Recent studies in multiple epithelial cancers have shown that the inhibitory receptor programmed cell death 1 (PD-1) is expressed on tumor-infiltrating lymphocytes and/or programmed death ligand 1 ...(PD-L1) is expressed on tumor cells, suggesting that antitumor immunity may be modulated by the PD-1/PD-L1 signaling pathway. In addition, phase 1 clinical trials with monoclonal antibodies targeting PD-1 or PD-L1 have shown promising results in several human cancers. The purpose of this study was to investigate the impact of PD-L1 expression in human breast cancer specimens. We conducted an immunohistochemistry study using a tissue microarray encompassing 650 evaluable formalin-fixed breast cancer cases with detailed clinical annotation and outcomes data. PD-L1 was expressed in 152 (23.4 %) of the 650 breast cancer specimens. Expression was significantly associated with age, tumor size, AJCC primary tumor classification, tumor grade, lymph node status, absence of ER expression, and high Ki-67 expression. In univariate analysis, PD-L1 expression was associated with a significantly worse OS. In multivariate analysis, PD-L1 expression remained an independent negative prognostic factor for OS. In subset analyses, expression of PD-L1 was associated with significantly worse OS in the luminal B HER2
−
subtype, the luminal B HER2
+
subtype, the HER2 subtype, and the basal-like subtype. This is the first study to demonstrate that PD-L1 expression is an independent negative prognostic factor in human breast cancer. This finding has important implications for the application of antibody therapies targeting the PD-1/PD-L1 signaling pathway in this disease.
This study investigated self-stigma and attitudes toward seeking professional psychological help among athletes with physical disabilities who compete at the intercollegiate level. The research study ...sought to explore the relationships between self-stigma of seeking help, attitudes toward seeking help, and demographic characteristics. Participants in the study included 29 collegiate athletes with various physical disabilities who competed in intercollegiate institutions across the United States. The measures utilized in the current study were Self-Stigma of Seeking Help (SSOSH) and Attitudes Toward Seeking Professional Psychological Help (ATSPPHS). Following a data analysis, it was identified that SSOSH scores were significantly associated with ATSPPHS scores and ATSPPHS was also significantly associated with SSOSH scores. The demographic characteristics age, sex, sport type, disability type, time since disability, and previous mental health treatment history were not identified as having significant relationships with either SSOSH or ATSPPHS. Lastly, a correlation was identified between SSOSH and ATSPPHS, between ATSPPHS and division level, and between SSOSH and beneficial mental health treatment experiences. The research should be used to guide mental health awareness and mental health help seeking programs for athletic departments that host collegiate adapted athlete programs. This research study was the first to explore self-stigma of seeking help and attitudes toward seeking help in the target population.
Purpose: Although gender disparities and workplace vitality for women has been studied in athletic training, gender discrimination has not been widely studied. The purpose of this study was to ...describe gender-based aggressions experienced by women athletic trainers (ATs) within their educational and workplace environments. Methods: We used a cross-sectional design, and the web-based survey was comprised of demographic questions, the Schedule of Sexism Events (SSE), and questions on incident reporting. The SSE asks participant to rank items on a Likert Scale (1 = the event never happened to 6 = the event happens almost all the time). Items within the SSE are contextualized to either events in the past year or events in their entire life. The survey was distributed to 5,667 women ATs through the National Athletic Training Association (NATA). Five hundred thirty-nine (539) participants accessed the survey (9.5%). Four hundred seventy-eight (478) participants (age=34.2±8.6y range=23–66y, experience=11.0±8.2y range=0-40y) completed the entire instrument (88.6%). We used descriptive statistics to analyze demographic variables, gender-based education- and work- related items of the SSE and incident reporting. Results: When asked about unfair treatment while interacting with teachers, professors, or engaging in academics in their lifetime, 89% (n=425) of participants indicated they had experienced unfair treatment. Comparatively, 53% (n=252) of participants experienced unfair treatment from teachers, or professors, or while engaging in academics in the last year. When asked about unfair treatment by an employer, boss, or supervisor, 88% (n=421) of participants experienced unfair treatment in their lifetime, where 55% (n=267) have experienced unfair treatment in the past year. Ninety percent (90%, n=430) indicated they experienced unfair treatment by co-workers, fellow students, or colleagues, in their lifetime compared to 61% (n=292) in the past year. When asked if they had experienced gender-based macroaggressions and microaggressions in the workplace, 41% (n=198) experienced both types of aggressions; 5% (n=22) experienced macroaggressions and 29% (n=137) experienced microaggressions. Only 25% (n=119) of participants have reported aggressions in the workplace. Conclusion: Women ATs experience gender-based aggressions in the workplace but they do not typically report these aggressions. All ATs have the responsibility to work towards an inclusive, equitable, and welcoming workplace that directly addresses aggressions.
