Preparing for the unexpected: Recommendations for returning secondary findings in late-stage cancer care.

PURPOSE: We conducted qualitative interviews with patients with cancer and providers to identify gaps in clinical care and highlight care delivery solutions for the return of secondary germline findings. METHODS: Twelve patients and 19 cancer providers from the United States were interviewed between January 2019 and May 2021. Interviews elicited feedback about patient information needs, emotional responses to secondary findings, and recommendations for improving pre-test education. RESULTS: Patients' responses ranged from gratitude to regret, depending on how much pre-test counseling they received before tumor testing. Providers cited insufficient clinic time as a major barrier to pretest education, favoring online support tools and standardized pre-test education models. Providers had differing perspectives on how pre-test education should be integrated into clinical workflows but agreed that it should include the differences between somatic and germline testing, the likelihood of medically actionable findings, and the possibility of being referred to a genetics provider. CONCLUSION: The spectrum of participants' responses to their secondary findings underscores the importance of adequate pre-test discussions before somatic sequencing. Although educational interventions could address patients' information needs and augment traditional pre-test counseling, health care systems, labs, and genetic providers may be called on to play greater roles in pre-test education.

CTH:YAG : from laser medium to luminescent concentrator.

This work presents what we believe is a new way to use a CTH:YAG crystal for spontaneous emission instead of laser emission. The spontaneous emission is collected in one main direction thanks to a luminescent concentrator configuration. The CTH:YAG is indirectly LED-pumped by a Ce:YAG delivering 3.5 ms pulses at 10 Hz with an energy of 2 J in the visible (550-650 nm). In a configuration optimized for light extraction, the CTH:YAG luminescent concentrator provides a broadband emission between 1.8 µm and 2.1 µm with a unique combination of power (1 W) and brightness (21.2 W/cm2/sr) that could be useful for short-wave infrared (SWIR) lighting applications.

LED-pumped Er:Cr:YSGG light sources.

For, what we believe is, the first time, an Er:Cr:YSGG crystal is pumped by LEDs through a Ce:YAG luminescent concentrator. We demonstrate both laser emission at 2.79 µm and strong spontaneous emission at 1.6 µm. The luminescent concentrator delivers 1.5 ms pulses at 10 Hz in the visible (550-650 nm) to the Er:Cr:YSGG crystal, in a transverse pumping configuration. The Er:Cr:YSGG laser produces up to 6.8 mJ at 2.79 µm in a biconcave cavity. The Er:Cr:YSGG also stands out as a bright broadband incoherent source around 1.6 µm with a unique combination of peak power (351 mW) and brightness (1.4 W/sr/cm2).

Secondary syphilis presenting as leukocytoclastic vasculitis in a 61-year-old man.

Cutaneous lesions of secondary syphilis are highly infectious and can mimic many skin disorders, making the diagnosis more difficult. They typically present as generalized, nonpruritic erythematous-to-copper-colored macules and papules, characteristically involving palms and soles. In 80% of patients the rash develops insidiously. However, rare forms of secondary syphilis present as rapidly progressive papulopustular lesions. These forms of syphilis are usually associated with human immunodeficiency virus infection and immunosuppression. We report a case of secondary syphilis presenting with an acute, rapidly progressive purpuric eruption mimicking leukocytoclastic vasculitis. A 61-year-old man presented with a 6-day history of nonpruritic rash on his chest and lower extremities associated with fatigue, sore throat, and night sweats. Examination revealed purpuric papules, extending from the dorsal feet to the hips; mucosal surfaces were not involved. A diagnosis of cutaneous small-vessel vasculitis was favored with possible triggers of IgA vasculitis. Initial work-up showed acute kidney injury and microscopic hematuria. Renal biopsy showed IgA nephropathy with mesangioproliferative glomerulonephritis. The patient's rash progressed to cover almost his entire body sparing palms and soles. Skin biopsy showed heavy perivascular lymphoplasmacytic infiltrate, capillary endothelial cell swelling, and sparse perivascular neutrophilic nuclear dust. Spirochetal stain highlighted scattered epidermal and dermal organisms.

