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Nurses are the largest segment of health care professionals and often the first one to interact with individuals about their health and illness. Ensuring nurses have the education to care for individuals with serious illness is essential to quality health care. The new AACN Essentials: Competencies for Professional Nursing Education delineates hospice/palliative/supportive care as one of four spheres of nursing care. Surveying undergraduate schools/colleges of nursing in Massachusetts about content pertaining to care of individuals with serious illness provides the foundation for a state strategy to ensure quality primary palliative education for undergraduate nursing students. A Massachusetts statewide college/school of nursing survey approach to assessing primary palliative nursing education within undergraduate baccalaureate nursing curricula was performed from June 2020 to December 2020. Because the project was a collaboration with the Deans of the college/school of nursing, the survey identified the programs. Survey results revealed that only a small number of Massachusetts nursing programs are preparing nurses with specific and formal primary palliative nursing education. However, programs are open to support and resources. The survey provided information to inform a successful strategy to support primary palliative nursing education within Massachusetts undergraduate baccalaureate nursing curricula. A survey approach can serve as a model for other states. • The AACN Essentials-Competencies for Professional Education now recognizes the specialty of palliative nursing. • Hospice/palliative/supportive care is one of four spheres of nursing education. • No national data exists on current undergraduate palliative nursing education to meet these competencies. • An undergraduate nursing survey guides state strategy for palliative nursing education and faculty support. • Collaborative efforts are essential to ensure quality undergraduate palliative nursing education. [ABSTRACT FROM AUTHOR]

Polybrominated diphenyl ethers (PBDEs) are among the most persistent and pervasive global environmental contaminants. Their toxic and endocrine-disrupting properties have made them a focus of concern for breast cancer. Our objective was to evaluate the risk of breast cancer associated with serum PBDE levels in a case-control study nested within the California Teachers Study. Participants were 902 women with invasive breast cancer (cases) and 936 with no such diagnosis (controls) who provided 10 mL of blood and were interviewed between 2011 and 2015. Blood samples were collected from cases an average of 35 months after diagnosis. PBDEs were measured in serum using automated solid phase extraction and gas chromatography/high resolution mass spectrometry. Statistical analyses were restricted to the three congeners with detection frequencies ≥75%: 2,2′,4,4′-tetrabromodiphenyl ether (BDE-47), 2,2′,4,4′,6-pentabromodiphenyl ether (BDE-100), and 2,2′,4,4′,5,5′-hexabromodiphenyl ether (BDE-153). Unconditional logistic regression was used to estimate multivariable-adjusted odds ratios (ORs) and their 95% confidence intervals (CI) for each BDE congener, adjusting for serum lipids and other potential confounders. The OR for each of the three BDE congeners was close to unity with a CI that included one. Analyses stratified by menopausal status, tumor hormone responsiveness, BMI, and changes in body weight yielded similarly null results. Our findings provide no evidence that serum levels of BDE-47, BDE-100 or BDE-153 are associated with breast cancer risk. These results should be interpreted in the context of study limitations which include the reliance on PBDE measurements that may not represent pre-diagnostic, early-life or chronic exposures and a lack of information on genetic polymorphisms and other factors which may affect endogenous estrogen levels. • Serum BDE-47, BDE-100 and BDE-153 levels were not associated with breast cancer risk. • Participants were unlikely to have exposures during early life windows of susceptibility. • PBDE serum levels were measured on average three years post-diagnosis in cases. [ABSTRACT FROM AUTHOR]

Patients with blood cancers have low rates of hospice use. While lack of transfusion access in hospice is posited to substantially contribute to these low rates, little is known about the perspectives of hospice providers regarding transfusion access in hospice. To characterize hospice providers' perspectives regarding care for patients with blood cancers and transfusions in the hospice setting. In 2022, we conducted a cross-sectional survey of a sample of hospices in the United States regarding their experience caring for patients with blood cancers, perceived barriers to hospice use, and interventions to increase enrollment. We received 113 completed surveys (response rate = 23.5%). Of the cohort, 2.7% reported that their agency always offers transfusions, 40.7% reported sometimes offering transfusions, and 54.9% reported never offering transfusions. In multivariable analyses, factors associated with offering transfusions included nonprofit ownership (OR 5.93, 95% CI, 2.2–15.2) and daily census >50 patients (OR 3.06, 95% CI, 1.19–7.87). Most respondents (76.6%) identified lack of transfusion access in hospice as a barrier to hospice enrollment for blood cancer patients. The top intervention considered as "very helpful" for increasing enrollment was additional reimbursement for transfusions (72.1%). In this national sample of hospices, access to palliative transfusions was severely limited and was considered a significant barrier to hospice use for blood cancer patients. Moreover, hospices felt increased reimbursement for transfusions would be an important intervention. These data suggest that hospice providers are supportive of increasing transfusion access and highlight the critical need for innovative hospice payment models to improve end-of-life care for patients with blood cancers. [ABSTRACT FROM AUTHOR]

