Search

PURPOSE The COVID-19 pandemic created an imperative to re-examine the role of telehealth in oncology. We studied trends and disparities in utilization of telehealth (video and telephone visits) and secure messaging (SM; ie, e-mail via portal/app), before and during the pandemic. METHODS Retrospective cohort study of hematology/oncology patient visits (telephone/video/office) and SM between January 1, 2019, and September 30, 2020, at Kaiser Permanente Northern California. RESULTS Among 334,666 visits and 1,161,239 SM, monthly average office visits decreased from 10,562 prepandemic to 1,769 during pandemic, telephone visits increased from 5,114 to 8,663, and video visits increased from 40 to 4,666. Monthly average SM increased from 50,788 to 64,315 since the pandemic began. Video visits were a significantly higher fraction of all visits ( P < .01) in (1) younger patients (Generation Z 48%, Millennials 46%; Generation X 40%; Baby Boomers 34.4%; Silent Generation 24.5%); (2) patients with commercial insurance (39%) compared with Medicaid (32.7%) or Medicare (28.1%); (3) English speakers (33.7%) compared with those requiring an interpreter (24.5%); (4) patients who are Asian (35%) and non-Hispanic White (33.7%) compared with Black (30.1%) and Hispanic White (27.5%); (5) married/domestic partner patients (35%) compared with single/divorced/widowed (29.9%); (6) Charlson comorbidity index ≤ 3 (36.2%) compared with > 3 (31.3%); and (7) males (34.6%) compared with females (32.3%). Similar statistically significant SM utilization patterns were also seen. CONCLUSION In the pandemic era, hematology/oncology telehealth and SM use rapidly increased in a manner that is feasible and sustained. Possible disparities existed in video visit and SM use by age, insurance plan, language, race, ethnicity, marital status, comorbidities, and sex.

Honey bee (Apis mellifera) health and hive transport are regulated by local apiary programs composed of apiary inspectors. Inspectors monitor and ensure the health of honey bees through field visits to apiaries where they inspect, identify, diagnose, and provide recommendations for the treatment of honey bee health issues. Laws and regulations pertaining to beekeeping and honey bee health are present in most states, territories, and provinces. Veterinarians are encouraged to establish a relationship with their local apiary inspector to further support beekeepers and the management of healthy honey bee colonies.

The idea that disabled young people should be at the centre of decision making about their future is promoted in policy, practice and research, yet this often translates into a narrow agenda on transitions through service and benefits systems. In this project, we aimed for an expansive exploration of disabled young people’s hopes and dreams in the context of unprecedented societal changes. Co-production methods brought academics, members of a Centre for Independent Living, and nine peer researchers together to host knowledge cafes with fifty seven disabled young people. Peer researchers visited a robotic laboratory and developed key messages around the freedom to define their future that engaged stakeholders in the impact events they took part in. The themes: being responsible, giving love, freedom and happiness and a strong sense of self and togetherness, convey a more filled-out vision of disabled young people’s futures and a new politics of the possible. Points of interest A co-production research approach was chosen to explore and promote disabled young people’s own views of their future in a rapidly changing society. Key themes arising from the research on ‘being responsible’, ‘giving love’, ‘freedom and happiness’ and a ‘strong sense of self and togetherness’, suggest rich visions of the future possibilities. New technologies, such as the automation in home and travel environments, were not highlighted by peer researchers, but were seen as possibilities supporting their key messages about quality of life. Peer researchers’ presentation of their key messages to public sector workers and politicians focussed on independence and social connections, rather than welfare services and benefits. The project themes discussed here resonate with those of disabled young people involved in citizenship research internationally. Reflections question ideas about ‘the future’ for a wider rich vision of life.

