Center Program Research Articles

The effect of introducing a nurse-practitioner-led peripherally inserted central venous catheter placement program on the utilization of central venous access device: A retrospective study in Japan.

Nurse-led peripherally inserted central venous catheter (PICC) placement teams are common in western hospitals, but they are still in their infancy in Japan. Although implementing a dedicated program may improve ongoing vascular-access management, the direct hospital-level effects of launching a nurse-led PICC team on specific outcomes have not been formally investigated. To evaluate the effect of introducing a nurse practitioner (NP)-led PICC-placement program on subsequent utilization of centrally inserted central catheters (CICCs) and to contrast the quality of PICC placements conducted by physicians and NPs. Patients who underwent central venous access devices (CVADs) between 2014 and 2020 at a university hospital in Japan were evaluated retrospectively using an interrupted time-series analysis on the trend for monthly CVAD utilization and logistic regression and propensity score-based analyses for PICC-related complications. Among 6007 CVAD placements, 2230 PICCs were inserted into 1658 patients (725 by physicians and 1505 by NPs). The monthly number of CICC utilization fell from 58 in April 2014 to 38 in March 2020, while PICC placements by the NP PICC team increased from 0 to 104. The implementation of the NP PICC program reduced the immediate rate (by 35.5; 95% confidence interval [CI]: 24.1-46.9; p < 0.001) and post-intervention trend (by 2.3; 95% CI: 1.1-3.5; p < 0.001) of monthly CICC utilization. Overall immediate complication rates were lower in the NP group than the physician group (1.5% vs 5.1%; adjusted odds ratio = 0.31; 95% CI: 0.17-0.59; p < 0.001). The cumulative incidences of central line-associated bloodstream infections were comparable between the NP and physician groups (5.9% vs 7.2%; adjusted hazard ratio = 0.96; 95% CI: 0.53-1.75; p = .90). This NP-led PICC program reduced CICC utilization without affecting the quality of PICC placement or complication rate.

544-P: Effect of Organization Type on Priority Population Outcomes in the National Diabetes Prevention Program (National DPP)

In 2012, the CDC Diabetes Prevention Recognition Program approved its first recognized organization. Since then, it has recognized 4,000+ organizations to deliver the National DPP lifestyle change program to 600,000+ participants at type 2 diabetes risk. This analysis examined data from 624,422 participants to determine the impact of 5 organization types on priority population outcomes: community centers, higher education, government, healthcare providers, and for-profit/insurers. Most participants (65.7%) enrolled in for-profit/insurer organizations. Community centers enrolled the highest percentage of participants who identified as Hispanic/Latino (20.8%) and Native Hawaiian/other Pacific Islander (3%), and government organizations the highest percentage of Black/African American (17.7%) and American Indian/Alaska Native participants (10.8%). Higher education organizations enrolled the highest percentage of Asian/Asian American participants (3.4%). Men primarily enrolled in for-profit/insurer organizations (25.3%), and those aged 65+ enrolled mainly in healthcare-based programs (30.6%). Time in the program is associated with type 2 diabetes risk reduction. Those enrolled in higher education organizations stayed in the program the longest, with a mean of 233 days. Community centers and government organizations, which lead in the enrollment of some priority populations, had means of 196 and 218 days, respectively. Native Hawaiian/other Pacific Islander participants stayed in community center programs above the mean of 226 days. In government organizations, Black/African American and American Indian/Alaska Native participants remained for an average of 227 and 219 days, respectively. Understanding which types of organizations better serve priority populations, and assisting them in recruitment and retention, is key to reducing the risk of developing type 2 diabetes among these groups and reducing disparities in outcomes. Disclosure S.Bowen: None. E.O.Landau: None. E.Ely: None.

Mental wellbeing of frontline health workers post-pandemic: lessons learned and a way forward.