A synergistic-healing strategy that combines molecular targeting within a system-wide perspective is presented as the Multiple Integrated Complementary Healing Approaches: Energetics And Light (MICHAEL). The basis of the MICHAEL approach is the realization that environmental, nutritional and electromagnetic factors form a regulatory framework involved in bone and nerve healing. The interactions of light, energy, and nutrition with neural, hormonal and cellular pathways will be presented. Energetic therapies including electrical, low-intensity pulsed ultrasound and light based treatments affect growth, differentiation and proliferation of bone and nerve and can be utilized for their healing benefits. However, the benefits of these therapies can be impaired by the absence of nutritional, hormonal and organismal factors. For example, lack of sleep, disrupted circadian rhythms and vitamin-D deficiency can impair healing. Molecular targets, such as the Wnt pathway, protein kinase B and glucocorticoid signaling systems can be modulated by nutritional components, including quercetin, curcumin and Mg(2+) to enhance the healing process. The importance of water and water-regulation will be presented as an integral component. The effects of exercise and acupuncture on bone healing will also be discussed within the context of the MICHAEL approach. [ABSTRACT FROM AUTHOR]

• Conducted an EWAS of PBDE serum levels. • Identified DNA methylation biomarkers of PBDE blood serum levels. • PBDE-associated blood DNA methylation associated with breast cancer risk at menopause. • Environmental chemicals and risk of breast cancer at the menopausal transition. • PBDE serum levels and association with methylation changes in hormone-pathway genes. Exposure to polybrominated diphenyl ethers (PBDEs) may influence risk of developing post-menopausal breast cancer. Although mechanisms are poorly understood, epigenetic regulation of gene expression may play a role. To identify DNA methylation (DNAm) changes associated with PBDE serum levels and test the association of these biomarkers with breast cancer risk. We studied 397 healthy women (controls) and 133 women diagnosed with breast cancer (cases) between ages 40 and 58 years who participated in the California Teachers Study. PBDE levels were measured in blood. Infinium Human Methylation EPIC Bead Chips were used to measure DNAm. Using multivariable linear regression models, differentially methylated CpG sites (DMSs) and regions (DMRs) associated with serum PBDE levels were identified using controls. For top-ranked DMSs and DMRs, targeted next-generation bisulfite sequencing was used to measure DNAm for 133 invasive breast cancer cases and 301 age-matched controls. Conditional logistic regression was used to evaluate associations between DMSs and DMRs and breast cancer risk. We identified 15 DMSs and 10 DMRs statistically significantly associated with PBDE levels (FDR < 0.05). Methylation changes in a DMS at BMP8B and DMRs at TP53 and A2M-AS1 were statistically significantly (FDR < 0.05) associated with breast cancer risk. We show for the first time that serum PBDE levels are associated with differential methylation and that PBDE-associated DNAm changes in blood are associated with breast cancer risk. [ABSTRACT FROM AUTHOR]

The article describes and evaluates characteristics associated with residential mobility in a sub-sample of the California Teachers Study (CTS) cohort. Especially for cancers with long latency periods, such as breast cancer, the issue of residential mobility hinders ecologic analyses seeking to examine the role of environmental contaminants in chronic disease etiology. The finding suggests that analyses of incidence rates based on current residence, while not capturing a woman's lull exposure history, may reasonably reflect some aspect of longer term chronic exposures, especially those related to urbanization, at least in professional women.

