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Objectives. We examined whether characteristics of local health departments (LHD) and their geographic region were associated with using Facebook and Twitter. We also examined the number of tweets per month for Twitter accounts as an indicator of social media use by LHDs. Methods. In 2012, we searched for Facebook and Twitter accounts for 2565 LHDs nationwide, and collected adoption date and number of connections for each account. Number of tweets sent indicated LHD use of social media. LHDs were classified as innovators, early adopters, or nonadopters. Characteristics of LHDs were compared across adoption categories, and we examined geographic characteristics, connections, and use. Results. Twenty-four percent of LHDs had Facebook, 8% had Twitter, and 7% had both. LHDs serving larger populations were more likely to be innovators, tweeted more often, and had more social media connections. Frequency of tweeting was not associated with adoption category. There were differences in adoption across geographic regions, with western states more likely to be innovators. Innovation was also higher in states where the state health department adopted social media. Conclusions. Social media has the potential to aid LHDs in disseminating information across the public health system. More evidence is needed to develop best practices for this emerging tool.

Combining PD-L1 blockade with inhibition of oncogenic mitogen-activated protein kinase (MAPK) signaling may result in long-lasting responses in patients with advanced melanoma. This phase 1, open-label, dose-escalation and -expansion study (NCT02027961) investigated safety, tolerability and preliminary efficacy of durvalumab (anti–PD-L1) combined with dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor) for patients with BRAF-mutated melanoma (cohort A, n = 26), or durvalumab and trametinib given concomitantly (cohort B, n  = 20) or sequentially (cohort C, n = 22) for patients with BRAF -wild type melanoma. Adverse events and treatment discontinuation rates were more common than previously reported for these agents given as monotherapy. Objective responses were observed in 69.2% (cohort A), 20.0% (cohort B) and 31.8% (cohort C) of patients, with evidence of improved tumor immune infiltration and durable responses in a subset of patients with available biopsy samples. In conclusion, combined MAPK inhibition and anti–PD-L1 therapy may provide treatment options for patients with advanced melanoma. Immune checkpoints inhibitors or MAPK inhibitors are currently used as standard of care therapies for patients with advanced melanoma. Here the authors report a phase 1 clinical trial testing the anti-PD-L1 antibody durvalumab in combination with the BRAF inhibitor dafrafenib and the MEK inhibitor trametinib in patients with BRAFV600-mutant melanoma.

Background Public health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health. Methods This developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas ( e . g ., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention). Results The literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program’s capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity—89% of the individual items composing the framework had specific support in the sustainability literature. Conclusions The sustainability framework presented here suggests that a number of selected factors may be related to a program’s ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers.

Although a high prevalence of hepatitis C virus (HCV) infection among non‐Hodgkin's lymphoma (NHL) patients had been reported, subsequent epidemiological studies conducted to examine a causal association between HCV and NHL have provided inconsistent results across studies. A strikingly positive association has been reported primarily from Italy and Japan, while no association was found in other regions of the world. To clarify the association between HCV and NHL, we conducted a systematic literature review. Eligible study designs were nested case‐control studies, population‐based case‐control studies, and hospital‐based case‐control studies using non‐cancer subjects as controls. The studies published through January 1991 to August 2003 were searched through Medline. Ultimately, 23 studies with 4049 NHL patients and 1,813,480 controls were identified. Summary statistics were crude odds ratios (ORs) comparing the anti‐HCV se‐ropositive and seronegative subjects. As we identified heterogeneity between studies, summary statistics were calculated based on a random‐effect model. We did not find any evidence of publication bias. The major sources of variation were the use of blood donor controls and year of publication. The summary OR for NHL was 5.70 (95% confidence interval (Cl), 4.09–7.96, P<0.001). The subgroup analysis by phenotype showed a similar trend for B‐cell (5.04, 95% Cl: 3.59–7.06) and T‐NHL (2.51, 95% Cl: 1.39–4.56). In conclusion, we found a strongly positive association between anti‐HCV seropositive test subjects and risk of NHL. Further biological studies examining this association are warranted.

