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Background Racial disparities in New York City (NYC) breast cancer incidence and mortality rates have previously been demonstrated. Disease stage at diagnosis and mortality‐to‐incidence ratio (MIR) may present better measures of differences in screening and treatment access. Racial/ethnic trends in NYC MIR have not previously been assessed. Methods Mammogram rates were compared using the NYC Community Health Survey, 2002‐2014. Breast cancer diagnosis, stage, and mortality were from the New York State Cancer Registry, 2000‐2016. Primary outcomes were MIR, the ratio of age‐adjusted mortality to incidence rates, and stage at diagnosis. Joinpoint regression analysis identified significant trends. Results Mammogram rates in 2002‐2014 among Black and Latina women ages 40 and older (79.9% and 78.4%, respectively) were stable and higher than among White (73.6%) and Asian/Pacific‐Islander women (70.4%) (P, Lower incidence of local stage breast cancer at diagnosis and slower decrease in mortality rates among Black and Latina women in NYC as compared to White women raises great concern about unequal access to quality care including quality screening and improvements in therapy. These differences were especially prominent among Black women, who merit additional public health focus.

There is marked variability in colonoscopy quality, limiting its effectiveness in colorectal cancer prevention. Multiple indicators have been established as markers for colonoscopy quality; however, there are conflicting data on the effects of quality reporting programs on endoscopist performance. In this study, we investigate the impact of a multicenter quarterly report card initiative on colonoscopy quality metric performance. Data were collected from 194 endoscopists at 10 participating sites throughout New York City using a Qualified Clinical Data Registry from January 2013 to December 2014. Adenoma detection rate (ADR), cecal intubation rate, withdrawal time, bowel preparation quality and appropriate interval recommendations were tracked. Report cards were distributed to each site on a quarterly basis and technical assistance was provided as needed. Performance trends were analyzed using the Cochran–Armitage trend and analysis of variance tests. 37,258 screening colonoscopies were performed during the study period. There was a positive performance trend for ADR over time from the first quarter of 2013 to the last quarter of 2014 (15.6–25.7%; p

Background Although colorectal cancer screening has contributed to decreased incidence and mortality, disparities are present by race/ethnicity. The Citywide Colon Cancer Control Coalition (C5) and NYC Department of Health and Mental Hygiene (DOHMH) promoted screening colonoscopy from 2003 on, and hypothesized future reductions in CRC incidence, mortality and racial/ethnic disparities. Methods We assessed annual percent change (APC) in NYC CRC incidence, stage and mortality rates through 2016 in a longitudinal cross-sectional study of NY State Cancer Registry, NYC Vital Statistics, and NYC Community Health Survey (CHS) data. Linear regression tested associations between CRC mortality rates and risk factors. Results Overall CRC incidence rates from 2000 decreased 2.8% yearly from 54.1 to 37.3/100,000 population in 2016, and mortality rates from 2003 decreased 2.9% yearly from 21.0 to 13.9 in 2016 at similar rates for all racial/ethnic groups. Local stage disease decreased overall with a transient increase from 2002 to 2007. In 2016, CRC incidence was higher among Blacks (42.5 per 100,000) than Whites (38.0), Latinos (31.7) and Asians (30.0). In 2016, Blacks had higher mortality rates (17.9), than Whites (15.2), Latinos (10.4) and Asians (8.8). In 2016, colonoscopy rates among Blacks were 72.2%, Latinos 71.1%, Whites 67.2%, and Asians, 60.9%. CRC mortality rates varied by neighborhood and were independently associated with Black race, CRC risk factors and access to care. Conclusions In a diverse urban population, a citywide campaign to increase screening colonoscopy was associated with decreased incidence and mortality among all ethnic/racial groups. Higher CRC burden among the Black population demonstrate more interventions are needed to improve equity.

