open access: The tumour suppressor SOX11 is associated with improved survival among high grade epithelial ovarian cancers and is regulated by reversible promoter methylation (references major epithelial OC cell types including clear cell)

Background

The neural transcription factor SOX11 has been described as a prognostic marker in epithelial ovarian cancers (EOC), however its role in individual histological subtypes and tumour grade requires further clarification. Furthermore, methylation-dependent silencing of SOX11 has been reported for B cell lymphomas and indicates that epigenetic drugs may be used to re-express this tumour suppressor, but information on SOX11 promoter methylation in EOC is still lacking.

Results

SOX11 expression was associated with an improved survival of patients with high grade EOC, although not independent of stage.

 

"SOX11 is a diagnostic and prognostic antigen in B cell lymphomas [12-17] and has recently been demonstrated by us to have tumour suppressor functions [18]. This transcription factor is also a prognostic antigen in EOC, where its presence is associated with improved recurrence-free survival (RFS) [19]. In the present study, we confirm the relationship between SOX11 and survival in EOC, although a larger set of endometrioid cancer needs to be investigated to show independent prognostic relevance."

 

Conclusions:

In the present study, SOX11 was demonstrated to be of prognostic value for high grade EOC, which could have a clear clinical value. The possibility to re-express SOX11 indicates a potential use of epigenetic drugs to affect cell growth through common cell regulatory pathways, controlled by SOX11, and other tumour suppressors that are silenced in EOC. 

 

Furthermore, functional investigations in vitro confirmed a growth regulatory role for SOX11 in EOC.

 

Competing interests

A patent has been filed on the use of SOX11 as a diagnostic and prognostic antigen in EOC.

open access: Intraoperative radiotherapy electron boost in advanced and recurrent epithelial ovarian carcinoma: a retrospective study - 45 pts

Blogger's Note: interesting study worth reading

Background

The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT) in advanced and recurrent EOC.

Conclusions

IOERT may be feasible and effective as a boosting technique for advanced and recurrent ovarian cancer. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. Peripheral nerves in the IOERT field are dose-limiting structures requiring nerve protection policies or a dose compromise to ensure against severe neurological damage.

Patients

This study was a non-randomized trial and included retrospective analysis of 45 women with EOC who were treated with IOERT at the 1st Affiliated Hospital of the Medical College of Xi'an Jiaotong University between January 2000 and January 2010.........The mean follow-up time was 78 months (range: 11-123 months).........

Table 1

Patient Characteristics

	Total	PD	ILR
Cases	45	25	20
Histology type
serous adenocarcinoma	36	21	16
papillary adenocarcinoma	9	4	4
CA-125 level
≥ 35 U/ml	38	20	18
< 35 U/ml	4	3	1
unknown	3	2	1

Conclusions
IOERT may be feasible and effective as a boosting technique to treat advanced and recurrent ovarian cancers. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. However, careful attention should be paid to peripheral nerves as specific IOERT dose-limiting structures.

abstract: Evaluation of microRNA expression profiles and their associations with risk alleles in lymphoblastoid cell lines of familial ovarian cancer

Lymphoblast - Wikipedia, the free encyclopedia

en.wikipedia.org/wiki/Lymphoblast

Lymphoblasts are immature cells which typically differentiate to form mature ... Although commonly lymphoblast refers to a precursor cell in the maturation of ...

open access: Cancer screening in the United States, 2012 - CA: A Cancer Journal for Clinicians

open access: Cancer risks associated with external radiation from diagnostic imaging procedures - Linet - 2012 - CA: A Cancer Journal for Clinicians

Blogger's Note: extensive (long) analysis; important to assess individual circumstances and as the research article indicates - risk vs benefit

 

Recommendations for Clinicians

• 1
  Become knowledgeable about the radiation doses for the imaging studies.
• 2
  Consider ultrasound and MRI when these are appropriate alternatives since these procedures do not subject the patient to ionizing radiation.172, 236
• 3
  Do not order a higher radiation dose study if a lower dose study (or an imaging study that does not use ionizing radiation) can provide the clinical information needed.
• 4
  All requests for imaging studies should be justified (eg, when all benefits and risks are considered, the study should be expected to do more good than harm).
• 5
  Available aids for justification, such as the ACR's Appropriateness Criteria and the ACC's Appropriate Use Criteria for Cardiac Computed Tomography, should be utilized to provide guidance for choosing the most appropriate imaging examination.
• 6
  Unnecessary imaging studies (duplicate studies and those that are not medically necessary) should not be performed.
• 7
  In general, neither screening nor elective x-ray examinations should be performed on pregnant women.
• 8
  Refer patients who require imaging studies to a facility that strives to optimize radiation dose, so that imaging is performed with the least amount of radiation necessary to provide adequate image quality.

How the CA-125 became a $50,000 blood test (blog) including public/professional responses

How the CA-125 became a $50,000 blood test

The New Old Age - Caring and Coping (looking after your pet/s) - 'pet trust' document

Australia: media - Charities push for overhaul of cancer funding 03/02/2012

ASHLEY HALL: "Cancer charities are calling for a massive overhaul of the $300 million fundraising and research sector.

They're becoming concerned about what they say is duplication and waste within the cancer research field.

The head of the Cancer Council of Australia says the attention paid to breast, cervix and ovarian cancer comes at the expense of other high mortality cancers including lung and pancreatic cancer....."

Art and Science: Color Explosion A fluorescence microscopy image (ovarian cancer cells/dna) competition straddles the boundary of science and art.

Research assistant at MD Anderson Cancer Center, Geoffrey Grandjean, obtained this image showing human ovarian cancer cells stained for DNA (red) and microtubules (green), during an siRNA screening. The particular gene knockdown in this screen disrupted cell division, causing the giant cell in the middle to grow very large.

The IN Cell Analyzer Image Competition winners 2011

Winning image for Asia PacificLeslie Caron GENEA, Australia

Winning image for the AmericasGeoffrey Grandjean MD Anderson Cancer Center, USA

Winning image for EuropeMarie Neguembor ALEMBIC - San Raffaele Scientific Institute, Italy

Vascular smooth muscle cells differentiated from human embryonic stem cells stained for DNA (blue) and the smooth muscle markers Smoothelin (red) and Caldesmon (green).

