months later) assessments that evaluated knowledge of screening, diagnosis, and treatment of breast cancer. Breast cancer specialists at the University of Minnesota and Honduras developed a 12-question assessment tool in Spanish.Results: A total of 157 people attended the course, and 86 completed the precourse knowledge assessment. The overall percentage of correct responses was 70% in the precourse assessment. Postcourse knowledge assessments were completed by 94 participants. The overall percentage of correct responses was 80% in the postcourse assessment and was significantly higher than precourse assessment scores (p<0.0001). For the individual domains of screening, diagnosis, and treatment, the postcourse knowledge assessment scores were significantly improved as compared with the precourse scores (p<0.0001).Conclusion: In this study, we found that a 1-day, in-person breast cancer educational course directed towards healthcare workers in Honduras resulted in improved breast cancer knowledge assessment scores. Future research and implementation strategies will include training healthcare workers throughout Honduras and determining the impact of these educational interventions on the late-stage presentation of breast cancer.

In the most severe cases, novel coronavirus (SARS-CoV-2) infection leads to Acute Respiratory Distress Syndrome which may be refractory to standard medical interventions including mechanical ventilation. There are growing reports of the use of venovenous (VV) extracorporeal membrane oxygenation (ECMO) in these cases. A subset of critically ill COVID-19 patients develops cardiomyopathy as well, manifested by cardiogenic shock with reduced ejection fraction, dysrhythmias, and subsequent increase in mortality. One strategy for managing ARDS with an element of cardiogenic shock is venoarteriovenous (VAV) ECMO. Less than 1% of the cases in the worldwide ELSO COVID-19 database employed any form of hybrid cannulation. To date, there has only been one reported case of patient salvage with arterial or partial arterial support. We present a case that demonstrates the potential role of VAV ECMO in the case of concomitant severe ARDS with cardiomyopathy in the setting of COVID-19 infection.

Background: The proportion of women Veterans are increasing and, as such, access to high-quality breast cancer care is important. Prior studies have shown that rural location, age, and a mental health diagnosis negatively impact breast cancer screening rates. Methods: We aimed to retrospectively assess the impact of these risk factors on breast cancer screening adherence rates among Veterans at our institution. Women who were eligible for breast cancer screening per the United States Preventative Services Taskforce guidelines were included. Results: Of 2321 women, overall adherence was 78.2%. There were no significant differences in screening rates between races, various age groups, geographical distribution, and having anxiety or post-traumatic stress disorder (PTSD). However, Veterans with a diagnosis of depression were more likely to adhere to screening guidelines. Having multiple mental health diagnoses was also not a negative risk factor. Conclusions: Our Veteran population’s adherence rates are higher than the national average and rural location, race, age, and certain mental health disorders did not negatively affect adherence to screening mammography. Though more research is needed, screening reminders from our women’s health coordinator may have improved adherence rates and lowered disparities.

Background The National Institutes of Health (NIH) recommends patient education materials reflect the average reading grade level of the US population. Due to the importance of shared decision-making in breast cancer surgery, this study evaluates the reading level of patient education materials from National Cancer Institute-designated cancer centers (NCI-DCC) compared with top Internet search results. Methods Online materials from NCI-DCC and top Internet search results on breast cancer, staging, surgical options, and pre- and postoperative expectations were analyzed using three validated readability algorithms: Simplified Measure of Gobbledygook Readability Formula, Coleman–Liau index, and Flesch–Kincaid grade level. Mean readability was compared across source groups and information subcategories using an unpaired t -test with statistical significance set at p < 0.05. Mean readability was compared using a one-way analysis of variance. Results Mean readability scores from NCI-DCC and Internet groups ranged from a 9th–12th grade level, significantly above the NIH recommended reading level of 6th–7th grade. There was no significant difference between reading levels from the two sources. The discrepancy between actual and recommended reading level was most pronounced for “surgical options” at a 10th–12th grade level from both sources. Conclusions Patient education materials on breast cancer from both NCI-DCC and top Internet search results were written several reading grade levels higher than the NIH recommendation. Materials should be revised to enhance patient comprehension of breast cancer surgical treatment and guide patients in this important decision-making process to ultimately improve health outcomes.