Recall of Genomic Testing Results Among Patients with Cancer.

BACKGROUND: Genomic testing of somatic and germline DNA has transformed cancer care. However, low genetic knowledge among patients may compromise care and health outcomes. Given the rise in genomic testing, we sought to understand patients' knowledge of their genetic test results. MATERIALS AND METHODS: We conducted a survey-based study with 85 patients at a comprehensive cancer center. We compared self-reported recall of (a) having had somatic/germline testing and (b) their specific somatic/germline results to the genomic test results documented in the medical record. RESULTS: Approximately 30% of patients did not recall having had testing. Of those who recalled having testing, 44% of patients with pathogenic/likely pathogenic germline mutations and 57% of patients with reported somatic alterations did not accurately recall their specific gene or variant-level results. CONCLUSION: Given significant knowledge gaps in patients' recall of genomic testing, there is a critical need to improve patient-directed education and return-of-results strategies.

Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study.

OBJECTIVE: To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment. DESIGN: Prospective cohort study. SETTING: A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands. PARTICIPANTS: A consecutive sample of patients with symptomatic CMC-1 instability (N=431). INTERVENTION: Nonsurgical treatment including exercise therapy and an orthosis. MAIN OUTCOME MEASURES: Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y). RESULTS: VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P<.001). No difference was present at 3 months for MHQ total score, but the subscales activities of daily living, work, pain, and satisfaction improved by 7 (97.5% CI, 1-14), 10 (97.5% CI, 4-16), 5 (97.5% CI, 2-9), and 12 (97.5% CI, 2-22) points, respectively (P<.001-.007). After median follow-up of 2.8 years, only 59 participants (14%) were surgically treated. Both in the subgroups that did and did not convert to surgery, VAS pain scores decreased at 3 months compared with baseline (P<.001-.010), whereas MHQ total score did not improve in both subgroups. However, VAS and MHQ scores remained worse for patients who eventually converted to surgery (P<.001). CONCLUSIONS: In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that nonsurgical treatment is a successful treatment of choice.

Variations in Classroom Language Environments of Preschool Children Who Are Low Income and Linguistically Diverse.

RESEARCH FINDINGS: This study aimed to (a) provide an in-depth description of the frequency and type of language interactions that children who are low-income and/or dual language learners (DLL) experience in their classrooms and (b) examine whether differenceFor instance, in a randomized control trial with 461 first grade s exist in children's language experiences based on children's DLL status and level of English proficiency. Using the Language Interaction Snapshot, we observed four focal children in each of 72 early childhood classrooms: one monolingual English-speaking child (i.e., non-DLL), one Spanish-dominant DLL child, and two bilingual Spanish-English DLL children. Findings indicate that both lead and assistant teachers predominantly spoke in English and implemented few evidence-based language practices. Children spoke more often to peers than to teachers. Little variation was noted in the quality of the language environment for children based on their DLL status or language proficiency. PRACTICE: Results suggest clear directions for professional development (PD). PD must include both lead and assistant teachers and should focus on evidence-based language strategies for facilitating children's language development, including how to effectively teach DLLs. Teachers may also benefit from PD that supports use of small group activity and peer strategies.

Determinants in HIV-2 Env and tetherin required for functional interaction.