Colorectal cancer (CRC) incidence rates are rising in younger Americans and mortality rates are increasing among younger white Americans. We used New York State Cancer Registry data to examine New York City CRC incidence and mortality trends among adults ages 20–54 years by race from 1976 to 2015. Annual percent change (APC) was considered statistically significant at P less than .05 using a two-sided test. CRC incidence increased among those ages 20–49 years, yet blacks had the largest APC of 2.2% (1993–2015; 95% confidence interval [CI] = 1.4% to 3.1%) compared with 0.5% in whites (1976–2015; 95% CI = 0.2% to 0.7%). Among those aged 50–54 years, incidence increased among blacks by 0.8% annually (1976–2015; 95% CI = 0.4% to 1.1%), but not among whites. CRC mortality decreased among both age and race groups. These findings emphasize the value of local registry data to understand trends locally, the importance of timely screening, and the need for clinicians to consider CRC among all patients with compatible signs and symptoms.

Objective. Examine the effectiveness of the 128 Hz tuning fork, two monofilaments, and Norfolk Quality of Life Diabetic Neuropathy (QOL-DN) questionnaire as tools for the early detection of diabetic peripheral neuropathy (DPN) in overweight, obese, and inactive (OOI) adults or those who have prediabetes (PD) or type 2 diabetes (T2D). Research Design and Methods. Thirty-four adults (mean age 58.4 years ± 12.1) were divided by glycemia (10 OOI normoglycemic, 13 PD, and 11 T2D). Sural nerves were tested bilaterally with the NC-stat DPNCheck to determine sural nerve amplitude potential (SNAP) and sural nerve conduction velocity (SNCV). All other testing results were compared to SNAP and SNCV. Results. Total 1 g monofilament scores significantly correlated with SNAP values and yielded the highest sensitivity and specificity combinations of tested measures. Total QOL-DN scores negatively correlated with SNAP values, as did QOL-DN symptoms. QOL-DN activities of daily living correlated with the right SNAP, and the QOL-DN small fiber subscore correlated with SNCV. Conclusions. The 1 g monofilament and total QOL-DN are effective, low-cost tools for the early detection of DPN in OOI, PD, and T2D adults. The 128 Hz tuning fork and 10 g monofilament may assist DPN screening as a tandem, but not primary, early DPN detection screening tools.

We characterized the ontogeny of cAMP-dependent protein kinase (PKA) enzymatic activity and PKA subunit mRNA expression in developing lung. The lungs of fetal Sprague-Dawley rat pups were removed after 16, 18, or 20 days of gestation and at term. PKA activity was greatest in the 18- and 20-day gestation lungs. Tissue cAMP levels were lowest in the 16-day lungs and increased with lung maturity. We were able to detect only low levels of mRNA for the C beta subunit of PKA by northern blot analysis of total lung RNA and we were able to detect mRNA for the RI beta and RII beta subunits only by RT-PCR. Therefore, we limited our analysis of PKA subunit mRNA levels to those for C alpha, RI alpha and RII alpha. The mRNA levels for C alpha, were highest in the 16-day lung, decreased at 18 and 20 days, were lower in the newborn and lowest in the adult lung. RI alpha mRNA levels were also highest at 16 days and lowest in the adult lung. However, RII alpha mRNA levels were similar in the 18-day, 20-day and newborn lungs. Dexamethasone treatment of fetal lung explants resulted in a small decrease in RI alpha mRNA levels but was not associated with a change in PKA activity. We conclude that PKA activity and PKA subunit mRNA expression are developmentally regulated in fetal lung. Such regulation results in optimal PKA activity at the time of type II alveolar cell differentiation, presumably in preparation for air breathing. The absence of an effect of glucocorticoid on PKA activity suggests that glucocorticoids are not responsible for the increase in PKA activity which accompanies this critical time in lung maturation.

The prevalence of colonization with uropathogenic Escherichia coli and their reservoirs and routes of acquisition are incompletely defined. To help clarify these issues, polymerase chain reaction (PCR)-based strain typing assays were used to evaluate the fecal and vaginal E. coli flora of 11 volunteers. PCR detected the virulence genes papG, aer, and cnf significantly more frequently in mixed intestinal samples than in the corresponding predominant strains, evidence that traditional methods are suboptimal for detecting colonization with uropathogens. For strain typing, repetitive-element PCR was as discriminating as pulsed-field gel electrophoresis and O:H serotyping but more convenient. Molecular epidemiologic analysis of subjects' E. coli suggested emergence of occult uropathogenic strains from within the host's own intestinal flora, strain sharing between household members, and de novo acquisition of (unshared) uropathogenic strains. These methods should facilitate the studies needed to clarify the relative contributions of these three pathways to the pathogenesis of urinary tract infection.

