The Cultural Cognitions and Actions Scale (CCAS) is an established self-report measure of White individuals’ microaggressive likelihood against Black people consisting of four subscales: Negative Attitudes, Colorblindness, Objectifying, and Avoidance. To replicate and address limitations of previous studies, the current study sought to validate the CCAS with a geographically diverse sample of White U.S. adults (N = 254) who completed a battery of measures of explicit and implicit racial bias, administered online with Amazon Mechanical Turk. A series of hierarchical multiple regressions assessing predictors of each individual item and subscale (except for Objectifying) provides evidence for concurrent validity with regard to measures of colorblindness (Colorblindness subscale, adjusted R2 = 0.47), allophilia, old-fashioned and modern racism (Negative Attitudes subscale, adjusted R2 = 0.52), and intergroup anxiety (Avoidance subscale, adjusted R2 = 0.29). Furthermore, partial correlations controlling for social desirability found that the CCAS scales did not significantly correlate to implicit racial bias as measured by the IAT, though they did relate to higher levels of aggression (r range: 0.26 to 0.30), lower implicit motivation to respond without prejudice (r range: − 0.27 to − 0.51), and higher levels of political conservatism (r range: 0.29 to 0.51). This research further supports the notion that common verbal racial microaggressions may be expressions of well-understood, racist and racially biased, psychological processes.

213 Background: Total neoadjuvant therapy (TNT) is increasingly used for locally advanced rectal cancer. However, which patients benefit most from TNT remains to be elucidated. In this study we sequenced a TNT cohort with long-term follow-up to identify genomic correlates of TNT efficacy. Methods: Patients with locally advanced rectal cancer who underwent TNT followed by surgery (Oct 2016-June 2020) were identified at our institution. MSS patients with paired tissues (normal, biopsy, and surgery) with successful DNA extraction and sequencing were analyzed. Retrospective chart review collected patient demographics and clinical outcomes. Genomic analyses were performed with the R maftools package. Descriptive statistics were calculated with Fisher’s exact, Wilcoxon rank sum, and Wilcoxon rank sum exact tests. Univariate survival analyses (UVA) were calculated with Cox proportional hazards regressions. All statistical analyses were performed using R (v4.3.2). Results: 53 patients met inclusion criteria and 32 patients with paired tissues (64 samples) were obtained and successfully sequenced. All patients received chemotherapy, most commonly FOLFOX (81.3%) as part of TNT and a 5-FU based chemoradiation therapy (RT) regimen. Almost all patients received 50.4 Gy (93.8%). Median followup was 57 months (IQR: 47-68). There were 24 pathological responders (R) [complete/partial] and 8 nonresponders (NR) [stable disease/progression]. R vs NR were not statistically different across demographic or treatment characteristics. Local recurrences were infrequent (9.4% 3/32). No covariates were prognostic on UVA survival analyses. However, NR was associated with worse distant metastases free survival (DMFS) (HR = 4.11, CI 1.01-16.8, p = 0.048) on UVA. 5-year DMFS was 83% for R and 50% for NR, and the median DMFS was not reached for R, 41 mo for NR. Tumor mutation burden (TMB) did not change with treatment (pre = 4.5 vs post = 6.2 mutations/Mb; r, 1.7-10.3, p=0.59) and was not different on biopsy between R and NR (4.1 vs 5.9, p=0.09). Pre-treatment, the most mutated gene was APC (81%), [majority nonsense/frameshift (88%)], followed by TP53 (69%), [missense (59%)]. When comparing frequent mutations (n ≥ 5), PIEZO1 was more mutated in NR (63%, 5/8) than R (4% 1/24 patients) (p = 0.023 [multiple testing corrected]). Putative radioresistant KRAS-TP53 co-mutations were uncommon with similar representation in both groups (R 12.5%, 3/24, NR 12.5%, 1/8). Conclusions: Pathologic response positively correlated with DMFS in this cohort with long-term followup. PIEZO1 mutations were negatively prognostic for pathologic NR to TNT. This uncovers a potential new role in chemoRT resistance in addition to a previously reported association with metastatic spread. Further evaluation of PIEZO1 as a prognostic biomarker may help personalize appropriate treatment for patients with locally advanced rectal cancer.