BACKGROUND: The interferon-inducible factor BST-2/tetherin blocks the release of nascent virions from the surface of infected cells for certain enveloped virus families. The primate lentiviruses have evolved several counteracting mechanisms which, in the case of HIV-2, is a function of its Env protein. We sought to further understand the features of the Env protein and tetherin that are important for this interaction, and to evaluate the selective pressure on HIV-2 to maintain such an activity. RESULTS: By examining Env mutants with changes in the ectodomain of the protein (virus ROD14) or the cytoplasmic tail (substitution Y707A) that render the proteins unable to counteract tetherin, we determined that an interaction between Env and tetherin is important for this activity. Furthermore, this Env-tetherin interaction required an alanine face in the tetherin ectodomain, although insertion of this domain into an artificial tetherin-like protein was not sufficient to confer sensitivity to the HIV-2 Env. The replication of virus carrying the ROD14 substitutions was significantly slower than the matched wild-type virus, but it acquired second-site mutations during passaging in the cytoplasmic tail of Env which restored the ability of the protein to both bind to and counteract tetherin. CONCLUSIONS: These results shed light on the interaction between HIV-2 and tetherin, suggesting a physical interaction that maps to the ectodomains of both proteins and indicating a strong selection pressure to maintain an anti-tetherin activity in the HIV-2 Env.

A case report of crusted scabies in an adult patient with Down syndrome.

IMPORTANCE: Crusted (Norwegian) scabies is a severe manifestation of the contagious skin infection caused by Sarcoptes scabiei. Crusted scabies has been well described in patients with known immunocompromised states. Treatment may be complicated by delayed diagnosis and/or inadequate treatment. This infection may not rank highly on one's differential diagnosis in the absence of an immunocompromised state, highlighting the uniqueness of the case being presented. Several papers describe immunocompromised children with Down syndrome who are infected with crusted scabies. We present a case of infection in an adult with Down syndrome without evidence of an immunocompromised state. OBSERVATIONS: Our patient came to us with a 13-month history of progressively worsening symptoms, the last 4-6 weeks of that time period being most dramatic, despite various treatments. We performed tissue biopsy, culture, and laboratory evaluations, which revealed numerous mites and bacterial superinfection. CONCLUSIONS AND RELEVANCE: Crusted scabies infection may occur in adult age individuals with Down syndrome regardless of immune status, leading us to encourage practitioners to consider this condition when presented with patients of this population. We also highlight the need for further exploration of disease prevalence in this patient population.

Depression, Control, and Climate: An Examination of Factors Impacting Teaching Quality in Preschool Classrooms.

RESEARCH FINDINGS: This study investigated the relationship of preschool teachers' self-reported depressive symptomatology, perception of classroom control, and perception of school climate to classroom quality as measured by the Classroom Assessment Scoring System Pre-K. The sample consisted of 59 urban preschool classrooms serving low-income and linguistically diverse students in the northeastern and southeastern United States. Results of hierarchical linear modeling revealed that teachers' individual reports of depressive symptomatology were significantly and negatively predictive of the observed quality of their instructional support and classroom organization. PRACTICE OR POLICY: The findings of this study have implications for increasing access to mental health supports for teachers in an effort to minimize depressive symptoms and potentially improve classroom quality.

Ameloblastic Carcinoma of the Maxilla With Uncommon Sinus Manifestations.

Ameloblastic carcinoma (AC) represents a distinct challenge in the realm of odontogenic malignancies due to its rarity and aggressive nature. We present a unique case of AC in a 70-year-old male, retired dry cleaner, with symptoms initially suggestive of chronic allergic rhinitis and recurrent acute sinusitis with asymmetric facial edema and paresthesia. Detailed evaluation revealed a prominent mass in the right maxillary sinus with extensive cortical destruction. Pathological assessment post-right maxillectomy identified a high-grade AC with malignant spindle cell transformation. The patient underwent subsequent interventions, including neck dissection and radiation therapy. Twelve months post-presentation, the patient was recovering appropriately without evidence of recurrence of malignancy. This case highlights the diagnostic challenges posed by AC as well as its unique presentations emphasizing the importance of a comprehensive approach and multidisciplinary management. It also raises considerations about potential chemical exposure implications in AC development.

Factors associated with attitudes toward research MRI in older Asian Americans.

