Sia, Irene G.

Summary Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals. The purpose of this process evaluation was to gain insights about how lay health worker as interventionists used theory-based approaches within a nutrition and physical activity health behavior change intervention in a clinical trial enrolling immigrant and refugee families. Data were comprised of ongoing reflective writing statements from four health workers about their implementation of the intervention. Using content analysis three themes emerged: (i) encouraging setting of small, family focused and relevant goals, (ii) being flexible in content delivery and (iii) being personally transformed (i.e. gained a sense of meaning from their experience). Lay health worker interventionist reflections on practice revealed they delivered the intervention within the primacy of the family partnering relationship by attending to unique family needs, and adjusting educational content and goal setting accordingly. Our results provide guidance for training and process evaluation of lay health worker intervention delivery in ethnically and racially diverse populations. Incorporating real-time reflection upon what was learned about skills of facilitating family motivation and family confidence enhanced affective learning and may be useful in future research studies and health promotion practice. The processes identified including setting small goals, flexibility and personal transformation could be considered in future lay health worker-delivered health promotion interventions.

Objective: To determine intervention needs and to gather stakeholder input regarding healthy eating promotion for youth members served at a Boys & Girls Club in Rochester, Minnesota. Design: Mixed-methods design informed by community-based participatory research principles. Setting and Method: Young people completed a dietary habits questionnaire and height and weight measure-ments. Focus groups gathered stakeholder – Boys & Girls Club members, staff, caregivers – perspectives on opportunities to improve children’s healthy eating through the club setting. Content analysis identified major themes in informants’ accounts. Results: Participants identified individual and environmental barriers to healthy eating and opportunities to reduce barriers at this Boys & Girls Club site. Few children met basic nutritional guidelines related to fruit, vegetable, milk and water consumption, and limiting consumption of sugar-sweetened beverages, and nearly half were overweight/obese. Stakeholders expressed interest in healthy eating promotion and identified multiple individual-level, interpersonal and environmental opportunities to promote healthier eating through the Boys & Girls Club site. Conclusion: Findings build on a growing literature indicating afterschool programmes are uniquely positioned to address health disparities related to paediatric nutrition and obesity, and can be used to inform the design of a multi-layered intervention to address the complexities influencing dietary quality and obesity among diverse and underserved youth.

Abstract The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. Although the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.

ABSTRACT Detection of cytomegalovirus (CMV) DNA in blood by PCR is a sensitive method for the detection of infection in patients posttransplantation. The test, however, has low specificity for the identification of overt CMV disease. Quantitative CMV PCR has been shown to overcome this shortcoming. The COBAS AMPLICOR CMV MONITOR test was evaluated by using consecutive serum and peripheral blood mononuclear cell (PBMN) samples from liver transplant patients. Twenty-five patients had CMV viremia (by shell vial cell culture assay) and/or tissue-invasive disease (by biopsy); 20 had no active infection. A total of 262 serum and 62 PBMN specimens were tested. Of 159 serum specimens from patients with overt CMV infection, the COBAS assay detected CMV DNA in 21 patients (sensitivity, 84%). Only 1 of 103 samples from patients with no evidence of active infection had detectable CMV DNA (341 copies/ml). By comparison of 62 matching serum and PBMN samples by the same assay, 12 PBMN samples were exclusively positive, whereas only 2 serum samples were exclusively positive (P < 0.05). At the time of clinical CMV infection, viral copy numbers were higher in PBMNs than serum from four of five patients. The COBAS AMPLICOR CMV MONITOR test is a sensitive and specific test for the quantitative detection of CMV DNA in blood. Clinical applications of the assay will require further validation with samples from a larger population of transplant patients.

