Challenges in collecting information on sexual orientation and gender identity for cancer patients: perspectives of hospital and central cancer registry abstractors.

PURPOSE: Sexual and gender minority (SGM) populations experience cancer treatment and survival disparities; however, inconsistent sexual orientation and gender identity (SOGI) data collection within clinical settings and the cancer surveillance system precludes population-based research toward health equity for this population. This qualitative study examined how hospital and central registry abstractors receive and interact with SOGI information and the challenges that they face in doing so. METHODS: We conducted semi-structured interviews with 18 abstractors at five Surveillance, Epidemiology, and End Results (SEER) registries, as well as seven abstractors from commission on cancer (CoC)-accredited hospital programs in Iowa. Interviews were transcribed, cleaned, and coded using a combination of a priori and emergent codes. These codes were then used to conduct a descriptive analysis and to identify domains across the interviews. RESULTS: Interviews revealed that abstractors had difficulty locating SOGI information in the medical record: this information was largely never recorded, and when included, was inconsistently/not uniformly located in the medical record. On occasion, abstractors reported situational recording of SOGI information when relevant to the patient's cancer diagnosis. Abstractors further noticed that, where reported, the source of SOGI information (i.e., patient, physician) is largely unknown. CONCLUSION: Efforts are needed to ensure standardized implementation of the collection of SOGI variables within the clinical setting, such that this information can be collected by the central cancer registry system to support population-based equity research addressing LGBTQ + disparities.

A hepatitis C elimination model in healthcare for the homeless organization: A novel reflexive laboratory algorithm and equity assessment.

BACKGROUND: Reaching World Health Organization hepatitis C (HCV) elimination targets requires diagnosis and treatment of people who use drugs (PWUD) with direct acting antivirals (DAAs). PWUD experience challenges engaging in HCV treatment, including needing multiple provider and laboratory appointments. Women, minoritized racial communities, and homeless individuals are less likely to complete treatment. METHODS: We implemented a streamlined opt-out HCV screening and linkage-to-care program in two healthcare for the homeless clinics and a medically supported withdrawal center. Front-line staff initiated a single-order reflex laboratory bundle combining screening, confirmation, and pre-treatment laboratory evaluation from a single blood draw. Multinomial logistic regression models identified characteristics influencing movement through each stage of the HCV treatment cascade. Multiple logistic regression models identified patient characteristics associated with HCV care cascade progression and Cox proportional hazards models assessed time to initiation of DAAs. RESULTS: Of 11,035 clients engaged in services between May 2017 and March 2020, 3,607 (32.7%) were screened. Of those screened, 1,020 (28.3%) were HCV PCR positive. Of those with detectable RNA, 712 (69.8%) initiated treatment and 670 (94.1%) completed treatment. Of those initiating treatment, 407 (57.2%) achieved SVR12. There were eight treatment failures and six reinfections. In the unadjusted model, the bundle intervention was associated with increased care cascade progression, and in the survival analysis, decreased time to initiation; these differences were attenuated in the adjusted model. Women were less likely to complete treatment and SVR12 labs than men. Homelessness increased likelihood of screening and diagnosis but was negatively associated with completing SVR12 labs. Presence of opioid and stimulant use disorder diagnoses predicted increased care cascade progression. CONCLUSIONS: The laboratory bundle and referral pathways improved treatment initiation, time to initiation, and movement across the cascade. Despite overall population improvements, women and homeless individuals experienced important gaps across the HCV care cascade.

The effect of negative pressure wound therapy on surgical site occurrences in closed incision abdominal wall reconstructions: a retrospective single surgeon and institution study.

