Opportunistic Testing Research Articles

The design and rationale of the Advancing Cardiac Care Unit-based Rapid Assessment and Treatment of hypErcholesterolemia (ACCURATE) study

Familial hypercholesterolemia (FH) is an inherited condition characterized by elevated low-density lipoprotein cholesterol (LDL-C) levels and premature atherosclerotic cardiovascular disease (ASCVD). Despite being the most common inherited cardiovascular disorder, it is still highly underdiagnosed and undertreated worldwide. We designed the Advancing Cardiac Care Unit-based Rapid Assessment and Treatment of hypErcholesterolemia (ACCURATE) study to test the hypothesis that opportunistic genetic testing for FH among patients hospitalized for acute coronary syndrome (ACS) will increase the diagnosis of FH and improve patient outcomes. ACCURATE is a non-randomized, controlled trial of patients <60 years old admitted to an acute cardiac unit with ACS and elevated LDL-C levels. The first cohort will consist of a control group of patients presenting with ACS who will be treated according to usual standard-of-care. The second cohort will consist of patients presenting with ACS in whom research-based genetic testing for FH will be performed during hospitalization and the results returned to the treating physicians. The primary endpoint will be the number of patients with a new diagnosis of FH. The secondary endpoints will be the proportion of patients who undergo intensification of lipid-lowering therapy, the lowest LDL-C level achieved, and the proportion of patients reaching guideline recommended lipid targets in the 12 months after the index ACS. To our knowledge, ACCURATE represents the first clinical trial of genetic testing for FH in the acute cardiac care setting and is expected to help identify optimal approaches to increase the diagnosis and treatment of FH.

Endemic HBV among hospital in-patients in Bangladesh, including evidence of occult infection.

Bangladesh is one of the top-ten most heavily burdened countries for viral hepatitis, with hepatitis B (HBV) infections responsible for the majority of cases. Recombinant and occult HBV infections (OBI) have been reported previously in the region. We investigated an adult fever cohort (n=201) recruited in Dhaka, to determine the prevalence of HBV and OBI. A target-enrichment deep sequencing pipeline was applied to samples with HBV DNA >3.0 log10 IU ml−1. HBV infection was present in 16/201 (8 %), among whom 3/16 (19 %) were defined as OBI (HBsAg-negative but detectable HBV DNA). Whole genome deep sequences (WGS) were obtained for four cases, identifying genotypes A, C and D. One OBI case had sufficient DNA for sequencing, revealing multiple polymorphisms in the surface gene that may contribute to the occult phenotype. We identified mutations associated with nucleos(t)ide analogue resistance in 3/4 samples sequenced, although the clinical significance in this cohort is unknown. The high prevalence of HBV in this setting illustrates the importance of opportunistic clinical screening and DNA testing of transfusion products to minimise OBI transmission. WGS can inform understanding of diverse disease phenotypes, supporting progress towards international targets for HBV elimination.

Prostate-specific antigen screening of men with lower urinary tract symptoms (opportunistic screening) and of asymptomatic men undergoing executive health check: an audit from two institutions.

Introduction:We evaluated incidence ofprostate-specific antigen (PSA) positivity (>4ng/mL) and cancer detection rate on prostate biopsy in two populations of men, one undergoing opportunistic testing for lower urinary tract symptoms and another during routine health checks.Methods:Data regarding PSA screening, rectal examination (RE), transrectal ultrasound-guided biopsy, clinical stage, and risk assessment grouping according to NCCN guidelines were studied. Group A included patients with lower urinary tract symptoms (LUTS) (opportunistic screening) at SGPGIMS, Lucknow and Group B included healthy men who had executive health check-up with PSA testing at Medanta the Medicity, Gurugram.Results:PSA positivity rate in 9906 symptomatic men for LUTS (Group A) and 24919 healthy men (Group B) was 28.4% and 3% respectively. In group A, PSA positivity rate was 28.4% but only around half of all men with an indication underwent a biopsy. Among men with PSA of 4–10 ng/mL, cancer was detected in 93 of 241 who underwent a biopsy (38.5%). In Group B, only 69 men (9.3% of those with an elevated PSA) underwent a prostate biopsy, of which 38/57 (with PSA of 4–10 had cancer. In Group A, the cancers was metastatic in 61.5% men, while none in-Group B had metastatic disease.Conclusion:Opportunistic screening and executive health check with PSA identifies a significant number of men with PSA positivity and may help decrease the proportion of men diagnosed in metastatic prostate cancer.