Rationale: Anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD) that is associated with higher morbidity and mortality. We evaluated three anxiety screening questionnaires: the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and the Anxiety Inventory for Respiratory Disease (AIR). Objectives: To evaluate and compare the test performance characteristics of three anxiety screening questionnaires, using the Mini-International Neuropsychiatric Interview (MINI), version 7.0, as the “gold standard.” Methods: Individuals with COPD were recruited at 16 centers. The MINI and questionnaires were administered by trained research coordinators at an in-person visit and readministered by telephone 2–4 weeks later. A composite score for the presence of any Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) anxiety disorder was computed, based on the MINI as the gold standard, compared with a participant screening positive on self-report measures for these analyses. Results: Two hundred and twenty eligible individuals with COPD were enrolled; 219 completed the study. Eleven percent were identified as having a DSM-V anxiety disorder, based on the MINI. Elevated anxiety symptoms based on questionnaires were 38% for the AIR, 30% for the GAD-7, and 20% for the HADS-A. Area under the receiver operating characteristic curve (AUC) was highest for the GAD-7 (0.78; 95% confidence interval [CI], 0.69–0.87), followed by the HADS-A (0.74; 95% CI, 0.64–0.84) and the AIR (0.66; 95% CI, 0.56–0.76). The AUC for the GAD-7 was significantly greater than for the AIR (P = 0.014). Sensitivity was not statistically different among the questionnaires: 77% for the GAD-7, 63% for the HADS-A, and 66% for the AIR. The HADS-A had the highest specificity, 85%, which was significantly higher than that of the GAD-7 (77%; P

BACKGROUND: The association between area-based social factors and sexually transmitted diseases has been demonstrated in numerous studies. Such associations have not previously been explored for their potential to quantify likelihood of higher transmission of gonorrhea in small geographic areas. METHODS: Aggregate census tract-level sociodemographic factors in 4 domains (demographics, educational attainment, household income, and housing characteristics) were merged with female gonorrhea incidence data from 113 counties in 10 US states. Multivariate models were constructed, and a tract-level composite gonorrhea risk index was calculated. This composite risk index was validated against gonorrhea incidence among women from 2 independent states. RESULTS: Seven tract-level factors were found to be most strongly correlated with female gonorrhea incidence: educational attainment, proportion of female headed households, annual household income below US $20,000, proportion of population non-Hispanic black, proportion of housing units currently vacant, proportion of population reporting moving in last year, and proportion of households that are nonfamily units. Composite index was highly correlated with female gonorrhea in the study area and validated with independent data. CONCLUSIONS: Social factors predict gonorrhea incidence at the census tract level and identify small areas at risk for higher morbidity. These data may be used by health departments and health care practices to develop geographically based disease prevention and control efforts. This is especially useful because gonorrhea incidence data are not routinely available below the county level in many states.

Citrus greening disease [Huanglongbing (HLB)] is the most significant and widespread threat to the citrus industry in recent history. A bacterium [Candidatus Liberibacter asiaticus (CLas)] vectored by the Asian citrus psyllid is the presumed causal agent of the disease, which results in the collapse of phloem tissue, leading to decreased productivity, chlorotic leaves, and bitter, misshapen fruit. Once infected, trees never fully recover and there currently is no cure, although foliar nutrient sprays and intensive irrigation appear to slow tree decline in some situations. Despite phloem necrosis in older tissue, new vegetative and reproductive growth occurs. Our current understanding of phloem collapse in citrus resulting from HLB is based on anatomical reports of trees in different stages of decline and does not explain the persistence of growth. Here, we present data that show new phloem cells are produced during the periodic flushes of vegetative growth and their subsequent collapse and plugging over a 6-month period. Cellular activity within the cambium and the ray parenchyma was diminished in HLB-affected petioles, suggesting an important link in the carbohydrate transport pathway is missing. Because of the short window of time during which the phloem appears healthy, the weeks immediately before and after the spring and summer flush are of critical importance for the management of citrus health.

To understand when patients use secure e-mail messaging with healthcare providers across several types of questions or concerns, associations between out-of-pocket costs for in-person visits and use of secure messaging, and to examine patient-reported impacts on care-seeking behavior and overall health.Cross-sectional survey of patients in an integrated healthcare delivery system, with access to a patient portal to send secure e-mail messages to providers at no out-of-pocket cost.The study included patients with a chronic condition (N = 1041). We described patient-reported preferences for contacting providers and patient-reported impact of e-mail use on phone calls, in-person visits, and overall health. We used multivariate analyses to examine patient characteristics associated with using e-mail as a first contact method, and effects on care-seeking and health.Overall, 56% of patients sent their provider an e-mail within 1 year, and 46% reported e-mail as their first method of contact for 1 or more types of medical concerns. After adjustment, higher out-of-pocket costs for in-person visits were significantly associated with choosing e-mail as a first method of contact (P.05). Among patients who had e-mailed their provider, 42% reported that it reduced their phone contacts, 36% reduced in-person office visits and 32% reported e-mailing improved their overall health.Patients reported using e-mail broadly to initiate conversations with their providers, and patients with higher out-of-pocket costs for in-person visits were more likely to choose e-mail as a first contact method. Use of secure e-mails reduced patients' use of other types of healthcare and resulted in improved overall health.

