Midwest Cancer Alliance: Partnership to Support Quality Cancer Care

Comparative Medicine - OneHealth and Comparative Medicine Poster SessionOver 85% of cancer patients nationwide receive care in the community setting (NCI, 2007). In 2008, the Midwest Cancer Alliance (MCA) launched with a vision of marshaling the exceptional cancer resources of the region to support the system of care provided to patients while keeping them “close to home”. With an emphasis on education and research, the MCA was developed to connect hospitals and physician groups across Kansas and western Missouri with the purpose of: Providing strong support to community cancer care professionals; Enhancing cancer care for patients across the region; Advancing access to innovative, investigator-initiated and cooperative group clinical trials; Advancing access to newly developed therapies and prevention strategies; Providing continuing professional and community education opportunities; Facilitating second opinion and consultation services; and Providing patient navigator technical assistance across the network. A membership-based organization, the MCA currently has 14 partners spanning the region including: Children's Mercy Hospital and Clinics; Goodland Regional Medical Center; Hays Medical Center; Kansas Bioscience Authority; Kansas State University; Mt. Carmel Regional Medical Center; Promise Regional Medical Center; Saint Luke's Health; Salina Regional Health Center; St. Francis Health Center; Stormont-Vail HealthCare; Stowers Institute for Medical Research; Truman Medical Center; The University of Kansas Hospital. Methods: In collaboration with members, the MCA facilitates a wide-array of cancer related services. Activities range from developing clinical trial infrastructure including, a centralized Institutional Review Board (IRB), online Velos clinical trials management software to facilitate enrollment and trial data management, and access to Southwest Oncology Group (SWOG), Clinical Trials Support Unit (CTSU) sponsored trials, and research initiated by The University of Kansas Cancer Center's Investigators. MCA provides professional and community education specific to the needs of the community. Members have access to The University of Kansas Cancer Center Tumor Boards as well as continuing education such as chemotherapy and oncology nurse certification curricula. Results: Numerous cancer-related activities have occurred since the inception of the MCA. Over 11,450 individuals attended MCA community education and screening events. 6,200 cancer screenings resulted in 470+ referrals back to local physicians for follow-up on abnormal results. Over 3,096 Continuing Nursing Education (CNE) credits and 296 Continuing Medical Education (CME) credits. Five members have capacity to enroll patients through MCA sponsored trials with access to SWOG and CTSU. 7 cases have been presented at tumor boards. 9 second opinion consultations occurred through the use of telemedicine technology. Discussion: Less than three percent of adult cancer patients participate in clinical trials (Christian & Trimble, 2003). The MCA was established, in part, to address disparities such as this, in an effort to enhance the excellent cancer care provided across the region. The MCA appears to hold great promise of achieving this vision, by leveraging region's collective cancer resources and cancer expertise

Vaccine effectiveness against COVID-19 among symptomatic persons aged ≥12 years with reported contact with COVID-19 cases, February-September 2021

BACKGROUND: Individuals in contact with persons with COVID-19 are at high risk of developing COVID-19; protection offered by COVID-19 vaccines in the context of known exposure is poorly understood. METHODS: Symptomatic outpatients aged ≥12 years reporting acute onset of COVID-19-like illness and tested for SARS-CoV-2 between February 1 and September 30, 2021 were enrolled. Participants were stratified by self-report of having known contact with a COVID-19 case in the 14 days prior to illness onset. Vaccine effectiveness was evaluated using the test-negative study design and multivariable logistic regression. RESULTS: Among 2229 participants, 283/451 (63%) of those reporting contact and 331/1778 (19%) without known contact tested SARS-CoV-2-positive. Adjusted vaccine effectiveness was 71% (95% confidence interval [CI], 49%-83%) among fully vaccinated participants reporting a known contact versus 80% (95% CI, 72%-86%) among those with no known contact (p-value for interaction = 0.2). CONCLUSIONS: This study contributes to growing evidence of the benefits of vaccinations in preventing COVID-19 and support vaccination recommendations and the importance of efforts to increase vaccination coverage

Girls and Boys Born before 28 Weeks Gestation: Risks of Cognitive, Behavioral, and Neurologic Outcomes at Age 10 Years