Testing by Betting: A Strategy for Statistical and Scientific Communication

AbstractThe most widely used concept of statistical inference—the p-value—is too complicated for effective communication to a wide audience. This paper introduces a simpler way of reporting statistical evidence: report the outcome of a bet against the null hypothesis. This leads to a new role for likelihood, to alternatives to power and confidence, and to a framework for meta-analysis that accommodates both planned and opportunistic testing of statistical hypotheses and probabilistic forecasts. This framework builds on the foundation for mathematical probability developed in previous work by Vladimir Vovk and myself.

ИЗУЧЕНИЕ ПЕРСПЕКТИВНЫХ ШТАММОВ LACTOBACILLUSPLANTARUMДЛЯ ДАЛЬНЕЙШЕГО ИХ ИСПОЛЬЗОВАНИЯ В ЖИВОТНОВОДСТВЕ И ПТИЦЕВОДСТВЕ

This paper discusses the research findings on 6 strains of lactic-acid bacteria of the species Lactobacillus planta-rum. These cultures were isolated from plant substrates from the Altai Region and included in the “Siberian Collec-tion of Microorganisms”. The research was carried out in the Laboratory of Milk and Dairy Product Microbiology of the Department “Siberian Research Institute of Cheese Making” of the Federal Altai Scientific Center of Agro-Biotechnologies. The conventional methods of microbiolog-ical and biochemical studies were used. To conduct the experiments, 18-hour cultures of lactobacilli were used; their active acidity on a liquid nutrient medium, the number of bacterial cells in the resulting biomass and antagonistic activity against opportunistic pathogenic test cultures of Escherichia coli were studied. According to the research data, the active acidity of lactobacillus strains varied in the range of 3.43-3.70 pH, as compared with the control -6.98 pH. These values show an active growth of cultures Lb. plantarumon a nutrient medium; this is additionally confirmed by the high number of bacterial cells in all sam-ples of the studied microorganisms. All lactobacillus strains actively suppressed the growth of E. colitest cultures. The obtained results show that the studied Lb. plantarumstrains may be used as probiotic cultures in the future when creating bacterial preparations for farm animals and poultry.

Application of a machine learning algorithm for detection of atrial fibrillation in secondary care.

Atrial fibrillation (AF) is the most common sustained heart arrhythmia and significantly increases risk of stroke. Opportunistic AF testing in high-risk patients typically requires frequent electrocardiogram tests to capture the arrhythmia. Risk-prediction algorithms may help to more accurately identify people with undiagnosed AF and machine learning (ML) may aid in the diagnosis of AF. Here, we applied an AF-risk prediction algorithm to secondary care data linked to primary care data in the DISCOVER database in order to evaluate changes in model performance, and identify patients not previously detected in primary care. We identified an additional 5,444 patients who had an AF diagnosis only in secondary care during the data extraction period. 2,696 (49.5%) were accepted by the algorithm and the algorithm correctly assigned 2,637 (97.8%) patients to the AF cohort. Using a risk threshold of 7.4% in patients aged≥30years, algorithm sensitivity and specificity was 38% and 95%, respectively. Approximately 15% of AF patients assigned to the AF cohort by the algorithm had a secondary care diagnosis with no record of AF in primary care. These additional patients did not substantially alter algorithm performance. The additional detection of previously undiagnosed AF patients in secondary care highlights unexpected potential utility of this ML algorithm.