To assess the state of mental wellbeing among medical and dental frontline health workers as the COVID-19 pandemic transitions to an endemic phase and to determine what employer-provided intervention strategies these workers perceive as effective and desirable to improve their mental wellbeing. An anonymous online survey distributed to frontline health workers in a hospitalist program of a tertiary care medical center and a university dental school in Minnesota in September 2022. The survey contained validated tools to measure depression severity, levels of perceived stress, and mental health status as well as questions to determine effective strategies to improve emotional wellbeing among these health workers. Data was evaluated on an aggregate level as well as stratified by level (e.g., physician, staff) and field (e.g., medicine, dentistry). On average, all groups of health workers suffered from moderate to moderately severe depression, had a much higher perceived stress level than average, and had a fair mental health status. There were no significant differences in depression severity, stress level, or mental health status among physicians, dentists, medical staff, and dental staff. The majority of the respondents perceived adjusted work hours, rewards and incentives, and teamwork as the most effective and desirable strategies to improve their mental wellbeing. The current mental wellbeing of frontline health workers is poor. Many are dissatisfied with healthcare and consider leaving the industry. To improve their employees' mental wellbeing, healthcare employers might want to consider adjusted work hours, rewards, and teamwork as these intervention strategies are perceived as most effective and desirable by the intended recipients.

Addressing Healthcare Utilization and Costs for Older Adults with Limited Mobility Through a Multidisciplinary Home-Based Primary Care Program.

Home-based primary care (HBPC) has shown promise in the management of multiple chronic conditions for patients who are homebound or who have limited mobility. The objective of this study was to implement and evaluate an HBPC program that integrates the services of clinical pharmacists and community aging services providers in a community-based setting. Mountain Area Health Education Center's (MAHEC) HBPC program brought together an interdisciplinary team including medical providers, pharmacists, and community aging services providers to conduct home visits with older adults (age 50+). A single-arm, prepost analysis was conducted to determine differences from the year before program enrollment to the year postenrollment. We examined the frequency of health care visits, high-cost health care utilization (emergency department [ED] utilization and hospitalizations), and health care costs. Descriptive statistics characterized the study population and outcomes. Fisher's Exact Tests were used to determine if there was a significant difference between years. There were 130 home visits with 62 patients enrolled in the program. The Medicare Annual Wellness Visit (AWV) was completed for 32 (51.6%) patients. There were 13 (21.0%) and 12 (19.4%) individuals who had at least 1 ED visit and hospitalization, respectively, pre-enrollment as compared with 8 (12.9%) and 9 (14.5%) individuals postenrollment (p-value = 0.05, p-value = 0.06). During the postenrollment year, patient enrollees had an average per-member-per-month (PMPM) cost of $1567.96 as compared with $3053.21 in the year prior. Pharmacist and community agency services-integrated HBPC was implemented in the community setting. There was a decrease in high-cost health care utilization and total health care expenditures for patients as compared with the previous year.

Community outbreak of COVID-19 among people who use drugs attending a harm reduction centre in Barcelona, Spain

BackgroundThe COVID-19 pandemic particularly affected the health of vulnerable population, such as people who use drugs. Due to compromised baseline health status, certain drug uses and settings and socioeconomic deprivation related to poverty and homelessness, drug users faced higher risk of COVID-19 infection. They had difficulty in adhering to the public health measures (i.e. physical distancing, hand hygiene and mask use). Also, the struggle to implement non-pharmaceutical actions (i.e. test–trace–isolate–quarantine strategy) among SARS-COV-2-infected drug users and their close contacts challenged the public health response. Therefore, this study aimed to describe a community COVID-19 outbreak and its approach among drug users of a harm reduction programme in an outpatient drug treatment centre in Barcelona, Spain.MethodsWe conducted an observational descriptive study of an outbreak of COVID-19 among people who use drugs attending the harm reduction programme of an outpatient drug treatment centre in the city of Barcelona, between July and October 2021 (n = 440). A passive search for cases was carried out with rapid antigens tests targeting symptomatic users who attended the facilities.ResultsNineteen positive COVID-19 cases were identified among symptomatic drug users, between July and October 2021, with an attack rate of 4.3%. Specific measures were taken to control the outbreak, such as offering accommodation to self-isolate in a low-threshold residential resource to homeless drug users who tested positive and intensifying the vaccination strategy. The management of the outbreak was carried out in close collaboration between the outpatient centre and the main public health stakeholders in the city of Barcelona.ConclusionsThis study shows the complexity of managing and investigating COVID-19 outbreaks in vulnerable population groups. Epidemiological control measures, such as the test–trace–isolate–quarantine strategy, were challenging to implement due to technology-related barriers and socioeconomic vulnerabilities, especially homelessness. Community-based interventions, cooperation among stakeholders and housing-related policies were helpful in tackling outbreaks among people who use drugs. When addressing vulnerable and hidden populations, the perspective of inequalities should be included in epidemiological surveillance and outbreak control strategies.