In this practice note, we document the progression of the Community Vaccine Collaborative (CVC), on which we first published in 2021. The CVC convened to address deep COVID-19-related disparities affecting the Black, Latine, immigrant/refugee, and lesbian, gay, bisexual, transgender, queer, (questioning), intersex, asexual, and (agender) (LGBTQIA+) communities. The COVID-19 pandemic is rooted in centuries of oppression and marginalization leading to inequities and required dedicated focus to support marginalized communities in times of crisis. The CVC comprises community members, community-based organizations, health care providers, researchers, health systems leaders, and public health practitioners (among others), all of whom are dedicated to promoting COVID-19 vaccine equity. As the pandemic shifts and changes, so too has our group, to remain relevant to community needs and priorities. This article details Year 2 of the CVC, focusing on how we have grown and sustained this unique partnership. We also share results from an evaluation of the CVC, documenting participation in the collaborative space and alignment with CVC core principles. Finally, we discuss next steps and implications for the CVC including our pivot from vaccines to community vitality as we expand and sustain our collaborative efforts to address the ongoing COVID-19 pandemic and intersecting public health crises.

BACKGROUND:Using community-engaged research may result in interventions that reduce infant oral health disparities in underserved populations.OBJECTIVE:Develop community partnerships to create a sustainable infant oral health program that meets specific community-identified needs and provides an interprofessional education experience.METHODS:Partnering with the Homewood Community Engagement Center, researchers engaged and surveyed key community partners to assess the need for an infant oral health invention.LESSONS LEARNED:Community-identified organizing principles and barriers became the framework for, "Healthy Teeth, Healthy Me," a community-driven infant oral health program. Barriers, like access to care, were addressed with community-specific solutions like agreements with local dental clinical for referrals.CONCLUSIONS:Community partnerships can be leveraged to develop oral health programs that fit specific community needs and provide resources to families at greatest risk for child dental caries. Community engagement can be used to modify the intervention to meet oral health needs of other vulnerable communities.

BACKGROUND & AIMS:Lugol's chromoendoscopy (LCE)-based detection of esophageal squamous cell neoplasia (ESCN) is limited by low specificity. High-resolution microendoscopy (HRME) was shown to improve specificity and reduce unnecessary biopsies when used by academic endoscopists. In this international randomized controlled trial, we determined the clinical impact, efficiency, and performance of HRME in true global health contexts with a range of providers. METHODS:Individuals undergoing screening or surveillance for ESCN by expert and novice endoscopists were enrolled in China and the United States from diverse clinical settings. Participants were randomized to LCE (standard of care) or LCE + HRME (experimental). The primary outcomes were the efficiency and clinical impact of LCE vs LCE + HRME using gold-standard consensus pathology. RESULTS:Among 916 consented participants, 859 (93.8%) were recruited in China and 36 (3.9%) in the United States; 21 (2.3%) were excluded due to incomplete procedure or data. In the screening arm, 217 participants were randomized to LCE and 204 to LCE + HRME; in the surveillance arm, 236 were randomized to LCE and 238 to LCE + HRME. HRME increased efficiency in screening: diagnostic yield (neoplastic/total biopsies) improved from 20.0% (95% confidence interval [CI], 12.7-29.2) to 51.7% (95% CI, 32.5-70.6) with 65.2% (95% CI, 54.6-74.9) of biopsies potentially saved and 59.7% (95% CI, 47.5-71.1) of participants potentially spared any biopsy. Six participants (0.7%) had neoplasia missed by the endoscopist on HRME (false negatives); of these, 3 were moderate or high-grade dysplasia missed by novices. CONCLUSIONS:A low-cost microendoscope improves the efficiency and clinical impact of ESCN screening and surveillance when combined with LCE. HRME may spare unnecessary biopsies, leading to cost savings in underserved global settings where the disease is prevalent. (ClinicalTrials.gov, Number NCT02029937).