Ribosomal intervening sequences (IVSs) were recently proposed as genetic markers for microbial source tracking (MST). This study comprehensively investigated host specificities of IVSs within the 16S rDNA of 73 genera of dominant fecal bacteria using the approaches of bioinformatics and next generation sequencing (NGS). Thirteen types of IVSs were identified in silico to be associated with particular host species; they were found within bacteria of the genera Anaerovibrio, Bacteroides, Faecalibacterium, Mitsuokella, Peptostreptococcus, Phascolarctobacterium, and Subdoligranulum. Based on the DNA sequences of the thirteen types of IVSs, polymerase chain reaction (PCR) assays were developed. PCR amplifications using fecal DNA samples of target and non-target host species demonstrated that eight out of the 13 IVSs were highly associated with human, chicken/turkey, beef cattle/pig, or horse/pig/human feces. Based on the IVS polymorphisms, NGS was applied to search for single-host-associated IVSs from those linked to multiple host species. Consequently, a new type of IVS specific to beef cattle was found and confirmed by PCR amplification using cattle and non-cattle fecal samples. The results suggest that some IVSs may be used as the genetic markers for MST and that NGS may be useful in identifying novel host-specific genetic markers.

Background: Passive reporting and laboratory testing delays may limit gastrointestinal (GI) disease outbreak detection. Healthcare systems routinely collect clinical data in electronic medical records (EMRs) that could be used for surveillance. This study's primary objective was to identify data streams from EMRs that may perform well for GI outbreak detection. Methods: Zip code-specific daily episode counts in 2009 were generated for 22 syndromic and laboratory-based data streams from Kaiser Permanente Northern California EMRs, covering 3.3 million members. Data streams included outpatient and inpatient diagnosis codes, antidiarrheal medication dispensings, stool culture orders, and positive microbiology tests for six GI pathogens. Prospective daily surveillance was mimicked using the space-time permutation scan statistic in single and multi-stream analyses, and space-time clusters were identified. Serotype relatedness was assessed for isolates in two Salmonella clusters. Results: Potential outbreaks included a cluster of 18 stool cultures ordered over 5 days in one zip code and a Salmonella cluster in three zip codes over 9 days, in which at least five of six cases had the same rare serotype. In all, 28 potential outbreaks were identified using single stream analyses, with signals in outpatient diagnosis codes most common. Multi-stream analyses identified additional potential outbreaks and in one example, improved the timeliness of detection. Conclusions: GI disease-related data streams can be used to identify potential outbreaks when generated from EMRs with extensive regional coverage. This process can supplement traditional GI outbreak reports to health departments, which frequently consist of outbreaks in well-defined settings (e.g., day care centers and restaurants) with no laboratory-confirmed pathogen. Data streams most promising for surveillance included microbiology test results, stool culture orders, and outpatient diagnoses. In particular, clusters of microbiology tests positive for specific pathogens could be identified in EMRs and used to prioritize further testing at state health departments, potentially improving outbreak detection. © Copyright 2012, Mary Ann Liebert, Inc.

Historically, chemotherapy has remained the most commonly utilized therapy in patients with metastatic cancers. In prostate cancer, chemotherapy has been reserved for patients whose metastatic disease becomes resistant to first line castration or androgen deprivation. While chemotherapy palliates, decreases serum prostate specific antigen and improves survival, it is associated with significant side effects and is only suitable for approximately 60% of patients with castrate-resistant prostate cancer. On that basis, exploration of other therapeutic options such as active secondary hormone therapy, bone targeted treatments and immunotherapy are important. Until recently, immunotherapy has had no role in the treatment of solid malignancies aside from renal cancer and melanoma. The FDA-approved autologous cellular immunotherapy sipuleucel-T has demonstrated efficacy in improving overall survival in patients with metastatic castrate-resistant prostate cancer in randomized clinical trials. The proposed mechanism of action is reliant on activating the patients’ own antigen presenting cells (APCs) to prostatic acid phosphatase (PAP) fused with granulocyte-macrophage colony stimulating factor (GM-CSF) and subsequent triggered T-cell response to PAP on the surface of prostate cancer cells in the patients body. Despite significant prolongation of survival in Phase III trials, the challenge to health care providers remains the dissociation between objective changes in serum PSA or on imaging studies after sipleucel-T and survival benefit. On that basis there is an unmet need for markers of outcome and a quest to identify immunologic or clinical surrogates to fill this role. This review focuses on the impact of sipuleucel-T on the immune system, the T and B cells, and their responses to relevant antigens and prostate cancer. Other therapeutic modalities such as chemotherapy, corticosteroids and GM-CSF and host factors can also affect immune response. The optimal timing for immunotherapy, patient selection and best sequencing with other prostate cancer therapies remain to be determined. A better understanding of immune response may help address these issues.

