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The use of DNA barcoding has revolutionized biodiversity science, but its application depends on the existence of comprehensive and reliable reference libraries. For many poorly known taxa, such reference sequences are missing even at higher-level taxonomic scales. We harvested the collections of the Smithsonian’s National Museum of Natural History (USNM) to generate DNA barcoding sequences for genera of terrestrial arthropods previously not recorded in one or more major public sequence databases. Our workflow used a mix of Sanger and Next-Generation Sequencing (NGS) approaches to maximize sequence recovery while ensuring affordable cost. In total, COI sequences were obtained for 5,686 specimens belonging to 3,888 genera and 202 families. Success rates varied widely according to collection data and focal taxon. NGS helped recover sequences of specimens that failed a previous run of Sanger sequencing. Success rates and the optimal balance between Sanger and NGS are the most important drivers to maximize output and minimize cost in future projects. The corresponding sequence and taxonomic data can be accessed through the Barcode of Life Data System, GenBank, the Global Biodiversity Information Facility, the Global Genome Biodiversity Network Data Portal and the NMNH data portal.

e18057 Background: We aimed to identify the incidence and risk factors for osteoradionecrosis (ORN) in head and neck cancer (HNC) patients. We also compared frequency of severity scores across different ORN grading systems. Methods: Retrospective review was conducted for HNC patients who were managed at our institution (2011-2018) with curative-intent definitive, pre- or post-operative intensity-modulated radiation therapy (IMRT) with 45Gy, and underwent pre-IMRT dental evaluation. Jaw ORN was defined based on: 1) clinical signs (exposed bone, bone spicules, sequestra, infection and fistula), 2) radiological finding (abnormal bone pattern, radiographic sequestra and pathological fracture), and 3) treatment required and response to therapy, either conservative (chlorhexidine rinse, antibiotics, PENTOCLO, and hyperbaric oxygen) or surgical (sequestrectomy, debridement, and jaw resection). ORN events were retrospectively graded using 6 different grading systems. Pre-IMRT periodontal condition (PC) was classified by universal multi-dimensional staging system based on number of teeth and bone loss (stages 0 to IV). Multivariable analysis (MVA) using logistic regression was applied to identify risk factors of ORN. Results: A total of 2735 HNC patients were included; median age 61 years, 30% (n = 807) current/ex-smokers, 72% (n = 1914) had moderate to severe PC (stage II-IV), 53% (n = 1459) oral cavity/oropharynx (OC/OP) primary tumor. The median IMRT dose was 70Gy/35 fractions, 43% (n = 1170) received concurrent chemotherapy, and 37% (n = 1006) underwent surgery. A total of 227 patients (8.3%) developed ORN. There was discrepancy in different grading system for capturing and reporting the degree of severity (i.e. grade) of ORN (table). On MVA, risk factors for ORN were: current/ex-smoker (OR 1.5, 95% CI: 1.12-2, p< 0.01), stage II-IV PC (OR 1.7, 95% CI: 1.17-2.36, p< 0.01), primary OC/OP tumor (OR 4.4, 95% CI: 3.08-6.29, p< 0.001], and IMRT dose prescription ≥60Gy (OR 3.5, 95%CI: 1.11-11.33, p< 0.01). Conclusions: ORN is relatively uncommon in HNC patients, however it can be under-reported by different grading systems. Risk factors for ORN were: smoking history, pre-IMRT poor PC condition, OC/OP primary tumor, and higher dose (≥60Gy) IMRT.[Table: see text]