Purpose The introduction of prostate-specific PET imaging to detect radiorecurrent prostate cancer (RRPCa) and the establishment of HDR brachytherapy salvage at our institution have resulted in an increased case volume of RRPCa being treated with HDR salvage. We sought to compare the patient make-up and outcomes of this new cohort in comparison to the last two decades of RRPCa patients salvaged with brachytherapy at our institution. Materials and Methods We retrospectively reviewed 20 years of RRPCa patients salvaged with whole-gland brachytherapy (2000-2021) with at least 3 years of follow-up. We identified 30 patients treated with MRI-guided LDR (Cohort 1: 2000-10), 39 patients treated with trans-rectal ultrasound(TRUS)-guided LDR (Cohort 2: 2011-20), and 32 patients treated with (TRUS guided: 22, CT planned: 10) HDR (Cohort 3: 2017-2021). All patients were biopsy-proven, locally-recurrent, without evidence of metastatic progression and received pre-salvage MRI. Percentages are actuarial and calculated using cumulative incidence. Survival analysis was conducted first via Log-Rank test, and Cox proportional hazards for univariate and multivariate analyses. Results The percentage of patients with EPE on MRI for cohort 1, cohort 2, and cohort 3 were 17%, 8.1%, and 26%, respectively. Pre-salvage, Axumin PET rates were 0%, 18%, and 100%. Rates of concurrent and adjuvant ADT at salvage were 3.3%, 59%, and 84%. At median follow-ups of 20.5, 6.9, and 3.4 years, the percentage of patients without BCR at 3 y were (cohort 1- 79.3%, cohort 2- 78.6%, cohort 3- 75.1%). The three salvage strategies were not statistically different with respect to BCR (Log-Rank p = 0.4). As the MRI patients (cohort 1) have been previously reported [Nguyen PL, Cancer 2007] and TRUS LDR is utilized as an HDR alternative at many other practices, we then reported outcomes between TRUS and HDR patients. There was no statistical difference in OS, DMFS, Local (Intraprostatic or SV) recurrence, or LRR by Log-Rank test (p > 0.05) (Fig 1). Long-term GU grade 3 toxicity (90d to 3 y) was not statistically different (Cohort 2: 4/39 (10%), Cohort 3: 4/32 (13%)). There was similarly no difference for long-term GI grade 3 toxicity (Cohort 2: 1/39 (2.6%), Cohort 3: 1/32 (3.1%)). PSA DT < 12 mo trended towards an association with BCR (p = 0.12) and LRR (p = 0.088) on UVA (Cox proportional hazards). SVI on pre-salvage MRI was negatively prognostic, UVA (p = 0.045 and p = 0.027) and MVA when accounting for cohort and PSA DT (p= 0.038 and p = 0.022) for BCR and LRR, respectively. Of the 6 local-regional recurrences after HDR salvage the LRR pattern of failure was: 1 in the prostate and subsequently R inguinal nodes and bilateral seminal vesicles; 2 regional only in the pelvic sidewall and LNs; 1 in the prostate and LNs, 1 in the SV and LNs, and 1 in the prostate and SV only (1 local recurrence only, 2 regional recurrence only, 3 local and regional recurrence) Conclusions This single-institution retrospective comparison study demonstrates that modern, salvage HDR brachytherapy for RRPCa is equally effective (BCR, LRR, OS) when compared to historical methods (MRI guided LDR) and contemporary alternatives (TRUS LDR). Additionally, long-term GU and GI toxicities are rare for both HDR and TRUS LDR. As the majority of LRR failures included intraprostatic or SV failure (4/6) for HDR therapy, prospective studies involving further dose-escalation to PSMA-avid lesions may be warranted.

Background: In 1990, the United States’ Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018–March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer–patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.

In this manuscript we assessed the utility of a low-cost 3D printed microscope to evaluate esophageal biopsies. We conducted a comparative analysis between the traditional microscope and our 3-D printed microscope, utilizing a set of esophageal biopsy samples obtained from patients undergoing screening endoscopy. Two pathologists independently examined 30 esophageal biopsies by light microscopy and digital images obtained using a low-cost 3D printed microscope (Observer 1 and 2). The glass slide consensus diagnosis was compared to the findings of 2 additional pathologist who independently just reviewed the digital images (Observer 3 and 4). The intra-observer agreement was substantial to almost perfect for observer 1 (k:0.64) and 2 (k:0.84). All four observers had 100% sensitivity and negative predictive value, whereas specificity ranged from 59% to 100% and positive predictive value ranged from 21% to 100%. The PPV and specificity were lower for the two Observers (3 and 4) who just examined the digital images. Overall, our results suggest that telepathology may be used with high sensitivity and specificity, utilizing the pictures produced by our 3D-printed microscope.

Background: Clinical guidelines reserve endoscopic surveillance after a gastric intestinal metaplasia (GIM) diagnosis for high-risk patients. However, it is unclear how closely guidelines are followed in clinical practice. We examined the effectiveness of a standardized protocol for the management of GIM among gastroenterologists at a US hospital. Methods: This was a preintervention and postintervention study, which included developing a protocol and education of gastroenterologists on GIM management. For the preintervention study, 50 patients with GIM were randomly selected from a histopathology database at the Houston VA Hospital between January 2016 and December 2019. For the postintervention study, we assessed change in GIM management in a cohort of 50 patients with GIM between April 2020 and January 2021 and surveyed 10 gastroenterologists. The durability of the intervention was assessed in a cohort of 50 GIM patients diagnosed between April 2021 and July 2021. Results: In the preintervention cohort, GIM location was specified (antrum and corpus separated) in 11 patients (22%), and Helicobacter pylori testing was recommended in 11 of 26 patients (42%) without previous testing. Gastric mapping biopsies were recommended in 14% and surveillance endoscopy in 2%. In the postintervention cohort, gastric biopsy location was specified in 45 patients (90%, P <0.001) and H. pylori testing was recommended in 26 of 27 patients without prior testing (96%, P <0.001). Because gastric biopsy location was known in 90% of patients ( P <0.001), gastric mapping was not necessary, and surveillance endoscopy was recommended in 42% ( P <0.001). One year after the intervention, all metrics remained elevated compared with the preintervention cohort. Conclusions: GIM management guidelines are not consistently followed. A protocol for GIM management and education of gastroenterologists increased adherence to H. pylori testing and GIM surveillance recommendations.

