Ancillary Benefit Research Articles

Improving the response to lenvatinib in partial responders using a Constrained-Disorder-Principle-based second-generation artificial intelligence-therapeutic regimen: a proof-of-concept open-labeled clinical trial.

The main obstacle in treating cancer patients is drug resistance. Lenvatinib treatment poses challenges due to loss of response and the common dose-limiting adverse events (AEs). The Constrained-disorder-principle (CDP)-based second-generation artificial intelligence (AI) systems introduce variability into treatment regimens and offer a potential strategy for enhancing treatment efficacy. This proof-of-concept clinical trial aimed to assess the impact of a personalized algorithm-controlled therapeutic regimen on lenvatinib effectiveness and tolerability. A 14-week open-label, non-randomized trial was conducted with five cancer patients receiving lenvatinib-an AI-assisted application tailored to a personalized therapeutic regimen for each patient, which the treating physician approved. The study assessed changes in tumor response through FDG-PET-CT and tumor markers and quality of life via the EORTC QLQ-THY34 questionnaire, AEs, and laboratory evaluations. The app monitored treatment adherence. At 14 weeks of follow-up, the disease control rate (including the following outcomes: complete response, partial response, stable disease) was 80%. The FDG-PET-CT scan-based RECIST v1.1 and PERCIST criteria showed partial response in 40% of patients and stable disease in an additional 40% of patients. One patient experienced a progressing disease. Of the participants with thyroid cancer, 75% showed a reduction in thyroglobulin levels, and 60% of all the participants showed a decrease in neutrophil-to-lymphocyte ratio during treatment. Improvement in the median social support score among patients utilizing the system supports an ancillary benefit of the intervention. No grade 4 AEs or functional deteriorations were recorded. The results of this proof-of-concept open-labeled clinical trial suggest that the CDP-based second-generation AI system-generated personalized therapeutic recommendations may improve the response to lenvatinib with manageable AEs. Prospective controlled studies are needed to determine the efficacy of this approach.

Ancillary Benefit of Microbiology Culture Diagnostic Stewardship: Decreasing Healthcare’s Climate Impact

Abstract We calculated weights of blood, urine, and endotracheal tube culture supplies and quantified greenhouse gas emissions emitted for disposal of these supplies. Of note, disposal related emissions for a positive blood and endotracheal tube culture are each equivalent to driving 0.6 and 0.4 miles, respectively, in a gasoline-powered vehicle.

The Psychological Impact of Hand Injuries Among Foreign Workers in Singapore.

Foreign workers comprise a significant portion of Singapore's workforce. They face multiple challenges when working there. A hand injury may add to these stressors, causing profound psychological and social impact. There are few studies in the literaturethat have analyzed this effect.The primary objective of this study, the firstof its kind in Singapore, is to investigate the psychological impact and functional outcomes of hand injuries among foreign workers. By assessing the prevalence of psychological conditions such as stress, anxiety, and depression, along with measuring functional impairment using validated tools, this study aims to provide insights into the psycho-social challenges faced by this vulnerable population. A single-encounter interview was conducted for eligible patients. Psychological impact was measured using the DASS-21, symptom severity and function with the QuickDASH, and pain with the VAS. Injury-specific and demographic data were also collected. The Mann-Whitney U test and the Chi-Squared test were applied for non-parametric variables and categorical data, respectively. The adjusted p-value was <0.05. Eighty foreign workers were recruited. The mean age was 33 years, and the median age was 31.5 years (28.2 to 37.0). The majority were male (97.5%), married (60%), and had a salary of less than SGD1500 (USD1077) per month (81.3%). The most common mechanism of injury was penetrating (60%, n=48). Stress, anxiety, and depression were positively associated with limitations in daily function. Multivariate analysis found that limitations in daily function were independently associated with stress, anxiety, and depression, regardless of hand dominance. Conclusion:This study has shown a significant psychological and social impact of hand injuries among foreign workers in Singapore. There is potential for the development of screening and support programs for at-risk workers to cater to their mental well-being. We recommend that the psychological impact of hand injuries be factored into holistic management and rehabilitation with adequate time and resource allocation. An ancillary benefit is the improvement of productivity and overall contribution to Singapore's economy.