The distribution of the three alleles of the P adhesin gene papG (classes I-III) was assessed among 74 Escherichia coli urine isolates from women with first-episode or recurrent cystitis, and papG genotype was compared with clinical origin, O serogroup, agglutination of Gal(alpha1-4)Gal-coated latex beads and human or sheep erythrocytes, and hemolysin production. The class-III-only papG genotype (27% of strains) predominated over the I + III (3%) and II-only (7%) genotypes, irrespective of clinical category. In contrast to the class II papG allele, the class III allele was significantly concentrated in serogroups O6 and O18. Agglutination phenotypes corresponded significantly but incompletely with papG genotype, whereas hemolysin production and papG positivity were tightly correlated. These findings suggest that in acute cystitis in adult women, the class III papG allele predominates, confers distinctive agglutination phenotypes, and is restricted to specific E. coli lineages.

Assessment of the urethral flora in patients with indwelling bladder catheters is problematic in the presence of urinary tract infection (UTI). A new surface swab method that samples the external catheter surface without interference from contaminated luminal contents is described. In vitro, recovery of adherent bacteria from the external catheter surface by the surface swab method was proportional to the bacterial density as measured by a comparison scrape method. In a prospective longitudinal assessment of three chronically catheterized subjects with polymicrobial catheter-associated UTI, a conventional roll plate catheter culture method suggested substantial overlap between the urethral and urine microbial populations, possibly a result of contamination of catheter cultures by infected urine. In contrast, the surface swab method revealed little overlap between these floras, evidence suggesting a predominantly luminal (rather than meatal) route of UTI acquisition. The new surface swab method should prove useful in future studies of the pathogenesis and prevention of catheter-associated UTI.

The pyelonephritis-associated adhesin gene papG of Escherichia coli occurs in three variants. Whereas the class II and class III variants are common among human urinary tract infection isolates, the class I allele, despite being the first cloned, has previously been found only in source strain J96. Five strains have been discovered from geographically diverse locales that, like J96, contain both the class I and class III papG alleles. One strain caused bacteremia, whereas 4 caused cystitis. Like J96, all 5 had group III capsule genes, expressed the H5 flagellar antigen and the F13 fimbrial antigen, and exhibited similar genomic patterns and virulence factor profiles. These findings demonstrate that the class I papG allele is not unique to J96 but is present in a group of extraintestinal isolates of E. coli O4:H5 that represent a disseminated virulent clonal group.

Group 2 capsules and lipopolysaccharides are regarded as important virulence factors in extraintestinal isolates of Escherichia coli, but their specific contributions to bladder and renal infections, if any, are unknown. Proven isogenic derivatives deficient in the K54 antigen alone (CP9.137), the O4 antigen alone (CP921), or both the K54 and O4 antigens (CP923) were compared with their wild-type parent (CP9 [O4/K54JH5]) for growth in human urine in vitro and for virulence in vivo in a mouse model of ascending urinary tract infection (UTI). Growth of CP9.137 and CP921 was equivalent to that of CP9 in human urine. CP923 demonstrated a small but reproducible decrease in log-phase growth but achieved the same plateau density. In the mouse model of UTI, the isogenic mutant deficient in the 04 antigen alone (CP921) and, to a greater degree, the derivative deficient in both the K54 and O4 antigens (CP923) were significantly less virulent in nearly all parameters measured. In contrast, the K54 knockout derivative was as virulent as its parent, CP9, in causing bladder infection and nearly as virulent in causing renal infection. These results demonstrate an important role for the O4 antigen moiety of lipopolysaccharide in the pathogenesis of UTI. The possibility that the K54 antigen also plays a minor role cannot be excluded.