Model Pendistribusian Dana Zakat Infak Sedekah (Zis) Dalam Pemberdayaan Masyarakat Di Balai Kreatif Laz-da Rizki Jember

The distribution of zakat funds comprises both consumptive and productive zakat in addition to the former. The Lamiga (Family Nutrition Pond) and Seel For Charity projects are examples of effective zakat. Utilizing zakat is a way to make the most of it without diminishing its worth or utility, making it effective for achieving social good. The infaq and alms funds itself are distributed through the Creative Center's community empowerment program. The Creative Center, also known as bakre, is a platform for empowerment that supports the development of a sense of community, character, independence, and responsibility that influences the transformation of the country. There are 15 bakre now dispersed throughout Jember Regency. With the help of this creative hub, the locals will feel more empowered, independent, and creative, which will raise their standard of living. At this bakre, there are various activities, including Roda (empowering potential), Tasya (planting family vegetables), Tasjali (collecting used items and protecting the environment), Supermas (supporting the prosperity of the mosque), Mas Rangga (packing baskets for families), and Dasat (health conscious).

Peran Bangoan Collection Center Dalam Mensejahterakan Ekonomi Masyarakat Desa Bangoan Kecamatan Kedungwaru Kabupaten Tulungagung

A high poverty rate indicates low social welfare. Welfare problems can be overcome by developing the economy, and economic development can be achieved by developing production activities. This study aims to determine the role of the Bangoan Collection Center for the economic welfare of the community and to determine the supporting factors and inhibiting factors for economic welfare in Bangoan Village. Types of descriptive qualitative data sources used in this study, primary data and secondary data used in research. The technique used for data collection is interview, observation and recording techniques. In analyzing the data, researchers used data reduction, data presentation, and drawing conclusions. The results of the study showed that the Bangoan Collection Center played a role in increasing the economic welfare of the community, especially the welfare of the elderly. The supporting factors for the Bangoan Collection Center are to make it a motivator and facilitator for the whole community. The Bangoan Collection Center plays a role in efforts to improve people's welfare by opening opportunities for people to work, increasing people's income and enabling people to support spiritual, educational and health needs. While the inhibiting factor at the Bangoan Collection Center is that many people do not participate in training or seminars. With the Bangoan Collection Center program, it is able to provide a fairly good role for the economic welfare of the community.&#x0D; Keywords: Bangoan Collection Center, Economic Prosperity, Empowerment Public.

Just ASK: A quality improvement project to enhance smoking assessment and treatment.