Tuning hydrogen boil-off via inert gas insulation purge in a vapor cooled shielded fuel tank

Vapor cooled polymer composite tanks for liquid hydrogen are a newopportunity for light weight power-system integration into unmanned aerial vehicles. Vapor shielding has the ancillary benefit of pre-conditioning the hydrogen for use by a fuel cell. However, the mass flow rate required by a fuel cell should be matched by the natural boil-off rate of the tank. With limited ability to vary insulation thicknesses, the challenge becomes satisfying the fuel cell consumption in UAVs at different mass flow rates when at varying stages of flight from take-off, cruise, and landing. This paper provides experimental measurements of mass flow rate of hydrogen from the tank considering batch purging with helium or argon in the vapor cool shielded insulation layer. A 5-shell vapor cooled shielded tank is used with two layers of insulation including aerogel, helium or argon, and two vapor channels. A more complete understanding of system-level thermal conductance is determined by mass flow of hydrogen leaving the tank during hypothetical flight.

Academic productivity in Orthopaedic Traumatology correlates positively with industry compensation.

To determine the association between academic productivity and industry compensation amongst Orthopaedic Traumatologists. Retrospective cohort study. Review of the CMS Open Payments System from 2016-2020. One-thousand one-hundred twenty (N=1,120) Orthopaedic Traumatologists. To determine if an Orthopaedic Traumatologist's h-index and m-index, as generated from Web of Science, Scopus, and Google Scholar User Profile databases, correlate with total payments from medical industry in seven categories, including Royalties and Licensing Fees, Consulting Fees, Gifts, Honoria, and three unique Speaking Fee delineations. Of 30,343 Orthopaedic Surgeons in the Open Payments system, 1,120 self-identified with the Orthopaedic Trauma taxonomy. From 2016-2020, 499 (44.6%) surgeons received compensation in one of the eligible categories, most commonly from Consulting Fees (67.3%), though payments from Royalties provided the greatest gross income (70.4%). Overall, for all 1,120 surgeons, h-index (r=0.253, p<0.001) and m-index (r=0.136, p<0.01) correlated positively with mean annual total industry compensation. The highest annual compensation group had higher h-index ($0 vs $1-$1k vs $1k-$10k vs >$10k: 5.0 vs 6.6 vs 9.6 vs 16.8, p<0.001) and m-index ($0 vs $1-$1k vs $1k-$10k vs >$10k: 0.48 vs 0.60 vs 0.65 vs 0.89, p<0.001) scores than either the intermediate or no compensation groups. Multivariable analysis of factors associated with increased industry compensation, including H-index and years active, identified both as having significant associations with physician payments (H-index (B=0.073, p<0.001); years active (B=0.059, p<0.001)). Subgroup analysis of the highest annual earner group (>$250k/year) also demonstrated the highest overall h-index (27.6, p<0.001) and m-index (1.23, p=0.047) scores, even when compared to other high-earners ($10k-$50k, $50k-$250k). Overall, each increase in h-index above an h-index of 3 was associated with an additional $1,722 (95% CI: $1,298-2,146) of annual industry compensation. Academic productivity metrics have a positive association with industry compensation for Orthopaedic Traumatologists. This may highlight a potential ancillary benefit to scholarly efforts. Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sistem Pendukung Keputusan Pengembangan Ekowisata Mangrove Potensial Menggunakan Simple Additive Weighting (SAW)

Adjusting resource availability and traveler preferences will allow for an objective assessment of prospective mangrove ecotourism growth. In order to build mangrove ecotourism destinations effectively, it is vital to identify their priority locations. It is required to create the development program as a criterion and the development zone as a prioritized alternative in light of this. This study used the Simple Additive Weighting (SAW) technique, which includes the following stages: deciding on criteria and alternatives; weighing the relative importance of each criterion; creating a matrix of findings; and ranking the alternatives based on the biggest value. The study's findings indicate that five criteria can be categorized based on benefit and cost with varying relative values: attraction (benefit), ancillary (benefit), accommodation (cost), accessibility (cost), and amenities (cost). Attraction has a relative value of 0.3, ancillary has a relative value of 0.2, and amenities (cost) has a relative value of 0.15. The ranking results showed that the amenity criteria came first, followed by accessibility, then attractions, lodging, and ancillary. Attractions were ranked third, while accommodations came in fourth. This demonstrates the necessity for amenities that pique tourist interest and accessibility through accessible modes of transportation, informational resources, and roads to tourist destinations to support the growth of mangrove ecotourism special interest tourism. The management of mangrove ecotourism destinations can be improved by offering lodging options. Following amenities, accessibility, attractions, and lodging, organizations or groups can be established, and infrastructure in tourist sites can be enhanced. As a result, the SAW approach can be used as a system to help decide which initiatives to prioritize