Fire fighters are at a high risk for exposure to toxic chemicals during and subsequent to fire suppression activities. In the Canadian Fire Station Dust Study (CFSDS) we measured 19 polybrominated diphenyl ether (PBDE) and six organophosphate flame retardant (OPFR) chemicals in dust collected in 2017–18 by vacuuming the living quarters of 24 Canadian fire stations from four provinces. The predominant flame retardant (FR) was BDE-209, with a median concentration of 7060 ng/g, which was a magnitude higher than medians of the major congeners of the pentaBDE formulation measured at 620 ng/g (Σ 5 BDE-47, 99, 100, 153 and 154). OPFR median concentrations exceeded those of pentaBDE and were on the same order of magnitude as BDE-209, with TCIPP, TDCIPP and TPHP as the dominant OPFRs with median concentrations ranging from 2350 to 4780 ng/g. Fire station age and carpeting were significantly correlated with select OPFRs and PBDEs. Furthermore, fire stations that also vacuumed equipment bays and fire truck interiors had median concentrations that were a magnitude higher (BDE-209: 81,700 ng/g) and two to three-fold higher (TCIPP, TDCIPP and TPHP) than fire stations that excluded those areas. FR concentrations in CFSDS dust were higher but on the same order of magnitude as Canadian residential dust and significantly lower than dust collected from Canadian WEEE dismantling. CFSDS FR concentrations were also significantly lower than those we reported in our 2015 U.S. fire station dust. Our data reflect the downward trend of PBDEs following their phase out and a shift toward OPFRs as replacements. • PBDE and OPFR flame retardant levels in fire station dust from 5 Canadian cities. • In general, FRs were higher in Canadian fire station dust than residential dust. • Dust collected from the interior of fire trucks was dominated by BDE-209. • Fire station age and carpeting correlated with PBDE and OPFR dust concentrations. [ABSTRACT FROM AUTHOR]

1. Characterize the value patients with blood cancers place on hospice services and transfusion access 2. Characterize the potential impact of innovative hospice models on hospice use for patients with blood cancers Lack of transfusion access in hospice is posited to be a key barrier to hospice use among patients with hematologic malignancies. Yet data are lacking on how these patients view the importance of transfusion access compared to traditional hospice services. Characterize the perceived utility of transfusion and hospice services among patients with advanced blood cancers who are potentially hospice-eligible. In 10/2020, we launched a web-based survey of adult patients with blood cancer recruited from two cancer centers, whose oncologists answered that "they would not be surprised if the patient died within the next 6 months." The survey was developed through patient/caregiver focus groups (n = 27) and cognitive debriefing (n = 5). We included best-worst scaling questions to assess the utility of routine (visiting nurse, case manager, home health aide, chaplain, social worker, respite care) and nonroutine (transfusion access, transportation, peer support, telemedicine) hospice services. Using a hierarchical Bayesian analysis, we determined the utility score of each service, a measure of the average propensity to choose a service as most important more often than least important. By 10/2021, 137 patients had completed the survey (response rate 63.4%). The median age was 70 years. The majority were male (62.0%) and married or partnered (67.9%), and most had acute leukemia (39.4%). Patients rated transfusion access as having the highest importance, with a utility score of 20.9, 95% CI 19.7-22.2, followed by telemedicine (19.8, 95% CI 18.5-21.1), transportation to and from medical appointments (12.1, 95% CI 10.6-13.6), and visiting nurses (11.9, 95% CI 10.7-13.1). The three least important services were respite care, social work, and chaplaincy. In this cohort of potentially hospice-eligible blood cancer patients, access to blood transfusion was rated as being most important relative to traditional hospice services. Innovative hospice delivery models that include access to palliative transfusions have strong potential to increase hospice use for patients with blood cancer. [ABSTRACT FROM AUTHOR]

Abstract: We measured major PBDEs and PCBs in breast adipose tissues of California women participating in a breast cancer study in the late 1990s. Samples were analyzed using gas chromatography with electron impact ionization and tandem mass spectrometry detection. The congener profile observed was: BDE47>BDE99>BDE153>BDE100>BDE154 and PCB153>PCB180>PCB138>PCB118. Whereas high correlations were observed within each chemical class, very weak correlations appeared between classes, pointing to different exposure pathways. Weak negative associations were observed for PBDE congeners and age. Our PBDE data are among the highest reported, exceeding data from the National Health and Nutrition Examination Survey and consistent with the high use of PBDEs in California. These data may be helpful in establishing a baseline for PBDE body burdens to gauge changes over time as a result of restrictions in the use of PBDE formulations. [ABSTRACT FROM AUTHOR]