Human ovarian cancer cells stained for DNA (red) and microtubules (green).

Myoblast stained for DNA (blue), Myosin heavy chain (green) and methylated Histone H4 (red).

press release: Avoid a Pet Emergency in Overtime: Super Sunday's Parties Can Be Dangerous, Feb. 3, 2012

abstract: Importance of Histologic Subtype in the Staging of Appendiceal Tumors.

Blogger's Note: common feature is mucinous cell type; understudied is familial appendiceal carcinoid

BACKGROUND:

Malignant neoplasms of the appendix have different behavior based on their histologic subtypes in anecdotal series. Current staging systems do not capture the diversity of histologic subtypes in predicting outcomes.

METHODS:

We queried all patients with appendiceal malignancies captured in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2007. Tumors were classified as colonic type adenocarcinoma, mucinous adenocarcinoma, signet ring cell type, goblet cell carcinoid, and malignant carcinoid. We compared incidence, overall survival, and disease-specific survival for these tumors on the basis of patient, tumor, and therapy characteristics. Estimates from Cox proportional hazard modeling were used to predict hazard ratios for differing histologic subtypes with similar tumor, node, metastasis system (TNM) stages.

RESULTS:

Of the 5672 patients identified, we included 5655 (99%) in our analysis. The 5-year disease-specific survival rates were 93% for malignant carcinoid, 81% for goblet cell carcinoid, 55% for colonic type adenocarcinoma, 58% for mucinous adenocarcinoma, and 27% for signet ring cell type. Predicted estimates of adjusted hazard ratios revealed an 8-fold difference between histologic subtypes for similar TNM stages.

CONCLUSIONS:

Histologic subtype is an important predictor of disease-specific survival and overall survival in patients with appendiceal neoplasms. Addition of the histologic subtype to the TNM staging is simple and may improve prognostication.

abstract: Use of Mismatch Repair Immunohistochemistry and Microsatellite Instability Testing: Exploring Canadian Practices

METHODS:

Two web-based questionnaires were administered, a general and a specialist laboratory questionnaire, to establish the availability of such tests, requisite clinical/pathology integration, current mode of test initiation, reporting and recommendation practices, and education and attitudes among pathologists. Technical aspects were reviewed on the basis of specialist laboratory practice.

RESULTS:

Of 76 respondents, 21.5% were unaware or were uncertain whether they had access to MMR immunohistochemistry. Although 78.9% of respondents had access to such testing, an integrated approach to the identification of patients with LS is lacking, being limited to just 9 centers. The majority (70%) of testing is clinician initiated, with variable implementation of reflex testing and divergent practices in recommendation to test. Standardized reporting is lacking in many centers. Education on MMR in endometrial cancer is poor compared with that in colorectal cancer (P<0.0001).

(Blogger's Note: and so it would be safe to assume, based on this abstract, that the full spectrum of Lynch Syndrome related cancers requires obviously increased attention. As a further note, this and similar abstracts should take the opportunity to detail, in the background section, the full cancer spectrum - a one-line sentence is all that is required.)

INTERPRETATION:

This multicenter questionnaire highlights heterogenous practices in dMMR testing and LS identification, both in clinical terms and with regard to technical aspects of testing. An integrated multidisciplinary approach is lacking, and there is a need to educate physicians and resolve ethical issues. A Canadian consensus statement and national guidelines on dMMR testing are urgently needed, requiring input from pathologists, clinicians, and genetic counselors.

abstract: Predicting platinum resistance in primary advanced ovarian cancer patients with an in vitro resistance index

PURPOSE:

We aimed to identify primary platinum resistance in epithelial ovarian cancer (OC) patients with FIGO stage III-IV disease by an in vitro drug-response assay and to correlate the findings with clinical response. We considered whether neoadjuvant chemotherapy or anatomic sample site and tumor heterogeneity would influence the results.

CONCLUSIONS:

This in vitro assay predicted primary platinum resistance, without misclassification of sensitive OC patients, and the results were significantly associated with PFS. We suggest that samples from primary tumor and metastatic samples have different responses to chemotherapy and that exposure to chemotherapy might induce in vitro platinum resistance.

abstract: Malignant ovarian germ-cell tumours

Malignant ovarian germ-cell tumours account for about 5% of all ovarian malignancies and typically present in the teenage years. They are almost always unilateral and are exquisitely chemosensitive. As such, the surgical approach in young women with such tumours confined to a single ovary should aim to preserve fertility.....

abstract: KRAS mutations in ovarian low-grade endometrioid adenocarcinoma: association with concurrent endometriosis (study of KRAS/BRAF mutations)

Summary

The association between ovarian endometrioid adenocarcinoma and endometriosis is well established. However, not all endometrioid adenocarcinomas are directly related to endometriosis, and it has been suggested that there may be clinicopathologic differences between endometriosis-positive and endometriosis-negative tumors. Molecular alterations in endometrioid adenocarcinoma include KRAS and BRAF mutations, but the incidence of these abnormalities in previous reports has been highly variable (0%-36% and 0%-24%, respectively).....

Keywords

• Ovary;
• Endometrioid;
• Adenocarcinoma;
• Endometriosis;
• Molecular

The Cost of Knowledge - petition to allow open access publishing - Elsevier journals

Blogger's Note: Gynecologic Oncology is a journal published through Elsevier

website: Choosingwisely - An Initiative of the ABIM Foundation

Choosing Wisely™ aims to get physicians, patients and other health care stakeholders thinking and talking about the overuse or misuse of medical tests and procedures that provide little benefit, and in some instances harm.

As part of the campaign, national organizations representing medical specialties are working with the ABIM Foundation to identify Five Things to Question — tests or procedures commonly used in their field whose necessity should be questioned and discussed. Consumer Reports is also working with the campaign to develop and disseminate materials to patients to help them engage their physicians in these conversations and ask questions about these test and procedures.

abstract: Physician Knowledge and Awareness of CA-125 as a Screen for Ovarian Cancer in the Asymptomatic, Average-Risk Population - CDC study

Physician Knowledge and Awareness of CA-125 as a Screen for

Abstract

Effective early detection strategies for ovarian cancer do not exist. 

Current screening guidelines recommend against routine screening using CA-125 alone or in combination with transvaginal ultrasonography (TVS). 