Multi-effect distillation: a sustainable option to large-scale green hydrogen production using solar energy

Development of sustainable, gigawatt capacity green hydrogen will require both renewable energy and water inputs, along with careful management of the waste heat produced by these processes (i.e., 9.3–16.7 kWhth/kgH2 for a 70–80% stack efficiency, high heat value). Here we compare the water demands and operating costs for a solar-driven electrolyser facility (powered by solar PV) operating on desalinated seawater produced using reverse osmosis or low-temperature multi-effect distillation. The waste heat was managed via passive cooling, evaporative cooling or through thermal recovery. It was found that the costs for low-temperature multi-effect distillation were up to 85% lower than reverse osmosis and generated 50–270L/ kgH2 of surplus water for ancillary benefit. This work challenges conventional wisdom surrounding the use of membrane desalination for meeting the water demands, offering compelling reasons for thermal desalination to be employed in large-scale production of green hydrogen.

Elena Ferrante’s loud solitude: The benefits and limitations of relational anonymity

This article examines the ethics of novelist Elena Ferrante’s anonymity through an analysis of her correspondences in Frantumaglia (2016). Prompted by Ferrante, I offer a critique of modern authorship and propose a relational understanding of creativity, an approach that emphasises the social uses of language and refutes the separation of the individual author from their social environment. I argue that Ferrante’s writing praxis enacts Judith Butler’s ethical methodology from Giving an Account of Oneself (2005) by withholding normative biographical details while providing readers with de-identified self-narration via her fiction and written correspondences. I argue that this methodology restores the primacy of language and the structure of address to the act of writing with the ancillary benefit of a conditional yet autonomous creative space in which to resist the pressure of normative morality – a space reconfigured as relational or “loud” solitude.

Frequency of bystander exposure to antibiotics for enteropathogenic bacteria among young children in low-resource settings

Children in low-resource settings carry enteric pathogens asymptomatically and are frequently treated with antibiotics, resulting in opportunities for pathogens to be exposed to antibiotics when not the target of treatment (i.e., bystander exposure). We quantified the frequency of bystander antibiotic exposures for enteric pathogens and estimated associations with resistance among children in eight low-resource settings. We analyzed 15,697 antibiotic courses from 1,715 children aged 0 to 2 y from the MAL-ED birth cohort. We calculated the incidence of bystander exposures and attributed exposures to respiratory and diarrheal illnesses. We associated bystander exposure with phenotypic susceptibility of E. coli isolates in the 30 d following exposure and at the level of the study site. There were 744.1 subclinical pathogen exposures to antibiotics per 100 child-years. Enteroaggregative Escherichia coli was the most frequently exposed pathogen, with 229.6 exposures per 100 child-years. Almost all antibiotic exposures for Campylobacter (98.8%), enterotoxigenic E. coli (95.6%), and typical enteropathogenic E. coli (99.4%), and the majority for Shigella (77.6%), occurred when the pathogens were not the target of treatment. Respiratory infections accounted for half (49.9%) and diarrheal illnesses accounted for one-fourth (24.6%) of subclinical enteric bacteria exposures to antibiotics. Bystander exposure of E. coli to class-specific antibiotics was associated with the prevalence of phenotypic resistance at the community level. Antimicrobial stewardship and illness-prevention interventions among children in low-resource settings would have a large ancillary benefit of reducing bystander selection that may contribute to antimicrobial resistance.

Large trees and forest heterogeneity facilitate prey capture by California Spotted Owls

Abstract Predators are among the most threatened animal groups globally, with prey declines contributing to their endangerment. However, assessments of the habitat conditions that influence the successful capture of different prey species are rare, especially for small, cryptic predators. Accordingly, most predator conservation plans are based on the relative importance of habitats inferred from coarse-scale studies that do not consider habitat features contributing to hunting success, which can vary among prey species. To address this limitation, we integrated high-resolution global positioning system tracking and nest video monitoring to characterize habitat features at prey capture locations during the nestling provisioning stage for the Spotted Owl (Strix occidentalis) a small, cryptic predator that has been at the center of a decades-long forest management conflict in western North America. When all prey species were considered collectively, males provisioning nests tended to capture prey: (1) in areas with more large-tree forest, (2) in areas with more medium trees/medium canopy forest, and (3) at edges between conifer and hardwood forests. However, when we considered the owl’s two key prey species separately, males captured woodrats (Neotoma fuscipes) and Humboldt flying squirrels (Glaucomys oregonensis) in areas with markedly different habitat features. Our study provides clarity for forest management in mixed-ownership landscapes because different prey species achieve high densities in different habitat types. Specifically, our results suggest that promoting large trees, increasing forest heterogeneity, and creating canopy gaps in forests with medium trees/high canopy cover could benefit Spotted Owls and their prey, which has the ancillary benefit of enhancing forest resilience. Combining high-resolution global positioning system tagging with video-based information on prey deliveries to breeding sites can strengthen conservation planning for small predators by more rigorously defining those habitat features that are associated with successful prey acquisition.