Изучение физико-химических свойств и биологической активности экстрактов из высушенной биомассы каллусных, суспензионных клеток и корневых культур in vitro

Introduction. One of the urgent problems of medicine and biology is the use of plant objects as industrial producers of target metabolites in vitro. In vitro cells can be used as pharmaceutical preparations. Study objects and methods. The present research featured medicinal plants that grow in the Siberian Federal district and are a popular source of medicinal raw materials. The physicochemical properties, e.g. total ash content in extracts, the content of heavy metals, the content of organic solvents in the extracts, and the mass loss upon drying was determined by standard methods. The antimicrobial properties of in vitro extracts were determined by the diffusion method and the method based on optical density measurement. The list of opportunistic and pathogenic test strains included the following microorganisms: E. coli ATCC 25922, S. aureus ATCC 25923, P. vulgaris ATCC 63, P. aeruginosa ATCC 9027, and C. albicans EMTC 34. The number of viable cancer cells was determined using the MTT colorimetric method. Results and discussion. The paper describes the physicochemical properties, safety indicators, antioxidant activity, antimicrobial activity, and antitumor properties of extracts of a complex of biologically active substances obtained in vitro from the dried biomass of callus and suspension cell cultures and root cultures. The root extracts proved to have the maximum antimicrobial and cytotoxic properties. They could reduce the survival rate of cancer cells to 24.8–36.8 %. Conclusion. The research featured extracts obtained from the dried biomass of callus and suspension cell cultures and root cultures in vitro of safflower leuzea (Leuzea carthamoides L.), Rhodiola rosea (Rhodiola rosea L.), various sorts of skullcap (Scutellaria baicalensis L., Scutellaria andrachnoides L., Scutellaria galericulata L.), Potentilla alba (Potentilla alba L.) and ginseng (Panax L.). The results showed that the extracts can be used for the production of pharmaceuticals and biologically active additives with antitumor, antimicrobial, and antioxidant properties.

Serological prevalence of six vector-borne pathogens in dogs presented for elective ovariohysterectomy or castration in the South central region of Texas

BackgroundMost vector-borne pathogens cause zoonotic diseases. These zoonoses often have wild animal reservoirs that play a significant role in disease epidemiology. However, pet animals have also been implicated in transmission of zoonotic agents to humans. To exemplify, dogs are competent reservoir hosts for several zoonotic vector-borne bacteria and protozoa. Despite that vector-borne diseases can be life-threatening for both pets and humans, studies on pathogen seroprevalence are very limited. Therefore, the objective of this study was to determine the serological prevalence of six zoonotic vector-borne agents in dogs from the South Central region of Texas (US).Electronic medical records of dogs, presenting over 2014–2019 for elective ovariohysterectomy or castration at a high volume spay and neuter clinic, were reviewed for serological testing. Sera from 418 dogs were tested for the Dirofilaria immitis antigen, and antibodies to Anaplasma phagocytophilum, Anaplasma platys, Borrelia burgdorferi, Ehrlichia canis, and Ehrlichia ewingi, using a commonly available commercial test kit. Descriptive statistics were computed to characterize the respective seroprevalence rates of the dog population. The study involved 192 (46%) male and 226 (54%) female dogs.ResultsOverall, 85 (20%) dogs tested positive for at least one of the 6 pathogens investigated. The highest seroprevalence rate averaged over the 6-year period was 11.7% for D. immitis followed by 8.4% for E. canis and/or E. ewingii, 4.3% for A. phagocytophilum and/or A. platys, and 0.2% for B. burgdorferi. The co-exposure or co-infection was only detected in 3.8% of the dog population.ConclusionsTogether, opportunistic testing of dogs presenting for elective surgical procedures may provide an effective way of assessing seroprevalence and/or risk factors for common vector-borne diseases within a geographic region of concern.

Approaches to screening for hyperglycaemia in pregnant women during and after the COVID-19 pandemic.