PURPOSE: The use of closed incision negative pressure wound therapy (ciNPWT) in abdominal wall reconstruction is heavily debated. The current literature shows mixed results for its efficacy in preventing surgical site occurrences (SSOs), and many of the studies are limited by small sample size or a lack of generalizability. We sought to assess whether the use of prophylactic ciNPWT has an effect on reducing the rate of SSOs. METHODS: Following institutional review board approval, a retrospective analysis of a prospectively collected abdominal wall reconstruction database of a single surgeon at a single institution was completed. Two hundred and seventy patients were reviewed. Univariate and multivariate logistic regressions were performed to assess the effect of each variable on the rate of SSOs. RESULTS: Two hundred and fifty-eight patients (95.56%) met inclusion criteria. One hundred and fifty-nine (61.63%) of these patients received ciNPWT. The median duration of ciNPWT was 6 days. Multivariate logistic regression analysis showed no significant difference in the prevalence of SSOs between groups (OR = 0.843, 95% CI [0.445-1.594], p = 0.598). It did, however, show a significant decrease in the rates of seroma (7.07% vs. 0.63%, p = 0.004). Moreover, skin resection was associated with a decreased rate of SSO (OR = 0.295, 95% CI [0.096-0.911], p = 0.034). CONCLUSIONS: ciNPWT was not associated with a decrease in SSOs following abdominal wall reconstruction but did show a statistically significant decrease in postoperative seromas. Future, large prospective analyses may help further discover the utility of ciNPWT in reducing SSOs.

Evaluation of a novel particle-based assay for detection of autoantibodies in idiopathic inflammatory myopathies.

BACKGROUND: Myositis specific antibodies (MSA) represent not only important diagnostic tools for idiopathic inflammatory myopathies (IIM), but also help to stratify patients into subsets with particular clinical features, treatment responses, and disease outcome. Consequently, standardization of MSA is of high importance. Although many laboratories rely on protein immunoprecipitation (IP) for the detection of MSA, IP standardization is challenging and therefore reliable alternatives are mandatory. Recently, we identified significant variation between IP and line immunoassay (LIA) for the detection of MSA and myositis associated antibodies. In this study we aimed to compare the results from our previous study to the results obtained with a novel fully automated particle-based technology for the detection of MSA and MAA. METHODS: A total of 54 sera from patients with idiopathic inflammatory myopathy (IIM) were tested using three methods: IP, LIA (Euroimmun, Germany) and a novel particle-based multi-analyte technology (PMAT, Inova Diagnostics, US, research use only). The analysis focused on antibodies to EJ, SRP, Jo-1, NXP-2, MDA5, TIF1-γ, and Mi-2. RESULTS: Significant variations were observed among all methods. Overall, the novel PMAT assays showed slightly better correlation with IP, but the kappa agreement was strongly dependent on the antibody tested. When the results obtained from IP were used as reference for receiver operating characteristic (ROC) curve analysis, good discrimination and a high area under the curve (AUC) value were found for PMAT (AUC = 0.83, 95% confidence interval, CI 0.70-0.95) which was significantly higher (p = .0332) than the LIA method (AUC = 0.70, 95% CI 0.56-0.84). CONCLUSION: The novel PMAT used to detect a spectrum of MSA in IIM represents a potential alternative to IP and other diagnostic assays. Additional studies based on larger cohorts are needed to fully assess the performance of the novel PMAT system for the detection of autoantibodies in myositis.

Highlights on novel technologies for the detection of antibodies to Ro60, Ro52, and SS-B.

OBJECTIVE: We aimed to compare a chemiluminescent immunoassay (CIA, QUANTA Flash) on BIO-FLASH with a multiplex flow immunoassay (MFI) on BioPlex 2200 for the detection of antibodies to Ro60, Ro52, and SS-B. METHODS: The study included 241 samples, from patients suffering from systemic autoimmune diseases (n = 108) as well as disease controls (n = 133). All samples were tested for anti-Ro52, anti-Ro60, and anti-SS-B (La) antibodies on QUANTA Flash (INOVA Diagnostics, San Diego, USA) and BioPlex 2200 (Bio-Rad Laboratories Inc., Hercules, USA). Discrepant samples were tested by two independent methods: BlueDot/ANA and QUANTRIX Microarray (both D-tek, Belgium). RESULTS: The overall qualitative agreements were 95.4% (95% confidence interval, CI 92.0-97.7%) for anti-Ro52, 98.8% (95% CI 96.4-99.7%) for anti-Ro60, and 91.7% (95% CI 87.5-94.9%) for anti-SS-B antibodies. There were 34 discrepant samples among all assays (20 anti-SS-B, 11 anti-Ro52, 3 anti-Ro60). 30/33 of retested samples (by D-tek dot blot) agreed with the QUANTA Flash results. Similar findings were obtained with QUANTRIX Microarray kit. CONCLUSION: QUANTA Flash and BioPlex 2200 show good qualitative agreement. The clinical performances were similar for anti-Ro52 and anti-Ro60 autoantibodies while differences were observed for anti-SS-B (La) antibodies.