In this study, the authors used the 2008 DocStyles survey to measure clinician beliefs about the effectiveness of CA-125 and TVS in the asymptomatic, average-risk population in the United States. 

To assess the need for provider education, the authors used the 2008 HealthStyles survey to examine public awareness of CA-125. 

Of 1,250 physician respondents, 40.4% said both CA-125 and TVS were effective screens, and 28.3% said neither was an effective ovarian cancer screen in the asymptomatic, average-risk population. 

Obstetrician/gynecologists [OB/GYNs] more often had responses consistent with current guidelines: 56.5% of OB/GYNs, compared with 34.4% and 29.8% of family/general practitioners and internists, respectively, said neither CA-125 nor TVS was an effective screen. 

Almost one third of women (patients/the public) surveyed reported having heard of CA-125, and about one tenth said they had the CA-125 test. 

These findings support the need for additional provider education. Educational efforts should include lack of evidence for, as well as the potential harms of, screening for ovarian cancer with CA-125.

abstract: Frequency of Rearrangements in Lynch Syndrome Cases Associated with MSH2: Characterization of a New Deletion Involving both EPCAM and the 5′ Part of MSH2

".......The tumors of the carriers show high-level MSI and MSH2 protein loss. The clinical correlation provided evidence that the type of mutation and the extension of the deletions involving the MSH2 gene could have different implications in cancer predisposition. Thus, the identification of EPCAM-MSH2 rearrangements and their comprehensive characterization should be included in the routine mutation screening protocols for Lynch syndrome."

Norway to bring cancer-gene tests to the clinic : Nature News & Comment

"Norway is set to become the first country to incorporate genome sequencing into its national health-care system. The Scandinavian nation, which has a population of 4.8 million, will use ‘next-generation’ DNA sequencers to trawl for mutations in tumours that might reveal which cancer treatments would be most effective.

In its three-year pilot phase, the Norwegian Cancer Genomics Consortium will sequence the tumour genomes of 1,000 patients in the hope of influencing their treatments. It will also look at another 3,000 previously obtained tumour biopsies to get a better idea of the mutations in different cancers, and how they influence a patient's response to a drug. In a second phase, the project will build the laboratory, clinical and computing infrastructure needed to bring such care to the 25,000 Norwegians who are diagnosed with cancer each year......"

"Similar projects are under way in the United Kingdom and at research hospitals in the United States, France and elsewhere. But Norway’s will be among the first to look for tumour mutations using next-generation DNA sequencing rather than conventional genetic testing."

Keeping patients safe : The Lancet (patient safety/whistleblowers/gag clauses....)

Canadian Health Reference Guide - Invisible Healthcare System Taking Toll on Canadian Caregivers

A Lesson for Global Donors from the Susan G. Komen Fallout: Transparency is a Virtue - Up Front Blog - Brookings Institution

Komen reverses cuts to Planned Parenthood funding - The Globe and Mail

Your comments - with thanks

Blogger's Note: your comments are very welcome; please be aware that comments will be posted generally within 24 hours. It is understood that this blog author reserves the sole and exclusive right to delete any posts which are deemed to be solicitation, spam etc

Compliments on the blog are not a pre-cursor nor required to having your comments posted!

Comments can be viewed on the right-hand side of the blog.

Thanks.

what others were reading Feb 2nd (top 5) - Ovarian Cancer and Us blog

open access: Participatory Medicine: Must You Be Rich to Participate...

Picture this: The new imaging techniques that can help doctors select the right treatment ...

(Canada) Romanow Commission - Health Human Resourc...

2012 Feb: Chemotherapy and Fingerprint Loss: Beyond Cosmetic...

in research:NIH study uncovers probable mechanism ...   Ovarian Cancer and Us - top 5 read items Feb 2nd

"Call It Cancer" - Editorial - the Oncologist

Blogger's Note: comments/interpretation:

excerpt from article: "...A more controversial aspect of the NIH panel’s report wasthe statement that it may be a mistake to call low-grade low-volume prostate cancer a “cancer” in these patients...."

• the Oncologist is a subscriber-based publication; 

• the 'gist' of the article is a focus on prostate cancer, but the theme is transferable to all cancers - a discussion on what to call (prostate) cancers eg. those at low/high risk of recurrence, the same could be applied to ovarian cancer eg. LMP; the authors conclusions are just to call it cancer so as not to distract patients from understanding that risks including those still outstandsing and unknown issues (and of course those with rare subtypes of differing cancers, as an example)
• a good discussion for those who are getting 'off track' - psychosocial aspects and what is meaningful to patients/providers who deal with cancer in real life

Research ethics: Coercive citations in academic publishing

abstract: Role of Fear of Movement in Cancer Survivors Participating in a Rehabilitation Program: A Longitudinal Cohort Study

Conclusions

Fear of movement is associated with the perceived global health status of cancer survivors.

2012 conference notice: SGO Annual Meeting on Women's Cancer Austin, Texas March 24-27 (early bird deadline Feb 6th)

Blogger's Note:

the SGO  has had for many years a tradition of a reduced fee for ovarian cancer advocates not to mention their inclusion- Dr David Mutch was instrumental in the inclusion of ovarian cancer advocates in the SGO's annual conference, which continues to be noteworthy, as this is not necessarily the 'standard' at all medical/oncology conferences

Registration fee: Advocate Supporter $325.00

                                 ~~~~~~~~~~~~~~~~~~

 2012 Annual Meeting on Women's Cancer®

March 24-27, 2012
The Austin Convention Center
Austin, Texas

For the most up to date information, please visit our dedicated, interactive Annual Meeting website at www.sgomeetingsonwomenscancer.com

This meeting focuses on offering programming and cutting-edge scientific research that demonstrates the latest data the subspecialty has to offer.

Register for the Annual Meeting

Book your Hotel Room

Schedule of Events (opens in pdf)

 

 SGO is offering open access for all education sessions at the 2012 Annual Meeting for all registration categories. This allows attendees access to: Scientific Plenary Sessions, Sunrise Seminars, Education Forums, Exhibit Hall and Social Functions. The registration price also includes access to select ‘on-demand’ sessions through the 2012 Annual Meeting Webcast. Revisit some of your favorite sessions or view those you might have missed due to scheduling conflicts.