A satisfactory mouse model of ascending urinary tract infection (UTI) must avoid inoculation-induced vesicoureteral reflex (VUR) yet still produce kidney and bladder infection in a substantial proportion of mice. To define inoculation conditions that would satisfy both these conditions, mice were evaluated for VUR immediately after inoculation under a variety of conditions and were assessed for kidney and bladder infection 48 h after inoculation. Elimination of VUR required a slowed infusion rate, a reduced inoculum volume (25 microliter), and use of less traumatic methods for euthanasia and organ harvest. Bladder and kidney infection were highly prevalent at 48 h among mice inoculated under VUR-free conditions with either of 2 wild type Escherichia coli strains. Together with reports from other investigators, these findings indicate that satisfactory experimental conditions for the mouse model of ascending UTI can be defined empirically but may be laboratory-specific.

Objective: Adult attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder, yet only 1 in 10 affected adults receives treatment. The study objective was to assess gaps in knowledge and describe current practice patterns of primary care physicians and psychiatrists in the United States in the management of adult patients with ADHD. Method: Primary care physicians and psychiatrists completed an Internet survey as a needs assessment of customary care related to management of adults with ADHD. Adult clinical case vignettes were followed by practice, confidence, and barrier questions. Survey data were collected from April 15, 2010, to August 22, 2010, and were deidentified and analyzed in aggregate to maintain confidentiality. χ2 and t tests were used to compare responses of primary care physicians with those of psychiatrists. Results: The survey was completed by 1,924 physicians: 1,216 primary care physicians and 708 psychiatrists. Fewer primary care physicians than psychiatrists were “extremely confident” in diagnosis (8% vs 28%, respectively, P < .001) and treatment (8% vs 27%, respectively, P < .001). Limited experience with ADHD diagnosis was more of a barrier in primary care than in psychiatry (44% vs 19%, respectively, P < .001). Mean scores on 12 evidence-based questions were lower for primary care physicians than for psychiatrists (6.1 vs 6.8 correct, respectively, P < .001). Awareness of adult ADHD prevalence was lower among primary care physicians than among psychiatrists (32% vs 47% correct, respectively, P < .001). Fewer primary care physicians than psychiatrists recognized comorbid substance use disorder (76% vs 82%, respectively, P = .002), but more primary care physicians than psychiatrists recognized eating disorders (35% vs 21%, respectively, P < .001). Conclusions: The self-assessment survey results indicate physician practices in primary care and psychiatry differ and show areas in which further education will be useful to improve care for adults with ADHD.

Posttraumatic stress disorder (PTSD) is a signature injury of war among returning soldiers and US National Guard and Reserve members, with symptoms even more likely on rescreening. Studies that examine health care provider screening and referral practices outside the military for these patients are needed. The objective of this study was to assess health care provider PTSD practices and barriers to care.A 25-item, anonymous Internet questionnaire was developed as an educational needs assessment survey based on the US Department of Veterans Affairs and Department of Defense PTSD guideline and the companion, primary care-directed PTSD Screening and Referral for Health Care Providers of the National Center for PTSD. The assessment design included patient vignettes followed by multiple-choice questions and was distributed on the Internet to health care providers free of charge and without compensation. Of 1,338 participant health care providers, mainly from primary care and mental health specialties, 507 responded to the questions. Participant privacy was maintained for the self-assessment survey, and all responses were deidentified and analyzed in aggregate. Overall participant responses and subgroups of primary care and mental health questionnaire responses were scored against guidelines. Participant data responses to survey questions were collected from August 20, 2010, to October 3, 2010.Gaps in screening skills compared with guidelines were shown, as PTSD diagnosis questions were correctly answered by 51% of primary care and 56% of mental health providers. Real-world screening and referral differed from guidelines, as only 24% of primary care and 48% of mental health providers have a system in place to routinely screen for mental health in their patients who are returning service members. Only 25% of primary care providers had access to referral to mental health services, showing large gaps in care. Stigma associated with mental disorders was the practice barrier most frequently cited by health care providers.The study identified gaps in PTSD screening and linkage to care among health care providers. Further training efforts and resources are needed to screen patients and to reduce barriers to care.