The 2009 Late Blight Pandemic in the Eastern United States - Causes and Results.

The tomato late blight pandemic of 2009 made late blight into a household term in much of the eastern United States. Many home gardeners and many organic producers lost most if not all of their tomato crop, and their experiences were reported in the mainstream press. Some CSAs (Community Supported Agriculture) could not provide tomatoes to their members. In response, many questions emerged: How did it happen? What was unusual about this event compared to previous late blight epidemics? What is the current situation in 2012 and what can be done? It's easiest to answer these questions, and to understand the recent epidemics of late blight, if one knows a bit of the history of the disease and the biology of the causal agent, Phytophthora infestans.

Development and performance evaluation of novel chemiluminescence assays for detection of anti-PR3 and anti-MPO antibodies.

BACKGROUND: The detection of anti-proteinase 3 (PR3) and anti-myeloperoxidase (MPO) autoantibodies represents a serological hallmark in the diagnosis of small vessel vasculitis such as granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). We evaluated novel chemiluminescence assays (CIAs) for PR3- and MPO-ANCA detection and investigated their utility for disease activity monitoring. METHODS: Sera collected from GPA (n=41) and MPA (n=30) patients were tested by QUANTA Lite® PR-3 and MPO ELISAs (INOVA Diagnostics) and by the QUANTA Flash™ PR3 and MPO CIAs (INOVA). Precision and linearity were analyzed following reference guidelines. The recently launched reference sera for PR3-and MPO-ANCA (Centers of Disease Control and prevention, CDC) were used to establish international units for the new assays. Disease activity was determined using the Birmingham Vasculitis Activity Score. RESULTS: The international standards for PR3-and MPO-ANCA yielded results of 403 CU and 332 CU in the novel CIAs, respectively. The linearity analysis showed linear regression values>0.97 with slopes between 0.96 and 1.04. Total variation obtained from the precision study showed CV% of ≤7.4 for PR3-ANCA and ≤12.8 for MPO-ANCA. Good agreement (Spearman rho ≥ 0.89) was observed between CIA and ELISA. PR3-ANCA determined by CIA, but not by ELISA, was correlated with disease activity. No correlation was found for MPO-ANCA. CONCLUSION: The novel PR3- and MPO-ANCA CIAs show good precision, linearity and correlation to ELISA. In addition, PR3-ANCA by CIA show correlation with disease activity.

Anti-C1q antibodies have higher correlation with flares of lupus nephritis than other serum markers.

OBJECTIVE: Autoantibodies are important in the diagnosis and classification of systemic lupus erythematosus (SLE), but whether they correlate with changes in disease activity within individual patients is controversial. We assessed the association between changes in SLE global and renal activity and changes in several autoantibodies and cell adhesion molecules in patients with SLE. METHODS: Stored sera collected at two or three clinic visits from each of 49 SLE patients (91% female, 59% African-American, 31% Caucasian, 10% other ethnicity, 38% under 30 years, 41% between 30-44 years, and 21% 45-63 years) were analyzed. The visits were chosen to include one visit with proteinuria, and one or two without, for each patient. Global disease activity was measured by the Physician's Global Assessment (PGA), SELENA-SLEDAI (SLE Disease Activity Index modified to exclude anti-dsDNA and complement) and renal activity assessed by urine protein (by urine dipstick) and Renal Activity Score. Sera were assayed for anti-C1q, anti-chromatin, anti-dsDNA, anti-ribosomal P, monocyte chemotactic protein-1 (MCP-1), vascular cell adhesion molecule (VCAM) intercellular adhesion molecule (ICAM) and complement. The associations between changes in disease activity and changes in biomarker levels were assessed. RESULTS: In terms of global disease activity, anti-C1q had the highest association with the PGA (p = 0.09) and was strongly associated with modified SELENA-SLEDAI (p = 0.009). In terms of renal activity, anti-C1q had the highest association with proteinuria (p = 0.079), and was strongly associated with Renal Activity Score (p = 0.006). CONCLUSION: Anti-C1q performed the best of the potential biomarkers, being significantly associated with the modified SELENA-SLEDAI and with the Renal Activity Score. This study indicates the potential superior utility of anti-C1q over anti-dsDNA and other measures to track renal activity.