Purpose The ACOSOG Z0011 (Z11) trial assessed the benefit of axillary dissection (ALND) for breast cancer patients with sentinel lymph node (SLN) metastases; however, Z11 excluded patients with ≥ 3 positive SLNs. We analyzed trends in ALND omission in patients with ≥ 3 positive SLNs. Methods Women with ≥ 3 positive SLNs who underwent breast-conserving surgery (BCS) or mastectomy between 2018 and 2020 in the National Cancer Database were included using SLN codes initiated in 2018. Patients with stage IV disease, recurrent breast cancer, and who underwent neoadjuvant chemotherapy were excluded. A multivariable logistic regression model was utilized to determine the proportion who received ALND and factors associated with ALND omission. A subgroup analysis was performed among patients who met the remainder of the Z11 inclusion criteria (BCS, T1/T2 breast cancer). Results We identified 3654 patients with ≥ 3 positive SLNs. ALND was omitted in 37% of patients, and omission significantly increased from 2018 to 2020 (29% vs. 41%, p < 0.0001). Older age, lower grade tumors, no radiation, non-academic facility, BCS, more SLNs examined and fewer positive SLNs were significantly associated with ALND omission. 942 patients with ≥ 3 positive SLNs met the remainder of the Z11 inclusion criteria. ALND was omitted in 49% of these patients, and omission increased from 2018 to 2020 (44% vs. 49%, p = 0.22). Conclusion Approximately one-third of patients with ≥ 3 positive SLNs do not undergo ALND; omission of ALND increased from 2018 to 2020. Studies assessing oncologic outcomes of patients with ≥ 3 positive SLNs who do and do not receive ALND are required.

BackgroundPatients with estrogen receptor (ER)-positive, HER2-negative breast cancer (BC), and high-risk 21-gene recurrence score (RS) results benefit from chemotherapy. We evaluated chemotherapy refusal and survival in healthy older women with high-RS, ER-positive BC.Methods Retrospective review of the National Cancer Database (2010–2017) identified women ≥ 65 years of age, with ER-positive, HER2-negative, high-RS (≥ 26) BC. Patients with Charlson Comorbidity Index ≥ 1, stage III/IV disease, or incomplete data were excluded. Women were compared by chemotherapy receipt or refusal using the Cochrane–Armitage test, multivariable logistical regression modeling, the Kaplan–Meier method, and Cox’s proportional hazards modeling.Results 6827 women met study criteria: 5449 (80%) received chemotherapy and 1378 (20%) refused. Compared to women who received chemotherapy, women who refused were older (71 vs 69 years), were diagnosed more recently (2014–2017, 67% vs 61%), and received radiation less frequently (67% vs 71%) (p ≤ 0.05). Refusal was associated with decreased 5-year OS for women 65–74 (92% vs 95%) and 75–79 (85% vs 92%) (p ≤ 0.05), but not for women ≥ 80 years old (84% vs 91%; p = 0.07). On multivariable analysis, hazard of death increased with refusal overall (HR 1.12, 95% CI 1.04–1.2); but, when stratified by age, was not increased for women ≥ 80 years (HR 1.10, 95% CI 0.80–1.51).Conclusions Among healthy women with high-RS, ER-positive BC, chemotherapy refusal was associated with decreased OS for women ages 65–79, but did not impact the OS of women ≥ 80 years old. Genomic testing may have limited utility in this population, warranting prudent shared decision-making and further study.

Background Studies demonstrate higher mortality rates from colon cancer in American Indian/Alaskan Native (AI/AN) patients compared to non-Hispanic White (nHW). We aim to identify factors that contribute to survival disparities. Methods We used the National Cancer Database to identify AI/AN ( n  = 2127) and nHW ( n  = 527,045) patients with stage I–IV colon cancer from 2004 to 2016. Overall survival among stage I–IV colon cancer patients was estimated by Kaplan–Meier analysis; Cox proportional hazard ratios were used to identify independent predictors of survival. Results AI/AN patients with stage I–III disease had significantly shorter median survival than nHW (73 vs 77 months, respectively; p  < 0.001); there were no differences in survival for stage IV. Adjusted analyses demonstrated that AI/AN race was an independent predictor of higher overall mortality compared to nHW (HR 1.19, 95% CI 1.01–1.33, p  = 0.002). Importantly, compared to nHW, AI/AN were younger, had more comorbidities, had greater rurality, had more left-sided colon cancers, had higher stage but lower grade tumors, were less frequently treated at an academic facility, were more likely to experience a delay in initiation of chemotherapy, and were less likely to receive adjuvant chemotherapy for stage III disease. We found no differences in sex, receipt of surgery, or adequacy of lymph node dissection. Conclusion We found patient, tumor, and treatment factors that potentially contribute to worse survival rates observed in AI/AN colon cancer patients. Limitations include the heterogeneity of AI/AN patients and the use of overall survival as an endpoint. Additional studies are needed to implement strategies to eliminate disparities.

Pipe bridges are structures that play an indispensable role in chemical and oil plants. They support cable trays or pipe-carrying material. This study aims to identify the ideal configuration of a pipe bridge through the comparative study of girders with drop hanger and truss arrangements for three different spans. The most efficient arrangement for each span was suitably identified. Through the analysis carried out, it was then identified that the Girder arrangement is suitable for smaller spans such as 15 meters; while the truss arrangement was preferable for longer spans.