Physicians must have an understanding of patients' medication beliefs in order to enhance medication adherence. To increase understanding, this study examined how beliefs about medication and four ...osteoporosis treatments influenced treatment selection and adherence.
Six focus groups, three with 28 African Americans and one with 11 non-Hispanic white women, were conducted in English. Two groups with 16 Hispanics were conducted in Spanish. The convenience sample was recruited from senior centers and housing in lower socioeconomic geographic areas. The average age was 74.8 +/- 1.1 years.
Adherence was associated with recognition of the serious consequences of nonadherence, realization of the beneficial effects, and the belief that medicines are not harmful. Doubts about physicians' competence to prescribe appropriate drugs were also revealed. Women who thought they were unlikely to fracture or perceived fracture outcomes as not severe chose no treatment. If they identified a need, they weighed benefits against the attendant risks to find the best alternative among the affordable options. Price considerations eliminated raloxifene and alendronate. Consideration of side effects eliminated estrogen and raloxifene. Calcium was viewed as a low-cost, low-risk alternative. Those who could afford alendronate and who viewed its side effects as preventable preferred it. Benefit and risk assessments may have been biased by fear of cancer and thromboembolic events.
Women's beliefs about necessity of treatment, medication safety, cost of treatment, and treatment goals appear critical to osteoporosis treatment selection and adherence.
Abstract
Background
Contact tracing is a critical component in controlling the spread of infectious diseases. During the COVID-19 pandemic, the demands for contract tracing far exceeded the resources ...available to infection prevention and control (IPC) programs. Leveraging our Poison Control Center, our organization established a Contact Tracing Center (CTC) with content expertise and oversight by IPC and Occupational Health. The CTC identifies exposed patients and employees, provides testing guidance and scheduling, and offers post-exposure recommendations for employees. We describe patient outcomes due to employee exposures in a pediatric healthcare system.
Methods
Exposure data about employee to patient exposures (EPE) were captured real-time by scripted telephone interviews by our CTC. Chart review was performed to determine outcomes of exposed patients. A concerning exposure from a direct patient care provider to a patient was defined as unprotected contact at less than 6 feet for greater than 5 minutes in the 24 hours prior to developing symptoms. Data were analyzed to determine COVID-19 conversion rates for children exposed to pre-symptomatic and symptomatic employees based upon exposure risk stratification, window of exposure, and employees who worked with symptoms.
Results
From March 2020 – present, we identified 38 EPE that involved 10 employees; 26 EPE were pre-symptomatic and 12 EPE symptomatic exposures. The average number of EPE per employee was 3.8 (SD 3.01). There were no secondary transmission events to patients from either pre-symptomatic or symptomatic employees. After instituting universal masking, the number of concerning exposures to patients were 3 compared to 35 prior to universal masking.
Conclusion
We describe the experience of a novel Contact Tracing Center, leveraging alternate staffing pools to track EPE resulting in no secondary transmission to patients either before or after universal masking. We credit sick policy adherence, high hand hygiene compliance, use of standard precautions, universal masking, robust contact tracing operations and a strong data collection system to identify process gaps.
Disclosures
All Authors: No reported disclosures
This study determined the extent to which fall risk assessment and management practices for older patients were implemented in Medicare‐certified home health agencies (HHAs) in a defined geographic ...area in southern New England that had participated in evidence‐based fall prevention training between October 2001 and September 2004. The standardized in‐service training sessions taught home health nurses and rehabilitation therapists how to conduct assessments for five evidence‐based risk factors for falls in older adults—mobility impairments, balance disturbances, multiple medications, postural hypotension, and home environmental hazards—using techniques shown to be efficacious in clinical trials. Twenty‐six HHAs participated in these in‐service training sessions; 19 of these participated in a survey of nurses and rehabilitation therapists between October 2004 and September 2005. Self‐reported assessment and management practices implemented with older patients during home healthcare visits were measured in this survey, and HHA‐level measures for each fall risk factor were constructed based on proportions of clinicians reporting assessment and management practices that were recommended in the fall prevention training sessions. For all fall risk factors except postural hypotension, 80% or more of clinicians in all HHAs reported implementing recommended fall risk management practices. Greater variation was found regarding fall risk assessment practices, with fewer than 70% of clinicians in one or more HHAs reporting recommended assessment practices for all risk factors. Results suggest that evidence‐based training for home healthcare clinicians can stimulate fall risk assessment and management practices during home health visits. HHA‐level comparisons hold the potential to illustrate the extent of diffusion of evidence‐based fall prevention practices within and between agencies.
We present the case of a 19-yr-old woman with a history of generalized dystonia who developed sudden onset of adductor spasms of the vocal cords and increased dystonia after the interruption or ...intrathecal baclofen therapy. Her symptoms resolved after intrathecal baclofen was restored. In patients with dystonia receiving intrathecal baclofen therapy, the onset of dyspnea associated with increased muscle tone should prompt the investigation of baclofen withdrawal.
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