Can automated treatment plans gain traction in the clinic?

Recently, there has been an increased interest in the feasibility and impact of automation within the field of medical dosimetry. While there have been many commercialized solutions for automatic treatment planning, the use of an application programming interface to achieve complete plan generation for specific treatment sites is a process only recently available for certain commercial vendors. Automatic plan generation for 20 prostate patients was achieved via a stand-alone automated planning script that accessed a knowledge-based planning solution. Differences between the auto plans and clinically treated, baseline plans were analyzed and compared. The planning script successfully initialized a treatment plan, accessed the knowledge-based planning model, optimized the plan, assessed for constraint compliance, and normalized the treatment plan for maximal coverage while meeting constraints. Compared to baseline plans, the auto-generated plans showed significantly improved rectal sparing with similar coverage for targets and comparable doses to the remaining organs-at-risk. Utilization of a script, with its associated time saving and integrated process management, can quickly and automatically generate an acceptable clinical treatment plan for prostate cancer with either improved or similar results compared to a manually created plan.

Porphyromonas gingivalis evasion of autophagy and intracellular killing by human myeloid dendritic cells involves DC-SIGN-TLR2 crosstalk.

Signaling via pattern recognition receptors (PRRs) expressed on professional antigen presenting cells, such as dendritic cells (DCs), is crucial to the fate of engulfed microbes. Among the many PRRs expressed by DCs are Toll-like receptors (TLRs) and C-type lectins such as DC-SIGN. DC-SIGN is targeted by several major human pathogens for immune-evasion, although its role in intracellular routing of pathogens to autophagosomes is poorly understood. Here we examined the role of DC-SIGN and TLRs in evasion of autophagy and survival of Porphyromonas gingivalis in human monocyte-derived DCs (MoDCs). We employed a panel of P. gingivalis isogenic fimbriae deficient strains with defined defects in Mfa-1 fimbriae, a DC-SIGN ligand, and FimA fimbriae, a TLR2 agonist. Our results show that DC-SIGN dependent uptake of Mfa1+P. gingivalis strains by MoDCs resulted in lower intracellular killing and higher intracellular content of P. gingivalis. Moreover, Mfa1+P. gingivalis was mostly contained within single membrane vesicles, where it survived intracellularly. Survival was decreased by activation of TLR2 and/or autophagy. Mfa1+P. gingivalis strain did not induce significant levels of Rab5, LC3-II, and LAMP1. In contrast, P. gingivalis uptake through a DC-SIGN independent manner was associated with early endosomal routing through Rab5, increased LC3-II and LAMP-1, as well as the formation of double membrane intracellular phagophores, a characteristic feature of autophagy. These results suggest that selective engagement of DC-SIGN by Mfa-1+P. gingivalis promotes evasion of antibacterial autophagy and lysosome fusion, resulting in intracellular persistence in myeloid DCs; however TLR2 activation can overcome autophagy evasion and pathogen persistence in DCs.

Do we need a new CT scan for retreatment of intracranial SRS patients?

PURPOSE: To determine if the treatment planning computed tomography scan (CT) from an initial intracranial stereotactic radiosurgery (SRS) treatment can be used for repeat courses of SRS. METHODS AND MATERIALS: Twenty-five patients with 40 brain metastases that received multiple courses of SRS were retrospectively studied. Magnetic resonance scans from repeat SRS (rMR) courses were registered to CT scans from the initial SRS (iCT) and repeat SRS (rCT). The CT scans were then registered to find the displacement of the rMR between iCT and rCT registrations. The distance from each target to proximal skull surface was measured in 16 directions on each CT scan after registration. The mutual information (MI) coefficients from the registration process were used to evaluate image set similarity. Targets and plans from the rCTs were transferred to the iCTs, and doses were recalculated on the iCT for repeat plans. The two dose distributions were compared through 3D gamma analysis. RESULTS: The magnitude of the mean linear translations from the MR registrations was 0.6 ± 0.3 mm. The mean differences in distance from target to skull on a per target basis were 0.3 ± 0.2 mm. The MI was 0.582 ± 0.042. Registration between a comparison group of 30 CT scans that had the same data resampled and 30 scans that were intercompared with different patients gave MI = 0.721 ± 0.055 and MI = 0.359 ± 0.031, respectively. The mean gamma passing rates were 0.997 ± 0.007 for 1 mm/1% criteria. CONCLUSIONS: The rMR can be aligned to the iCT to accurately define targets. The skull shows minimal change between scans so the iCT can be used for set-up at repeat treatments. The dosimetry provided by the iCT dose calculation is adequate for repeat SRS. Treatment based on iCT is feasible.