e18040 Background: While several studies have documented a link between socioeconomic status and survival in head and neck cancer, nearly all have used ecologic, community-based measures. Studies using more granular patient level data are lacking. We sought to determine the association between baseline annual household income with financial toxicity, health utility and survival. Methods: This was a prospective cohort of adult head and neck cancer patients treated at tertiary cancer center between September 17, 2015, and December 19, 2019. Our primary exposure was annual household income at time of diagnosis. Outcomes of interest included disease-free survival, financial toxicity, measured using the FIT tool, and health utility, measured using the Health Utilities Index Mark 3. Cox proportional hazards models were used to estimate the relationship between household income and survival. Income was regressed onto log-transformed FIT scores using linear models. The association between income and health utility was explored using generalized linear models. A generalized estimating equations approach was incorporated to account for patient level clustering. Results: There were 555 patients included in this cohort. Two-year disease-free survival was worse for patients in the bottom income quartile (< $30,000 - 67% [95%CI 58-78])) compared to the top quartile (≥$90,000 - 88% [95%CI 83-93]). In risk adjusted models, patients in the bottom income quartile had inferior disease-free survival (aHR 2.13 [95%CI 1.22-3.71]) but not overall survival (aHR 2.01 [95%CI 0.94-4.29]). The average FIT score was 22.6 in the lowest income quartile vs. 11.7 in the highest quartile. In adjusted analysis, low-income patients had 12-month FIT scores that were, on average, 134% higher (worse) [95%CI 16%-253%] than high-income patients. Similarly, health utility scores were, on average, 0.106 [95%CI 0.029-0.184] points lower for low-income patients. Conclusions: Head and neck cancer patients with a household income < $30,000 experienced worse financial toxicity, health status and disease-free survival. Significant disparities exist for Ontario’s head and neck cancer patients.

6067 Background: TORS has improved the likelihood of identifying an oropharyngeal cancer for patients presenting with unknown primary. We evaluate the oncologic and functional outcomes after reduction of RT volumes based on TORS findings. Methods: Patients with p16-positive, neck SCC (cN1-N3) with no primary on examination and CT/MRI were included between 08/2017 and 12/2019. All patients underwent PET-CT, surgical evaluation with either therapeutic intent including neck dissection for cN1 without extranodal extension (Group 1, n=9) or diagnostic intent (Group 2, n=13). Patients underwent excision of palatine tonsil (PT) followed by lingual tonsil (LT), if the PT was negative, or excision of PET-CT avid regions. Pharyngeal-sparing radiotherapy (PSRT) was given when no primary was found (pT0) and for primaries completely excised (margins >= 3mm). Unilateral neck radiotherapy (UNRT) was given for lateralized (>1 cm from midline) primaries or pT0 with unilateral disease. The primary outcome was 2-year out-of-treated volume failures (OTVF). Swallowing-related quality of life (SR-QOL) was measured using MD Anderson Dysphagia Inventory (MDADI) composite score. A sample size of 22 was required assuming OTVF cannot exceed 15% (vs. 1% historical), power of 0.8, alpha of 0.05 (one-sided), and loss to follow-up of 10%. Results: All 22 patients [median age 60 (46-68); 86% male; 86% N1, 9% N2, 5% N3] underwent surgical evaluation. PET-CT showed suspicious findings in 12 (55%) [sensitivity = 0.44, specificity = 0.29]. Excision of PT and LT were performed in 14 (64%) and 14 (64%) patients respectively; and 8 (36%) had previous PT. Oropharyngeal primaries were found in 17 patients (77%) [14 (64%) single primary, 3 (13%) two primaries]. RT volume de-intensification was achieved in 11 patients (50%) who had PSRT and 10 (45%) who had UNRT. In Group 1, adjuvant RT was given to 6 (67%) and CRT to 1 (11%). In group 2, 8 (62%) had RT and 5 (38%) had CRT. There were no OTVF, local, or regional failures [median follow-up 29 months]. Two-year OS, DFS, and LRC were 100%, 95%, and 100%. SR-QOL showed good recovery (Table). Grade III/IV surgical as well as acute and late toxicities occurred in 2 (9%), 5 (23%), and 1 (5%) respectively. Conclusions: TORS evaluation for p16-positive unknown primary SCC allowed RT volume de-intensification with excellent disease control and quality of life. Future randomized trials can compare transoral surgery versus existing diagnostic approaches. MDADI composite scores. Clinical trial information: NCT03281499. [Table: see text]