INTRODUCTION: South Asian (SA) and East Asian (EA) older adults represent the fastest-growing racial/ethnic groups of Americans at risk for dementia. While recruiting older SA adults into a brain health study, we encountered unexpected hesitancy toward structural brain magnetic resonance imaging (MRI) analysis and stigmatizing attitudes related to internal locus of control (LoC) for future dementia risks. We hypothesized that support for MRI-related research was influenced by these attitudes as well as personal MRI experience, perceived MRI safety, and concerns for personal risk for future dementia/stroke. METHODS: We developed a brief cross-sectional survey to assess older adults' MRI experiences and perceptions, desire to learn of six incidental findings of increasing impact on health, and attitudes related to dementia (including LoC) and research participation. We recruited a convenience sample of 256 respondents (74% reporting as 50+) from the New Jersey/New York City area to complete the survey (offered in English, Chinese, Korean, and Spanish) and modeled the proportional odds (PO) for favorable attitudes toward research activities. RESULTS: Seventy-seven SA and 84 EA respondents were analyzed alongside 95 White, Black, or Hispanic adults. White (PO = 2.54, p = 0.013) and EA (PO = 2.14, p = 0.019) respondents were both more likely than SA respondents to endorse healthy volunteers' participation in research, and the difference between White and SA respondents was mediated by the latter's greater internal LoC for dementia risks. EA respondents had more worries for future dementia/stroke than SA respondents (p = 0.006) but still shared SA respondents' lower wish (measured by proportion of total) to learn of incidental MRI findings. DISCUSSION: SA-and EA compared to SA-older adults had low desire to learn of incidental MRI findings but had different attitudes toward future dementia/stroke risks. A culturally appropriate protocol to disclose incidental MRI findings may improve SA and EA participation in brain health research. Highlights: Older Asian Americans have limited interest in incidental findings on research MRISouth Asians are most likely to attribute dementia to people's own behaviorsSouth Asians' attitudes mediate lower support for healthy volunteers in researchSouth and East Asians differ in dementia worries and research-related attitudes.

Anti-tetherin activities of HIV-1 Vpu and Ebola virus glycoprotein do not involve removal of tetherin from lipid rafts.

BST-2/tetherin is an interferon-inducible host restriction factor that blocks the release of newly formed enveloped viruses. It is enriched in lipid raft membrane microdomains, which are also the sites of assembly of several enveloped viruses. Viral anti-tetherin factors, such as the HIV-1 Vpu protein, typically act by removing tetherin from the cell surface. In contrast, the Ebola virus glycoprotein (GP) is unusual in that it blocks tetherin restriction without apparently altering its cell surface localization. We explored the possibility that GP acts to exclude tetherin from the specific sites of virus assembly without overtly removing it from the cell surface and that lipid raft exclusion is the mechanism involved. However, we found that neither GP nor Vpu had any effect on tetherin's distribution within lipid raft domains. Furthermore, GP did not prevent the colocalization of tetherin and budding viral particles. Contrary to previous reports, we also found no evidence that GP is itself a raft protein. Together, our data indicate that the exclusion of tetherin from lipid rafts is not the mechanism used by either HIV-1 Vpu or Ebola virus GP to counteract tetherin restriction.

Azithromycin as a Possible Cause of Linear IgA Bullous Dermatosis.

We present a rare case of linear IgA bullous dermatosis (LABD) in a 72-year-old male associated with the use of azithromycin. LABD presents as subepidermal blisters due to IgA antibodies targeting BPAG2, a component of hemidesmosomes. LABD is a rare diagnosis and may be idiopathic, associated with illness, or medication-induced. The patient experienced a rash five days after completing a course of azithromycin for pneumonia. The diagnosis of LABD was confirmed with a biopsy and direct immunofluorescence. Lesions resolved over two weeks with an oral prednisone taper and topical clobetasol. This case represents just one of two previously reported cases in the literature of azithromycin-associated LABD. While LABD is well known to be induced by certain medications, this is only the second report of it being associated with the use of a macrolide. We propose that macrolides be included as a potential cause of medication-induced LABD.