To compare the prevalence of cognitive, neurological, and behavioral outcomes at 10 years of age in 428 girls and 446 boys who were born extremely preterm (EP)

The Relationship of Maternal Prepregnancy Body Mass Index and Pregnancy Weight Gain to Neurocognitive Function at Age 10 Years among Children Born Extremely Preterm

OBJECTIVE: To assess the association between maternal prepregnancy body mass index and adequacy of pregnancy weight gain in relation to neurocognitive function in school-aged children born extremely preterm. STUDY DESIGN: Study participants were 535 ten-year-old children enrolled previously in the prospective multicenter Extremely Low Gestational Age Newborns cohort study who were products of singleton pregnancies. Soon after delivery, mothers provided information about prepregnancy weight. Prepregnancy body mass index and adequacy of weight gain were characterized based on this information. Children underwent a neurocognitive evaluation at 10 years of age. RESULTS: Maternal prepregnancy obesity was associated with increased odds of a lower score for Differential Ability Scales-II Verbal IQ, for Developmental Neuropsychological Assessment-II measures of processing speed and visual fine motor control, and for Wechsler Individual Achievement Test-III Spelling. Children born to mothers who gained an excessive amount of weight were at increased odds of a low score on the Oral and Written Language Scales Oral Expression assessment. Conversely, children whose mother did not gain an adequate amount of weight were at increased odds of a lower score on the Oral and Written Language Scales Oral Expression and Wechsler Individual Achievement Test-III Word Reading assessments. CONCLUSION: In this cohort of infants born extremely preterm, maternal obesity was associated with poorer performance on some assessments of neurocognitive function. Our findings are consistent with the observational and experimental literature and suggest that opportunities may exist to mitigate risk through education and behavioral intervention before pregnancy

Extremely low gestational age and very low birthweight for gestational age are risk factors for autism spectrum disorder in a large cohort study of 10-year-old children born at 23-27 weeks’ gestation

No prospective cohort study of high-risk children has used rigorous exposure assessment and optimal diagnostic procedures to examine the perinatal antecedents of autism spectrum disorder (ASD), separately among those with and without cognitive impairment

Inorganic nutrients measured on water bottle samples from CTD/Water sampler-system during RV POLARSTERN cruise PS129

The aim of the sub-project HAFOS-nutrients was to determine the nutrients phosphate, nitrate, silicate, nitrite and ammonium in water samples from the entire water column in order to obtain nutrient sections through the Weddell Sea: 954 water samples were taken, in total; 4770 data points for all the different nutrients were measured. The determination of nutrients and biogeochemical parameters is closely connected with physical and biological investigations. The development of phytoplankton blooms and particulate organic matter flux is especially dependent on the available nutrients. Nutrients are also well suited as tracers for the identification of water masses. This work was carried out to continue the investigation of the seasonal as well as the interannual variability of nutrients in the Antarctic Circumpolar Current (ACC) and the Weddell Gyre. In comparison to similar transects of former years, our work focused especially on the transect from Kapp Norvegia to Joinville Island (Hoppema et al., 2015)

Are children's vitamin D levels and BMI associated with antibody titers produced in response to 2014–2015 influenza vaccine?

Background: Vitamin D is an immunomodulating hormone, which has been associated with susceptibility to infectious diseases. Methods: Serum vitamin D levels in 135 children ages 3–17 y were measured at baseline and hemagglutinin influenza antibody titers were measured pre- and 21 d post influenza vaccination with live attenuated influenza vaccine (LAIV) or inactivated influenza vaccine (IIV). Height and weight were derived from the electronic medical record and were used to calculate body mass index (BMI). Results: Thirty-nine percent of children were ages 3–8 years; 75% were black, 34% were obese (BMI ≥ 95th percentile); vitamin D levels were >20 ng/ml in 55%. In linear regression analyses, post vaccination antibody titers for LAIV B lineages (B Brisbane and B Massachusetts) were significantly higher among those with lower vitamin D levels and among younger participants (P < 0.05). No associations between vitamin D levels and responses to LAIV A strains (A/H1N1 and A/H3N2) or to any IIV strains or lineages were found. Conclusion: Low vitamin D levels were associated with higher response to LAIV B lineages in the 2014–2015 LAIV, but not related to LAIV A or any IIV strains