Stem Cell Network Blog: News roundup: open access, new funding for personalized medicine and spinal cord injury update (eg. Elsevier - subscriber-based publisher)

February 01, 2012

News roundup: open access, new funding for personalized medicine and spinal cord injury update

Some updates and news items of note:

Call for boycott of subscriber-based journals gains momentum
The ongoing friction between proponents of open access and the academic publishers has jumped into the spotlight once again with calls from a number of academics, most notably from prominent British mathmetician Tim Gowers, who publicly announced his decision to stop submitting and reviewing for Elsevier. His objections are worth reading. Within days of his comments, a web site was created that allows other researchers to pledge their support for open access and against the practices of Elsevier and other academic publishers. At time of writing, there were over 2400 signatures. Of course, this is not the first time such calls for open access have surfaced from within the research community, the last big push resulted in the formation of the Public Library of Science in 2000.....

Picture this: The new imaging techniques that can help doctors select the right treatment at the right time - Cutting Edge - Cancer World (eg. MRI/PET/CT/therapies/biomarkers....)

Blogger's Note: worth reading

Cancer Risks for the Relatives of Colorectal Cancer Cases with a Methylated MLH1 Promoter Region: Data from the Colorectal Cancer Family Registry

Blogger's Note: focus on MLH1

".....The cohort consisted of 3,128 first- and second-degree relatives of the 233 MLH1-methylated CRC cases with no MMR or MUTYH gene mutations.

The standardized incidence ratio (SIR) for CRC was 1.60 [95% confidence interval (CI), 1.22–2.16] for first-degree relatives and 1.08 (0.74–1.60) for second-degree relatives.

The SIR for gastric cancer was 2.58 (1.52–4.71) for first-degree relatives and 4.52 (2.23–10.61) for second-degree relatives and, for ovarian cancer, it was 2.16 (1.29–3.86) for first-degree relatives.

The risk of liver cancer was also increased significantly in first-degree relatives but the estimate was on the basis of only two cases.

These data imply that relatives of CRC cases with MLH1 methylation may be at increased risk of CRC and stomach cancer and possibly ovarian and liver cancer, suggesting that there may be a heritable factor for CRC and other cancers associated with MLH1 methylation in non–Lynch syndrome."

abstract - Identification of Cancer Patients with Lynch Syndrome: Clinically Significant Discordances and Problems in Tissue-Based Mismatch Repair Testing

(open access publisher) BioMed Central Blog : OSTP publishes public comments in response to RFIs on public access to publications and data

BioMed Central Blog

Friday Feb 03, 2012

OSTP publishes public comments in response to RFIs on public access to publications and data

The US Office of Science and Technology Policy has published the comments received as part of the latest phase of its public consultations on Public Access to Peer-Reviewed Scholarly Publications Resulting From Federally Funded Research and Public Access to Digital Data Resulting From Federally Funded Scientific Research.

BioMed Central responded to both Requests for Information, and our contributions are now publicly available online:

• BioMed Central response to RFI on Publications
• BioMed Central response to RFI on Data

2012 Feb: Chemotherapy and Fingerprint Loss: Beyond Cosmetic (hand foot syndrome - chemotherapy induced/capecitabine) - case report

INTRODUCTION

Hand–foot syndrome (HFS), or palmar–plantar erythrodysesthesia,
is a distinct localized skin reaction characterized by erythema,
numbness, tingling, and either dysesthesia or
paresthesia, especially on the palms or soles. Symptoms include
pain and swelling, and can progress to blistering, desquamation,
and ulceration [1].

A single report describes the loss of fingerprints as a manifestation
of HFS in a cancer patient who was detained several hours
by airport security as a result [2].

We present the case of a patient who lost his fingerprints during the course of treatment with a capecitabine-based protocol who also experienced stressful and inconvenient administrative delays because of his condition.......

Table 1. National Cancer Institute hand–foot
syndrome grades
Grade Definition

1 Skin changes or dermatitis (e.g., erythema)
without accompanying pain

2 Skin changes (e.g., peeling, blisters, bleeding,
edema) with accompanying pain not
interfering with activities of daily living

3 Ulcerative dermatitis or skin changes with
accompanying pain interfering with activities
of daily living

abstract: A hypofractionated radiotherapy regimen (0-7-21) for advanced gynaecological cancer patients.

Abstract

AIMS:

To evaluate the efficacy of a palliative three fraction radiation regimen delivered on days 0, 7 and 21 (0-7-21 regimen) for advanced stage gynaecological cancer patients.

MATERIALS AND METHODS:

Fifty-one patients with advanced gynaecological cancer who were treated with the 0-7-21 regimen between 1998 and 2008 were identified. The median follow-up period was 1.4 months (range 0.2-33.4). Treatment completion data, symptomatic response, toxicity and survival were retrospectively analysed.

RESULTS:

Forty-eight patients received at least two of the three planned fractions. Complete and partial responses of vaginal bleeding were seen in 92% of 26 evaluable patients. Complete and partial responses of pain were seen in 76% of 25 evaluable patients. Eighteen of the 33 evaluable patients experienced grade 1/2 acute toxicity. No patients experienced grade 3/4 toxicity. Grade 1/2 and grade 3 late toxicity occurred in four and one of 12 evaluable patients, respectively. Grade 5 toxicity was assigned in two patients. It was uncertain whether these deaths were radiation related or due to tumour progression. Eleven patients survived longer than 12 months.

CONCLUSIONS:

The 0-7-21 regimen provided effective and rapid symptomatic relief with acceptable toxicity, and offered the advantage of convenience for most patients. It offers an alternate treatment option for carefully selected patients with incurable gynaecological malignancies.

in research:NIH study uncovers probable mechanism underlying resveratrol activity, February 2, 2012 News Release - National Institutes of Health (NIH)

"....Chung noted that because resveratrol in its natural form interacts with many proteins, not just PDEs, it may cause not-yet-known toxicities as a medicine, particularly with long-term use. He added that the levels of resveratrol found in wine or foods are likely not high enough to produce significant health benefits or problems. Convincing clinical studies in humans have used about 1 gm of resveratrol per day, roughly equal to the amount found in 667 bottles of red wine....."