To identify the key factors that are necessary to account for in planning and developing rehabilitation and community services for stroke based on users' perspectives.A meta-synthesis of qualitative research comprising three stages: (i) systematic searching and identification of relevant reports; (ii) critical appraisal of selected reports; (iii) analysis and synthesis of included reports.A total of 138 reports were identified, 101 were rejected after applying the inclusion criteria. Following critical appraisal, 18 papers were included. The main interconnecting themes relate to how the impact of stroke is influenced by: (i) the person; (ii) close social relationships; (iii) the social environment; (iv) interactions between all three. The lines-of-argument synthesis relates to the social world a person inhabits and its effect on how a person will perceive and deal with their stroke. Support will be most effective when delivered in the context of this social world.How stroke is perceived is highly dependent on a person's identity. Support can be effective if delivered within the existing structures of a stroke survivor's unique social world.

Background and Objective We present our experience in the era of HAART with 5,112 patients having HIV infection or AIDS, treated between 2002 and 2006 in our hospital, 182 of whom had malignancies (3.56%). We compared our findings to those from a similar cohort of patients studied 10 years earlier. Methods The charts were reviewed and data was electronically collected as in our 1993–1998 study. Similar statistical analyses were performed in both studies and the results were compared. Results For the current study the average patient age increased by 9 years. A decrease in AIDS-defining cancers (ADC), from 63.6% to 37.3% and a higher incidence of non-AIDS-defining cancers (NADC), 62.7 as opposed to 37.9% was found. No decrease in the incidence of non-Hodgkin's B cell lymphoma (NHL) was noted. There was an increase in the number of opportunistic infections notably hepatitis C virus (HCV) and hepatitis B virus (HBV). Conclusions HIV/AIDS patients on HAART are older, have lower rates of AIDS related Kaposi's sarcoma and a higher incidence of NADCs than did patients in the early HAART era. No decrease in the proportion of NHL was observed. J. Surg. Oncol. 2010;102:282–286. © 2010 Wiley-Liss, Inc.

Objective: A qualitative study using a phenomenological approach, to explore stroke survivors’ needs and their perceptions of whether a community stroke scheme met these needs. Methods: Semi-structured in-depth interviews of 12 stroke survivors, purposively selected from participants attending a new community stroke scheme. Interpretative phenomenological analysis of interviews by two researchers independently. Results: Participants attending the community stroke scheme sought to reconstruct their lives in the aftermath of their stroke. To enable this they needed internal resources of confidence and sense of purpose to ‘create their social self’, and external resources of ‘responsive services’ and an ‘informal support network’, to provide direction and encouragement. Participants felt the community stroke scheme met some of these needs through exercise, goal setting and peer group interaction, which included social support and knowledge acquisition. Conclusion: Stroke survivors need a variety of internal and external resources so that they can rebuild their lives positively post stroke. A stroke-specific community scheme, based on exercise, life-centred goal setting, peer support and knowledge acquisition, is an external resource that can help with meeting some of the stroke survivor’s needs.

Objective: The evaluation of a community-based exercise and education scheme for stroke survivors. Design: A single blind parallel group randomized controlled trial. Setting: Leisure and community centres in the south-west of England. Subjects: Stroke survivors (median (IQR) time post stroke 10.3 (5.4—17.1) months). 243 participants were randomized to standard care (124) or the intervention (119). Intervention: Exercise and education schemes held twice weekly for eight weeks, facilitated by volunteers and qualified exercise instructors (supported by a physiotherapist), each with nine participants plus carers or family members. Method: Participants were assessed by a blinded independent assessor at two weeks before the start of the scheme, nine weeks and six months. One-year follow-up was by postal assessment. Main measures: Primary outcomes: Subjective Index of Physical and Social Outcome (SIPSO); Frenchay Activities Index; Rivermead Mobility Index. NHS, social care and personal costs. Secondary outcomes included WHOQoL-Bref. Analysis: Intention-to-treat basis, using non-parametric analysis to investigate change from baseline. Economic costs were compared in a cost-consequences analysis. Results: There were significant between-group changes in SIPSO physical at nine weeks (median (95% confidence interval (CI)), 1 (0, 2): P = 0.022) and at one year (0 (—1, 2): P = 0.024). (WHOQol-Bref psychological (6.2 (—0.1, 9.1): P = 0.011) at six months. Mean cost per patient was higher in the intervention group. The difference, excluding inpatient care, was £296 (95% CI: —£321 to £913). Conclusion: The community scheme for stroke survivors was a low-cost intervention successful in improving physical integration, maintained at one year, when compared with standard care.