The study assessed competencies and practices of a large group of healthcare providers in childhood attention-deficit/hyperactivity disorder (ADHD), and identified barriers to improving care. Methods were self-assessment using an Internet questionnaire with a standardized patient case; analysis compared with professional association recommendations; and measurement of provider self-efficacy levels. Of 2,103 participants who completed the assessment, 44% were only "somewhat confident" and 20% "not at all confident" in being up-to-date in diagnosis and management of ADHD. Based on American Board of Psychiatry and Neurology's Child and Adolescent Core Competencies and American Academy of Child and Adolescent Psychiatry Practice Parameters, participants selected appropriate responses 60% of the time, 57% for items on diagnosis, and 62% for treatment. Providers under-used the family interview, and relied on ADHD rating scales for diagnosis. Lack of effective communication between provider, child, family, and teachers was the top barrier cited, yet participants rated involving the child and family as very important. In conclusion, education should include training on effective communication with the family to improve care for children with ADHD and dedication of further health education resources in the area of ADHD is needed.

Development of new therapies for human hepatitis B virus infection (HBV) would be greatly facilitated by the availability of a suitable small-animal model for HBV virus production in vivo. To develop a murine model for HBV production, we established an immortalized, cloned liver cell line by transferring the Simian Virus 40 Large T-Antigen into primary human hepatocytes. These cells were stably transfected with a full-length HBV genome to generate a clone that expresses HBV genes and replicates HBV. The HBV-producing cells were transplanted into the livers of mice with combined immunodeficiency (Rag-2 deficient) by intrasplenic injection. Survival of the engrafted human hepatocytes was shown in several ways: fluorescent in situ hybridization (FISH) with a human-chromosome-specific DNA probe (human alpha satellite), dot-blot hybridization of the genomic DNA extracted from liver biopsy specimens with a human-specific Alu repetitive DNA probe, Blur-8, as well as with an HBV DNA probe, and secretion of human proteins into plasma. Histological examination of mouse liver up to 8 months following human cell transplant shows completely normal architecture. Determination of plasma HBV DNA levels indicated that engrafted cells secreted 3x10(7) to 3x10(8) virions per mL into the blood, and HBsAg was detected in plasma. This new murine model of HBV viremia should be useful for in vivo HBV studies.

Data regarding the hemagglutination (HA) patterns of the three variants (classes I, II, and III) of the Escherichia coli adhesin PapG are conflicting. These HA patterns usually have been assessed for each papG allele separately with recombinant strains in slide HA assays. We rigorously evaluated an alternative microtiter tray HA assay and then used it to assess the HA of four erythrocyte types (human A 1 P 1 and OP 1 , rabbit, and sheep erythrocytes) by multiple wild-type E. coli strains representing the four naturally occurring combinations of the papG alleles, i.e., class I plus III, class III only, class II plus III, and class II only. The microtiter tray HA assay displayed significantly better reproducibility of intraobserver (83%) and interobserver (86%) results than did slide HA assays (39 and 73%, respectively). Novel findings from the study of 32 wild-type P-fimbriated strains included reproducible determinations of phenotypic diversity among different papG categories, among strains within each papG category, and from day to day for individual strains. There was also substantial overlap of phenotypes between papG categories I plus III and III only and between II plus III and II only. A class III papG recombinant strain’s HA pattern differed significantly from that of the wild-type class III strains. These data demonstrate that HA phenotypes of wild-type P-fimbriated E. coli strains can be reproducibly assessed by a microtiter HA assay and that they correspond broadly to papG genotype but in a more complex and varied fashion than previously recognized.