NCCAM’s Advisory Council welcomes six new members, February 2, 2012 News Release - National Institutes of Health (NIH)

The National Center for Complementary and Alternative Medicine (NCCAM)

Commission on the Future of Health Care in Canada: The Romanow Commission - Health Canada

Blogger's Note: 

the facts: 

With the exception of this blogger, 

 no  public presentations were made on behalf of ovarian cancer by any professional organization nor charity (NP)

                           ~~~~~~~~~~~~~~~~~~~~~~

Commission on the Future of Health Care in Canada: The Romanow Commission

Note: This section replaces the former Web site of the Commission on the Future of Health Care in Canada (Romanow Commission) which has been archived in the Government of Canada Web Archive.

In April 2001, the federal government established the Commission on the Future of Health Care in Canada to review Medicare - Canada's universally accessible, publicly funded health care system - and recommend policies and measures to improve the system and its long-term sustainability.

The Commission embarked on an ambitious effort to ensure that the final recommendations were evidence-based and reflected the values Canadians want in the health care system. Headed by Roy J. Romanow, Q.C., former Attorney General and Deputy Premier of Saskatchewan, the Commission carried out its work in two distinct phases:

• fact-finding; and
• consultation and dialogue - engaging Canadians in a national discussion about the future of Canada's health care system.

The fact-finding phase included:

• analyzing existing reports on health care;
• identifying knowledge gaps and commissioning independent research from experts to address those gaps and gain new perspectives;
• soliciting and analyzing submissions concerning health care challenges and opportunities from health care providers, stakeholder groups and concerned Canadians; and
• consulting with key health care stakeholders, provincial and territorial governments, and Aboriginal organizations to refine research and consultation priorities.

During the consultation and dialogue phase, the Commission worked collaboratively with a variety of partners to provide Canadians with opportunities to engage in an informed discussion about the future of health care in Canada. Tens of thousands of Canadians - from ordinary citizens to health experts, health ministers and premiers, researchers and health care workers - participated in the process, which included public hearings, workshops, policy dialogues and other consultations.

Reports

On November 28, 2002, the Commission tabled its final report, Building on Values: The Future of Health Care in Canada, in the House of Commons. The report recommended sweeping changes to ensure the long-term sustainability of Canada's health care system.

Electronic and print copies are available from Government of Canada Publications.

Copies may also be available through associated bookstores and booksellers that carry Government of Canada publications or through Depository Libraries of Canadian government information.

What Information is Available

• Recommendations in Brief
• Key Commission Documents

(Canada) Romanow Commission - Health Human Resources Strategy - Health Canada

Myriad Cert Petition Now Fully Briefed; Supreme Court May Decide by Feb. 20 | Bloomberg BNA

open access: Canada - Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program Longwoods - Healthcare Policy

Blogger's Note: see excerpts/notes in italics

Purpose:

Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services.

"....Care at home in the final weeks of life and an adequately supported home death is a goal expressed by most patients with a terminal illness (Higginson and Sen-Gupta 2000 (excerpt from abstract.......Respondents indicated preferences for home death (range 49%-100%), except one study of patients in the care of a continuing care team in London where only 25%-29% of patients wanted a home death, and inpatient hospice was the most favored option.........Only 2 of the studies provided longitudinal data, and 9 of the 18 had major deficits in design or reporting..........) ;

Teirnan et al. 2002 (Blogger's Note: this study was from Dublin and the abstract does not indicate whether cancer patients were included);

Townsend et al. 1990).  

It is also a health system policy imperative (Romanow 2000) (Blogger's Note: no reference/link provided)............."

open access: Participatory Medicine: Must You Be Rich to Participate? | Journal of Participatory Medicine

Participatory Medicine: Must You Be Rich to Participate?

“Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.[1]”

Our lofty definition of participatory medicine requires patients who are both interested and capable of taking an active role in their health care as well as providers who have time to listen and work together in a partnership with patients.

We fear that this movement may be leaving too many people behind.........

Society for Participatory Medicine. Available at: http://participatorymedicine.org/.

press release: U of Leeds - A silver bullet to beat cancer? (silver)

A silver bullet to beat cancer?

"The internet is awash with stories of how silver can be used to treat cancer.........."

"...........The research, still the first phase of drug development, involved exposing breast and colon cancer cells with different silver-based chemicals for six day periods. It has been shown that ligands which are co-ordinately bonded to the central silver atom through two sites are more effective than those coordinated through only one site. This may be due to the release of silver being much slower and make these compounds more effective over a longer period of time.
A major barrier to the continued development of these compounds is a lack of understanding of how they work. Over the next 12 months, research will focus on investigating how the compounds damage cancerous cells and what effects they have on healthy cells. This will establish whether these silver complexes are in fact less toxic to ordinary human tissue, and will help to design and develop the next-generation of chemotherapy drugs.
This work is been carried out in collaboration with Dr. Roger Phillips at the University of Bradford and is funded by Yorkshire Cancer Research."

open access: BioMed Central Blog : Connecting the evidence: an “ontology” (vocabulary) for Threaded Publications (unpublished research)

Thursday Feb 02, 2012

Connecting the evidence: an “ontology” for Threaded Publications

"Unpublished research is a serious problem for evidence-based decision making in healthcare, and this was recently highlighted on BBC Radio 4’s Today programme and in an entire issue of the BMJ. Systematic reviews aim to present the totality of the evidence, and a problem for those preparing and maintaining these reviews is how to find unpublished studies and data. But, even when clinical trials are reported in journals and their supplements the formats and descriptions are widely heterogeneous and studies can remain difficult to discover and challenging to compare with similar trials.
Clearly connecting trial-related publications is a way to help with this problem and is a major goal of BioMed Central’s Threaded Publications initiative. To achieve its fundamental aims of connecting all digital published content relating to the evidence about a particular trial, however, Threaded Publications must go beyond a single journal or publisher.
Through our partnership with CrossRef – an organisation founded by publishers, for publishers – and engagement with editors and publishers we hope to achieve interoperability across different publishing platforms.
The desired outcome is that articles reporting the protocol or the findings of a trial published in different journals or by different publishers will be linked in a thread, which should also include the trial’s entry in a research register......."

not yet recruiting - Phase 11 - Weekly Paclitaxel/Carboplatin With Neupogen in Gynaecological Cancers - Full Text View - ClinicalTrials.gov

Weekly Paclitaxel/Carboplatin With Neupogen in Gynaecological Cancers

This study is not yet open for participant recruitment.