Supplementary Figures 1-2 from PEA-15 Induces Autophagy in Human Ovarian Cancer Cells and Is Associated with Prolonged Overall Survival

PURPOSE:Chemotherapy (CHT) or radiation therapy (RT) are first-line treatments for clinical stage II (CS-II) testicular seminoma. Historically, clinical stage I (CS-I) seminoma was also treated with CHT or RT, but in the past 2 decades practice has shifted toward active surveillance for CS-I with RT or CHT reserved for patients with progression to CS-II. Limited data exist on contemporary RT techniques and patient stratification (ie, de novo [CS-II at orchiectomy] vs relapsed [CS-II diagnosed during surveillance after orchiectomy for CS-I]). We investigated outcomes in CS-II patients treated with RT in the modern era across 2 institutions. METHODS AND MATERIALS:A retrospective review identified 73 patients treated with RT for CS-II A or B seminoma between 2001 and 2022. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method and univariate analyses were performed with log-rank or Cox proportional hazard regression. Recurrence was defined as biopsy-proven metastatic seminoma after RT completion. Second malignancies were defined as a biopsy-proven malignancy originating in the prior RT field. RESULTS:Thirty-eight (52%) patients presented with de novo CS-II and 35 (48%) patients had relapsed CS-II. Median follow-up was 4.8 years (IQR: 2.3-8.1). Five-year RFS was 82% overall (92% in relapsed patients and 73% in de novo patients). Relapsed CS-II disease had lower recurrence rates after RT compared with de novo CS-II disease. All recurrences occurred outside the prior RT field and were salvaged. Disease-specific survival was 100%. Two second malignancies occurred (prostate, colorectal cancer at 67 months and 119 months post-RT, respectively). CONCLUSIONS:In patients with CS-II seminoma treated with modern RT, there were no in-field recurrences. Presentation with de novo CS-II is associated with out-of-field recurrence. Subject to further larger-scale validation, our results suggest that compared with CS-II at time of relapse, de novo CS-II may portend more aggressive or micrometastatic disease beyond the retroperitoneum, raising the possibility of benefit from CHT after radiation.

Purpose Emergency medical service (EMS) workers are at risk for burnout related to the opioid overdose crisis because they are frequently present during overdose events. The study’s aims were twofold: 1) to determine whether variables related to the opioid crisis were associated with burnout and 2) to explore the relationship between mental health, sleep, substance use, social support, and attitudes about working during the opioid overdose crisis with burnout. Design/methodology/approach In a cross-sectional web-based study, surveys were distributed by supervisors to EMS workers in Pennsylvania (winter 2018). Participants ( n = 214) completed measures on burnout, social support, mental health, substance use, and sleep quality and reported their frequency of naloxone administration and their attitudes about working during the opioid overdose crisis. Bivariate and multivariable analyses were run to determine correlates of burnout. Findings The sample was 65.4% male, 91.5% white, and 43% were between 36–55 years old. In the regression model ( n = 177), depression, anxiety, post-traumatic stress disorder (PTSD), sleep, attitudes about working during the opioid crisis, cannabis use, social support, age, hours worked each week, and frequency of naloxone administration were significantly correlated with burnout. Originality/value This study contributes to the emergent literature on burnout and EMS professionals during the opioid overdose crisis by finding that attitudes about working during the opioid overdose crisis are correlated with burnout. While the relationship should be explored in future research, the authors believe that interventions to prevent EMS burnout could incorporate training to improve attitudes about supporting individuals during overdose events.