6571 Background: Persistent smoking after cancer diagnosis causes adverse clinical outcomes. ASCO and other organizations view smoking assessment and treatment as indicators of high-quality cancer care. Yet, adoption of clinical practice guidelines like the 3As (Ask, Advise and Assist) for smoking assessment and treatment has been slow and inconsistent in cancer care settings. Methods: Led by the American College of Surgeons Cancer Programs’ Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), the “Just ASK” national quality improvement project focuses on enhancing smoking assessment and treatment in cancer care settings. All CoC/NAPBC programs (n~2000) were invited to participate, which consisted of educational webinars, online resources, and 3 online surveys (baseline, 6- and 12-month) collecting information on smoking assessment and treatment practices, plus other variables (e.g., organizational priority, implementation barriers). Program participation was incentivized by fulfillment of accreditation standards. Results: In total, 776 programs (731 CoC, 45 NAPBC), participated. At baseline, most programs strongly endorsed the importance of addressing smoking within cancer care and the majority of programs reported routinely assessing smoking (90%) and advising all patients reporting current smoking to quit (71%). However, routine delivery of evidence-based smoking cessation assistance (e.g., quitline referral, cessation medications, counseling services) was low (all &lt; 30%). Program retention was excellent (91%). As shown in the table, the 12-month follow-up revealed marked improvements in evidence-based Ask, Advise and Assist, practices. Conclusions: At enrollment, the importance of addressing smoking was evident and high rates of smoking assessment were reported. At 12-month follow-up, marked improvement was reported in all quality indicators of the 3As. These findings guided the sharing of strategies for improving patient assessment, clinical workflow and documentation. Suboptimal delivery of smoking cessation assistance persisted despite overall improvements, which highlight persistent challenges and opportunities for implementing smoking assessment and treatment in cancer care settings. [Table: see text]

Implementing a health-system–wide antibiotic stewardship program in ambulatory surgery centers

Background: In 2016, the CDC released the Core Elements of Outpatient Antibiotic Stewardship, which extended the requirements previously released for hospital facilities and nursing homes to the outpatient setting. Several regulatory agencies focused on outpatient antimicrobial use. However, The Joint Commission and the Ambulatory Surgery Center (ASC) Leapfrog Group excluded ambulatory surgery centers from their medication management standards and questions. Due to the public health and patient safety benefits of implementing an antimicrobial stewardship program (ASP) and increasing regulatory interest in the matter, the Hospital Corporation of America (HCA) Ambulatory Surgery Division formally launched a nationwide ASP for its ambulatory surgery centers in March 2021. Methods: HCA is a large healthcare system with 146 ASCs in 16 states in 2021. The structure of the ASCs are local surgery centers with a medical director, a nurse responsible for infection prevention, and a pharmacist at a regional level. The types of surgeries vary based on location and ASC site. In 2019, a multidisciplinary team formed the corporate planning committee. The program was modeled after the CDC Core Elements and The Joint Commission’s requirements for an ASP. Each ASC was asked to build a local ASP team, led by a local physician and a regionally based pharmacist. In addition, a stewardship goal was established to update all preoperative antibiotic surgical-site infection prophylaxis order sets. The corporate committee provided educational resources, including evidence-based guidelines for appropriate antibiotic selection for surgical-site infections. They collected antibiotic cost per case as a baseline metric to track and analyze. Pediatric, ophthalmic, and gastrointestinal endoscopic procedures were excluded from the program. Results: From January 1, 2020, through December 31, 2021, including only centers that were operational during this period and excluding single specialty endoscopy centers, antibiotic cost per case decreased annually from $2.38 to $1.84 (t = 4.157; P &lt; .005), and the postoperative infection rate also declined from 0.370 to 0.304 (t = 2.079; P = .040). Conclusions: Our findings suggest that implementing a health-system–wide outpatient antibiotic stewardship program in the ambulatory surgery center setting is feasible and may contribute to decreased antibiotic cost per case and improved postoperative surgical site infection rates.Disclosures: None

WS03.06 Effective cystic fibrosis team training in low - and medium income countries leads to significant outcome improvements

Objective: Despite advances in research and improvements in care, unacceptable disparities in CF outcomes exist between developed and low-and middle-income countries (LMIC). A primary factor responsible for worse CF outcomes in LMIC is the paucity of specialized networks of CF centers with expert multidisciplinary teams to manage the disease process. We report the implementation of a sustainable training program for CF Centers in LMIC to improve the quality of care, clinical outcomes, and life expectancy.