6092 Background: Sinonasal cancers (SC) are heterogeneous diseases. Despite multimodality treatment, overall survival (OS) remains unsatisfactory. We aimed to identify prognostic factors (PFs) associated with patterns of failure and OS in non-metastatic SC (nmSC). Methods: We retrospectively reviewed a pooled dataset of nmSC from Princess Margaret (Canada) and Catalan Institute of Oncology (Spain) treated with definitive surgery ± postop radiotherapy (RT) or RT ± chemo according to institutional protocols between 2010-2019. In squamous cell carcinoma (SCC), HPV status was tested by p16 staining, and HPV DNA (ISH or PCR) if equivocal. The primary goal was to assess the association of tumor histology, stage (by 7th edition TNM), and other clinicopathological variables on locoregional control (LRC), distant control (DC) and OS. Actuarial rates were calculated with Kaplan–Meier (KM) method. Multivariable analysis (MVA) calculated hazard ratios (aHR) adjusted for histology type, T-/N-categories, and primary treatment. Results: Out of 342 pts, median age was 62 years (y) (range 21-96), Male:Female = 212:130, 95% had ECOG 0-1. Tumor histology types were: 192 (56%) SCC (p16+: 35; p16-/untested: 157), 40 (12%) adenocarcinoma (AD), 33 (10%) sinonasal undifferentiated carcinoma or sinonasal neuroendocrine tumors (SNUC/SNEC), 28 (8%) malignant melanoma (MM), 27 (8%) esthesioneuroblastoma (ES) and 22 (6%) adenoid cystic carcinoma (ACC). Median follow up was 3.6 y (range 0.1-11.3). Three-year actuarial rates for each endpoint are included in table. The PFs for LRC by MVA were: SNUC/SNEC (vs SCC) histology, T3-4 (vs T1-2: aHR 2.4, p = < 0.01) and N+ (vs N-: aHR 1.7, p = 0.02) diseases. The PFs for DC were: MM (vs SCC) and SNUC/SNEC (vs SCC) histology, and T3-4 (vs T1-2: aHR 6.0, p = 0.01) disease. The PFs for OS were: MM (vs SCC) histology, older age (aHR 1.0, p < 0.01), T3-4 (vs T1-2: aHR 5.6, p < 0.01), and N+ (vs N-: aHR 2.5, p < 0.01) disease. There was no difference in primary surgery vs RT in any outcome endpoint (all p > 0.05). p16+ SCC had a marginally higher LRC but similar DC and OS vs p16-/untested SCC (table). Conclusions: This large multicentre cohort of nmSC shows different patterns of relapse and survival with different tumor histologies. Our results suggest that individualization of treatment and follow-up strategies by histologic type is recommended to optimize outcomes in these orphan diseases. [Table: see text]

BACKGROUND Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting. OBJECTIVE The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. METHODS A patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada’s largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts. RESULTS A total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28% (2366/5343) using the paper-based approach to 65.72% (3538/5383) using CEASE (P CONCLUSIONS CEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.

It is known that the body can efficiently repair hard tissue (bone) micro fractures by suturing the defect through the deposition of minerals resulting in an area that is stronger post-injury. Larger defects, however, generally cause more trouble since the body is incapable of repairing them. Bone defects can occur as a result of congenital abnormalities, trauma, or disease. Traditional methods for addressing these defects have involved the use of acellular cadaverous bone or autologous bone. Both contain innate prob- lems associated with them; the former method can result in disease transmission, as well as very low integration with the host due to the lack of viable cells while the latter is associated with two surgical sites and morbidity at the donor site. Alternative methods have been developed, but no method has yet provided a satisfactory solution. As a result, resear- chers and the medical community are turning toward the promising fields of biomaterial development and tissue engineering to develop new materials and me- thods of bone regeneration. In this work, a design of experiments (DOE) approach was performed to ren- der commercially available biodegradable polymers (Poly(caprolactone)-diol/triol) photocrosslinkable and resultantly manufacturable using stereolithography (SL), a rapid prototyping technology. To perform the investigations, a commercial SL system (Viper HA, 3D Systems, Valencia, CA) equipped with a solid state laser system (355 nm wavelength) was used to manu-facture synthesized poly(caprolactone) trifuma- rate (PCLtF) 3D porous constructs. Results of the work conducted produced constructs which provided pro- mising chemical and biological results for the in- tended application.