Tooth decay is the most common chronic disease in children, and children often see their primary care practitioners more frequently than dentists (Adjaye-Gbewonyo and Black 2019-2020; National Center for Health Statistics 2019-2020). This Infant Oral Health Education Program included two online training sessions for trainees in social work, nursing, medicine, and dentistry. Trainees were assessed on anticipated changes to their practice related to children's oral health. During the first training session, trainees received a lecture on infant oral health, and then discussed a case study in interprofessional groups to reinforce the content. Trainees in medicine and nursing completed training to receive Medicaid reimbursement for performing preventive oral health services. The second training session was profession specific with tailored instructions in the form of videos, as well as a demonstration on fluoride varnish application. Of the 78 trainees (22 social work, 4 pediatric nurse practitioner, 38 pediatric medicine residents, and 14 pediatric dentistry residents), 91% (n=70) reported that they were introduced to at least one new health information resource or tool. Four-fifths of the eligible trainees (n=16/20, 80%) who completed the evaluation had fulfilled the State's requirements to receive Medicaid reimbursement for performing preventive oral health services. Three-fourths of trainees (n=22/29, 75%) reported that they are likely to promote children's oral health in future clinical practice. Trainees from all four professions provided positive feedback about the content.

Objective: This study aimed to determine the effect that the transition to incorporating remote care had on patients in medication for opioid use disorder (MOUD) treatment and to identify benefits and gaps in services due to this transition.Materials and Methods: Treatment data on patients receiving buprenorphine through the MOUD program were collected using electronic medical records. A 28-month window was created and encompassed three time periods: in-person MOUD prepandemic, fully remote/telehealth for MOUD (tele-MOUD), and hybrid services (combination of tele-MOUD and in-person care).Results: Rates of reported illicit drug use were consistent across all three time periods, with no statistically significant differences. Attendance at MOUD appointments and urine drug screen completion trended downward during fully remote care but approached prepandemic levels during hybrid services.Discussion: Tele-MOUD presents opportunities for improving treatment of patients with opioid use disorder, and hybrid models should continue to be adopted, evaluated, and reimbursed by insurances.

Supplementary Figures S1-S2; Supplementary Tables S1-S2.

BACKGROUND For trans-rectal ultrasound (TRUS)-based high dose rate (HDR) prostate brachytherapy, prostate contouring can be challenging due to artifacts from implanted needles, bleeding, and calcifications. PURPOSE To evaluate the geometric accuracy and observer preference of an artificial intelligence (AI) algorithm for generating prostate contours on TRUS images with implanted needles. METHODS We conducted a retrospective study of 150 patients, who underwent HDR brachytherapy. These patients were randomly divided into training (104), validation (26) and testing (20) sets. An AI algorithm was trained/validated utilizing the TRUS image and reference (clinical) contours. The algorithm then provided contours for the test set. For evaluation, we calculated the Dice coefficient between AI and reference prostate contours. We then presented AI and reference contours to eight clinician observers, and asked observers to select their preference. Observers were blinded to the source of contours. We calculated the percentage of cases in which observers preferred AI contours. Lastly, we evaluate whether the presence of AI contours improved the geometric accuracy of prostate contours provided by five resident observers for a 10-patient subset. RESULTS The median Dice coefficient between AI and reference contours was 0.92 (IQR: 0.90-0.94). Observers preferred AI contours for a median of 57.5% (IQR: 47.5, 65.0) of the test cases. For resident observers, the presence of AI contours was associated with a 0.107 (95% CI: 0.086, 0.128; p < 0.001) improvement in Dice coefficient for the 10-patient subset. CONCLUSION The AI algorithm provided high-quality prostate contours on TRUS with implanted needles. Further prospective study is needed to better understand how to incorporate AI prostate contours into the TRUS-based HDR brachytherapy workflow.

PurposeThis study focuses on Emergency Medical Service (EMS) personnel and examines the impact of overdose calls for opioids and attitudes of EMS workers towards individuals with substance use disorders on EMS workers' mental well-being while accounting for self-reported sleep and social support.Design/methodology/approachThis cross-sectional study surveyed EMS workers (N = 608) across Pennsylvania on demographic variables, frequency of overdose calls, attitudes towards opioid use and naloxone administration on measures of mental health. Multiple logistic regression models were estimated to examine the relationship of perception of opioid use and treatment and likelihood that EMS workers might experience depression.FindingsAuthors found two main findings: (1) There was a significant relationship between more negative perceptions about opioid use/naloxone and the likelihood that EMS workers might experience depression. (2) There was a significant relationship between number of overdose calls EMS workers responded to and likelihood of depression, which appeared to be alleviated by improvements in sleep and social support.Research limitations/implicationsThere is potential opportunity for EMS employers to minimize the impact of the opioid epidemic on EMS worker mental health. Trainings to highlight effectiveness of treatment should be further explored, along with ways to enhance social support and improve sleep for EMS workers to protect against the stress associated with responding to this public health crisis.Originality/valueThis study adds to the literature on the impact of the opioid epidemic as it relates to mental health outcomes for EMS professionals providing frontline care to those experiencing opioid use disorders.