„Arbeit und Brot“ – die sozioökonomische NS-Propaganda vor 1933

Abstract The NSDAP not only copied the style of the labour movement from the start, but also shifted the focus of its propaganda from 1928 onward from nationalistic foreign policy to domestic and social issues. Until 1932, however, the new socio-economic focus was not underpinned by any concrete economic policy programme. This changed in the final phase of the Weimar Republic, when the NSDAP recognised the political importance of taking action against mass unemployment like no other party. Ideas for active economic policy using central bank-financed employment programmes, which the leading National Socialist Gregor Strasser adopted from early Keynesian and trade union circles, served as the programmatic basis. The topic was job creation, the slogan was “work and bread” and the explicit main opponent, the SPD, was blamed for unemployment, misery and bankruptcy. This socio-economic focus may have contributed significantly to the electoral success of the NSDAP in July 1932, when it replaced the SPD as the strongest party in the Reichstag. The Nazis were able to garner more than a quarter of the workers‘ votes and became the strongest party - even among the workers. With this, the NSDAP turned into a people‘s party, which was drawn from all milieus.

Water management model of Sei Teras fishpond irrigation area in the Central Kalimantan food estate program

This study aims to apply semi-technical irrigation technology as an intermediate plan before an advanced development of the Sei Teras fishpond Irrigation Area can be established. Results of the previous study show that the availability of saline and freshwater sources enables the Sei Teras fishpond irrigation area to be developed into a semi-intensive advanced cultivation level. This study evaluates an alternative scheme of fresh and saline water management, which enlarges channel capacity and introduces gates. The evaluation compares the alternative schemes of hydraulic and water quality performance against the existing conditions using the HEC-RAS. The boundary conditions for modelling are obtained from measurement and Secondary data of the previous studies. The measured data are salinity, tides, and channel flow velocity. The parameters being compared are the discharge capacity, tidal water level, and salinity. The evaluation points are located at the Primary and Secondary channels. The simulation results show that enlargement of the channel capacity can increase the discharge to 129,22% at the evaluation point, but no significant water level change. Furthermore, the salinity level can maintain the aquaculture requirement by assigning the gates. Therefore, the alternative development scheme of the pond irrigation system is feasible and supports shrimp cultivation.

Turning Rage Into Action: Abortion Care and Residency Training in the United States.

Turning Rage Into Action: Abortion Care and Residency Training in the United States.

Efektivitas Pelayanan Program Home Care Saat Masa Pandemi Covid19 di Puskesmas Jumpandang Baru Kota Makassar

Effectiveness states that the patient’s right is to get health services in accordance with services in accordance with service standards. Some of the programs provided can be in the form of public health insurance, free health up to health services that directly touch the community through the home care program. During the pandemic, people reduced activities outside the home. The home care program is expected to able be serve people’s complaints who want to get health services even at home. Study is aims determine to the effectiveness of home care program during services the pandemic at the Jumpandang Baru Health Center in Makassar City. This type of research uses a quantitative research design with descriptive methods. This study in population all people who used home care services pandemic during the covid-19 in 2020-2021 residing in the Jumpandang Baru health center area. This study sample used a total sampling of 70 respondents. The results of the study show that on average., the home care service program during the covid-19 pandemic was very effective. Judging from the five variable sizes, namely program understanding, on time, goal achievement, ,right on target and real change. Several respondents also stated that the home care service program during the pandemic provided many benefits. The conclusion study is that all the variables examined in this study show the effectiveness of the home care service pandemic at the Jumpandang Baru health center program during the covid-19, it is hoped that the Jumpandang Baru health center can continue to improve health services even though only at home.

Monocyte-derived IL-6 programs microglia to rebuild damaged brain vasculature.