AimTo evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA1c, during the COVID‐19 pandemic.MethodsRetrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004–2008; 826 consecutive gestational diabetes pregnancies, 2014–2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large‐for‐gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver‐operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA1c performance.ResultsGestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver‐operating characteristic curve for both criteria 0.81 (95% CI 0.79–0.83)], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver‐operating characteristic curve 0.75 (95% CI 0.65–0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver‐operating characteristic curve 0.92 (95% CI 0.85–0.98)] and HbA1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75–0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77–0.91)]. Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2–5.4 mmol/l (sensitivity 18–41%; specificity 97–98%).ConclusionsRandom plasma glucose at 12 weeks, and fasting plasma glucose or HbA1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available.

PSA testing patterns in a large Swedish cohort before the implementation of organized PSA testing

Background Organized PSA testing for asymptomatic men aged 50–74 years will be implemented in Sweden to reduce opportunistic testing in groups who will not benefit. The aim of this study was to describe the opportunistic PSA testing patterns in a Swedish region before the implementation of organized PSA testing programs. Method We included all men in the Uppsala-Örebro health care region of Sweden who were PSA tested between 1 July 2012 and 30 June 2014. Information regarding previous PSA testing, prostate cancer diagnosis, socioeconomic situation, surgical procedures and prescribed medications were collected from population-wide registries to create the Uppsala–Örebro PSA cohort (UPSAC). The cohort was divided into repeat and single PSA testers. The background population used for comparison consisted of men 40 years or older, living in the Uppsala–Örebro region during this time period. Results Of the adult male population in the region, 18.1% had undergone PSA testing. Among men over 85 years old 21% where PSA tested. In our cohort, 62.1% were repeat PSA testers. Of men with a PSA level ≤1µg/l 53.8% had undergone repeat testing. Prostate cancer was found in 2.7% and 4.8% of the repeat and single testers, respectively. Conclusion Every fifth man in the male background population was PSA tested. Repeated PSA testing was common despite low PSA values. As repeated PSA testing was common, especially among older men who will not be included in organized testing, special measures to change the testing patterns in this group may be required.

Differences in cervical test coverage by age, socioeconomic status, ethnic origin and municipality type – A nationwide register-based study

An invitational organized cervical cancer screening together with widely spread opportunistic testing has coexisted for decades in Finland. The aim of this study was to examine the coverage of cervical tests by age, socioeconomic status, ethnicity and municipality type within and outside the organized screening program. We had a cohort of women of whom 1,2 million were in the target age range of screening and residing in Finland in 2010–2014. Data on Pap and/or HPV -tests within and outside the screening program were collected from the Mass Screening Registry, the pathology laboratories and the health insurance reimbursement registry and five-year population coverages of tests were reported. The total test coverage was 86.0%; 95% CI, (85.8–86.1), and was notably lower for those with an unknown socioeconomic status and pensioners (68.8%; 95% CI, (67.9–69.6) and 77.1%; 95% CI, (76.5–77.6), respectively) compared to upper-level employers (89.8%; 95% CI, (89.5–90.2)). Coverage was also lower for non-native speaking women (72.4%; 95% CI, (71.8–73.0)) compared to native speakers (86.9%; 95% CI, (86.7–87.0)) and for women living in urban municipalities (85.5%; 95% CI, (85.3–85.7)) compared to semi-urban (87.4%; 95% CI, (87.0–87.8)). Although overall coverage was high, tests within and outside the program seemed to concentrate on women with presumably good access to health services. Tests outside the program were especially common among young women who are at a low risk of invasive cervical cancer. Efforts should be made to reduce excessive opportunistic testing and to increase attendance at the program among hard-to-reach populations.

Budget impact analysis reveals walk-in fingertip HbA1c testing in community pharmacies could provide a significant long-term reduction in public expenditure.