Evaluating betterment projects.

In the past decade Australia has experienced a series of large-scale, severe natural disasters including catastrophic bushfires, widespread and repeated flooding, and intense storms and cyclones. There appears to be a prima facie case for rebuilding damaged infrastructure to a more disaster resilient (that is, to 'betterment') standard. The purpose of this paper is to develop and illustrate a consistent and readily applied method for advancing proposals for the betterment of essential public assets, which can be used by governments at all levels to determine the net benefits of such proposals. Case study results demonstrate that betterment investments have the potential to deliver a positive economic return across a range of asset types and regions. Results, however, are highly sensitive to underlying assumptions; in particular the probability of the natural disaster affecting the infrastructure in the absence of betterment.

Triad influence on the detection of crime in Hong Kong.

We use bootstrap data envelopment analysis, adjusting for endogeneity, to examine police efficiency in detecting crime in Hong Kong. We address the following: (i) is there a correlation between the detection of crime and triad influence? (ii) does the level of triad influence affect the efficiency in translating inputs (police strength) into outputs (crime detection)? and (iii) how can the allocation of policing resources be adjusted to improve crime detection? We find that nighty-eight percent of Hong Kong police districts in our sample were found to be inefficient in the detection of crime. Variation was found across districts regarding the detection of violent, property and other crimes. Most inefficiencies and potential improvements in the detection of crime were found in the categories violent and other crimes. We demonstrate how less efficient police districts can modify police resourcing decisions to better detect certain crime types while maintaining current levels of resourcing. Finally, we highlight how the method we outline improves efficiency estimation by adjusting for endogeneity and measuring the conditional efficiency of each district (i.e. the efficiency of crime detection taking the instrumental variables (e.g. influence of triads) into consideration). The use of frontier models to assist in evaluating policing performance can lead to improved efficiency, transparency, and accountability in law enforcement, ultimately resulting in better public safety outcomes and publicly funded resource allocation.

A method and app for measuring the heterogeneous costs and benefits of justice processes.

Can the impact of justice processes be enhanced with the inclusion of a heterogeneous component into an existing cost-benefit analysis (CBA) APP that demonstrates how benefactors and beneficiaries are affected? Such a component requires: (i) moving beyond the traditional cost benefit conceptual framework of utilising averages; (ii) identification of social group or population-specific variation; (iii) identification of how justice processes differ across groups/populations; (iv) distribution of costs and benefits according to the identified variations; and (v) utilisation of empirically informed statistical techniques to gain new insights from data and maximise impact to beneficiaries. In this paper, we outline a method for capturing heterogeneity. We test our method and the CBA online APP we developed using primary data collected from a developmental crime prevention intervention in Australia. We identify how subgroups in the intervention display different behavioural adjustments across the reference period revealing the heterogeneous distribution of costs and benefits. Finally, we discuss the next version of the CBA APP, which incorporates an AI-driven component that reintegrates individual CBA projects using machine learning and other modern data science techniques. We argue that the APP, enhances CBA, development outcomes, and policy making efficiency for optimal prioritization of criminal justice resources. Further, the APP advances policy accessibility of enhanced, social group-specific data illuminating policy orientation for more inclusive, just, and resilient societal outcomes.

Corrigendum: A method and app for measuring the heterogeneous costs and benefits of justice processes.

[This corrects the article DOI: 10.3389/fpsyg.2023.1094303.].

Ethnic Economic Inequality and Fatalities From Terrorism.

Few studies have explored the influence of horizontal (i.e., among group) inequalities on terrorism, yet it seems plausible that these inequalities may be relevant. Employing data from the Global Terrorism Database and Ethnologue, this article examines the effect of ethnic economic inequality on domestic terrorism for 130 countries over the period 2001 to 2018. We present evidence that higher degrees of ethnic inequality lead to higher numbers of terrorist attacks as well as a higher number of people killed or injured. This positive association between ethnic inequality and terrorism is robust to alternative measures of ethnic inequality, omission of influential countries and regions, the inclusion and exclusion of controls, and alternative estimation strategies. In contrast, countries with high degree of political freedom and high governance quality tend to suffer less from terrorism. Promoting economic equality among ethnic groups, therefore, has the potential to reduce the risk of domestic terrorism. We propose that a critical step towards promoting this equality is to enhance social inclusion. The benefits of increasing social inclusion extend beyond simply reducing the incidence of terrorism and inter-racial violence; creating a socially inclusive society is a social justice imperative and the responsibility of policymakers, social institutions, civil society, and the private sector. It is also consistent with the notion of inclusive economic growth, as championed by organizations such as the OECD and the United Nations Development Program.

