Publications by authors named "PURCELL W"

Climate change and related pollution and environmental damage are an urgent focus for public health physicians. Curricular content is increasing in medical schools, but to date, only pediatrics has published guidance for residency education. To survey program directors of Accreditation Council for Graduate Medical Education preventive medicine specialties (public health and preventive medicine [PHPM], occupational and environmental medicine [OEM], and aerospace medicine [AM]) for current teaching on climate and health issues.

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  • - The study investigated the safety and effectiveness of combining alisertib and sapanisertib in patients with difficult-to-treat solid tumors, focusing on pancreatic adenocarcinoma.
  • - A total of 31 patients were treated, and while similar side effects to previous studies were noted, only one patient with breast cancer showed a significant improvement, and pancreatic cancer patients had modest treatment responses.
  • - The findings suggest that targeting proteins involved in cell cycle regulation (Aurora A kinase) and tumor growth (mTOR) had limited overall clinical impact, but responses varied based on tumor characteristics and patient treatment history.
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  • - A 58-year-old woman experienced progressive visual loss after taking topiramate for migraines over 3-4 years, reporting issues like light adaptation difficulty and color vision problems.
  • - Her visual acuity was severely diminished, and tests such as optical coherence tomography and electroretinogram revealed abnormalities consistent with retinal damage.
  • - Extensive medical testing ruled out other potential causes, suggesting that her condition was likely induced by the long-term use of topiramate.
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Higher education (HE) matters to the global struggle to combat climate change. Research builds knowledge and informs climate solutions. Educational programmes and courses upskill current and future leaders and professionals to tackle the systems change and the transformation needed to improve society.

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Background: Cancer-related fatigue (CRF) is one of the most reported and functionally limiting symptoms experienced by individuals living with and beyond cancer. Exercise is effective at reducing CRF, though currently it is not possible to predict the magnitude and time course of improvement for an individual participating in an exercise program.

Objective: To develop a reference chart of CRF improvement for individuals participating in a 3-month cancer-specific exercise program.

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Context: Psychological distress is common in patients with cancer, and oncology providers are often tasked with utilizing psychotropic medications to treat such symptoms.

Objective: This study aims to characterize how oncology providers prescribe psychotropic medications and to assess their comfort level with prescribing these medications.

Methods: A cross-sectional survey was sent to oncology medical doctors, nurse practitioners, and physician assistants who prescribe psychotropic medications to patients with cancer at a large academic medical center in the Mountain West.

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The impact of radiation prescription dose on postoperative complications during standard of care trimodality therapy for operable stage II-III esophageal and gastroesophageal junction cancers has not been established. We retrospectively reviewed 82 patients with esophageal or gastroesophageal junction cancers treated between 2004 and 2016 with neoadjuvant chemoradiation followed by resection at a single institution. Post-operative complications within 30 days were reviewed and scored using the Comprehensive Complication Index (CCI).

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Background: Cancer care coordination across major academic medical centers and their networks is evolving rapidly, but the spectrum of organizational efforts has not been described. We conducted a mixed-methods survey of leading cancer centers and their networks to document care coordination and identify opportunities to improve geographically dispersed care.

Methods: A mixed-methods survey was sent to 91 cancer centers in the United States and Canada.

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Purpose: Exercise programs delivered in community- or clinic-based settings improve physical and psychosocial outcomes among cancer survivors; however, adherence is essential to achieve such benefits. This study examined predictors of attendance to an exercise program in a large, diverse sample of cancer survivors.

Methods: Participants (n = 302) were enrolled in BfitBwell, an exercise program for adults diagnosed with cancer, and currently receiving or within 6 months of completing chemotherapy or radiation therapy.

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Namodenoson, an A3 adenosine-receptor agonist, showed promising results in advanced hepatocellular carcinoma (HCC) and moderate hepatic dysfunction (Child-Pugh B; CPB) in a phase I/II clinical study. This phase II study investigated namodenoson as second-line therapy in such patients. Patients were randomized 2:1 to twice a day (BID) namodenoson (25 mg; = 50) or placebo ( = 28).

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The COVID-19 health crisis has caused profound social and economic disruptions. Affecting everyone, its impact is not equal. Exacerbating deep social fissures and long-standing systemic inequalities, the pandemic reveals the fragilities and inequities in global higher education.

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Introduction: Sleep disturbance is the second leading negative side effect reported by cancer survivors, and evidence exists to suggest that exercise may improve sleep for cancer survivors. This study examined changes in sleep following a 3-month, clinic-based exercise program among a diverse group of cancer survivors.

Methods: Single group, pre-post study design.

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Osimertinib is a 3rd-generation tyrosine kinase inhibitor (TKI) that blocks the epidermal growth factor receptor (EGFR) in non-small lung cancer (NSCLC) and has dramatically improved outcomes for patients with EGFR mutations. While gastrointestinal complications such as diarrhea have been reported with EGFR inhibitors (due to off-target interactions with EGFR receptors within the gut lining), cecal volvulus is an extremely rare complication in advanced malignancy. To date, there are no reported cases associating cecal volvulus with any EGFR TKIs.