Verified January 2012 by Belgian Gynaecological Oncology Group

not yet recruiting - Phase 1 Vaccine Therapy With or Without Sirolimus in Treating Patients With NY-ESO-1 Expressing Solid Tumors - Full Text View - ClinicalTrials.gov

Cleveland Clinic: Talking to patients: Barriers to overcome

introduction: new journal - open access publisher: GigaScience

Now accepting submissions

GigaScience is accepting submissions; please use the online submission system to submit your manuscript.  

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open access: PLoS ONE: BRCAness Profile of Sporadic Ovarian Cancer Predicts Disease Recurrence

Background

The consequences of defective homologous recombination (HR) are not understood in sporadic ovarian cancer, nor have the potential role of HR proteins other than BRCA1 and BRCA2 been clearly defined. However, it is clear that defects in HR and other DNA repair pathways are important to the effectiveness of current therapies. We hypothesize that a subset of sporadic ovarian carcinomas may harbor anomalies in HR pathways, and that a BRCAness profile (defects in HR or other DNA repair pathways) could influence response rate and survival after treatment with platinum drugs. Clinical availability of a BRCAness profile in patients and/or tumors should improve treatment outcomes.

Objective

To define the BRCAness profile of sporadic ovarian carcinoma and determine whether BRCA1, PARP, FANCD2, PTEN, H2AX, ATM, and P53 protein expression correlates with response to treatment, disease recurrence, and recurrence-free survival.

Results

High PARP, FANCD2 and BRCA1 expressions were significantly correlated with each other; however, elevated p53 expression was associated only with high PARP and FANCD2. Of all patients, 9% recurred within the first year. Among early recurring patients, 41% had high levels of PARP, FANCD2 and P53, compared to 19.5% of patients without early recurrence (p = 0.04). Women with high levels of PARP, FANCD2 and/or P53 had first year cumulative cancer incidence of 17% compared with 7% for the other groups (P = 0.03).

Conclusions

Patients with concomitantly high levels of PARP, FANCD2 and P53 protein expression are at increased risk of early ovarian cancer recurrence and platinum resistance.

abstract: Clinicopathologic Characteristics and Survival in BRCA1- and BRCA2-Related Adnexal Cancer: Are They Different?

Abstract

Objective:  

Our aim was to examine the clinicopathologic characteristics and survival of ovarian, tubal, and peritoneal (further denoted "adnexal") cancer in BRCA1 compared with BRCA2 carriers.

Methods: A consecutive series of adnexal cancers in BRCA1/2 mutation carriers diagnosed in 1980 to 2010 at the University Medical Center Groningen was analyzed.

Results: 

We evaluated 55 BRCA1- and 16 BRCA2-related adnexal cancers, consisting of 51 ovarian, 13 tubal, and 7 peritoneal cancers. Peritoneal cancer was restricted to BRCA1 carriers. Ovarian and tubal cancer was equally present in both carrier groups. Median age at diagnosis was younger in BRCA1 compared with BRCA2 carriers (50 vs 54 years; P = 0.03). No other clinicopathologic differences were found. Regarding survival, a nonsignificant trend was noted for BRCA2 carriers to have fewer relapses, a longer time to first relapse, and a longer disease-free and overall survival.

Conclusions: Except for age at diagnosis and prevalence of peritoneal cancer, no significant clinicopathologic differences were found between BRCA1- versus BRCA2-associated adnexal cancer. On survival, it might be suggested that BRCA2 carriers have a more favorable outcome than BRCA1 carriers, marked by fewer relapses, a longer time to first relapse, and a longer disease-free and overall survival.

open access: Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm UK/Wales

Objective To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms.

Main outcome The primary outcome was incident diagnosis of ovarian cancer recorded in the next two years.

Methods Risk factors examined included age, family history of ovarian cancer, previous cancers other than ovarian, body mass index (BMI), smoking, alcohol, deprivation, loss of appetite, weight loss, abdominal pain, abdominal distension, rectal bleeding, postmenopausal bleeding, urinary frequency, diarrhoea, constipation, tiredness, and anaemia. Cox proportional hazards models were used to develop the risk equation. Measures of calibration and discrimination assessed performance in the validation cohort.

Results In the derivation cohort there were 976 incident cases of ovarian cancer from 2.03 million person years. Independent predictors were age, family history of ovarian cancer (9.8-fold higher risk), anaemia (2.3-fold higher), abdominal pain (sevenfold higher), abdominal distension (23-fold higher), rectal bleeding (twofold higher), postmenopausal bleeding (6.6-fold higher), appetite loss (5.2-fold higher), and weight loss (twofold higher). On validation, the algorithm explained 57.6% of the variation. The receiver operating characteristics curve (ROC) statistic was 0.84, and the D statistic was 2.38. The 10% of women with the highest predicted risks contained 63% of all ovarian cancers diagnosed over the next two years.

Conclusion The algorithm has good discrimination and calibration and, after independent validation in an external cohort, could potentially be used to identify those at highest risk of ovarian cancer to facilitate early referral and investigation. Further research is needed to assess how best to implement the algorithm, its cost effectiveness, and whether, on implementation, it has any impact on health outcomes.

audio: Pre-emptive surgery - ovarian/breast genetics/brca - ABC Queensland - Australian Broadcasting Corporation (ABC)

Pre-emptive surgery.

02 February 2012 , 1:34 PM by Christopher Welsh

Did you hear the story of a few women who are choosing to have Ovaries removed to avoid the risk of ovarian cancer.

It made me wonder what other surgical procedures are people choosing to avoid the possibility of serious illness or disease.

I have heard of pre-emptive mastectomies but are there similar procedures men are electing to have and does it work?

From the AMAQ Dr Gino Pecoraro explains.

Download the audio file

After that talk we had a call from Sharn who is in this exact situation.

She is now confronted with the decision whether to wait and see if she develops breast cancer, or have a double mastectomy because her chances of getting the cancer are so high....