Gold nanoparticle design for RNA compaction.

RNA-based therapeutics hold a great promise in treating a variety of diseases. However, double-stranded RNAs (dsRNAs) are inherently unstable, highly charged, and stiff macromolecules that require a delivery vehicle. Cationic ligand functionalized gold nanoparticles (AuNPs) are able to compact nucleic acids and assist in RNA delivery. Here, we use large-scale all-atom molecular dynamics simulations to show that correlations between ligand length, metal core size, and ligand excess free volume control the ability of nanoparticles to bend dsRNA far below its persistence length. The analysis of ammonium binding sites showed that longer ligands that bind deep within the major groove did not cause bending. By limiting ligand length and, thus, excess free volume, we have designed nanoparticles with controlled internal binding to RNA's major groove. NPs that are able to induce RNA bending cause a periodic variation in RNA's major groove width. Density functional theory studies on smaller models support large-scale simulations. Our results are expected to have significant implications in packaging of nucleic acids for their applications in nanotechnology and gene delivery.

Financial Fraud against Older People in Hong Kong: Assessing and Predicting the Fear and Perceived Risk of Victimization.

While the majority of studies on the fear of crime focus on the impact of violent and property crimes at the population level, financial fraud against senior citizens is often under-investigated. This study uses data collected from 1061 older citizens in the community through a cross-sectional survey in Hong Kong to examine the levels of fear and perceived risk among Chinese senior citizens toward financial fraud and the factors behind them. Logistic regression analyses were conducted to assess the explanatory power of four theoretical perspectives (vulnerability, victimization, social integration, and satisfaction with police) on fear and perceived risk of fraud victimization. The results indicate significant predictive effects of victimization experience and satisfaction with police fairness and integrity on both the fear and the perceived risk of fraud among respondents. The findings not only confirm the differential impact of theoretical explanations on these constructs but can also contribute to crime prevention policy and practice in an aging society.

Effect of an Antiracism Intervention on Racial Disparities in Time to Lung Cancer Surgery.

PURPOSE: Timely lung cancer surgery is a metric of high-quality cancer care and improves survival for early-stage non-small-cell lung cancer. Historically, Black patients experience longer delays to surgery than White patients and have lower survival rates. Antiracism interventions have shown benefits in reducing racial disparities in lung cancer treatment. METHODS: We conducted a secondary analysis of Accountability for Cancer Care through Undoing Racism and Equity, an antiracism prospective pragmatic trial, at five cancer centers to assess the impact on overall timeliness of lung cancer surgery and racial disparities in timely surgery. The intervention consisted of (1) a real-time warning system to identify unmet care milestones, (2) race-specific feedback on lung cancer treatment rates, and (3) patient navigation. The primary outcome was surgery within 8 weeks of diagnosis. Risk ratios (RRs) and 95% CIs were estimated using log-binomial regression and adjusted for clinical and demographic factors. RESULTS: A total of 2,363 patients with stage I and II non-small-cell lung cancer were included in the analyses: intervention (n = 263), retrospective control (n = 1,798), and concurrent control (n = 302). 87.1% of Black patients and 85.4% of White patients in the intervention group (P = .13) received surgery within 8 weeks of diagnosis compared with 58.7% of Black patients and 75.0% of White patients in the retrospective group (P < .01) and 64.9% of Black patients and 73.2% of White patients (P = .29) in the concurrent group. Black patients in the intervention group were more likely to receive timely surgery than Black patients in the retrospective group (RR 1.43; 95% CI, 1.26 to 1.64). White patients in the intervention group also had timelier surgery than White patients in the retrospective group (RR 1.10; 95% CI, 1.02 to 1.18). CONCLUSION: Accountability for Cancer Care through Undoing Racism and Equity is associated with timelier lung cancer surgery and reduction of the racial gap in timely surgery.

The Effect of the Moscow Theatre Siege on Expectations of Well-Being in the Future.

