Raising awareness of human trafficking in key professional fields via a multidisciplinary educational approach

Purpose Human trafficking (HT) for sex and labor services is among the fastest growing criminal enterprises, causing significant physical and psychological morbidity to victims. Although many survivors encounter medical, legal and social work professionals during their captivity, lack of awareness of HT in these fields results in under-recognition of victims. The purpose of this study is to evaluate the effectiveness of a multidisciplinary educational conference on raising awareness of HT in these fields. Design/methodology/approach A single-day educational conference on HT was hosted in Miami, Florida. Participants were recruited from medical, law enforcement, social work and political fields. The research team issued a ten-item HT survey at the start and end of the conference. Results were analyzed for improvement in survey score using an exact Wilcoxon sign rank test. The results were analyzed both as a single cohort and stratified by profession. Findings For all participants, there was a significant improvement in post-survey score (0.355, p < 0.05). When stratified by profession, significant improvement was noted in the legal subgroup (0.561, p < 0.05). No significant changes were noted for the other individual professional cohorts, although all subgroups trended toward improvement. Research limitations/implications A multi-disciplinary educational conference may be effective in raising awareness of HT. Further research is needed to determine the effect of increased awareness on actual outcomes for trafficking survivors. Originality/value This study represents unique, original research which provides valuable data as to the effectiveness of educational conferences on raising awareness of HT for professionals with the best opportunity to make meaningful interventions

Challenges of Zika Virus Testing in Pregnancy in the Setting of Local Mosquito-Borne Transmission

Abstract Background Zika Virus (ZIKV) infection in pregnancy is a major clinical concern. The CDC recommended that pregnant women living in an area with a ZIKV travel notice undergo ZIKV screening in the first and second trimesters of pregnancy. This study investigated the consequences of this screening on clinical management. Methods An IRB approved retrospective chart review was conducted using laboratory records of ZIKV testing on pregnant patients from January through December 2016 at multiple tertiary care centers in Miami, FL. Serum and/or urine samples were collected, based on CDC guidelines at the time, and evaluated for PCR and/or IgM evidence of ZIKV infection. Positive ZIKV PCR results indicated acute phase of infection. Previous infection was suggested by positive IgM antibody, but required confirmatory ZIKV plaque reduction neutralization testing (PRNT) testing due to IgM antibody cross reactivity with other flaviviruses. Results During 2016, 2,327 pregnant women were screened for ZIKV infection. At the peak in August 2016, 607 (26%) patients were tested and only 31 (5.1%) tests resulted within the month. Of those screened, 113 (4.85%) women tested positive for ZIKV PCR and/or IgM. In October 2016, 40 (35.4%) positive screening tests were received, the most positives resulting in a month. Confirmatory ZIKV PRNT testing was performed on those who were ZIKV IgM positive and PCR negative, with a total of 92 results received. Eighty-eight women were considered positive, 49 confirmed with positive titers (≥10). There were 28 women with negative titers (< 10), thus a false positive ZIKV screening rate of 30.4%, and 15 results were pending. Of women with false positive IgM screening, a median of 1 (range 0–4) additional ultrasound was done between receipt of the initial positive ZIKV screening and the subsequent receipt of the negative PRNT testing. Delays of results led to 21 (24%) positive tests reported after delivery and hospital discharge. Additionally, 18 (20.5%) women who tested PRNT positive had their originating sample drawn during admission for delivery with results available only after discharge. Conclusion Both delays in ZIKV testing results and false positive screening with ZIKV IgM led to challenges in counseling and clinical care of pregnant women living in an area of ongoing ZIKV transmission. Disclosures All authors: No reported disclosures

Zika Virus Testing and Outcomes during Pregnancy, Florida, USA, 2016

Zika virus infection during pregnancy can lead to congenital Zika syndrome. Implementation of screening programs and interpretation of test results can be particularly challenging during ongoing local mosquitoborne transmission. We conducted a retrospective chart review of 2,327 pregnant women screened for Zika virus in Miami–Dade County, Florida, USA, during 2016. Of these, 86 had laboratory evidence of Zika virus infection; we describe 2 infants with probable congenital Zika syndrome. Delays in receipt of laboratory test results (median 42 days) occurred during the first month of local transmission. Odds of screening positive for Zika virus were higher for women without health insurance or who did not speak English. Our findings indicate the increase in screening for Zika virus can overwhelm hospital and public health systems, resulting in delayed receipt of results of screening and confirmatory tests and the potential to miss cases or delay diagnoses