Receptor specificities of the three recognized variants of PapG, the major adhesin of uropathogenic Escherichia coli, have been deduced in part from the distinctive hemagglutination (HA) patterns these adhesins ostensibly exhibit with different erythrocytes. A comprehensive reevaluation of these HA patterns using sheep, rabbit, and diverse human erythrocytes revealed that the erythrocyte binding ranges of the three PapG variants are broader and more overlapping than generally recognized, suggestive of receptor specificities beyond those posited in the prevailing model. Experiments involving guinea pig erythrocytes artificially labeled with defined Gal(alpha1-4)Gal-containing glycolipids supported this hypothesis and further suggested that HA patterns with naturally occurring erythrocytes cannot be used to determine reliably an adhesin's glycolipid binding specificities. Finally, slide HA assays exhibited considerable interexperiment, interobserver, and intraobserver irreproducibility, limiting their usefulness for assessing either the receptor specificities of PapG variants or the PapG repertoire of wild-type E. coli strains.

Our knowledge of the traits possessed by extraintestinal isolates of Escherichia coli, necessary for growth and survival in urine, is limited. To identify such determinants, transposon (TnphoA′1,4) mutant libraries of a clinical isolate (CP9) were generated and screened for derivatives exhibiting decreased growth in urine in vitro, and for mutants with active lacZ fusions that were induced in urine relative to laboratory medium. Using this approach we identified two genes, guaA (CPA24) and argC (CPI-1), which were previously unrecognized as being important for growth in human urine. Unexpectedly, not only does CPA24 (guaA) not grow in human urine in vitro, but it is sensitive to its effects, undergoing a 2–3 log loss of viability over 6 h. By contrast, CPA24 neither grows nor is killed in M9 minimal medium and artificial urine. Therefore, we postulate that lack of guanine or its derivatives in urine, and the inability of CPA24 to synthesize these compounds de novo, prevents CPA24 from synthesizing other guanine (or derivatives)-dependent products that are critical for growth and survival in urine. Although it seems logical that decreased growth in urine in vitro should correlate with diminished urovirulence, this concept was tested by challenging mice with CPA24 in vivo in a mouse model of urinary tract infection (UTI). Indeed, CPA24 was found to be significantly less virulent compared with its wild-type parent CP9. CPI-1(argC) was identified because of the significant induction of its argC::lacZ fusion in urine. Subsequent testing in urine demonstrated that its growth was significantly diminished in all urine samples tested (four females, three males). Polyamine synthesis is dependent upon, in part, the arginine biosynthetic pathway. Therefore, we tested whether the induction of argC in urine and/or the decreased growth of CPI-1 was a result of low levels of polyamines or arginine in urine. The results suggest that low levels of arginine, but not polyamines, in human urine are responsible. When tested in vivo in the mouse model of UTI, CPI-1 was also found to be significantly less virulent than CP9. In summary, we have established that guaA and argC are the first genes, which we are aware of, that have been shown to contribute to the growth of E. coli in urine in vitro and both have diminished urovirulence in vivo. These results support the concept that urine can be used in vitro as a screening tool to identify urovirulence traits.

A more convenient assay is needed for the three recognized allelic variants of papG, which encode the Gal(alpha 1-4)Gal-binding adhesin molecules of P fimbriae of uropathogenic Escherichia coli. The development and validation of a novel multiply primed polymerase chain reaction (PCR) assay is described. The assay was 100% sensitive and specific for the three papG variants, whether present individually or in any combination. PCR products specific for the "class I" (papGJ96), "class II" (papGIA2), and "class III" (prsGJ96) alleles of papG could be resolved by size in the same lane using agarose gel electrophoresis after simultaneous amplification in a single tube by multiply primed PCR. This new papG PCR assay should aid future molecular epidemiologic studies that assess the contribution of the three variants of papG to the pathogenesis of urinary tract infection.