Ce:LYSO, from scintillator to solid-state lighting as a blue luminescent concentrator.

Cerium-doped lutetium-yttrium oxyorthosilicate (Ce:LYSO) is a well-known single crystal scintillator used in medical imaging and security scanners. Recent development of high power UV LED, matching its absorption band, questions the possibility to use Ce:LYSO in a new way: as LED-pumped solid-state light source. Since Ce:LYSO is available in large size crystals, we investigate its potential as a luminescent concentrator. This paper reports an extensive study of the performance in close relation to the spectroscopic properties of this crystal. It gives the reasons why the Ce:LYSO crystal tested in this study is less efficient than Ce:YAG for luminescent concentration: limited quantum efficiency and high losses coming from self-absorption and from excited-state absorption are playing key roles. However, we demonstrate that a Ce:LYSO luminescent concentrator is an innovative source for solid-state lighting. Pumped by a peak power of 3400 W in quasi-continuous wave regime (40 µs, 10 Hz), a rectangular (1 × 22 × 105 mm3) Ce:LYSO crystal delivers a broadband spectrum (60 nm FWHM) centered at 430 nm. At full output aperture (20 × 1 mm2), it emits a peak power of 116 W. On a squared output surface (1 × 1 mm2) it emits 16 W corresponding to a brightness of 509 W cm-2 sr-1. This combination of spectrum power and brightness is higher than blue LEDs and opens perspectives for Ce:LYSO in the field of illumination namely for imaging.

Long-Term Outcomes of Nonsurgical Treatment of Thumb Carpometacarpal Osteoarthritis: A Cohort Study.

BACKGROUND: Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we investigated patient-reported pain and limitations in activities of daily living (ADL) at >5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at >5 years of follow-up and the rate of conversion to surgery. METHODS: This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and >5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217). RESULTS: At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval [CI],1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At >5 years, 5% of the patients rated their satisfaction as "poor," 14% as "moderate," 26% as "fair," 39% as "good," and 16% as "excellent." The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years). CONCLUSIONS: We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable. LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

Too much information? Asian Americans' preferences for incidental brain MRI findings.

INTRODUCTION: South Asian (SA) and East Asian (EA) older adults represent the fastest growing group of Americans at risk for dementia, but their participation in aging and dementia research has been limited. While recruiting healthy SA older adults into a brain health study, we encountered unexpected hesitancy towards structural brain MRI analysis along with some stigmatizing attitudes related to internal locus of control (LoC) for future dementia risks. We hypothesized that support for MRI-related research was influenced by these attitudes as well as one's own MRI experience, perceived MRI safety, and concerns for one's own risks for future dementia/stroke. METHODS: We developed a brief cross-sectional survey to assess older adults' MRI experiences and perceptions, desire to learn of six incidental findings of increasing health implications, and attitudes related to dementia as well as research participation. We recruited a convenience sample of 256 respondents (74% reporting as 50+) from the New Jersey/New York City area to complete the survey, and modeled the proportional odds (P.O.) for pro-research attitudes. RESULTS: 77 SA and 84 EA respondents were analyzed with 95 non-Asian adults. White (P.O.=2.54, p=0.013) and EA (P.O.=2.14, p=0.019) respondents were both more likely than SA respondents to endorse healthy volunteers' participation in research, and the difference between White and SA respondents was mediated by the latter's greater internal LoC for dementia risks. EA respondents had more worries for future dementia/stroke than SA respondents (p=0.006), but still shared SA respondents' low desire to learn of incidental MRI findings. DISCUSSION: SA and EA older adults had different attitudes towards future dementia/stroke risks, but shared a low desire to learn of incidental MRI findings. A culturally-appropriate protocol to disclose incidental MRI findings may improve SA and EA participation in brain health research.

A preclinical medical student curriculum to introduce health disparities and cultivate culturally responsive care.