Exposure of young C. elegans nematodes to three different concentrations of oil resulted in changes in the meiotic chromosomes, nucleus, nucleolus, and nuclear envelope associations. Such alterations decreased the viability and fertility of this organism which was used as a biological model. The morphological changes in the “young” group were similar to nematodes that were senescent and post-reproductive. Comparison of meiotic chromosomes at the pachytene stage of meiosis from young, old, and oil-exposed wild-type hermaphrodites were made following three-dimensional electron microscopy reconstruction of serial ultrathin sections. Age-related and oil-exposure related changes included: 1) Induced condensation of chromatin with increased variance in length of chromosomes; 2) Changes in nuclear and nucleolar volume; 3) Increased density of the nucleoplasm; and 4) Absence of Disjunction Regulator Regions, resulting in the loss of control of the segregation of the X-chromosome into gametes during meiosis. Abnormal clustering of the telomeric ends of the chromosomes was present on the nuclear envelope affecting the segregation of the chromosomes during meiosis.

Despite differing legal interpretations and changes in how eligibility requirements applied in practice (see Hunt and Baumohl, this issue), all individuals formerly receiving Supplemental Security Income (SSI) for drug addiction and/or alcoholism (DAA Lurigio & Swartz, 1999). One aspect of this relationship, the propensity of some addicts to commit robbery or property crimes such as burglary and theft in order to obtain money for the immediate purchase of drugs, has received significant emphasis and support in the research literature (Chaiken & Chaiken, 1990; Inciardi, 1981; Johnson, Anderson & Wish, 1988). If in fact some or most of the federal cash benefits received by DAA Shaner, Eckman, Roberts et al., 1995; but see also Frisman & Rosenheck, 1997, and Rosenheck & Frisman, 1996, for findings and opinions contradicting these studies), the loss of DA&A benefits may have prompted some individuals, those who were still using drugs, to begin committing crimes or to intensify their criminal activity to support their illegal drug use.To date there has been little research on the relationship between the loss of federal cash benefits and crime among DA&As or among other populations similarly affected by federal welfare reform legislation (e.g., TANF recipients). Recent studies of these populations, especially of those on TANF, have focused on the degree to which individuals have been able to replace their lost benefits through employment and the social and psychological impediments that have prevented them from doing so (e.g., Danziger, Corcoran, Danziger et al., 1999). These studies have found that many former welfare recipients have great difficulty attaining and sustaining employment because of drug abuse and/or mental illness (e.g., Jayakody, Danziger & Pollack, 2000). …

Survival after gamma irradiation (generated from either a 137Cs or 60Co source) was determined for two strains of the nematode Caenorhabditis elegans. Animals were between 1.3 and 39 times more sensitive to cesium than to cobalt. The magnitude of this differential sensitivity was dependent upon the strain, developmental stage and sex tested. Several control experiments eliminated trivial explanations for this difference. Since cobalt- and cesium-generated gamma particles have nearly identical energy depositions, the differential sensitivity likely reflects different mechanisms of processing the slightly different spectra of DNA damage induced by these two radiations. Sex-specific differences in radiation sensitivity were also noted and were likely due to the fact that males possess a single X chromosome rather than two, as do hermaphrodites.

At Sharp HealthCare in San Diego, California administrators, medical staff, and educators are working collaboratively on a “continuous medical education” project to link continuous quality improvement (CQI), quality assurance (QA), and continuing medical education (CME). The purpose of this project is to change the way physicians define quality health care and use education to impact their competence and performance as clinicians. Given the rapid changes occurring within health care in this country and the failure of many previous attempts to link CME and health care delivery, a new paradigm is needed. Using the model of the Harvard Community Health Plan, the administrative and medical director of CME and four medical staff leaders at Sharp Memorial and Cabrillo hospitals spent several days in Boston learning the process of designing clinical algorithms. Currently four algorithms are being developed by these physicians and the algorithm development groups, assisted by the office of CME. The algorithms include the prevention of deep-vein thrombosis, management of abnormal mammograms, management of the hospitalized acute MI patient, and the management of the obstetric patient who fails to progress during labor. The role of the office of CME and preliminary findings are described, along with a projection of the next steps in the implementation of these algorithms. Participating physicians' attitudes are also examined.