Lack of activational influence of ovarian hormones on the size of the female rat's corpus callosum.

The sex difference in the midsagittal area of the adult rat corpus callosum (CC) has been shown to be mediated, in part, by gonadal steroids in early development, with the sensitive period of hormone action in the female extending at least up to postnatal day 25. Given this prolonged sensitivity, the current study attempted to delineate organizational vs. activational influences of gonadal hormones on the female rat CC. In Experiment 1, callosal size was examined across the estrous cycle at 52 and 90 days of age. In Experiment 2, females were ovariectomized at 78 days and CC parameters assessed at 110 days. Last, in Experiment 3, females were ovariectomized at 78 days and sacrificed at 110 days; in addition, sham females were sacrificed during proestrus or estrus. Neither stage of estrous cycle nor adult ovariectomy affected midsagittal CC size. These results provide evidence for organizational effects of ovarian steroids on the female callosum, with the sensitive period of hormone action ending sometime between days 25 and 78.

Intra-cellular and extra-cellular growth of L. monocytogenes in chick embryo fibroblast cell culture.

The growth of L. monocytogenes in isolated chick embryo fibroblast cell culture was studied. Hanks balanced salt solution and Eagles minimal essential medium were shown to support a limited growth of L. monocytogenes. Extra-cellular growth on the maintenance medium occurs for 48 h prior to the establishment of intra-cellular organisms. As the uptake of the parasite by the cell culture takes place, intra-cellular replication begins with subsequent release of the organisms into the surrounding medium. The organism continues to replicate intra-cellularly until all the cell culture is destroyed.

The effect of progesterone on the growth and virulence of Listeria monocytogenes.

Progesterone was examined for action on the virulence of Listeria monocytogenes and the toxicity of its haemolysin. Progesterone at concentrations between 5 and 20 micrograms/ml reduced the numbers of L. monocytogenes over the first two hours of growth. Virulence and haemolysin toxicity were assessed using the allantoic sac route of inoculation into embryonated hens eggs. Increasing the concentrations of progesterone in the culture medium resulted in a decrease in the mortality of chick embryos inoculated with either organisms, or cell-free extracts or purified haemolysin. Progesterone had no effect on the lethality of pre-formed haemolysin.

Role of haemolysin and temperature in the pathogenesis of Listeria monocytogenes in fertile hens' eggs.

The haemolysin produced by Listeria monocytogenes at 37 degrees C and 4 degrees C was examined in fertile hens' eggs. Organisms, cell free extracts and purified haemolysin derived from broth cultures grown at the lower temperature were more pathogenic for chick embryos, induced higher mortality with toxic changes in the embryos. These effects were most pronounced with the purified haemolysin as shown by LD50 determinations and following inoculation of constant haemolytic doses. Pathological changes induced by the haemolysin included sub-cutaneous haemorrhage due to endothelial damage, hepatosplenomegaly with macroscopic and histological lesions in heart, spleen and liver in the absence of an inflammatory response. At the cellular level, the myocardial tissue, and hepatocyte structure were destroyed with intravascular haemolysis, fatty degeneration of mitochondria, dilation of endoplasmic reticulum and distortion of liver cell nuclear membranes evident. The mortality and morphological data showed an increase in virulence for Listeria after culture at 4 degrees C compared with 37 degrees C and suggested a more cytotoxic component of the haemolysin which was activated at lower temperatures.

Role of lipid in butylatedhydroxyanisole (BHA) resistance of Listeria monocytogenes.

The lipid content of Listeria monocytogenes 5214m was increased by successive subculturing in a glycerol medium. Fattened cells showed considerably greater resistance to Butylatedhydroxyanisole (BHA). Polar lipids and fatty acid composition of four cultures with different BHA sensitivity were analysed. They are basically similar but the resistant cultures had a lower percentage of unsaturated and anteiso to saturated and iso fatty acids.