In Japan, a new opportunistic community-based walk-in HbA1c testing program at pharmacies was enabled in 2014. An economic evaluation of this program from societal perspective has previously been published. This study examines the effect of a subsidy program for walk-in HbA1c-testing at community pharmacies in Japan on public health care expenditure by conducting a budget impact analysis from payer's perspective. The study focused on Adachi Ward in Tokyo, where a pioneering subsidy program was implemented. It examined the budget impact of the subsidy program over a 15 years. The total subsidy paid by the local authority during the first year was 2909 USD. Public expenditure remained positive for the first five years before becoming negative in the sixth year, eventually resulting in savings of 221,000 USD in the 15th year. The cost of treating type 2 diabetes that is detected early is offset by a reduction in expensive treatments for complicated cases. Subsidizing walk-in fingertip HbA1c testing in community pharmacies is likely to result in a significant reduction in public expenditure over the mid-to long term. Our result suggests that a similar strategy in other areas could also have a potentially favorable budget impact.

Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care

ObjectiveTo evaluate the effectiveness and cost effectiveness of a complex intervention in primary care that aims to increase uptake of hepatitis C virus (HCV) case finding and treatment.DesignPragmatic, two armed,...

Contemporary Distribution of High-Grade Prostate Cancer in the Circumstances of Opportunistic Testing

Abstract Screening has dramatically changed the distribution of the mean age, stage and grade of prostate cancer (PCa) at diagnosis. However, regional-level data that characterize contemporary PCa patients are limited. The aim of the study was to ascertain main clinical and pathological characteristics of PCa at the present time in the circumstances of opportunistic testing. High-grade PCa according to age, serum prostate specific antigen (PSA), volume prostate, PSA density (PSAD), digital rectal examination (DRE) number of positive cores biopsies and the average percentage of cancer in biopsy at diagnosis has been retrospectively evaluated in 100 men with biopsyproven PCa, at Clinical Centre Kragujevac, from September 2016 until September 2017. PCa were stratified according to Gleason score (GS) into low/intermediate-grade (GS ≤ 7) and high-grade (GS ≥ 8). To identify the determinants associated with high-grade PCa, we performed univariate and multivariate logistic regression. The most prevalent PCa were the low/intermediate-grade (65%), followed by high-grade (35%). The mean age of the patients was 71.5 (range: 56–88) years and median PSA was 14.6 (range: 1.4–935) ng/ml. There were significant differences in age, PSA, PSAD, DRE, number of positive biopsy and average percentage of cancer in biopsy between patients with or without high-grade GS. Logistic analysis demonstrated the PSAD and age have strong prognostic value of high-grade PCa. In conclusion, our study has shown the worrying frequency of high-grade PCa in the circumstances of opportunistic testing. Older men and higher level of PSAD had a much higher probability of high-grade PCa.

P582 Adalimumab therapeutic drug monitoring: Does time of testing matter?