I spoke with Sharn and asked how many of her relatives had developed breast or ovarian cancer

Download the audio file

Comments

You can follow this conversation by subscribing to the comment feed for this post.

Uproar as Komen Foundation Cuts Money to Planned Parenthood - NYTimes.com

Association des Patients du Canada, Patients' Association of Canada - conference notice/members' bios

Organization Overview

The Patients’ Association of Canada (PAC) has been established to fill an important gap in the health field. Until now, there have been no national patient-led and patient-governed organizations that speak to the experience that people have as patients. In many public discussions about health care, the patient perspective is presented by health care professionals, disease-based organizations, researchers, or policy makers who have their own points of view that are not the same as those of patients....


conference notice: February 2, 2012

members

NCCN Annual Conference: Clinical Practice Guidelines & Quality Cancer Care March 14-18 Florida

eg:

Clinical Practice Decisions in Ovarian Cancer

Roundtable Discussion - Optimal Care for Patients: Who Decides?

Clinical Practice Decisions in Treating the Adolescent and Young Adult with Cancer

Clinical Practice Decisions in CNS (central nervous system) Metastases  

Sunday Brunch with the Experts (the patients??): Issues in Cancer Survivorship 

open access: Cancer control: life and death in an unequal world | Sutcliffe | Current Oncology

"...So cancer is not under control. The problem is big; will get bigger; will affect nations unequally, prejudicing those with the least ability to respond; and will have enormous societal and economic consequences. However, this situation is not the problem, it is a reality. The real challenge is “What we are going to do about it,” because quite clearly, “more of the same” will be an inadequate, insufficient, and ineffective response....."

the ART for Cancer group (international)

open access: 2011 Progression-free survival in advanced ovarian cancer: a Canadian review and expert panel perspective | Dr A. Oza | Current Oncology (topics: eg chronic disease, 1st line therapy...)

Blogger's Note: may require registration (free); note also list of useful (international) reference papers

                                                                                        


Ovarian cancer is leading cause of gynecologic cancer mortality in Canada. To date, overall survival ( os ) has been the most-used endpoint in oncology trials because of its relevance and objectivity. However, as a result of various factors, including the pattern of sequential salvage (outdated term)  therapies, measurement of os and collection of os data are becoming particularly challenging. Phase ii and iii trials have therefore adopted progression-free survival ( pfs ) as a more convenient surrogate endpoint; however, the clinical significance of pfs remains unclear. This position paper presents discussion topics and findings from a pan-Canadian meeting of experts that set out to

• evaluate the relevance of pfs as a valid endpoint in ovarian cancer;
• reach a Canadian consensus on the relevance of pfs in ovarian cancer; and
• try to address how pfs translates into clinical benefit in ovarian cancer.
  
  
  ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Recommendations for future investigations include these:

• Ensure that trials are designed to evaluate pfs , os , and other clinically relevant endpoints such as disease-related symptoms or qol .
• Incorporate interim futility analyses intended to stop accrual early when the experimental regimen is not active.
• Stop trials early to declare superiority only when compelling evidence suggests that a new treatment provides benefit for a pre-specified clinically relevant endpoint such as os or symptom relief.
• Importantly, discourage early release of secondary endpoint results when such a release might increase the frequency of crossover to the experimental intervention.

Genome Research publishes special issue: Cancer Genomics

Genome Research (www.genome.org) publishes online and in print today a special issue entitled, "Cancer Genomics," highlighting insights gained form cutting-edge genomic and epigenomic analyses of cancer.

Included in this special issue are novel biological insights gained from genomic analyses of pancreatic cancer, ovarian cancer, and melanoma, including, functional genomic analyses of breast cancer genes, large scale colorectal and breast cancer epigenomics, advances in methodology identifying driver genes and networks in cancer, in genome-wide cancer association analyses, and using next-generation sequencing technology to detect driver mutations.

Additionally, the issue includes unique perspectives from leaders in the field on the translation of cancer genomics to improved outcomes in medicine. The following sections highlight several of the papers published in the issue:

1. Whole-genome and whole-exome sequencing: Searching for the drivers of cancer
2. Circulating free DNA holds clues to cancer diagnosis and risk of relapse
3. Epigenomic analyses shed new light on breast, colon, and prostate cancers
4. Cutting-edge methods to detect the genes and networks that drive cancer
    

Breast Cancer Action (includes petition) - Take Action: Komen’s decision

Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report - Appendix B

Table B-9. Composite-Level Average Percent Positive Response by Interaction with Patients
Table B-10. Item-Level Average Percent Positive Response by Interaction with Patients
Table B-11. Average Percentage of Respondents Giving Their Work Area/Unit a Patient Safety Grade by Interaction with Patients
Table B-12. Average Percentage of Respondents Reporting Events in the Past 12 Months by Interaction with Patients

Pulitzer Prize-winning playwright focuses on lessons in ‘Wit’ (ovarian cancer) as work hits Broadway - The Washington Post

Blogger's Note: as background 'Wit' underwent both much criticism and many accolades when first introduced; great, if not short, interview

open access: Hospital Survey on Patient Safety Culture 2012 User Comparative Database Report (U.S.)

Hospital Survey on Patient Safety Culture

2012 User Comparative Database Report Based on data from 1,128 U.S. hospitals, the Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report provides initial results that hospitals can use to compare their patient safety culture to other U.S. hospitals. In addition, the 2012 report presents results showing change over time for 650 hospitals that submitted data more than once. The report consists of a narrative description of the findings and four appendixes, presenting data by hospital characteristics and respondent characteristics for the database hospitals overall and separately for the 650 trending hospitals. Select to download print version (Part 1, PDF File, 1.8 MB; Parts 2 and 3, PDF File, 1.6 MB). PDF Help. The Agency for Healthcare Research and Quality (AHRQ) released the Hospital Survey on Patient Safety Culture, a tool to help hospitals evaluate how well they had established a culture of safety

BMC Cancer | open access - Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs

Background

"The report, "To Err is Human", from the Institute of Medicine estimated that between 44, 000 and 98, 000 patients die each year in the USA as a result of medical errors [1]. Although certain adverse events are unavoidable, many are preventable, with medication errors being a major cause of such accidents [2]. Medication errors may occur anytime and at any stage during the medication use process, from the prescription of the drug to its preparation, dispensing, and final administration to the patient. Moreover, the medication process involves the whole medical team, involving physicians, pharmacists, and nurses [3].