Cerebrovascular injury (CVI) is a common pathology caused by infections, injury, stroke, neurodegeneration and autoimmune disease. Rapid resolution of a CVI requires a coordinated innate immune response. In the present study, we sought mechanistic insights into how central nervous system-infiltrating monocytes program resident microglia to mediate angiogenesis and cerebrovascular repair after an intracerebral hemorrhage. In the penumbrae of human stroke brain lesions, we identified a subpopulation of microglia that express vascular endothelial growth factor A. These cells, termed 'repair-associated microglia' (RAMs), were also observed in a rodent model of CVI and coexpressed interleukin (IL)-6Ra. Cerebrovascular repair did not occur in IL-6 knockouts or in mice lacking microglial IL-6Ra expression and single-cell transcriptomic analyses revealed faulty RAM programming in the absence of IL-6 signaling. Infiltrating CCR2+ monocytes were the primary source of IL-6 after a CVI and were required to endow microglia with proliferative and proangiogenic properties. Faulty RAM programming in the absence of IL-6 or inflammatory monocytes resulted in poor cerebrovascular repair, neuronal destruction and sustained neurological deficits that were all restored via exogenous IL-6 administration. These data provide a molecular and cellular basis for how monocytes instruct microglia to repair damaged brain vasculature and promote functional recovery after injury.

INCREASING THE CAPACITY OF CADRE FOR CONTROLLING HIGH BLOOD PRESSURE (HYPERTENSION) IN THE COMMUNITY IN THE WORKING AREA OF CIBADAK HEALTH CENTER RANGKASBITUNG LEBAK DISTRICT

57 million (63%) mortality occurs in the world, and 36 million (43%) morbidity is caused by non-communicable diseases. WHO in 2010 reported that 60% of the causes of death for all ages in the world were PTM and 4% died before the age of 70 years. Community service in the regional partnership program contributed to the Cibadak Rangkasbitung Community Health Center program with the Lebak District Health Office, PTM patient care with hypertension control. Efforts by the Health Office, Cibadak Health Center to educate the community on prevention, control through POSBINDU, training of cadres in the village on hypertension control. not yet optimal and evenly reach the community. The solution is to increase the understanding of cadres in the village of the Cibadak Community Health Center who have not had training in controlling high blood pressure (hypertension). The method of carrying out the Pre test, providing information inviting health service resource persons to increase the cadre's understanding of the concept of hypertension, prevention efforts, early detection. Lecturers train the skills of cadres to measure blood pressure with digital blood pressure. The next meeting was Post test, Monev cadres conducted education, examined 5 patients with high risk of hypertension. There was an increase in the average score of community knowledge about hypertension from 64.3% to 88.3% from 64.3%, there was an increase in the skills of cadres to measure blood pressure with digital blood pressure from 5 people to 12 people. As a continuation of activities, there needs to be community participation, good cooperation between health cadres and village supervisors, program holders

Reflecting on LTCOS Scholarship and Implications for Educational Practice

The Long Term Career Outcome Study is a central program of research in the Center for Health Professions Education at the Uniformed Services University. The overarching goal of Long Term Career Outcome Study is to perform evidence-based evaluations before, during, and after medical school, and as such, it represents a form of educational epidemiology. In this essay, we highlighted the findings of the investigations published in this special issue. These investigations span from "before" medical school matriculation to "during" medical school and "after" learners go on to graduate training and practice. Furthermore, we discuss how this scholarship might shed light on improving the educational practices at the Uniformed Services University and potentially elsewhere. We hope that this work demonstrates how research can enhance medical education processes and connect research, policy, and practice.

Immunometabolic modulation by targeting UCP2 and IL-17A boost anti-tumor immunity against pancreatic cancer