We employ the Russia Longitudinal Monitoring Survey-Higher School of Economics (RLMS-HSE), a survey of 6,000 individuals, and a difference-in-differences estimation strategy to examine the effect of the 2002 Moscow theatre siege on the level of self-reported expectations of life in the future of the Russian population. The longitudinal nature of the data allows us to explore both the short- and long-term effects of terrorism on this population as well as contribute to the limited number of quasi-experimental studies in this area. By focusing on expectations of life in the future, we broaden our understanding of the social consequences of terrorism. Controlling for a range of sociodemographic variables including self-assessed relative income, our findings suggest that the well-being effects of terrorism are complex and the net effect of a terrorism incident on well-being may not necessarily be negative. This can be explained, at least in part, by the theory of posttraumatic growth-a theory that refers to the positive psychological change experienced as a result of adversity, with terrorism incidents inadvertently promoting more meaningful interpersonal relationships, new views of the self and new views of the world. That is not to suggest that terrorism is a positive phenomenon-rather, that individuals have a lifelong plasticity rendering them capable of recovery from adversity. The primary objectives of terrorists, therefore, are unlikely to be fully achieved. It is hoped that our research allows for the development of more refined policies that aim to encourage posttraumatic growth while simultaneously attempting to minimize posttraumatic stress disorder. This may involve engaging with the psychological community to devise policies and programs that target those in the population who are most vulnerable and for these groups devise strategies to enhance their psychological resilience following a terrorist (or other traumatic) event.

Expanding the Reach of an Evidence-Based, System-Level, Racial Equity Intervention: Translating ACCURE to the Maternal Healthcare and Education Systems.

The abundance of literature documenting the impact of racism on health disparities requires additional theoretical, statistical, and conceptual contributions to illustrate how anti-racist interventions can be an important strategy to reduce racial inequities and improve population health. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) was an NIH-funded intervention that utilized an antiracism lens and community-based participatory research (CBPR) approaches to address Black-White disparities in cancer treatment completion. ACCURE emphasized change at the institutional level of healthcare systems through two primary principles of antiracism organizing: transparency and accountability. ACCURE was successful in eliminating the treatment completion disparity and improved completion rates for breast and lung cancer for all participants in the study. The structural nature of the ACCURE intervention creates an opportunity for applications in other health outcomes, as well as within educational institutions that represent social determinants of health. We are focusing on the maternal healthcare and K-12 education systems in particular because of the dire racial inequities faced by pregnant people and school-aged children. In this article, we hypothesize cross-systems translation of a system-level intervention exploring how key characteristics of ACCURE can be implemented in different institutions. Using core elements of ACCURE (i.e., community partners, milestone tracker, navigator, champion, and racial equity training), we present a framework that extends ACCURE's approach to the maternal healthcare and K-12 school systems. This framework provides practical, evidence-based antiracism strategies that can be applied and evaluated in other systems to address widespread structural inequities.

Preoperative Radiosurgery for Resected Brain Metastases: The PROPS-BM Multicenter Cohort Study.

PURPOSE: Preoperative radiosurgery (SRS) is a feasible alternative to postoperative SRS, with potential benefits in adverse radiation effect (ARE) and leptomeningeal disease (LMD) relapse. However, previous studies are limited by small patient numbers and single-institution designs. Our aim was to evaluate preoperative SRS outcomes and prognostic factors from a large multicenter cohort (Preoperative Radiosurgery for Brain Metastases [PROPS-BM]). METHODS AND MATERIALS: Patients with brain metastases (BM) from solid cancers who had at least 1 lesion treated with preoperative SRS and underwent a planned resection were included from 5 institutions. SRS to synchronous intact BM was allowed. Radiographic meningeal disease (MD) was categorized as either nodular or classical "sugarcoating" (cLMD). RESULTS: The cohort included 242 patients with 253 index lesions. Most patients (62.4%) had a single BM, 93.7% underwent gross total resection, and 98.8% were treated with a single fraction to a median dose of 15 Gray to a median gross tumor volume of 9.9 cc. Cavity local recurrence (LR) rates at 1 and 2 years were 15% and 17.9%, respectively. Subtotal resection (STR) was a strong independent predictor of LR (hazard ratio, 9.1; P < .001). One and 2-year rates of MD were 6.1% and 7.6% and of any grade ARE were 4.7% and 6.8% , respectively. The median overall survival (OS) duration was 16.9 months and the 2-year OS rate was 38.4%. The majority of MD was cLMD (13 of 19 patients with MD; 68.4%). Of 242 patients, 10 (4.1%) experienced grade ≥3 postoperative surgical complications. CONCLUSIONS: To our knowledge, this multicenter study represents the largest cohort treated with preoperative SRS. The favorable outcomes previously demonstrated in single-institution studies, particularly the low rates of MD and ARE, are confirmed in this expanded multicenter analysis, without evidence of an excessive postoperative surgical complication risk. STR, though infrequent, is associated with significantly worse cavity LR. A randomized trial between preoperative and postoperative SRS is warranted and is currently being designed.