Segregating the effects of ferric citrate-mediated iron utilization and FGF23 in a mouse model of CKD.

Ferric citrate (FC) is an approved therapy for chronic kidney disease (CKD) patients as a phosphate (Pi) binder for dialysis‐dependent CKD, and for iron deficiency anemia (IDA) in non‐dialysis CKD. Elevated Pi and IDA both lead to increased FGF23, however, the roles of iron and FGF23 during CKD remain unclear. To this end, iron and Pi metabolism were tested in a mouse model of CKD (0.2% adenine) ± 0.5% FC for 6 weeks, with and without osteocyte deletion of Fgf23 (flox‐Fgf23/Dmp1‐Cre). Intact FGF23 (iFGF23) increased in all CKD mice but was lower in Cre+ mice with or without FC, thus the Dmp1‐Cre effectively reduced FGF23. Cre+ mice fed AD‐only had higher serum Pi than Cre− pre‐ and post‐diet, and the Cre+ mice had higher BUN regardless of FC treatment. Total serum iron was higher in all mice receiving FC, and liver Tfrc, Bmp6, and hepcidin mRNAs were increased regardless of genotype; liver IL‐6 showed decreased mRNA in FC‐fed mice. The renal 1,25‐dihydroxyvitamin D (1,25D) anabolic enzyme Cyp27b1 had higher mRNA and the catabolic Cyp24a1 showed lower mRNA in FC‐fed mice. Finally, mice with loss of FGF23 had higher bone cortical porosity, whereas Raman spectroscopy showed no changes in matrix mineral parameters. Thus, FC‐ and FGF23‐dependent and ‐independent actions were identified in CKD; loss of FGF23 was associated with higher serum Pi and BUN, demonstrating that FGF23 was protective of mineral metabolism. In contrast, FC maintained serum iron and corrected inflammation mediators, potentially providing ancillary benefit.

The Next Pandemic

The Next Pandemic

Adding Adaptation/Modification Size and Scope to Frameworks for Classifying Changes to an Intervention.

Frameworks for classifying adaptations and modifications to an intervention have been developed and continue to evolve. These frameworks capture a range of attributes of adaptations and modifications. However, the size and the scope of a change, relative to the intervention's overall size and structure, are not currently included. This omission can have negative consequences, especially for conclusions about how different kinds of changes to an intervention may influence implementation quality and intervention outcomes. Coding the relative size and scope of an adaptation or modification should be simple when the original intervention is described in detail. For interventions that are not manualized, coding may alternatively be based on rater judgments. Attending to the size and the scope of adaptations and modifications could have an ancillary benefit, generating increased conceptual and empirical work on procedures for identifying the distinct components and sub-elements of an intervention.

Reinforcement Learning for Active Noise Control in a Hydraulic System

Abstract Hydraulic pressure ripple in a pump, as a result of converting rotational power to fluid power, continues to be a problem faced when developing hydraulic systems due to the resulting noise generated. In this paper, we present simulation results from leveraging an actor-critic reinforcement learning method as the control method for active noise control in a hydraulic system. The results demonstrate greater than 96%, 81%, and 61% pressure ripple reduction for the first, second, and third harmonics, respectively, in a single operating point test, along with the advantage of feed forward like control for high bandwidth response during dynamic changes in the operating point. It also demonstrates the disadvantage of long convergence times while the controller is effectively learning the optimal control policy. Additionally, this work demonstrates the ancillary benefit of the elimination of the injection of white noise for the purpose of system identification in the current state of the art.