Pathogenesis and growth of Listeria monocytogenes in fertile hens' eggs.

The LD50 for 15-day old chicken embryos inoculated with Listeria monocytogenes into the allantoic sac was determined. The growth cycle of the organism was investigated in different tissues and fluids derived from embryonated eggs following inoculation with a suspension of L. monocytogenes equivalent to the LD50. Eggs receiving doses of 100 and 1000 times the LD50 were used to examine the effect of high doses on the pathogenesis and growth of Listeria in ovo. The pattern of growth of the organism in embryonic blood showed two distinct peaks and correlated with these was the development of large and small pock lesions on the chorioallantoic membrane. Bacterial growth in the internal organs exhibited a single peak. Histological and electron microscopic evidence indicated that the primary cellular damage was due to a soluble haemolysin present prior to the establishment of the organism within the tissues.

Pathogenicity of natural and experimental listeriosis in newly hatched chicks.

The pathogenicity of Listeria monocytogenes for newly hatched chickens exposed to natural infection was examined. Organisms entered through the alimentary tract and dissemination followed bacteraemia. Among a number of symptoms recorded were unilateral and bilateral toe paralysis. In addition to gross abnormalities in the following tissues, histological lesions were seen in the liver, spleen, heart and kidneys of all infected chicks but brain lesions were observed only in birds with central nervous system involvement. The organism was recovered from some tissues derived from apparently healthy chicks as well as those with listeriosis. The use of trypsin in the isolation process increased the probability of a positive result from tissues, reduced the storage time needed and had no adverse effect on the rate of organism growth.

Infection, haemorrhagia and death of chick embryos experimentally inoculated with Listeria monocytogenes by the intra-allantoic route.

When allantoic sacs of embryonated (SPF) chicken eggs were inoculated with different doses to investigate the pathogenicity of two strains of Listeria monocytogens (4379 and NCTC 5214), infection resulted which spread rapidly throughout the embryonated eggs. When low doses were used small pock lesions on the chorio-allantoic membrane (CAM), generalized haemorrhage (especially on the head region) and deaths of the embryos with necrotic foci on the liver and heart were observed. Neither the pock lesions nor the haemorrhage were detected in embryos dying from high doses of the bacterium. Bacteria were recovered from the CAM's, allantoic fluids, amniotic fluids and selected organs of the dead embryos. The pathogenicity was shown to be strain dependent, strain 4379 being more pathogenic than strain NCTC 5214. In vitro studies indicated that brain homogenates of uninoculated chicken embryos are not inhibitory to Listeria monocytogenes at 37 degrees C and will increase the viable count.

The adsorption of phage by Staphylococcus spp.

Phages for coagulase-negative staphylococci were adsorbed to heat-killed cells. The phages showed equal affinities for all the cells, which appeared to have an equal number of binding sites for all the phages tested. This number is estimated at 1.2 x 10(6) sites/cell. Competition for binding sites could be demonstrated between a pair of phages. It is concluded that coagulase-negative staphylococci have only a single series of binding sites for phage, probably the outer 20% or so of the wall teichoic acids. These organisms therefore bind all 'coagulase-negative' phages whether or not they are sensitive to them.

Survival of Listeria monocytogenes in high salt concentrations.

The bactericidal effects of high concentrations of common salt has been determined in a laboratory medium for Listeria monocytogenes strain (1, 2a, No. 18). The survival time for the organism was followed at three different incubation temperatures (4, 22, 37 degrees C). The influence of temperature on the action of salt is discussed.

Immunofluorescent identification of Listeria monocytogenes.

A fluorescent antibody technique for the rapid diagnosis and identification of L. monocytogenes in smears, impression smears from tissues of animals dead from listeriosis, and in meat and milk is described. The technique could well be exploited for detecting L. monocytogenes in meat and meat products, animal tissues, and in milk provided that it is supplemented with adequate controls. The technique has been compared with conventional cultural technique and found to be superior as far as the time factor is concerned. The use of the technique also demonstrates the possibility of actually determining the serological type concurrently.