Abstract Metabolic reprograming of cytotoxic effectors by tumor microenvironment (TME) is one of the key mechanisms by which TME impairs the success of cancer immunotherapy. Therapeutic strategies that mitigate the immunosuppressive TME and selectively enhance bioenergetic fitness of cytotoxic effectors may enhance benefits of immunotherapy, particularly in TME-abundant pancreatic cancer. IL-17 is a key TME cytokine engaged in a feed-forward loop promoting the immunosuppressive milieu that facilitates cancer progression. Mitochondrial uncoupling protein 2 (UCP2) acts as an inhibitor of T cell metabolic fitness and directly promotes tumorigenesis. Therefore, we hypothesized that targeting IL-17 and UCP2 could act additionally to enhance antitumor immune response and directly inhibit pancreatic cancer growth. UCP2 deficiency regulated bioenergetic metabolism and mTOR signaling in cytotoxic T cells to enhance IFN-γ production and anti-tumor immune responses. UCP2 inhibition increased anti-tumor immunity in PBMCs and tumors of patients with PDAC. The dual inhibition of IL-17 and UCP2 boosted antitumor immunity and suppressed tumorigenesis in tumor-bearing mice. Combination of UCP2 and IL-17 blockade may offer additional complimentary and cooperative mechanisms of antitumor immunity against pancreatic cancer. 1. Ministry of Science and Technology (MOST 108-2320-B-039-024-MY3) 2. China Medical University Hospital (DMR-110-186) 3. Chinese Medicine Research Center, China Medical University from the Featured Areas Research 4. Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (CMRC-CHM-2)

AIDμS double knockout mice but not AID single knockout mice are highly susceptible to PneumocystisInfection

Abstract Pneumocystispneumonia can be a life-threatening disease to individuals who are immunocompromised due to infection, such as HIV, receiving immunotherapy drugs including corticosteroids or due to genetic defect such as hyper IgM syndrome. B cells are important to the defense and clearance of Pneumocystisinfection; however, the exact role has yet to be elucidated. Prior studies have demonstrated that B cell antigen presentation and priming of CD4 +T cells plays a major role in Pneumocystisclearance, while passive transfer of immune serum can prevent Pneumocystisinfection in mice. To better understand the B cell role in control and clearance of Pneumocystisinfection, using a natural exposure model, we compared the kinetics of Pneumocystis murinainfection in activation-induced cytidine deaminase (AID −/−), AIDμS −/−double knockout, and wild-type C57BL/6 mice. By 5 – 6 weeks post initial exposure all three murine strains were infected with Pneumocystis murina, detected by qPCR of the single copy gene dihydrofolate reductase (DHFR). However, after 10 weeks of infection only the AIDμS −/−double knockout mice continued to have high levels of Pneumocystisinfection. These data suggests that deficiency of B cells to class switch, such as in the AID −/−strain, is not in itself enough to confer increased susceptibility to Pneumocystis. However, in combination with μS deficiency, which inhibits the secretion of antibodies, it is enough to debilitate the immune response resulting in uncontrolled Pneumocystisinfection. Intramural Research Program of the NIH Clinical Center

Salivary gland fine-needle aspiration biopsy: quality assurance results from a tertiary cancer center.

Fine-needle aspiration biopsy (FNAB) plays a critical role in the management of patients with salivary gland lesions. A specific diagnosis can be difficult due to the wide range of lesions with overlapping morphologic features, potentially leading to interpretation errors. We analyzed the cytologic-histologic discrepancies identified in the quality assurance program of a major cancer center in cases of salivary gland FNAB and performed a root cause analysis. Salivary gland FNAB specimens performed during a 12-year period at a major tertiary cancer center were reviewed. The inclusion criteria for this study included FNAB cases of salivary glands with subsequent histologic or flow cytometry follow up. The cytologic diagnoses for these cases were recategorized according to the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) based on the original reports. The risk of neoplasm and malignancy based on the cases with subsequent resection or flow cytometry and the most common causes of discrepancy were analyzed. The risk of neoplasm ranged from 41% to 99% and the risk of malignancy ranged from 22% to 99% among the different MSRSGC categories. Lymphoid and myoepithelial rich lesions were the most common miscategorized lesions using the MSRSGC. Reactive changes due to inflammation were associated with overcalls. The most common malignancy in the atypical category was mucoepidermoid carcinomas. Myoepithelial and lymphoid rich lesions arising in the salivary gland are associated with a higher risk of misclassification. The use of category IVB in the MSRSGC is appropriate for lesions with abundant myoepithelial cells. Reactive atypia seen in sialadenitis was the most common feature associated with overcall.