Magnetic Tracking and Electrocardiography-Guided Tip Confirmation System Versus Fluoroscopy for Placement of Peripherally Inserted Central Catheters: A Randomized, Noninferiority Comparison

PurposeTo determine whether the use of a magnetic tracking and electrocardiography-guided catheter tip confirmation system (TCS) is safe and noninferior to fluoroscopy concerning positioning accuracy of a peripheral inserted central catheter (PICC).MethodsIn this prospective, randomized, single-center study, adult patients scheduled for PICC insertion were assigned 1:1 either to TCS or fluoroscopy. The primary objective was a noninferiority comparison of correct PICC tip position confirmed by X-ray obtained immediately after catheter insertion. Time needed for PICC insertion and insertion-related complications up to 14 days after the procedure were secondary outcomes to be assessed for superiority.ResultsA total of 210 patients (62.3 ± 14.4 years, 63.8% male) were included at a single German center between June 2016 and October 2017. Correct PICC tip position was achieved in 84 of 103 TCS (82.4%) and 103 of 104 fluoroscopy patients (99.0%). One-sided 95% lower confidence limit on the difference between proportions was −23.1%. Thus, noninferiority of TCS was not established (p > 0.99). Insertion of PICC took longer with TCS compared to fluoroscopy (8.4 ± 3.7 min vs. 5.0 ± 2.7 min, p < 0.001). Incidence of complications within a mean follow-up of 5.0 ± 2.3 days did not differ significantly between groups.ConclusionNoninferiority of TCS to fluoroscopy in the incidence of correct PICC tip position was not reached. Ancillary benefit of TCS over fluoroscopy including less radiation exposure and lower resource requirements may nonetheless justify the use of TCS. The study is registered with Clinical.Trials.gov (Identifier: NCT02929368).

Constraining invader dominance: Effects of repeated herbicidal management and environmental factors on curlyleaf pondweed dynamics in 50 Minnesota lakes

Abstract Curlyleaf pondweed (Potamogeton crispus) is one of the most widespread and widely managed aquatic invasive plants in North America. Despite decades of management, the efficacy of long‐term management strategies and the effects of environmental drivers on curlyleaf pondweed populations remain uncertain. To evaluate the effects of management and environmental factors on within‐lake distribution and local density of curlyleaf pondweed, we collated monitoring data from point–intercept surveys collected by a variety of lake managers across Minnesota, U.S.A. Using this dataset, comprising 177 lake‐years of plant data, we examined the influence of herbicide treatment, water clarity, snow depth, and ice cover duration on curlyleaf pondweed distribution and density between 2006 and 2015. We evaluated the effects of herbicides on curlyleaf pondweed at three time points relative to treatment: within year, carryover effects the following year, and cumulative effects over multiple years of treatment. All three temporal measures were associated with significant reductions of curlyleaf pondweed. Additionally, herbicidal management reduced both the density and distribution of curlyleaf pondweed. Given that herbicide management led to reductions that carried over into future years, managers may be able to design multi‐year treatments to reduce total management effort over time. We also found strong effects of environmental conditions on curlyleaf pondweed. Elevated lake productivity and decreased winter snow cover were associated with increased springtime distributions of curlyleaf pondweed, whereas duration of winter ice cover had no influence. The influence of productivity suggests that reductions of this invasive species may be an ancillary benefit of water‐quality improvements that lower lakes’ trophic status. Our results also show that decreased winter snow cover, as predicted under climate change, could exacerbate problematic growth of curlyleaf pondweed. Harnessing monitoring data from multiple projects, as this study does, allows for robust inference about environmental and management constraints on macrophytes. Because of environmental and management variability, we suggest that treatment regimens follow an adaptive management cycle, with outcomes of management monitored and evaluated, and strategies updated accordingly. It is also vital to continue monitoring both managed and unmanaged lakes to enable stronger inferences about treatment effectiveness.

Women's views about contraception requirements for biomedical research participation.

The scientific and ethical importance of including women of reproductive age in biomedical research is widely acknowledged. Concerns about preventing fetal exposure to research interventions have motivated requirements for contraception among reproductive aged women in biomedical studies–often irrespective of risks and benefits or a woman’s actual potential for pregnancy, raising important questions about when such requirements are appropriate. The perspectives of women themselves on these issues are largely unexplored. We conducted 140 interviews, 70 in the U.S. and 70 in Malawi, with women either living with or at-risk for HIV, exploring their views about the practice of requiring contraception in clinical trials. A majority of women interviewed from both countries indicated overall support for the practice, with seven themes characterizing advantages and disadvantages raised: reproductive control, health effects, prevention of fetal harm, burden on women, deferral to authority, autonomy regarding enrollment and birth control method, and relationship concerns. While women in the US frequently raised prevention of fetal harm as a key advantage, many other positives noted by women in both countries were related to contraception use in general, not specific to a trial context. With regard to disadvantages, U.S. women tended to focus on biomedical risks such as side effects and impact on fertility, whereas Malawian women focused on the social risks of contraception requirements, including violations of trust in marital relations and suspicions of potential infidelity. Given the potential benefits and burdens highlighted, contraception in research should be sensitive to actual fetal risk assessments; directed where justified at optimizing effective pregnancy prevention; responsive to women’s reproductive preferences; and made available as an ancillary benefit even where risk thresholds do not justify requirement–in order to facilitate trials that are both ethical and robustly oriented around the interests and lives of women who will participate in them.