This ethnographic case study of the Massachusetts voucher system tests the belief that demand subsidies increase choice and purchasing power for working poor families while improving the quality of care for children. Using multiple methodologies, we examined vouchers' impact on parents, child care providers, and resource and referral agencies. All participants recognized the value of the subsidy. Yet low reimbursement rates forced providers to subsidize the system; many limited or refused vouchers. Providers and families had a strong bond; each was often overwhelmed by and suspicious of voucher administration. Children experienced discontinuity of care. Underresourced, resource and referral agencies struggle to balance a dual mission of service and “policing.” Specific policy recommendations were suggested, and adopted, in Massachusetts.

OBJECTIVE: To determine the effectiveness of didactic case-based instruction methodology to improve medical student comprehension of common neurological illnesses and neurological emergencies. SETTING: Neurology department, academic university. PARTICIPANTS: 415 third and fourth year medical students performing a required four week neurology clerkship. MAIN OUTCOME MEASURES: Raw test scores on a 1 hour, 50-item clinical vignette based examination and open-ended questions in a post-clerkship feedback session. RESULTS: There was a statistically significant improvement in overall test scores (p

This study examined polymorphism of the glucosyltransferase gene (ycjM) in fecal Escherichia coli isolates and evaluated the use of the sequence polymorphism for measuring human fecal pollution in water. Significant nucleotide variations were observed through comparative analysis of the ycjM sequences of 70 E. coli strains isolated from the feces of humans, domestic livestock, and wild animals. Three distinct types of ycjM sequences were found: universal-ycjM, human/chicken-ycjM, and human-ycjM. Using the human-ycjM sequences, both a polymerase chain reaction (PCR), Hycj-PCR and a quantitative PCR, Hycj-qPCR, were developed. As shown by the Hycj-PCR amplification, the human-ycjM marker appeared to be highly associated with the E. coli strains isolated from human feces, based on the analysis of 370 E. coli strains isolated from humans and seven other animal species. Similarly, the human-ycjM marker was highly linked with human feces, as demonstrated by the Hycj-PCR assay, when using 337 fecal DNA samples from 16 host animal sources, including both domestic and wild animals. Overall, the specificity and sensitivity of the human-ycjM marker for differentiating between the feces of humans and those of nonhuman groups were 99.7% and 100%, respectively; the prevalence of the marker appeared to be greater than 50% in the human-feces-associated E. coli population. In addition, our study showed that the quantification of human E. coli by the Hycj-qPCR was linearly correlated with the anthropogenic activity within a watershed. Our study suggests that this novel human-ycjM marker and the resulting PCR-based methods developed should be useful for measuring human-associated E. coli and human fecal pollution in water.

BACKGROUND: Replacing oral treatments with ceftriaxone is a central component of public health efforts to slow the emergence of cephalosporin-resistant Neisseria gonorrhoeae in the United States; US gonorrhea treatment guidelines were revised accordingly in 2010. However, current US gonorrhea treatment practices have not been well characterized. METHODS: Six city and state health departments in Cycle II of the STD Surveillance Network (SSuN) contributed data on all gonorrhea cases reported in 101 counties and independent cities. Treatment data were obtained through local public health surveillance and interviews with a random sample of patients. Cases were weighted to adjust for site-specific sample fractions and for differential nonresponse by age, sex, and provider type. RESULTS: From 2010 to 2012, 135,984 gonorrhea cases were reported in participating areas, 15,246 (11.2%) of which were randomly sampled. Of these, 7,851 (51.5%) patients were interviewed. Among patients with complete treatment data, 76.8% received ceftriaxone, 16.4% received an oral cephalosporin, and 6.9% did not receive a cephalosporin; 51.9% of persons were treated with a regimen containing ceftriaxone and either doxycycline or azithromycin. Ceftriaxone treatment increased significantly by year (64.1% of patients in 2010, 79.3% in 2011, 85.4% in 2012; P = 0.0001). Ceftriaxone use varied widely by STD Surveillance Network site (from 44.6% to 95.1% in 2012). CONCLUSIONS: Most persons diagnosed as having gonorrhea between 2010 and 2012 in the United States received ceftriaxone, and its use has increased since the release of the 2010 Centers for Disease Control and Prevention STD Treatment Guidelines.