Recently enacted federal legislation targeted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DAA) may be creating a residual population that is too seriously impaired to work owing to psychiatric and substance use disorders.Data in this report were derived from 1-year follow-up interviews of 204 randomly selected DAA beneficiaries in Chicago who were initially interviewed between January 1997 and March 1997, immediately following their termination in the Supplemental Security Income DAA program. Information on subjects' work and benefits status were collected along with DSM-III-R psychiatric and substance use disorder diagnostic information. Urine specimens were also collected and tested for recent use of marijuana, cocaine, opiates, phencyclidine, amphetamines, and methadone.Twenty-six percent had a past-year severe mental illness while 34% met the DSM-III-R criteria for drug dependence. Illegal drug use was also prevalent with about 50% of the sample testing positive for marijuana, cocaine, or opiates. Compared with those working and earning at least $500 a month, unemployed or underemployed subjects who had lost all federal benefits had a much greater likelihood of being dependent on drugs (odds ratio, 5.0; P.005; 95% confidence interval, 1.6-15.7) and of having 2 or more comorbid psychiatric disorders (odds ratio, 6.9; P.005; 95% confidence interval, 1.9-24.7).Those who have lost DAA disability benefits and who continue to be unemployed or underemployed have elevated rates of drug dependence and psychiatric comorbidities; consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult.

HIV/AIDS is the third-leading cause of death among adults ages 25 to 44. As of December 31, 1994, there were 441,528 reported cases of AIDS in the U.S.

The treatise writer's dilemma is that while reliability requires faithful interpretation of the law as it stands, he or she must also remain sufficiently detached and forward-looking to assist decisionmakers in shaping the law as it ought to be. The better treatise writers resolve this tension by devising jurisprudential and methodological approaches that broaden the horizons of experienced practitioners in the field. Paul Goldstein's Copyright: Principles, Law and Practice fits this mold. His ability to use economic analysis to illuminate discrepancies between judicial decisions and legal doctrines distinguishes this major new treatise from other useful commentaries in the field.2 Professor Goldstein's treatise arrives at a time when economic and inter

At metaphase of the first spermatocyte meiotic division in Ascaris lumbricoides var. suum the polymorphic bivalents are arranged at the equatorial plate peripheral to a central aggregate mass. The aggregate mass segregates to only one of the two daughter cells and thus behaves as a sex chromosome. The mass is comprised of two components: a granular chromatin that can be differentiated from the autosomes at metaphase I, and a condensed chromatin that has a similar morphology to the autosomes but is functionally differentiated at anaphase I. The condensed chromatin may be autosomes that have fused with the sex chromsomes and may be responsible for the segregation of the whole aggregate at anaphase I. Analysis of the origin of the mass is discussed and microtubular association in the movement of the mass is described.

Pairing of the three X chromosomes in the triplo-X strain of Caenorhabditis elegans occurs at pachytene in a two-by-two fashion such that one bivalent and one univalent are formed. The XX bivalent pairs synchronously with the autosomes and the univalent X remains in a similar chromatic state as the rest of the chromosomal complement. Normal tripartite synaptonemal complexes (SC) are formed between all bivalents. The univalent X lacks a SC and an axial core is not observed. The condensation of the univalent X in the triplo-X is different than in the male where the univalent X is heterochromatic. This real difference in condensation states of the chromatin may explain the fact that the univalent X is maintained in the male line yet it is easily lost in the triplo-X strain.

The duplication mutant Dp1 presents morphological changes of the pachytene nuclei which include enlarged nuclei (58% greater than the wild type (WT)) and increased total length of the synaptonemal complex (SC) complement (32% greater than WT). The size of the nucleolus is similar to that of the wild type. The SC of the XX bivalent is 2.5 μm long which is similar to the length in other strains. Genetic analysis (Herman et al. 1976) has shown that a duplicated segment of the X chromosome has been transposed to linkage group V in the Dp1 mutant. The present analysis, however, did not reveal the expected duplication loop in bivalent V of the heterozygous Dp1 strain. There is an average of three “Disjunction Regulator Regions” (DRR) per nucleus and approximately 1% X-chromosome nondisjunction which is consistent with the notion that the presence of DRRs somehow facilitates regular disjunction of the X chromosome. Statistical analysis, based on 9 different strains and 81 nuclei, indicates that there is a good correlation between the frequency of occurrence of X-chromosome nondisjunction and the number of DRRs.