Abstract Background Whilst anti-TNF drugs such as adalimumab (ADL) have revolutionised the management of inflammatory bowel disease treatment outcomes are not universally favourable with 30% primary non-response (PNR) and 46% secondary loss of response (SLOR) rates reported.1,2 Therapeutic drug monitoring (TDM)—the measurement of serum drug levels and anti-drug antibodies—has become popular with clinicians who use it to optimise biologic therapy through serum drug-level guided dose adjustment. Conventionally TDM is based on the interpretation of trough drug levels (DL) which are obtained by drawing a blood sample immediately prior to the next drug dose. Obtaining an ADL trough DL can be challenging as the drug is administered as a subcutaneous injection usually in the patient’s own home. The aim of this project was to determine the current use of non-trough ADL TDM in clinical practice and determine whether timing of ADL TDM in relation to the next planned dose is clinically important. Methods All ADL DLs performed in 2018 in the Scottish Biologic TDM service3 were identified. DLs were included for patients in sustained clinical remission (SCR), on 40mg every other week dosing, and if the time from the last dose was ≤14 days. TDM performed during induction and for PNR or SLOR were excluded, as were patients on nonstandard dosing or with missing data on dose and interval. Results were analysed by quartile according to time from the last drug dose. Results 338 DLs were included. Median DL is 8µg/ml (range &amp;lt;0.4–36). Median time from last dose is 12 (range 0–14) days. The first quartile (n = 83, median 5 (range 0–7) days) had a median DL of 8.2µg/ml (&amp;lt;0.4–28.1). The second quartile (n = 90, median 11 (8–12) days) had a median DL of 7.9µg/ml (&amp;lt;0.4–36). The third quartile (n = 80, 13 days from last dose) had a median DL of 8µg/ml (&amp;lt;0.4 – 28.1). fourth quartile samples (n = 85, 14 days from last dose – true trough DLs) had a median DL of 8 µg/ml (&amp;lt;0.4–34.8). No relationship was identified between observed DL and the time of DL testing (ρ= -0.3162, p = 0.23). Conclusion It is not necessary to use trough DLs when performing ADL TDM for individuals in SCR. These data should give clinicians the confidence to use opportunistic ADL TDM testing in a clinical setting. Further work should be undertaken on non-trough testing of ADL DLs in other clinical scenarios. Disclosure Biogen GmbH contributed funding for this research. Authors had full editorial control and approval of all content. References

Seroprevalence of leptospirosis and Japanese encephalitis in swine in ten provinces of Vietnam.

BackgroundLeptospirosis is an important zoonotic disease with a global distribution, affecting a wide range of mammalian animals and humans. Japanese encephalitis (JE) virus is the major vector-borne zoonotic disease in the Asia-Pacific region. The main objective of this study was to evaluate the seroprevalence of serovar-specific Leptospira and JE in swine from 10 provinces in Vietnam.MethodsSamples were initially collected for swine influenza surveillance from March to April 2017 at large-scale farms (with at least 50 sows and/or 250 fattening pigs) with pigs that tested positive for influenza in the previous surveillance period (2015–16).FindingsA total of 2,000 sera samples were analyzed from 10 provinces. Overall, the seroprevalence of leptospirosis was 21.05% (95% CI: 19.28–22.90) using a cut-off titer of ≥ 1:100. The apparent prevalence of JE was 73.45% (95% CI: 71.46–75.37) while the true prevalence was slightly higher (74.46%, 95% credible interval: 73.73–86.41). We found a relatively high presence of leptospirosis and JE in pigs kept on large farms. Prevalence was comparable with other studies suggesting opportunistic testing of samples collected for other surveillance purposes can be a valuable tool to better understand and prevent the potential transmission of these zoonotic diseases from pigs to people in Vietnam.ConclusionOur study provides evidence to veterinarians and animal health professionals for evidence-based practice such as diagnosis, vaccination and zoonotic control. Further investigation into the possible role of different domestic animals, wildlife species or environmental factors is needed to identify the potential risk factors and transmission routes in Vietnam.

Jane Hocking: an expert of the nether regions

“My whole career has tended to focus on the ‘nether regions’!” Jane Hocking tells The Lancet Infectious Diseases from her office at the University of Melbourne. In her role as Head of the Sexual Health Unit at the Melbourne School of Population and Global Health, she has carried out research on various sexually transmitted infections, with a particular emphasis on chlamydia. Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trialThese findings, in conjunction with evidence about the feasibility of sustained uptake of opportunistic testing in primary care, indicate that sizeable reductions in chlamydia prevalence might not be achievable. Full-Text PDF

Description of a pharmacist-led diabetes prevention service within an employer-based wellness program