†BackgroundandAims Despite the importance of vessels in angiosperm roots for plant water transport, there is little research on the microanatomy of woody plant roots. Vessels in roots can be interconnected networks or nearly solitary, with few vessel –vessel connections. Species with few connections are common in arid habitats, presumably to isolate embolisms. In this study, measurements were made of root vessel pit sizes, vessel air-seeding pressures, pit membrane thicknesses and the degree of vessel interconnectedness in deep (approx. 20 m) and shallow (,10 cm) roots of two co-occurring species, Sideroxylon lanuginosum and Quercus fusiformis. †Methods Scanning electron microscopy was used to image pit dimensions and to measure the distance between connected vessels. The number of connected vessels in larger samples was determined by using high-resolution computed tomography and three-dimensional (3-D) image analysis. Individual vessel air-seeding pressures were measured using a microcapillary method. The thickness of pit membranes was measured using transmission electron microscopy. †Key Results Vessel pit size varied across both species and rooting depths. Deep Q. fusiformis roots had the largest pits overall (.500 mm) and more large pits than either shallowQ.fusiformis roots orS.lanuginosum roots. Vessel airseeding pressures were approximately four times greater in Q. fusiformis than in S. lanuginosum and 1.3–1.9 times greater in shallow roots than in deep roots. Sideroxylon lanuginosum had 34–44 % of its vessels interconnected, whereas Q. fusiformis only had 1 –6 % of its vessels connected. Vessel air-seeding pressures were unrelated to pit membrane thickness but showed a positive relationship with vessel interconnectedness. †Conclusions These data support the hypothesis that species with more vessel– vessel integration are often less resistant to embolism than species with isolated vessels. This study also highlights the usefulness of tomography for vessel network analysis and the important role of 3-D xylem organization in plant hydraulic function.

Introduction: Central venous catheterization (CVC) can be an important component of the management of patients with severe sepsis and septic shock. CVC, however, is a time- and resource-intensive procedure associated with serious complications. The effects of the absence of shock or the presence of relative contraindications on undertaking central line placement in septic emergency department (ED) patients eligible for early goal-directed therapy (EGDT) have not been well described. We sought to determine the association of relative normotension (sustained systolic blood pressure >90 mmHg independent of or in response to an initial crystalloid resuscitation of 20 mL/kg), obesity (body mass index [BMI] ≥30), moderate thrombocytopenia (platelet count

To examine the association between use of electronic health records (EHR) and care coordination.Two surveys, in 2005 and again in 2006, of primary care clinicians working in a prepaid integrated delivery system during the staggered implementation of an EHR system. Using multivariate logistic regression to adjust for clinician characteristics, we examined the association between EHR use and clinicians' perceptions of three dimensions of care coordination: timely access to complete information; treatment goal agreement; and role/responsibility agreement.Compared to clinicians without EHR, clinicians with 6+ months of EHR use more frequently reported timely access to complete information, and being in agreement on treatment goals with other involved clinicians. There was no significant association between EHR use and being in agreement on roles and responsibilities with other clinicians.EHR use is associated with aspects of care coordination involving information transfer and communication of treatment goals.

Parcel ED-3 was the location of a portion of 'Happy Valley', a temporary worker housing area occupied from 1943 to 1947 during the construction of the K-25 Oak Ridge Gaseous Diffusion Plant. The project was carried out under subcontract for the Department of Energy. The survey report will be used in the preparation of an Environmental Assessment under the National Environmental Policy Act (NEPA). New South Associates conducted a Phase I Archaeological Survey of Parcel ED-3 at the US Department of Energy's Oak Ridge Reservation in Roane County, Tennessee. The survey was conducted in two parts. The first survey was carried out in 2008 and covered an area measuring approximately 110 acres. The second survey took place in 2009 and focused on 72 acres west of the first survey area. The objective of the surveys was to identify any archaeological remains associated with Happy Valley and any additional sites on the property and to assess these sites for National Register eligibility. New South Associates also conducted a historic assessment to gather information on Happy Valley. This historic assessment was used in conjunction with the archaeological survey to evaluate the significance of the Happy Valley site. Archaeological remains of Happy Valleymore » were located throughout the parcel, but no additional sites were located. The official state site number for Happy Valley is 40RE577. During the two surveys a total of 13 artifact concentrations, 14 isolated finds, and 75 structural features were located. Due to the Happy Valley's stron gassociation with the Manhattan Project, the site is recommended eligible for the National Register of Historic Places under Criterion A.« less