Differential gene expression in peripheral blood mononuclear cells from children immunized with inactivated influenza vaccine

The human immune response to inactivated influenza vaccine is dynamic and impacted by age and preexisting immunity. Our goal was to identify postvaccination transcriptomic changes in peripheral blood mononuclear cells from children. Blood samples were obtained before and at 3 or 7 days postvaccination with 2016–2017 quadrivalent inactivated influenza vaccine and RNA sequencing was performed. There were 1,466 differentially expressed genes (DEGs) for the Day 0–Day 3 group and 513 DEGs for the Day 0–Day 7 group. Thirty-three genes were common between the two groups. The majority of the transcriptomic changes at Day 3 represented innate inflammation and apoptosis pathways. Day 7 DEGs were characterized by activation of cellular processes, including the regulation of cytoskeleton, junctions, and metabolism, and increased expression of immunoglobulin genes. DEGs at Day 3 were compared between older and younger children revealing increased inflammatory gene expression in the older group. Vaccine history in the year prior to the study was characterized by robust DEGs at Day 3 with decreased phagosome and dendritic cell maturation in those who had been vaccinated in the previous year. PBMC responses to inactivated influenza vaccination in children differed significantly by the timing of sampling, patient age, and vaccine history. These data provide insight into the expected molecular pathways to be temporally altered by influenza vaccination in children

Morphoelectric and transcriptomic divergence of the layer 1 interneuron repertoire in human versus mouse neocortex

Neocortical layer 1 (L1) is a site of convergence between pyramidal-neuron dendrites and feedback axons where local inhibitory signaling can profoundly shape cortical processing. Evolutionary expansion of human neocortex is marked by distinctive pyramidal neurons with extensive L1 branching, but whether L1 interneurons are similarly diverse is underexplored. Using Patch-seq recordings from human neurosurgical tissue, we identified four transcriptomic subclasses with mouse L1 homologs, along with distinct subtypes and types unmatched in mouse L1. Subclass and subtype comparisons showed stronger transcriptomic differences in human L1 and were correlated with strong morphoelectric variability along dimensions distinct from mouse L1 variability. Accompanied by greater layer thickness and other cytoarchitecture changes, these findings suggest that L1 has diverged in evolution, reflecting the demands of regulating the expanded human neocortical circuit

Effectiveness of two and three mRNA COVID-19 vaccine doses against Omicron- and Delta-Related outpatient illness among adults, October 2021–February 2022

BackgroundWe estimated SARS-CoV-2 Delta- and Omicron-specific effectiveness of two and three mRNA COVID-19 vaccine doses in adults against symptomatic illness in US outpatient settings.MethodsBetween October 1, 2021, and February 12, 2022, research staff consented and enrolled eligible participants who had fever, cough, or loss of taste or smell and sought outpatient medical care or clinical SARS-CoV-2 testing within 10 days of illness onset. Using the test-negative design, we compared the odds of receiving two or three mRNA COVID-19 vaccine doses among SARS-CoV-2 cases versus controls using logistic regression. Regression models were adjusted for study site, age, onset week, and prior SARS-CoV-2 infection. Vaccine effectiveness (VE) was calculated as (1 − adjusted odds ratio) × 100%.ResultsAmong 3847 participants included for analysis, 574 (32%) of 1775 tested positive for SARS-CoV-2 during the Delta predominant period and 1006 (56%) of 1794 participants tested positive during the Omicron predominant period. When Delta predominated, VE against symptomatic illness in outpatient settings was 63% (95% CI: 51% to 72%) among mRNA two-dose recipients and 96% (95% CI: 93% to 98%) for three-dose recipients. When Omicron predominated, VE was 21% (95% CI: −6% to 41%) among two-dose recipients and 62% (95% CI: 48% to 72%) among three-dose recipients.ConclusionsIn this adult population, three mRNA COVID-19 vaccine doses provided substantial protection against symptomatic illness in outpatient settings when the Omicron variant became the predominant cause of COVID-19 in the United States. These findings support the recommendation for a third mRNA COVID-19 vaccine dose.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175107/1/irv13029_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175107/2/irv13029.pd