Factors affecting adherence to a high-risk surveillance protocol among patients with Li-Fraumeni syndrome.

BACKGROUND: High-risk surveillance for patients with Li-Fraumeni syndrome (LFS) has shown a stage shift and improved overall survival, but is demanding. Our objective was to evaluate surveillance adherence in a population of patients with LFS presenting for high-risk care. METHODS: A retrospective analysis of surveillance adherence of adult patients with LFS at a single institution was performed. Adherence was defined by the duration from initial University of Virginia (UVA) LFS clinic visit to the time of first missed surveillance test. Two-sample t-tests and ANOVA tests were used to identify factors associated with duration of adherence. RESULTS: A total of 42 patients were evaluated in the UVA LFS clinic between 2017 and 2021. Of these, 21 patients met inclusion criteria. At the time of review, 6 patients (29%) were up to date with high-risk surveillance recommendations. The mean duration of adherence was 17 months. Female sex was found to be associated with longer duration of adherence (mean 21 mo vs. 3.5 mo for males, p = 0.02). A personal history or active diagnosis of cancer was also associated with increased adherence (p = 0.02). However, neither age (p = 0.89), geography (p = 0.84), or known family history of LFS (p = 0.08) were associated with duration of adherence. CONCLUSION: Female sex as well as a personal history of cancer were associated with longer duration of adherence to recommended high-risk surveillance among patients with LFS. Identification of barriers to surveillance will be essential moving forward to increase adherence and promote early detection of cancer, thereby reducing the morbidity and mortality of LFS.

A survey of the management and development of captive African elephant (Loxodonta africana) calves: birth to three months of age.

We used four surveys to collect information about the birth, physical growth, and behavioral development of 12 African elephant calves born in captivity. The management of the birth process and neonatal care involved a variety of standard procedures. All of the calves were born at night, between 7PM and 7AM. The calves showed a systematic progression in behavioral and physical development, attaining developmental milestones at least a quickly as calves in situ. This study emphasized birth-related events, changes in the ways that calves used their trunks, first instances of behaviors, and interactions of the calves with other, usually adult, elephants. Several behaviors, such as the dam covering her calf with hay and the calf sucking its own trunk, were common in the captive situation and have been observed in situ. Overall, the behaviors of the calves resembled those observed for African elephant calves in situ. These data should help in the management of African elephants under human care by providing systematic reference values for the birth and development of elephant calves.