Faculty Development As a Tool to Impact Culturally Competent Care of Sexual and Gender Minorities

Presentation: 5:39 Background: This poster focuses on the integration of faculty development of sexual and gender identity health knowledge and skill into health education. There is a gap in inclusion of this content in health professional curriculum. While awareness of LGBTQ+ population health has been indirectly addressed within curriculum, a consistent approach targeting all coursework and faculty can increase culturally competent care of patients that identify as LGBTQ+. Faculty confidence, awareness, and experience regarding knowledge, respectful terminology, and skill directly impacts the likelihood of students becoming culturally competent practitioners. Objectives: The objectives of this poster are to share outcomes of faculty development. This poster will: ● Discuss integration of faculty roles in academia and health profession accreditation standards with theories of cultural competence and humility inclusive of sexual and gender minorities; ● Describe a faculty development program to build foundational understanding of respectful terminology to optimize trust and respect when conversing with/about individuals within sexual and gender minority populations; ● Demonstrate changes in knowledge, awareness, skill, and perceived comfort with sexual and gender minority communities following participation in the program. Methods/ Research: Monthly structured learning sessions were paired with 20-30 minute mentoring check-ins with Sexual and Gender Minorities Education and Training (SG-MET) faculty to address components of LGBTQ+ inclusive curriculum. Pre, mid, and post surveys, composed of open and close-ended questions, assessed satisfaction and changes in knowledge, awareness, and perception of skills. Standardized assessments of sexual and gender minority knowledge, experience and clinical skills were completed and collected anonymously through an electronic survey system to protect the faculty’s identification. Conclusions/ Impact: This faculty development program provides pilot data to suggest that this is an effective way to increase knowledge, awareness, and skills in the area of sexual and gender minority health content delivery and practice to impact healthcare disparities in these populations.https://jdc.jefferson.edu/sexandgenderhealth/1001/thumbnail.jp

Sensitive MRD detection from lymphatic fluid after surgery in HPV-associated oropharyngeal cancer

PURPOSE: Our goal was to demonstrate that lymphatic drainage fluid (lymph) has improved sensitivity in quantifying postoperative minimal residual disease (MRD) in locally advanced human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) compared with plasma, and leverage this novel biofluid for patient risk stratification. EXPERIMENTAL DESIGN: We prospectively collected lymph samples from neck drains of 106 patients with HPV (+) OPSCC, along with 67 matched plasma samples, 24 hours after surgery. PCR and next-generation sequencing were used to quantify cancer-associated cell-free HPV (cf-HPV) and tumor-informed variants in lymph and plasma. Next, lymph cf-HPV and variants were compared with TNM stage, extranodal extension (ENE), and composite definitions of high-risk pathology. We then created a machine learning model, informed by lymph MRD and clinicopathologic features, to compare with progression-free survival (PFS). RESULTS: Postoperative lymph was enriched with cf-HPV compared with plasma (P \u3c 0.0001) and correlated with pN2 stage (P = 0.003), ENE (P \u3c 0.0001), and trial-defined pathologic risk criteria (mean AUC = 0.78). In addition, the lymph mutation number and variant allele frequency were higher in pN2 ENE (+) necks than in pN1 ENE (+) (P = 0.03, P = 0.02) or pN0-N1 ENE (-) (P = 0.04, P = 0.03, respectively). The lymph MRD-informed risk model demonstrated inferior PFS in high-risk patients (AUC = 0.96, P \u3c 0.0001). CONCLUSIONS: Variant and cf-HPV quantification, performed in 24-hour postoperative lymph samples, reflects single- and multifeature high-risk pathologic criteria. Incorporating lymphatic MRD and clinicopathologic feature analysis can stratify PFS early after surgery in patients with HPV (+) head and neck cancer. See related commentary by Shannon and Iyer, p. 1223

Cell-free DNA ultra-low-pass whole genome sequencing to distinguish malignant peripheral nerve sheath tumor (MPNST) from its benign precursor lesion: A cross-sectional study