Medication errors with antineoplastic drugs may be catastrophic due to the drugs' high toxicity and small therapeutic index in addition to the health status of cancer patients. A study revealed that antineoplastic agents were the second most common cause of fatal medication errors [4]. While overdosage is likely to result in permanent damage to the patient, underdosage may compromise the success of therapy. Although several individual case reports focused on medication errors [5-8], some of which were fatal [9-12], an overview of the issue is still needed......."

abstract: External Validation of Diagnostic Models to Estimate the Risk of Malignancy in Adnexal Masses (in research)

Purpose: To externally validate and compare the performance of previously published diagnostic models developed to predict malignancy in adnexal masses.

Results: Seven hundred and forty-two (74%) benign and 255 (26%) malignant masses were included. ........ The superior performance of the IOTA models was most pronounced in premenopausal patients but was also observed in postmenopausal patients. IOTA models were better able to detect stage I ovarian cancer.

Conclusion: External validation shows that the IOTA models outperform other models, including the current reference test RMI, for discriminating between benign and malignant adnexal masses

abstract: Stem Cell Pathways Contribute to Clinical Chemoresistance in Ovarian Cancer (in research)

Experimental Design: We examined 45 matched primary/recurrent tumor pairs of high-grade ovarian adenocarcinomas for expression of CSC markers ALDH1A1, CD44, and CD133 using immunohistochemistry. Tumors collected immediately after completion of primary therapy were then laser capture microdissected and subjected to a quantitative PCR array examining stem cell biology pathways (Hedgehog, Notch, TGF-β, and Wnt). Select genes of interest were validated as important targets using siRNA-mediated downregulation.

Conclusions: These data indicate that ovarian tumors are enriched with CSCs and stem cell pathway mediators, especially at the completion of primary therapy. This suggests that stem cell subpopulations contribute to tumor chemoresistance and ultimately recurrent disease.

abstract: Health-related quality of life in recurrent platinum-sensitive ovarian cancer—results from the CALYPSO trial

Background: In the CALYPSO trial, carboplatin–pegylated liposomal doxorubicin (CD) demonstrated superior therapeutic index versus carboplatin–paclitaxel (CP) in patients with recurrent ovarian cancer. This paper reports the health-related quality of life (HRQoL) findings.

Conclusions: These patient-reported outcomes confirm the overall lower toxicity of CD versus CP. The improved disease-related outcomes achieved with CD were not at the expense of QoL.

abstract: Clinical Effects of Adjuvant Active Specific Immunotherapy Differ between Patients with Microsatellite-Stable and Microsatellite-Instable Colon Cancer

Blogger's Note:  the abstract does not detail MSI-L/MSI-H (colon cancer in Lynch Syndrome)


Experimental Design:
Microsatellite status was assessed on archival tumor material from patients with stage II and III colon cancer. Microsatellite status was next associated with clinical outcome in control and ASI treatment groups using Kaplan–Meier analysis.



Conclusion:

This retrospective study indicated that patients with MSI tumors did well, irrespective of treatment arm and tumor stage. The data also indicate that the clinical benefit, measured as recurrence-free survival, from adjuvant ASI treatment of patients with colon cancer was restricted to patients with MSS Dukes B tumors. 

abstract: Cancer Dormancy: A Model of Early Dissemination and Late Cancer Recurrence

The RARE List™ Feb. 1, 2012 /PRNewswire-USNewswire/

Blogger's Note: the full list of rare disorders is included in the article





7,000 Different Rare Diseases and Disorders Comprise 65 Page RARE List™, 95% of the Medical Conditions Included on RARE List™ Have No FDA Approved Treatments
DANA POINT, Calif., Feb. 1, 2012 /PRNewswire-USNewswire/ -- The R.A.R.E. Project (http://RAREproject.org), a leading patient advocacy organization representing the rare disease community, today issued the RARE List™, a stunning 65 page alphabetical listing of roughly 7,000 known rare diseases and disorders. The rare diseases and disorders that comprise the RARE List™ impact 30 million Americans (or 10% of the U.S. population) and an estimated 350 million people worldwide. The RARE List™ was released by the R.A.R.E. Project as part of month long public awareness campaign leading up to World Rare Disease Day on February 29, 2012.

Ovarian cancer, Ovarian cancer childhood, Ovarian carcinosarcoma, Ovarian epithelial cancer, Ovarian germ cell tumor, Ovarian insufficiency due to FSH resistance, Ovarian insufficiency familial, Ovarian low malignant potential tumor, Ovarian remnant syndrome, Ovarian small cell carcinoma

open access: A Senior Primary Care Physician Trying to Take Good Care of His Patients - — JAMA

New Survey Gauges Opinions on What to Do With Genetic Information - ABC News + link to survey

media report -  ABC News

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

link to the website/questionnaire:

GenomeEthics: 

Questionnaire:

Why should I participate?

Is it confidential?

What does it involve?

Who can take part?

• Anyone can participate in our questionnaire and you don't have to know anything about genomics or genetics already.
• We are inviting the following groups: genomic researchers, health professionals, lay members of the public.

 

 

 

Repeat Breast Cancer Surgery Guidelines Found Unclear - NYTimes.com

".....Nearly half the repeat operations were done in women whose pathology reports did not indicate that any stray cancer cells had been left behind, meaning that the operations probably did not help the patients. More disturbingly, 14 percent of patients who did have evidence of cancer left behind did not have another operation, for unknown reasons...."

Picture Your Life After Cancer - Interactive Feature - NYTimes.com - add your photo and story/discussion

Readers' Photos

Picture Your Life After Cancer

For the estimated 12 million cancer survivors in the U.S., some of life's biggest challenges and successes begin after treatment ends. Here are your photos and insights about life after cancer. (Join the discussion here.)

Add your photo to the collage here.

SLOCA - St Louis, MO

S
SLOCA's founders are shown here in 2002. 

Back row, left to right: Nancy Larson-Vomund, Judy Parham, Grace Katzenberger, Joanne Guerrerio. 

Front row, left to right: the late Christina Carr, Diane Harrison, JoAnn Carter.

SLOCA blog