ObjectivesTo describe a pharmacist-led diabetes prevention service piloted within an employer-based wellness program. Practice descriptionA pharmacist-led ambulatory care clinic within a school of pharmacy that provides wellness services to university employees. Practice innovationImplementation of a diabetes prevention service using opportunistic A1C screening within a biometric screening program. Patients with a prediabetes-level A1C from July 2016 to March 2019 were invited to participate in the National Diabetes Prevention Program (NDPP). EvaluationComparison of baseline characteristics of participants with normal and elevated A1C. Evaluation of participation in the NDPP and changes in clinical values at the subsequent biometric screening appointment for individuals with a prediabetes-level AlC. ResultsA1C testing of 740 individuals identified 69 participants (9.3%) with a prediabetes-level A1C and 7 (1.0%) with a diabetes-level A1C. Compared with those with a normal A1C (< 5.7%), participants with an elevated A1C were more likely to be older, nonwhite, obese, and physically inactive, to have a sibling with diabetes, higher random blood sugar (RBS), lower high-density lipoprotein (HDL), and more likely to have hypertension. Twelve patients participated in the NDPP, although most attended only 1 session. Attenders had a significantly lower baseline weight and body mass index (BMI). There were no significant differences in the changes in A1C, BMI, weight, RBS, or HDL between attenders and nonattenders approximately 1 year later. ConclusionThis pilot demonstrated that opportunistic A1C testing could be incorporated into an ambulatory care clinic within a pharmacist-led employer-based wellness program. Uptake and retention of the NDPP were poor. Barriers to NDPP participation need to be investigated and addressed to improve service impact.

First Report of a Novel Hepatozoon sp. in Giant Pandas (Ailuropoda melanoleuca).

The first report of giant pandas (Ailuropoda melanoleuca) infected with a novel Hepatozoon species is presented. An intraleukocytic parasite was detected via routine blood smear from a zoo-housed giant panda at the National Zoological Park. Ribosomal DNA sequences indicated a previously undescribed Hepatozoon species. Phylogenetic and distance analyses of the sequences placed it within its own branch, clustered with Old World species with carnivore (primarily ursid and mustelid) hosts. Retrospective and opportunistic testing of other individuals produced additional positive detections (17/23, 73.9%), demonstrating 100% prevalence (14/14) across five institutions. All animals were asymptomatic at time of sampling, and health implications for giant pandas remain unknown.

Opportunistic testing of BRCA1, BRCA2 and mismatch repair genes improves the yield of phenotype driven hereditary cancer gene panels.

Multigene panels provide a powerful tool for analyzing several genes simultaneously. We evaluated the frequency of pathogenic variants (PV) in customized predefined panels according to clinical suspicion by phenotype and compared it to the yield obtained in the analysis of our clinical research gene panel. We also investigated mutational yield of opportunistic testing of BRCA1/2 and mismatch repair (MMR) genes in all patients. A total of 1,205 unrelated probands with clinical suspicion of hereditary cancer were screened for germline mutations using panel testing. Overall, 1,048 females and 157 males were analyzed, mean age at cancer diagnosis was 48; 883 had hereditary breast/ovarian cancer-suspicion, 205 hereditary nonpolyposis colorectal cancer (HNPCC)-suspicion, 73 adenomatous-polyposis-suspicion and 44 with other/multiple clinical criteria. At least one PV was found in 150 probands (12%) analyzed by our customized phenotype-driven panel. Tumoral MMR deficiency predicted for the presence of germline MMR gene mutations in patients with HNPCC-suspicion (46/136 vs. 0/56 in patients with and without MMR deficiency, respectively). Opportunistic testing additionally identified five MSH6, one BRCA1 and one BRCA2 carriers (0.6%). The analysis of the extended 24-gene panel provided 25 additional PVs (2%), including in 4 out of 51 individuals harboring MMR-proficient colorectal tumors (2 CHEK2 and 2 ATM). Phenotype-based panels provide a notable rate of PVs with clinical actionability. Opportunistic testing of MMR and BRCA genes leads to a significant straightforward identification of MSH6, BRCA1 and BRCA2 mutation carriers, and endorses the model of opportunistic testing of genes with clinical utility within a standard genetic counseling framework.