School-Based Weekend Feeding Program: A Comparison Group Design Documents Selection Efficacy and Appreciable Effects on School Attendance

ABSTRACTFood insecurity is experienced by one in five children in the United States. Weekend feeding programs administered in schools are designed to alleviate food insecurity and rely on the ability of school administrators to correctly identify students in need. While the central goal of this program is to alleviate food insecurity, an ancillary benefit may be increased attendance on days when the food is distributed. We surveyed 283 households that participated in a weekend feeding program and compared them to households that were identified by school personnel as eligible for the program but did not participate in the program. We find that, in comparison to children who are on the wait list for the program, those students receiving the BackPack were more likely to attend school on Fridays, the day that food is typically distributed, than the comparison group. School personnel were able to accurately identify children who were food insecure and weekend feeding programs may have appreciable effects on school attendance in the long run.

Matrix completion as a post-processing technique for probabilistic roadmaps

Inspired by the recent literature on matrix completion, this paper describes a novel post-processing algorithm for probabilistic roadmaps (PRMs). We argue that the adjacency matrix associated with real roadmaps can be decomposed into the sum of low-rank and sparse matrices. Given a PRM with n vertices and only collision-checked candidate edges, our algorithm numerically computes a relaxation of this decomposition, which estimates the status of all possible edges in the full roadmap with high accuracy, without performing any additional collision checks. Typical results from our experiments on problems from the Open Motion Planning Library indicate that after checking of the possible edges, the algorithm estimates the full visibility graph with accuracy. The practical utility of the algorithm is that the average path length across the resulting denser edge set is significantly shorter (at the cost of somewhat increased spatial complexity and query times). An ancillary benefit is that the resulting low-rank plus sparse decomposition readily reveals information that would be otherwise difficult to compute, such as the number of convex cells in free configuration space and the number of vertices in each. We believe that this novel connection between motion planning and matrix completion provides a new perspective on sampling-based planning and may guide future algorithm development.

Ancillary Benefit of Increased HPV Immunization Rates Following a CBPR Approach to Address Immunization Disparities in Younger Siblings.

Increasing HPV vaccination rates may decrease the disproportionately high HPV-associated disease incidence and mortality in African Americans (AA) and lower socioeconomic individuals. Data from a community-based participatory research (CBPR) study addressing immunization disparities among 19-35month old children was analyzed to identify ancillary benefits in HPV immunization rates for adolescent siblings. Sub-study analysis inclusion criteria: AA (N = 118), 13-17years old, younger sibling enrolled in parent study, and enrolled ≥ 9months. Parent/caregiver interventions included: a web-based immunization toolkit with information on age-appropriate vaccines; a multimedia community outreach campaign; and reminder mailings. HPV up-to-date (UTD) status was defined as Wisconsin Immunization Registry (WIR) documentation of at least three HPV vaccines. McNemar's test compared pre/post intervention HPV status. Two dependent proportions testing compared the proportion of adolescents that became UTD in the study cohort, City of Milwaukee, and State of Wisconsin. Parents/caregivers perceived that 92% of adolescents were HPV-UTD, while only 24% had a WIR-verified HPV-UTD status. Baseline UTD status of the younger siblings 19-35month old 4:3:1:3:3:1:4 antigen series was 63%, which increased to 86% at study completion. Adolescent's HPV-UTD immunization status increased from 30 (25%) at enrollment to 54 (46%) at study completion [p = 0.004]. A statistically significant larger proportion of adolescents became HPV-UTD in the study cohort (20%) compared to the City of Milwaukee [14%, p = 0.042] and the State of Wisconsin [14%, p = 0.046]. A culturally-tailored CBPR approach targeting parents/caregivers of younger AA children can have significant ancillary benefit to increase HPV immunization rates in adolescent siblings.