Background Mantle cell lymphoma (MCL) is an aggressive type of B-cell non-Hodgkin's lymphoma that originates from small to medium sized lymphocytes located in the mantle zone of the lymph node. Extra nodal involvement is present in the majority of cases, with a peculiar tendency to invade the gastro-intestinal tract in the form of multiple lymphomatous polyposis. MCL can be accurately diagnosed with the use of the highly specific marker Cyclin D1. Few cases of mantle cell lymphoma presenting with intussuception have been reported. Here we present a rare case of multiple intussusceptions caused by mantle cell lymphoma and review the literature of this disease. Case presentation A 68-year-old male presented with pain, tenderness in the right lower abdomen, associated with nausea and non-bilious vomiting. CT scan of abdomen revealed ileo-colic intussusception. Laparoscopy confirmed multiple intussusceptions involving ileo-colic and ileo-ileal segments of gastrointestinal tract. A laparoscopically assisted right hemicolectomy and extended ileal resection was performed. Postoperative recovery was uneventful. The histology and immuno-histochemistry of the excised small and large bowel revealed mantle cell lymphoma with multiple lymphomatous polyposis and positivity to Cyclin D1 marker. The patient was successfully treated with Rituximab-CHOP chemotherapy and remains in complete remission at one-year follow-up. Conclusion This is a rare case of intestinal lymphomatous polyposis due to mantle cell lymphoma presenting with multiple small bowel intussusceptions. Our case highlights laparoscopic-assisted bowel resection as a potential and feasible option in the multi-disciplinary treatment of mantle cell lymphoma.

181 Background: SipT prolongs OS in asymptomatic or minimally symptomatic CRPC without regularly inducing PSA declines. Elevated CD54 count, CD54 upregulation (UPREG) and total nucleated cells (TNC), markers of immune activation in the product, have been shown to correlate with longer survival. We prospectively collected clinical characteristics and inflammatory markers as part of an audit to identify possible predictors of immune response in patients receiving SipT. Methods: 92 men with CRPC had blood drawn routinely before and after SipT treatment at USC. Circulating tumor cells (CTC), PSA, prostatic acid phosphatase (PAP), albumin (Alb), hemoglobin (Hb), serum alkaline phosphatase (SAP), LDH, C-reactive protein (CRP) and β2-microglobulin (β2m) were evaluated in a reference lab. SipT product parameters, CD54, UPREG and TNC were measured by Dendreon. These datasets were analyzed using Spearman coefficients for continuous variables and the Kruskal-Wallis test for categorical variables. Results: 92 pts who received SipT were included. Median age was 69 (48-90). 43% had Gleason 8-9. 42% had ECOG Performance Status (PS) 0, 44% PS 1, and 13% PS 2. 26% had received prior chemotherapy and 18% had used opioids. 84% had bone mets, 42% had lymphadenopathy, and 12% had visceral mets. Increases in the PSA, PAP, LDH and Alb was directly correlated with increased CD54 counts, increases in the CTC was directly correlated with increased TNC, whereas decrease in SAP was correlated with increased upregulation of dendritic cells. Conclusions: Our results show that increased tumor markers immediately after treatment are more common in high CD54 product pts. This may represent a “flare” due to immune activation. [Table: see text]

We show that the proportion of community social capital attributable to religious groups is inversely and strongly related to the number of cigarettes that smokers consume. We do not find overall community social capital or the proportion of community social capital attributable to religious groups to be related to the overall prevalence of smoking. Using a new validated measure of community social capital, the Petris Social Capital Index and three years (1998–2000) of US data on 39 369 adults, we estimate a two-part demand model incorporating the following controls: community-level fixed effects, price (including excise taxes), family income, a smuggling indicator, nonsmoking regulations, education, marital status, sex, age, and race/ethnicity. Copyright © 2006 John Wiley & Sons, Ltd.