Mutational Frequency in Hispanic Vs. Non-Hispanic Patients with Acute Myeloid Leukemia (AML)

Abstract Introduction: There is a paucity of data on the distribution of acute leukemia (AL) across ethnic groups. Historically, B-cell acute lymphoblastic leukemia (B-ALL) and acutepromyelocytic leukemia (APL) are over-represented in Hispanic patients, while acute myeloid leukemia (AML) is less frequent. We analyzed the ethnic distribution of AL in Florida based on incidence rates and nativity differences using Florida Cancer Data System (FCDS). In our study, B-ALL and APL were more common in Hispanics vs. non-Hispanics (IRR of 1.627 and 1.302, respectively); however, contrary to prior reports, AML was also more common (IRR 1.533) (Swords et al, BCJ 2016, in press). No nativity differences were observed. Given this novel finding of increased AML incidence in Hispanics in South Florida, we examined AML patients at Sylvester Comprehensive Cancer Center (SCCC) to look for ethnic differences in mutational frequency. Methods: We obtained molecular genetic data on AML patients treated from 2012-2015 across multiple centers.Genomic DNA from bone marrow or peripheral blood was sequenced for ASXL1, DNMT3A, FLT3 TKD, IDH1, IDH2, KIT, NPM1, PHF6, TET2 on the IlluminaMiSeq platform using a lower limit of detection of 5% and minimum coverage of 500X. Alignment and variant calling were performed usingNextGENe® software as previously described byGenoptix, Inc. MLL PTD, FLT3 ITD and CEBPA mutations were detected by PCR amplification followed by fragment analysis.For patients treated at SCCC, we obtained IRB approval to conduct retrospective chart reviews for clinical and pathologic data. Categorical data was analyzed by Fisher exact test or Chi-square test as appropriate. Continuous data was analyzed by independent t-test and Wilcoxon-Mann Whitney test for parametric and non-parametric data, respectively. Statistical analysis was performed using Stata (version 13.0).Circos plots were created usingCircos. Results: We examined the 11-gene mutational profile of 927 unique AML patients. The frequency of these mutations was consistent with previous reports (Park et al, NEJM 2012). DNMT3A, NPM1, and FLT3 were the most common abnormalities (Figure 1A). 75 of these 927 patients were treated at our center. Of these, median age was 60.2 years; 53.3% were female; 80% were white, 13.3% black,6.7% other. 68% (n=51) self-identified as non-Hispanic and 32% (n=24) as Hispanic (Table 1). Median WBC was 3.95 K/µL (1.4-100.7); 37% had antecedent MDS or MDS-related changes; 8% had favorable-, 69% intermediate-, and 23% poor-risk cytogenetics. There were no differences in WBC, MDS, or cytogenetic risk by ethnicity. In the 75 patient SCCC cohort, TET2 (n=14, 18.7%), CEBPA (n=14, 21.9%), and DNMT3A (n=11, 14.7%) were the most common mutations. 16 patients had an IDH mutation (10 IDH1 and 6 IDH2). We found no statistically significant difference in mutation frequency in Hispanic vs. non-Hispanic patients (Figure 1B); however, there was a non-significant increase in MLL-PTD mutations in Hispanic patients (15.8% vs. 9.3%, p=0.665) and IDH1 mutations in non-Hispanics (11.8% vs. 0%, p=0.168). Conclusions: We present one of the largest examinations to date (n=927 patients) of mutational frequency in AML. Our findings corroborate prior literature; however, we did note the rare co-occurrence of TET2 and IDH mutations-showing the 2 are not always mutually exclusive. We examined demographic data on a subset of these patients treated at SCCC, where we have a large Hispanic population, and assessed for ethnic differences in mutational frequency. We found a suggestion of increased MLL PTD mutations, a poor-risk abnormality, in Hispanic patients, and increased IDH1 mutations in non-Hispanics, but found no significant differences. This may be due to our relatively small sample size. We are now examining the full 927 patient cohort for demographic data and updated results will be presented. If certain AML mutations cluster by ethnicity, this might explain differing incidence rates and outcomes in Hispanics, and examination of predisposing heritable or environmental factors should be pursued. Table 1. Distribution of mutations in an 11-gene AML molecular profile by ethnicity in 75 patients with AML. Figure 1.Circosplots characterizing the distribution of concomitant mutations in 927 patients with AML (A); and the incidence of mutations by ethnicity in 75 patients with AML (B). Figure 1 Figure 1. Figure 2 Figure 2. Disclosures Vaupel: Genoptix, a Novartis Company: Employment. Hall:Genoptix, a Novartis Company: Employment