BackgroundLimited data exist on potential clinical benefit with anti-programmed cell death ligand-1 (PD-L1) retreatment in patients who stop initial therapy for reasons other than disease progression or toxicity and develop disease progression while off treatment.Patients and methodsNCT01693562 was a phase I/II study evaluating durvalumab monotherapy in advanced solid tumors. Patients benefiting from treatment were taken off durvalumab at 1 year per protocol and prospectively followed. At disease progression, they were eligible for durvalumab retreatment. Outcomes evaluated during retreatment included best overall response (BOR2), duration of response (DoR2), disease control rate (DCR2), and progression-free survival (PFS2).ResultsOf 980 patients enrolled and treated with durvalumab 10 mg/kg every 2 weeks (Q2W) in the dose-expansion cohorts, 168 completed 1 year of initial durvalumab treatment with confirmed BOR1 of complete response in 20 (11.9%), partial response (PR) in 84 (50%), stable disease (SD) in 52 (31%), and disease progression in 12 (7.1%). All 168 patients stopped treatment and were eligible for retreatment at progression; 70 patients (41.7%) representing 14 primary tumor types were retreated and response evaluable. Confirmed BOR2 was PR in 8 patients (11.4%), SD in 42 (60.0%), disease progression in 16 (22.9%), and unevaluable in 4 (5.7%). Median DoR2 was 16.5 months. DCR2 ≥24 weeks (DCR2 24) was 47.1%. PFS2 rate at 12 months was 34.2%, and median PFS2 was 5.9 months. Median overall survival (OS2) was 23.8 months. Response rates, DCR2 24, and median DoR2 were generally greater in patients with high PD-L1 expression than those with low/negative expression. No new safety signals were observed during retreatment.ConclusionRetreatment restored antitumor activity, resulting in high rates of durable disease control with an acceptable safety profile. This evidence supports retreatment of patients who stop anti-PD-L1 therapy for reasons other than progression or toxicity, and supports further investigation.

Background Since March 2020, COVID-19 has disproportionately impacted communities of color within the United States. As schools have shifted from virtual to in-person learning, continual guidance is necessary to understand appropriate interventions to prevent SARS-CoV-2 transmission. Weekly testing of students and staff for SARS-CoV-2 within K-12 school setting could provide an additional barrier to school-based transmission, especially within schools unable to implement additional mitigation strategies and/or are in areas of high transmission. This study seeks to understand the role that weekly SARS-CoV-2 testing could play in K-12 schools. In addition, through qualitative interviews and listening sessions, this research hopes to understand community concerns and barriers regarding COVID-19 testing, COVID-19 vaccine, and return to school during the COVID-19 pandemic. Methods/design Sixteen middle and high schools from five school districts have been randomized into one of the following categories: (1) Weekly screening + symptomatic testing or (2) Symptomatic testing only. The primary outcome for this study will be the average of the secondary attack rate of school-based transmission per case. School-based transmission will also be assessed through qualitative contact interviews with positive contacts identified by the school contact tracers. Lastly, new total numbers of weekly cases and contacts within a school-based quarantine will provide guidance on transmission rates. Qualitative focus groups and interviews have been conducted to provide additional understanding to the acceptance of the intervention and barriers faced by the community regarding SARS-CoV-2 testing and vaccination. Discussion This study will provide greater understanding of the benefit that weekly screening testing can provide in reducing SARS-CoV-2 transmission within K-12 schools. Close collaboration with community partners and school districts will be necessary for the success of this and similar studies. Trial Registration NCT04875520 . Registered May 6, 2021.

Cerebral toxoplasmosis is characterized by activation of brain resident cells and recruitment of specific immune cell subsets from the periphery to the central nervous system (CNS). Our studies revealed that the rapidly invaded Ly6G neutrophil granulocytes are an early non-lymphoid source of interferon-gamma (IFN-γ), the cytokine known to be the major mediator of host resistance to ( ). Upon selective depletion of Ly6G neutrophils, we detected reduced IFN-γ production and increased parasite burden in the CNS. Ablation of Ly6G cells resulted in diminished recruitment of Ly6C monocytes into the CNS, indicating a pronounced interplay. Additionally, we identified infiltrated Ly6G neutrophils to be a heterogeneous population. The Ly6G CD62-L CXCR4 subset released cathelicidin-related antimicrobial peptide (CRAMP), which can promote monocyte dynamics. On the other hand, the Ly6G CD62-L CXCR4 subset produced IFN-γ to establish early inflammatory response. Collectively, our findings revealed that the recruited Ly6G CXCR4 neutrophil granulocytes display a heterogeneity in the CNS with a repertoire of effector functions crucial in parasite control and immune regulation upon experimental cerebral toxoplasmosis.

Objectives. We studied 5 members of the National Network Consortium on Tobacco Control in Priority Populations. These networks, which consist of governmental and nongovernmental organizations, targeted lesbian, gay, bisexual, and transgender persons; Asian Americans, Native Hawaiians, and Pacific Islanders; American Indians and Alaska Natives; African Americans; and persons with low socioeconomic status, respectively. Methods. We used statistical network analysis modeling to examine collaboration among these national networks in 2007. Results. Network size and composition varied, but all 5 networks had extensive interorganizational collaboration. Location and work area were significant predictors of collaboration among network members in all 5 networks. Organizations were more likely to collaborate with their network's lead agency; collaborations with other agencies were more likely if they were geographically close. Collaboration was perceived to be important for achieving the goals of the national network. Conclusions. The similarity of collaboration patterns across the 5 networks suggests common underlying partnership formation processes. Statistical network modeling promises to be a useful tool for understanding how public health systems such as networks and coalitions can be used to improve the nation's health.