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The emergence of epizootic shell disease in American lobsters (Homarus americanus) has presented many new challenges to understanding the interface between disease and the management of the lobster fishery. While a variety of the potentially causative and correlative factors for shell disease have been explored, a clear etiological agent remains elusive. The recency of this disease and the lack of identifiable causal agents have hindered the development of conceptual models that can yield testable predictions. Here, a model originally developed for human-parasite interactions was applied to lobster shell disease as a means to unify the broad experimental and field observations. The model is a graphical means to understand the onset and severity of shell disease and is a function of the length of the molt cycle and the rate of the decrease of health both before and after lesion formation as a function of bacterial abundance and pathogenicity. The model also accounts for shell hardening and passive and active portals of entry for the bacteria. The timing for a conceptual understanding of the epidemiology of shell disease is critical because its prevalence is increasing in key fishing areas. Ideally, such a model will help researchers create hypothesis-driven predictive experiments from which we can further our understanding of an important disease to a critical member of the Gulf of Maine ecosystem. L'apparition de l'epizootie de la maladie de la carapace chez le homard (Homarus americanus) a pose de nombreux defis nouveaux en ce qui concerne la comprehension de l'interface entre la maladie et la gestion de la peche au homard. Si divers facteurs potentiellement causatifs et correlatifs ont ete examines, un agent etiologique bien defini n'a pas encore ete cerne. Le court laps de temps ecoule depuis l'apparition de cette maladie et l'absence d'agents causaux identifiables ont limite l'elaboration de modeles conceptuels pouvant fournir des predictions verifiables. Nous avons applique un modele elabore a l'origine pour des interactions humains-parasites a la maladie de la carapace du homard afin d'integrer les differentes observations experimentales et de terrain. Le modele est un outil graphique pour comprendre l'apparition et la gravite de la maladie de la carapace et est fonction de la longueur du cycle de mue, du taux de deterioration de l'etat de sante avant et apres la formation de lesions en fonction de l'abondance bacterienne et de la pathogenicite; il explique le durcissement de la carapace et les portails d'entree passifs et actifs pour les bacteries. Il est d'importance capitale d'etablir rapidement une comprehension conceptuelle de l'epidemiologie de la maladie de la carapace etant donne l'augmentation de sa prevalence dans des zones de peche cles. Idealement, un tel modele aidera les chercheurs a concevoir des experiences predictives reposant sur des hypotheses, qui permettront d'etayer la comprehension de cette importante maladie affectant un membre cle de l'ecosysteme du golfe du Maine. [Traduit par la Redaction], Introduction Epizootic shell disease (ESD) is a bacteria-induced degeneration of the cuticle of the American lobster (Homarus americanus) that can lead to disfigurement, decreased health, and subsequent mortality (Castro et [...]

ABSTRACT Epizootic shell disease (ESD) is an emerging disease in American lobster, Homarus americanus, in southern New England (SNE). Monitoring surveys and research projects have been able to identify the [...]

Organizational characteristics, including organizational structures and processes, are important to understanding care delivery and health outcomes. However, organizational-level constructs present measurement challenges in care delivery research. This analysis aims to understand if, when, and how organizational characteristics are examined in a National Cancer Institute (NCI) research network conducting cancer care delivery research (CCDR). The NCI Community Oncology Research Program encourages consideration of organizational variables in CCDR studies. We conducted a cross-sectional thematic analysis to identify organizational characteristics examined in this portfolio of research. Organizational characteristics targeted, related measures, and analytic approach were abstracted by 2 study investigators using a coding framework adapted from 2 existing frameworks. A total of 78.9% of eligible study protocols included organizational characteristics. Structural characteristics were the most common, collected in all 15 included protocols, 14 examined at least 1 organizational process, and 12 examined organizational-level outcomes. Most studies proposed descriptive practice-level analyses or multilevel analyses using random effects to account for clustering of patients and staff within practices. Few (n = 5) specified that organizational variables would be modeled as effects of interest (vs covaried out) or proposed analytic approaches that could more robustly examine effects of targeted organizational characteristics on primary outcomes. Inclusion of organizational variables is common in CCDR conducted through the NCI Community Oncology Research Program, NCI's national network charged with bringing cancer clinical trials to people in their communities. Nonetheless, opportunities remain to improve the use of theory to guide organizational construct selection, operationalization, measurement, and incorporation into study hypotheses and analyses. [ABSTRACT FROM AUTHOR]

Research seeking to improve patient engagement with decision-making, use of evidence-based guidelines, and coordination of multi-specialty care has made important contributions to the decades-long effort to improve cancer care. The National Cancer Institute expanded support for these efforts by including cancer care delivery research in the 2014 formation of the National Cancer Institute Community Oncology Research Program (NCORP). Cancer care delivery research is a multi-disciplinary effort to generate evidence-based practice change that improves clinical outcomes and patient well-being. NCORP scientists and community-based clinicians and organizations rapidly embraced the addition of this type of research into the network, resulting in a robust portfolio of observational studies and intervention studies within the first 5 years of funding. This commentary describes the initial considerations in conducting this type of research in a network previously focused on cancer prevention, control, and treatment studies; characterizes the protocols developed to date; and outlines future directions for cancer care delivery research in the second round of NCORP funding. [ABSTRACT FROM AUTHOR]

Background: PRO-CTCAE is a library of items that measure cancer treatment-related symptomatic adverse events (NCI Contracts: HHSN261201000043C and HHSN 261201000063C). The objective of this study is to examine the equivalence and acceptability of the three data collection modes (Web-enabled touchscreen tablet computer, Interactive voice response system [IVRS], and paper) available within the US National Cancer Institute (NCI) Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) measurement system.Methods: Participants (n = 112; median age 56.5; 24 % high school or less) receiving treatment for cancer at seven US sites completed 28 PRO-CTCAE items (scoring range 0-4) by three modes (order randomized) at a single study visit. Subjects completed one page (approx. 15 items) of the EORTC QLQ-C30 between each mode as a distractor. Item scores by mode were compared using intraclass correlation coefficients (ICC); differences in scores within the 3-mode crossover design were evaluated with mixed-effects models. Difficulties with each mode experienced by participants were also assessed.Results: 103 (92 %) completed questionnaires by all three modes. The median ICC comparing tablet vs IVRS was 0.78 (range 0.55-0.90); tablet vs paper: 0.81 (0.62-0.96); IVRS vs paper: 0.78 (0.60-0.91); 89 % of ICCs were ≥0.70. Item-level mean differences by mode were small (medians [ranges] for tablet vs. IVRS = -0.04 [-0.16-0.22]; tablet vs paper = -0.02 [-0.11-0.14]; IVRS vs paper = 0.02 [-0.07-0.19]), and 57/81 (70 %) items had bootstrapped 95 % CI around the effect sizes within +/-0.20. The median time to complete the questionnaire by tablet was 3.4 min; IVRS: 5.8; paper: 4.0. The proportion of participants by mode who reported "no problems" responding to the questionnaire was 86 % tablet, 72 % IVRS, and 98 % paper.Conclusions: Mode equivalence of items was moderate to high, and comparable to test-retest reliability (median ICC = 0.80). Each mode was acceptable to a majority of respondents. Although the study was powered to detect moderate or larger discrepancies between modes, the observed ICCs and very small mean differences between modes provide evidence to support study designs that are responsive to patient or investigator preference for mode of administration, and justify comparison of results and pooled analyses across studies that employ different PRO-CTCAE modes of administration.Trial Registration: NCT Clinicaltrials.gov identifier: NCT02158637. [ABSTRACT FROM AUTHOR]