Leptomeningeal disease and neurologic death after surgical resection and radiosurgery for brain metastases: A multi-institutional analysis.

PURPOSE: Postoperative stereotactic radiosurgery (SRS) is associated with up to 30% risk of subsequent leptomeningeal disease (LMD). Radiographic patterns of LMD (classical sugarcoating [cLMD] vs. nodular [nLMD]) in this setting has been shown to be prognostic. However, the association of these findings with neurologic death (ND) is not well described. METHODS AND MATERIALS: The records for patients with brain metastases who underwent surgical resection and adjunctive SRS to 1 lesion (SRS to other intact lesions was allowed) and subsequently developed LMD were combined from 7 tertiary care centers. Salvage radiation therapy (RT) for LMD was categorized according to use of whole-brain versus focal cranial RT. RESULTS: The study cohort included 125 patients with known cause of death. The ND rate in these patients was 79%, and the rate in patients who underwent LMD salvage treatment (n = 107) was 76%. Univariate logistic regression demonstrated radiographic pattern of LMD (cLMD vs. nLMD, odds ratio: 2.9; P = .04) and second LMD failure after salvage treatment (odds ratio: 3.9; P = .02) as significantly associated with ND. The ND rate was 86% for cLMD versus 68% for nLMD. Whole-brain RT was used in 95% of patients with cLMD and 52% with nLMD. In the nLMD cohort (n = 58), there was no difference in ND rate based on type of salvage RT (whole-brain RT: 67% vs. focal cranial RT: 68%, P = .92). CONCLUSIONS: LMD after surgery and SRS for brain metastases is a clinically significant event with high rates of ND. Classical LMD pattern (vs. nodular) and second LMD failure after salvage treatment were significantly associated with a higher risk of ND. Patients with nLMD treated with salvage focal cranial RT did not have higher ND rates compared with WBRT. Methods to decrease LMD and the subsequent high risk of ND in this setting warrant further investigation.

Proposed Hydrogel-Implant Quality Score and a Matched-Pair Study for Prostate Radiation Therapy.

PURPOSE: SpaceOAR hydrogel has been Food and Drug Administration approved to reduce rectal toxicity in prostate radiation therapy. Training and certification for this procedure is performed by the manufacturer, without independent quality measures. We propose a Hydrogel-Implant Quality Score (HIQS) as a surrogate to quantify hydrogel placement accuracy, to assist clinicians in tracking their implant proficiency, and to support quality improvement. A matched-pair study was designed to investigate the benefit of SpaceOAR in rectal dose reduction for low-dose-rate brachytherapy and to validate the principle of the proposed HIQS. METHODS: Eighty-one prostate patients were retrospectively selected for this study. Each patient had SpaceOAR implantation under manufacturer supervision. Postprocedure computed tomography and T2-weighted magnetic resonance imaging were acquired for radiation planning. A HIQS system was proposed to evaluate the hydrogel placement quality. Hydrogel implantation was performed immediately after LDR seed placement. For each LDR patient, a non-SpaceOAR patient was matched based upon intraoperative rectal dose and prostate coverage. Intraoperative and postoperative rectal dose reduction was compared between SpaceOAR and non-SpaceOAR groups. RESULTS: The average HIQS was 77 ± 10.8 (range, 49-97). Rectal anatomic distortions were seen in 17 cases. Significant rectal dose reductions between intraoperative and postoperative plans were found for SpaceOAR patients compared with non-SpaceOAR patients (25.1 Gy vs -5.0 Gy for ΔD2cc and 65.7 Gy vs 13.0 for ΔD0.1cc). Additional rectal dose reductions (8.4 Gy for ΔD2cc and 12.7 Gy for ΔD0.1cc) were found for patients without rectal distortion when SpaceOAR was used. CONCLUSIONS: The proposed HIQS system measured the hydrogel placement quality and provided insights into clinician learning and DVH outcome. SpaceOAR was shown to be effective in reducing rectal dose for LDR patients.

