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The COVID-19 pandemic presents clinicians a unique set of challenges in managing breast cancer (BC) patients. As hospital resources and staff become more limited during the COVID-19 pandemic, it becomes critically important to define which BC patients require more urgent care and which patients can wait for treatment until the pandemic is over. In this Special Communication, we use expert opinion of representatives from multiple cancer care organizations to categorize BC patients into priority levels (A, B, C) for urgency of care across all specialties. Additionally, we provide treatment recommendations for each of these patient scenarios. Priority A patients have conditions that are immediately life threatening or symptomatic requiring urgent treatment. Priority B patients have conditions that do not require immediate treatment but should start treatment before the pandemic is over. Priority C patients have conditions that can be safely deferred until the pandemic is over. The implementation of these recommendations for patient triage, which are based on the highest level available evidence, must be adapted to current availability of hospital resources and severity of the COVID-19 pandemic in each region of the country. Additionally, the risk of disease progression and worse outcomes for patients need to be weighed against the risk of patient and staff exposure to SARS CoV-2 (virus associated with the COVID-19 pandemic). Physicians should use these recommendations to prioritize care for their BC patients and adapt treatment recommendations to the local context at their hospital.

An important fact that is never stated in articles that recommend against routine screening for the potentially fatal disease of prostate cancer, including the one recently published in American Family Physician,1 is that if the U.S. Preventive Services Task Force and the American Academy of Family Physicians current recommendations for prostate cancer screening are followed, then more men will die of the disease. Remember, all these men are spared the anxiety, treatments, and complications of a prostate cancer diagnosis.1 Then, it assumes that the number needed to detect-number of diagnoses needed to avert one prostate cancer death-is 27, as it was in one out of five randomized trials of the PSA screening.2 But, in my editorial, I explained why looking at this one trial in isolation is misleading. [...]malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis.

Background Patient engagement plays a valuable role in health research and quality improvement. While prior research highlights some principles and key considerations for patient involvement in these efforts, there is a limited understanding of how best to structure and support this engagement, especially from the patient perspective and for healthcare innovation projects. Methods Transcripts and notes from semi‐structured debrief interviews with patient partners (n = 14) and team leads (n = 22) of 14 healthcare innovation projects conducted between 2020 and 2023 were analyzed thematically to identify perceived benefits, structures and supports that shape lived‐experience engagement, and recommendations for future patients' participation in healthcare innovation teams. Results Lived‐experience engagement was perceived as highly valuable to project teams and rewarding to the patients themselves. Approaches for structuring and supporting the patient role shaped engagement, highlighting several strategies (e.g., providing patient partners with opportunities to reflect and prepare, having smaller check‐ins, truly getting to know the patient, and offering opportunities for in‐person connection) to enhance the experience and ameliorate challenges. Patients also emphasized the importance of sharing their perspectives to fully realize the benefits of their engagement. Conclusion These findings highlight the importance of recognizing the bidirectional benefits of patient engagement within project teams. Taking opportunities to check in with patients throughout the project period, both formally and informally, regarding their preferences for involvement and experiences on the team would enable real‐time feedback and adjustments to optimize patient partner engagement. Patient or Public Contribution Since its inception, the Susan and Richard Levy Healthcare Delivery Incubator has incorporated patient and public involvement into the design and operations of its healthcare innovation projects. While the conceptualization of this analysis did not engage patients or the public, patients and individuals with lived experience provided the data. Further, three patient partners were engaged in the review of the findings, two of whom also actively contributed to the preparation of the manuscript by reviewing drafts, adding content, and making revisions.

IL-15 has been postulated to play an important role in HIV-1 infection, yet there are conflicting reports regarding its expression levels in these patients. We sought to measure the level of IL-15 in a large, well characterised cohort of HIV-1 infected patients and correlate this with well known markers of inflammation, including CRP, D-dimer, sCD163 and sCD14. IL-15 levels were measured in 501 people (460 patients with HIV-1 infection and 41 uninfected controls). The HIV-1 infected patients were divided into 4 groups based on viral load: <50 copies/ml, 51-10,000 copies/ml, 10,001-100,000 copies/ml and >100,000 copies/ml. The Mann Whitney test (non-parametric) was used to identify significant relationships between different patient groups. IL-15 levels were significantly higher in patients with viral loads >100,000 copies/ml (3.02 ± 1.53 pg/ml) compared to both uninfected controls (1.69 ± 0.37 pg/ml, p<0.001) or patients with a viral load <50 copies/ml (1.59 ± 0.40 pg/ml (p<0.001). There was a significant correlation between HIV-1 viremia and IL-15 levels (Spearman r = 0.54, p<0.001) and between CD4+ T cell counts and IL-15 levels (Spearman r = -0.56, p<0.001). IL-15 levels are significantly elevated in HIV-1 infected patients with viral loads >100,000 copies/ml compared to uninfected controls, with a significant direct correlation noted between IL-15 and HIV-1 viremia and an inverse correlation between IL-15 levels and CD4+ T cell counts. These data support a potential role for IL-15 in the pathogenesis of HIV-associated immune activation.