BACKGROUND: The leading cause of mortality for patients with the neurofibromatosis type 1 (NF1) cancer predisposition syndrome is the development of malignant peripheral nerve sheath tumor (MPNST), an aggressive soft tissue sarcoma. In the setting of NF1, this cancer type frequently arises from within its common and benign precursor, plexiform neurofibroma (PN). Transformation from PN to MPNST is challenging to diagnose due to difficulties in distinguishing cross-sectional imaging results and intralesional heterogeneity resulting in biopsy sampling errors. METHODS AND FINDINGS: This multi-institutional study from the National Cancer Institute and Washington University in St. Louis used fragment size analysis and ultra-low-pass whole genome sequencing (ULP-WGS) of plasma cell-free DNA (cfDNA) to distinguish between MPNST and PN in patients with NF1. Following in silico enrichment for short cfDNA fragments and copy number analysis to estimate the fraction of plasma cfDNA originating from tumor (tumor fraction), we developed a noninvasive classifier that differentiates MPNST from PN with 86% pretreatment accuracy (91% specificity, 75% sensitivity) and 89% accuracy on serial analysis (91% specificity, 83% sensitivity). Healthy controls without NF1 (participants = 16, plasma samples = 16), PN (participants = 23, plasma samples = 23), and MPNST (participants = 14, plasma samples = 46) cohorts showed significant differences in tumor fraction in plasma (P = 0.001) as well as cfDNA fragment length (P \u3c 0.001) with MPNST samples harboring shorter fragments and being enriched for tumor-derived cfDNA relative to PN and healthy controls. No other covariates were significant on multivariate logistic regression. Mutational analysis demonstrated focal NF1 copy number loss in PN and MPNST patient plasma but not in healthy controls. Greater genomic instability including alterations associated with malignant transformation (focal copy number gains in chromosome arms 1q, 7p, 8q, 9q, and 17q; focal copy number losses in SUZ12, SMARCA2, CDKN2A/B, and chromosome arms 6p and 9p) was more prominently observed in MPNST plasma. Furthermore, the sum of longest tumor diameters (SLD) visualized by cross-sectional imaging correlated significantly with paired tumor fractions in plasma from MPNST patients (r = 0.39, P = 0.024). On serial analysis, tumor fraction levels in plasma dynamically correlated with treatment response to therapy and minimal residual disease (MRD) detection before relapse. Study limitations include a modest MPNST sample size despite accrual from 2 major referral centers for this rare malignancy, and lack of uniform treatment and imaging protocols representing a real-world cohort. CONCLUSIONS: Tumor fraction levels derived from cfDNA fragment size and copy number alteration analysis of plasma cfDNA using ULP-WGS significantly correlated with MPNST tumor burden, accurately distinguished MPNST from its benign PN precursor, and dynamically correlated with treatment response. In the future, our findings could form the basis for improved early cancer detection and monitoring in high-risk cancer-predisposed populations

Wound dressings for a proteolytic-rich environment

Wound dressings have experienced continuous and significant changes over the years based on the knowledge of the biochemical events associated with chronic wounds. The development goes from natural materials used to just cover and conceal the wound to interactive materials that can facilitate the healing process, addressing specific issues in non-healing wounds. These new types of dressings often relate with the proteolytic wound environment and the bacteria load to enhance the healing. Recently, the wound dressing research is focusing on the replacement of synthetic polymers by natural protein materials to delivery bioactive agents to the wounds. This article provides an overview on the novel protein-based wound dressings such as silk fibroin keratin and elastin. The improved properties of these dressings, like the release of antibiotics and growth factors, are discussed. The different types of wounds and the effective parameters of healing process will be reviewed

Basal monothalamous and pseudochambered benthic foraminifera associated with planktonic foraminiferal shells and mineral grains from the Porcupine Abyssal Plain, NE Atlantic

We present a survey of ‘live’ (stained) and dead monothalamous (single-chambered, mainly spherical) and pseudochambered (chain-like) foraminifera associated with planktonic foraminiferal shells and mineral grains, based on two samples from one abyssal plain site (F2, 4,880 m water depth) and one abyssal hill site (H4, 4,330 m water depth) on the Porcupine Abyssal Plain (PAP), northeast Atlantic. Our study is the first to focus on this poorly known component of abyssal foraminiferal faunas and highlight their abundances and diversity at the PAP. In both samples these monothalamids and pseudochambered forms represented 27–35 % and 18–23 %, respectively, of the entire ‘live’ and dead foraminiferal assemblage (>150 ?m, 0–1 cm sediment layer). Among 1,078 stained and dead specimens we recognise a total of 18 distinct morphotypes on the basis of test characteristics. Another 144 specimens could not be assigned to any morphotype and are regarded as indeterminate. Most of the monothalamids are small (<150 ?m), although some incorporate planktonic foraminiferal shells to create larger structures. In absolute terms, stained and dead individuals of these morphotypes were more abundant at the abyssal hill site, although data from additional samples are needed to confirm if this is representative of differences between abyssal hills and the surrounding abyssal plain at the PAP. Agglutinated spheres and domes similar to some of our abyssal forms have been reported from shelf and slope settings, but they are generally much larger. Small agglutinated spheres are very common in the abyssal Pacific, at depths close to or below the carbonate compensation depth (CCD). However, they are composed largely of siliceous particles, including mineral grains, radiolarians and diatom fragments. In contrast, carbonate oozes at the PAP, situated above the CCD, are rich in coccoliths and planktonic foraminiferal shells, which are used in the construction of agglutinated spheres and domes. Our results underline the important contribution made by largely underestimated foraminiferal taxa to abyssal communities