The impact of IoT security labelling on consumer product choice and willingness to pay.

The Internet of Things (IoT) brings internet connectivity to everyday electronic devices (e.g. security cameras and smart TVs) to improve their functionality and efficiency. However, serious security and privacy concerns have been raised about the IoT which impact upon consumer trust and purchasing. Moreover, devices vary considerably in terms of the security they provide, and it is difficult for consumers to differentiate between more and less secure devices. One proposal to address this is for devices to carry a security label to help consumers navigate the market and know which devices to trust, and to encourage manufacturers to improve security. Using a discrete choice experiment, we estimate the potential impact of such labels on participant's purchase decision making, along with device functionality and price. With the exception of a label that implied weak security, participants were significantly more likely to select a device that carried a label than one that did not. While they were generally willing to pay the most for premium functionality, for two of the labels tested, they were prepared to pay the same for security and functionality. Qualitative responses suggested that participants would use a label to inform purchasing decisions, and that the labels did not generate a false sense of security. Our findings suggest that the use of a security label represents a policy option that could influence behaviour and that should be seriously considered.

Evaluating Potential Racial Inequities in Low-dose Computed Tomography Screening for Lung Cancer.

BACKGROUND: Lung cancer is the leading cause of cancer death in the US, and significant racial disparities exist in lung cancer outcomes. For example, Black men experience higher lung cancer incidence and mortality rates than their White counterparts. New screening recommendations for low-dose computed tomography (LDCT) promote earlier detection of lung cancer in at-risk populations and can potentially help mitigate racial disparities in lung cancer mortality if administered equitably. Yet, little is known about the extent of racial differences in uptake of LDCT. OBJECTIVE: To evaluate potential racial disparities in LDCT screening in a large community-based cancer center in central North Carolina. METHODS: We conducted a retrospective study of the initial patients undergoing LDCT in a community-based cancer center (n = 262). We used the Pearson chi-squared test to assess potential racial disparities in LDCT screening. RESULTS: Study results suggest that Black patients may be less likely than White patients to receive LDCT screening when eligible (χ2 = 51.41, p < 0.0001). CONCLUSION: Collaboration among healthcare providers, researchers, and decision makers is needed to promote LDCT equity.

A Multi-faceted Intervention Aimed at Black-White Disparities in the Treatment of Early Stage Cancers: The ACCURE Pragmatic Quality Improvement trial.

BACKGROUND: Reports continue to show that Blacks with curable lung or breast cancer complete treatment less often than similar Whites contributing to worse survival. ACCURE is an intervention trial designed to address this problem. PATIENTS AND METHODS: A pragmatic, quality improvement trial comparing an intervention group to retrospective and concurrent controls. Patients with early stage breast or lung cancer aged 18 to 85 were enrolled (N = 302) at 2 cancer centers between April 2013 and March 2015 for the intervention component. Data from patients seen between January 2007 and December 2012 with these diagnoses were obtained to establish control completion rates. Concurrent data for non-study patients were used to identify secular trends. The intervention included: a real time registry derived from electronic health records of participants to signal missed appointments or unmet care milestones, a navigator, and clinical feedback. The primary outcome was "Treatment Complete", a composite variable representing completion of surgery, recommended radiation and chemotherapy for each patient. RESULTS: The mean age in the intervention group was 63.1 years; 37.1% of patients were Black. Treatment completion in retrospective and concurrent controls showed significant Black-White differences (Blacks (B) 79.8% vs. Whites (W) 87.3%, p < 0.001; 83.1% B vs. 90.1% W, p < 0.001, respectively). The disparity lessened within the intervention (B 88.4% and W 89.5%, p = 0.77). Multivariate analyses confirmed disparities reduction. OR for Black-White disparity within the intervention was 0.98 (95% CI 0.46-2.1); Black completion in the intervention compared favorably to Whites in retrospective (OR 1.6; 95% CI 0.90-2.9) and concurrent (OR 1.1; 95% CI 0.59-2.0) controls. CONCLUSION: A real time registry combined with feedback and navigation improved completion of treatment for all breast and lung cancer patients and narrowed disparities. Similar multi-faceted interventions could mitigate disparities in the treatment of other cancers and chronic conditions.