Background Cryopreservation of peripheral blood mononuclear cells (PBMCs) is a common and essential practice in conducting research. There are different reports in the literature as to whether cryopreserved PBMCs need to only be stored ≤ −150 °C or can be stored for a specified time at −80 °C. Therefore, we performed gene expression analysis on cryopreserved PBMCs stored at both temperatures for 14 months and PBMCs that underwent temperature cycling 104 times between these 2 storage temperatures. Real-time RT-PCR was performed to confirm the involvement of specific genes associated with identified cellular pathways. All cryopreserved/stored samples were compared to freshly isolated PBMCs and between storage conditions. Results We identified a total of 1,367 genes whose expression after 14 months of storage was affected >3 fold in PBMCs following isolation, cryopreservation and thawing as compared to freshly isolated PBMC aliquots that did not undergo cryopreservation. Sixty-six of these genes were shared among two or more major stress-related cellular pathways (stress responses, immune activation and cell death). Thirteen genes involved in these pathways were tested by real-time RT-PCR and the results agreed with the corresponding microarray data. There was no significant change on the gene expression if the PBMCs experienced brief but repetitive temperature cycling as compared to those that were constantly kept ≤ −150 °C. However, there were 18 genes identified to be different when PBMCs were stored at −80 °C but did not change when stored < −150 °C. A correlation was also found between the expressions of 2′–5′- oligoadenylate synthetase (OAS2), a known interferon stimulated gene (IFSG), and poor PBMC recovery post-thaw. PBMC recovery and viability were better when the cells were stored ≤ −150 °C as compared to −80 °C. Conclusions Not only is the viability and recovery of PBMCs affected during cryopreservation but also their gene expression pattern, as compared to freshly isolated PBMCs. Different storage temperature of PBMCs can activate or suppress different genes, but the cycling between −80 °C and −150 °C did not produce significant alterations in gene expression when compared to PBMCs stored ≤ −150 °C. Further analysis by gene expression of various PBMC processing and cryopreservation procedures is currently underway, as is identifying possible molecular mechanisms.

Introduction/Objectives: Patients returning to the community from incarceration (ie, reentry) are at heightened risk of experiencing trauma when interacting with the healthcare system. Healthcare professionals may not recognize patients’ trauma reactions or know how to effectively respond. This paper describes the development and pilot evaluation of a single-session training to prepare primary care teams to deliver trauma-informed care (TIC) to patients experiencing reentry. Methods: A multidisciplinary team including community members with lived experience engaged in a multiphase human-centered design process that incorporated interviews, discussions, and a participatory process to design and evaluate a single-session interactive pilot training targeting providers’ attitudes toward formerly incarcerated patients and confidence to deliver TIC. Results: Both pre- and post-training surveys were completed by 12 TIC training attendees, which included primary care providers and staff. Trainees reported significant increases in confidence to reduce potentially re-traumatizing practices and improved attitudes toward formerly incarcerated individuals. They also expressed interest in receiving additional TIC training and learning how best to care for and meet the needs of persons with a history of incarceration. Trainees described the panel of community members with lived experience as one of the most rewarding aspects of the training. Conclusion: Centering people with lived experience in the training design and delivery produced a single-session TIC training that was both well-received and effective. Our TIC training helped primary care providers and staff move from being merely informed on trauma to having the self-efficacy to prevent and respond to trauma reactions during encounters with all patients, particularly those with a history of incarceration.

At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.

Of the estimated 13,700 women in the United States in whom invasive cervical cancer was diagnosed in 1998, 1 nearly 5000 will ultimately die of the disease because of the inadequacies of current treatment. In the United States, cervical cancer disproportionately affects women who are members of minority groups and women of low socioeconomic status, partly because such women tend to have insufficient access to and knowledge of screening programs for cervical cancer. The nationwide use of such screening programs has greatly reduced the incidence of invasive cervical cancer. Women with early cervical cancer can be successfully treated with radical surgery. . . .

We describe successful placement of the Inspiris Resilia aortic valve in the pulmonary position. This valve has advantages for immediate benefit and future percutaneous interventions, making it a promising prosthesis for adult congenital patients. We describe successful placement of the Inspiris Resilia aortic valve in the pulmonary position. This valve has advantages for immediate benefit and future percutaneous interventions, making it a promising prosthesis for adult congenital patients.