PURPOSE: To evaluate the efficacy of a newly reformed curriculum for teaching culturally responsive care and to build awareness of health and health care disparities in first-year medical students. Secondary outcomes were to determine if a progressive approach to teaching this content would improve not only knowledge of vulnerable groups but also awareness of inherent personal biases and cultural assumptions, which contribute to inequitable care. PROCEDURES: Students enrolled in Social and Cultural Issues in Health Care from October 2009 through December 2009, who agreed to participate, completed pretests and posttests that assessed their awareness and knowledge of culturally responsive care and health disparities. FINDINGS: In 3 of the questions assessing cultural awareness, the participants improved significantly after the course compared to before the course. Participants also significantly improved in 6 of the 7 knowledge-based questions. CONCLUSIONS: Our findings demonstrate that this innovative curriculum was successful in improving students' knowledge of vulnerable populations and health disparities. Our progressive curricular approach also successfully increased participant awareness of health disparities by requiring students to assess the socioeconomic and environmental factors of inequitable care. Additionally, it emphasized a process of continuous self-appraisal in delivering culturally responsive care.

Assessing the Phonological Skills of Bilingual Children From Preschool Through Kindergarten: Developmental Progression and Cross-Language Transfer.

The developmental progression hypothesis for phonological awareness states that children perform better on lower level tasks; and has mainly been addressed in the literature with children beginning at age 5. In addition, there has been limited amount of research done regarding the performance of dual language learners on phonological awareness tasks under the age of 5. There is a need for a valid measure of phonological awareness for bilingual preschool children at an earlier age. This article addresses three purposes: 1) developing a reliable measure of phonological awareness for bilingual preschool children, 2) testing the developmental progression hypothesis in both English and Spanish, and 3) comparing longitudinal performance across language on the measure. Two hundred and forty-one Spanish-English bilingual children were assessed on the author-developed Phonological Awareness Test at three time points (mean age of 4.58; mean age of 4.96; mean age of 5.94). Findings indicate differences in developmental progression by language as well as shifts in performance across language as children go through school. The children in this study transition from a language specific model of phonological awareness to a more skill specific model of phonological awareness as they progress through school.

Leveraging an Informatics Approach to Identify an Unmet Clinical Need for BRCA1/2 Testing Among Patients With Ovarian Cancer.

PURPOSE: Although BRCA1/2 testing in ovarian cancer improves outcomes, it is vastly underutilized. Scalable approaches are urgently needed to improve genomically guided care. METHODS: We developed a Natural Language Processing (NLP) pipeline to extract electronic medical record information to identify recipients of BRCA testing. We applied the NLP pipeline to assess testing status in 308 patients with ovarian cancer receiving care at a National Cancer Institute Comprehensive Cancer Center (main campus [MC] and five affiliated clinical network sites [CNS]) from 2017 to 2019. We compared characteristics between (1) patients who had/had not received testing and (2) testing utilization by site. RESULTS: We found high uptake of BRCA testing (approximately 78%) from 2017 to 2019 with no significant differences between the MC and CNS. We observed an increase in testing over time (67%-85%), higher uptake of testing among younger patients (mean age tested = 61 years v untested = 65 years, P = .01), and higher testing among Hispanic (84%) compared with White, Non-Hispanic (78%), and Asian (75%) patients (P = .006). Documentation of referral for an internal genetics consultation for BRCA pathogenic variant carriers was higher at the MC compared with the CNS (94% v 31%). CONCLUSION: We were able to successfully use a novel NLP pipeline to assess use of BRCA testing among patients with ovarian cancer. Despite relatively high levels of BRCA testing at our institution, 22% of patients had no documentation of genetic testing and documentation of referral to genetics among BRCA carriers in the CNS was low. Given success of the NLP pipeline, such an informatics-based approach holds promise as a scalable solution to identify gaps in genetic testing to ensure optimal treatment interventions in a timely manner.