Abstract 3156 Introduction Clinicians have different expectations and perceptions regarding the role of primary care providers (PCPs) and hematologist/ oncologists (Hem/Oncs) in the provision of follow-up and survivorship care for patients with hematologic malignancies, and for the cancer survivor in general [Cheung JCO 2009]. The continuing decline in the number of specialists will require PCP involvement in the care of the patients with hematologic malignancies in particular, as well as cancer survivors in general. An outcomes study investigated barriers to shared care/ co-management of patients with hematologic malignancies and current practices of PCPs and Hem/Oncs regarding communication, provider roles and responsibilities and resources needed to implement effective cancer survivorship care plans. Methods: Internet polling surveys within an educational activity developed by the Leukemia & Lymphoma Society (LLS) and Medscape LLC with outcomes assessment by CE Outcomes, LLC. The activity learning objectives centered on roles and communication touch points for PCPs and Hem/Oncs, strategies and tools for optimal patient care, and recommendations for care of survivors with hematologic malignancies. Case-based education was delivered by an expert panel of hematologist/oncologist and primary-care physicians to illustrate critical communication points between Hem/Onc and PCP. The activity addressed regional variations in care, fragmentation of care, and helped define healthcare provider roles in the shared–care model. Electronic health records (EHR) and a treatment summary form were discussed as methods for effectively communicating a survivorship care plan among healthcare providers. More than 4, 000 physicians participated in the activity; 170 specialists and 587 PCPs were respondents to the survey. Polling questions and outcomes survey addressed barriers and current practices in shared care of patients with hematologic malignancies. Responses of PCPs and Hem/Oncs were aggregated and compared to identify gaps in continuity of care between specialties. Results: A summary of interactivity responses of PCPs (N=587) and Hem/Oncs (N=170) shows the most significant barrier to co-management of patients with hematologic malignancies was “lack of defined roles and responsibilities for PCPs vs specialists” (51.5% Hem/Onc vs 53.2% PCP). Confusion over roles is evident as 55.6% of Hem/Onc respondents expect the oncology specialist to follow the patient during the “watch and wait' period, while 45.8% of PCPs expect the PCP to follow the patient, and 35.4% expect the PCP and specialist to follow the patient together. More than half of PCPs and specialists report that they should co-manage follow up for cancer recurrence. The majority of PCPs and specialists report that standardized communication tools are from “very to extremely important” yet only approximately one third of PCPs and specialists are currently using EHR resources, with a third in the process of implementing EHR in their practices. Conclusions: Barriers to the provision of shared care and co-management of the cancer survivor can be addressed by more clearly defining individual clinician roles and responsibilities. Bridging gaps in the survivorship care plan requires improved communication between Hem/Oncs and PCPs to coordinate “watch and wait” care and follow-up screening, and effective methods to transfer patient records and history including Treatment Summary Forms and EHR. Disclosures: No relevant conflicts of interest to declare.

Quantitative assay methods for CAMP factor activity of group B streptococci and for neutralization of this activity by animal sera are described. The course of the CAMP reaction is influenced by preincubation of red cells with staphylococcal beta-hemolysin and the rate of the reaction by the concentration of CAMP factor. The production of CAMP factor is enhanced by substitution of maltose for glucose in culture broth. Rising inhibitory titers to CAMP activity in sera of rabbits injected with sterile culture supernates of group B streptococci suggest that CAMP factor is an antigen in the rabbit. Cows with experimentally induced group B streptococcal mastitis also demonstrated significant rises in neutralizing titers for CAMP activity.

Background The amount of medical education offered through the Internet continues to increase, providing unprecedented access for physicians nationwide. However, the process of evaluating these activities is ongoing. This study is a continuation of an earlier report that found online continuing medical education (CME) to be highly effective in making evidence-based decisions. Methods To determine the effectiveness of 114 Internet CME activities, case vignette-based surveys were administered to U.S.-practicing physicians immediately following participation, and to a representative control group of non-participants. Survey responses were analyzed based on evidence presented in the content of CME activities. An effect size for each activity was calculated using Cohen's d to determine the amount of difference between the two groups in the likelihood of making evidence-based clinical decisions. Results In a sample of 17,142 U.S. physicians, of the more than 350,000 physicians who participated in 114 activities, the average effect size was 0.82. This indicates an increased likelihood of 48% that physicians participating in online activities were making clinical choices based on evidence. Conclusion Physicians who participated in online CME activities continue to be more likely to make evidence-based clinical choices than non-participants in response to clinical case vignettes.