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Background: The clinicopathologic characteristics, acquired resistance patterns, and outcomes among patients with atypical EGFR mutations and HER2 alterations remain underexplored.

Patients And Methods: A single-center retrospective review was conducted. Oncogenes assessed include typical EGFR (t-EGFR; exon 19 del and L858R), atypical EGFR (a-EGFR; G719X, exon 20, L861Q), HER2 (exon 19, exon 20, amplifications), gene fusions (ALK, ROS1, RET), RAS (KRAS, NRAS), and RAF (BRAF V600E).

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Background: Locally advanced esophageal cancer is often treated with neoadjuvant therapy followed by surgery. Many patients present with or experience clinical deconditioning during neoadjuvant therapy. Prehabilitation programs in other areas of surgery have demonstrated improved postoperative outcomes.

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Objective: To investigate the anti-biofilm efficacy of root canal irrigants in canal spaces, isthmi and dentinal tubules of root canals ex vivo.

Methods: Fifty-one single-rooted premolars, each containing an isthmus, were instrumented, autoclaved and inoculated with Enterococcus faecalis for 4 weeks. One specimen was sectioned for bacteria-specific staining to confirm the presence of biofilms using light microscopiy.

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Compared to two-dimensional (2D) cell culture, cellular aggregates or spheroids (3D) offer a more appropriate alternative system where individual cell-cell communication and micro-environment more closely represent the organ; yet we understand little of the physiological conditions at this scale. The relationship between spheroid size and oxygen microenvironment, an important factor influencing the metabolic capacity of cells, was first established using the fish intestine derived RTgutGC cell line. Subsequently, pharmaceutical metabolism (Propranolol), as determined by high performance liquid chromatography, in this intestinal model was examined as a function of spheroid size.

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Introduction: Central nervous system (CNS) metastases in lung cancer are a frequent cause of morbidity and mortality. There are conflicting data on the incidence of CNS metastases in stage IV ROS1-positive NSCLC and the rate of CNS progression during crizotinib therapy.

Methods: A retrospective review of 579 patients with stage IV NSCLC between June 2008 and December 2017 was performed.

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Despite initial benefit from tyrosine kinase inhibitors (TKIs), patients with advanced non-small cell lung cancer (NSCLC) harboring (ALK) and (ROS1) gene fusions ultimately progress. Here, we report on the potential resistance mechanisms in a series of patients with ALK and ROS1 NSCLC progressing on different types and/or lines of -targeted therapy. We used a combination of next-generation sequencing (NGS), multiplex mutation assay, direct DNA sequencing, RT-PCR, and FISH to identify fusion variants/partners and copy-number gain (CNG), kinase domain mutations (KDM), and copy-number variations (CNVs) in other cancer-related genes.

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Patients with advanced non-small cell lung cancer (NSCLC) whose tumors harbor anaplastic lymphoma kinase ( gene fusions benefit from treatment with ALK inhibitors (ALKi). Analysis of cell-free circulating tumor DNA (cfDNA) may provide a noninvasive way to identify fusions and actionable resistance mechanisms without an invasive biopsy. The Guardant360 (G360; Guardant Health) deidentified database of NSCLC cases was queried to identify 88 consecutive patients with 96 plasma-detected fusions.

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Purpose: Despite national recommendations, exercise programs are still not clinically implemented as standard of care for cancer survivors. This investigation examined the effects of a clinically implemented and personalized exercise program on physical fitness, fatigue, and depression in a diverse population of cancer survivors. The association of various participant characteristics on program performance was also examined.

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Introduction: Patients with brain metastases (BMs) arising from EGFR-mutated and anaplastic lymphoma kinase gene (ALK)-rearranged NSCLC have a favorable prognosis compared with patients with non-oncogene-addicted NSCLC, emphasizing the importance of minimizing toxicities such as the cognitive sequelae of whole brain radiation therapy (WBRT). Although radiosurgery without WBRT is the preferred strategy for one to three BMs, this paradigm remains controversial for patients with multiple BMs.

Methods: We reviewed the cases of patients with EGFR-mutated and ALK-rearranged NSCLC presenting to our cancer center between 2008 and 2017 and included only patients receiving treatment to four or more BMs in a single radiosurgery session.

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Introduction: The role of serum tumor markers in the modern management of advanced NSCLC remains poorly described.

Methods: A single-center retrospective analysis of available carcinoembryonic antigen, CA125, CA19.9, and CA27.

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There is an acknowledged need for in vitro fish intestinal model to help understand dietary exposure to chemicals in the aquatic environment. The presence and use of such models is however largely restrictive due to technical difficulties in the culturing of enterocytes in general and the availability of appropriate established cell lines in particular. In this study, the rainbow trout (Oncorhynchus mykiss) intestinal derived cell line (RTgutGC) was used as a surrogate for the "gut sac" method.

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Objectives: The role of radiotherapy (RT) in locally advanced pancreatic cancer (LAPC) is uncertain. This study examines patterns of care and survival outcomes of LAPC undergoing chemotherapy alone versus chemotherapy plus RT (C + RT).

Methods: The National Cancer Database was queried for nonmetastatic LAPC patients who received chemotherapy alone or C + RT.

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