Abstract Introduction Patients with hematologic malignancies are at higher risk for infection due to the nature of their immunocompromised status, therapy-related complications, and numerous other factors. Multiple myeloma (MM) is the second most common hematologic malignancy after non-Hodgkin's lymphomas. Current literature on bone and joint infections (BJI) in MM is limited to case reports, and this study aims to identify the frequency and characteristics of BJI in MM. Methods We retrospectively reviewed 4607 patients within the MM database at Mayo Clinic from 1/1/2005 through 1/1/2015. A computerized search of the electronic medical record using diagnosis codes, pathology reports, and free text searches, followed by manual chart review, identified 39 unique patients with BJI as depicted in Figure 1. Results Of the 39 patients with BJI and a diagnosis of multiple myeloma, 28/39 (72%) were male, and median age was 70 years-old (range 39-86). 35/39 (90%) had IgG subtype MM, and 21/39 (54%) were in remission from MM while 4/39 (10%) were neutropenic at the time of BJI. 14/39 (36%) occurred after hematopoietic stem cell transplant, and the median duration from transplant to BJI was 45.0 months (range 1.0-88.7). 11/39 (28%) had chronic kidney disease on chart review, and 8/39 (21%) were on corticosteroids. 32/39 (82%) had prior exposure to chemotherapy, and median duration from most recent chemotherapy to BJI was 32 days (range 0-1559). Septic arthritis (9/39, 23%) and osteomyelitis (9/39, 23%) occurred most frequently followed by prosthetic joint infection (PJI) (8/39, 21%). Pathogens were primarily Gram positive organisms (20/39, 51%), and 7/20 (35%) had polymicrobial infections. All patients received culture-guided induction antimicrobial therapy. 27/39 (69%) underwent surgical intervention. Treatment and outcomes by infection can be seen in Figure 1. Of the 5 (13%) treatment failures (TF), 3 (60%) had PJI while 1 (20%) had osteomyelitis with necrotizing fasciitis, and 1 (20%) had septic arthritis. Median time from diagnosis of BJI to TF was 6.3 months (range 0.0-13.5), and none of the TF were neutropenic at the time of BJI. 26/39 (67%) were alive one year after BJI, and at latest chart review, 8/39 (21%) were alive, of whom 7 were treated successfully. Median overall survival from diagnosis of BJI was 34.3 months for all cases. Conclusions BJI are uncommon in MM, and pathogens are similar to patients without MM, though with polymicrobial infections occurring frequently. Treatment is successful in the majority of cases, but PJI appear to have higher TF rates. However, TF may not necessarily correlate with hematologic status or survival. Figure 1 Flowchart of the multiple myeloma study cohort, BJI, treatment, and outcomes MM = Multiple Myeloma; BJI = Bone and Joint Infection; PJI = Prosthetic Joint Infections; VO = Vertebral Osteomyelitis; I&D = Irrigation & Debridement; Abx = Antibiotic Therapy Alone; DAIR = Debridement and Implant Retention; TF = Treatment Failure; CHF = Congestive Heart Failure Figure 1. Flowchart of the multiple myeloma study cohort, BJI, treatment, and outcomes. / MM = Multiple Myeloma; BJI = Bone and Joint Infection; PJI = Prosthetic Joint Infections; VO = Vertebral Osteomyelitis; I&D = Irrigation & Debridement; Abx = Antibiotic Therapy Alone;. / DAIR = Debridement and Implant Retention; TF = Treatment Failure; CHF = Congestive Heart Failure Disclosures Kapoor: Amgen: Research Funding; Takeda: Research Funding; Celgene: Research Funding.

SUMMARY In the past three decades since the inception of human organ transplantation, cytomegalovirus (CMV) has gained increasing clinical import because it is a common pathogen in the immunocompromised transplant recipient. Patients may suffer from severe manifestations of this infection along with the threat of potential fatality. Additionally, the dynamic evolution of immunosuppressive and antiviral agents has brought forth changes in the natural history of CMV infection and disease. Transplant physicians now face the daunting task of recognizing and managing the changing spectrum of CMV infection and its consequences in the organ recipient. For the microbiology laboratory, the emphasis has been geared toward the development of more sophisticated detection assays, including methods to detect emerging antiviral resistance. The discovery of novel antiviral chemotherapy is an important theme of clinical research. Investigations have also focused on preventative measures for CMV disease in the solid-organ transplant population. In all, while much has been achieved in the overall management of CMV infection, the current understanding of CMV pathogenesis and therapy still leaves much to be learned before success can be claimed.

ABSTRACT The QuantiFERON-TB Gold Plus (QFT-Plus; Qiagen, Germantown, MD) interferon gamma release assay (IGRA) received FDA clearance in 2017 and will replace the prior version of the assay, the QFT-Gold In-Tube (QFT-GIT). Here, we compared performances of the QFT-Plus assay and the QFT-GIT version in a diverse patient population, including patients undergoing evaluation for or follow-up of latent tuberculosis infection (LTBI; n = 39) or active TB infection ( n = 3), and in health care workers (HCWs; n = 119) at Mayo Clinic (Rochester, MN). Compared to the QFT-GIT, the QFT-Plus assay showed 91.2% (31/34) positive, 98.4% (124/126) negative, and 96.6% (156/161) overall qualitative agreement among the 161 enrolled subjects, with a Cohen's kappa value of 0.91 (excellent interrater agreement). Among the 28 patients diagnosed with LTBI at the time of enrollment, the QFT-GIT and QFT-Plus assays agreed in 24 (85.7%) patients; in all four discordant patients, the positivity of the QFT-GIT or QFT-Plus IGRA was associated with low-level interferon gamma (IFN-γ) reactivity, ranging from 0.36 IU/ml to 0.66 IU/ml. Additionally, we document a high degree of correlation between IFN-γ levels in the QFT-GIT TB antigen tube and each of the two QFT-Plus TB antigen tubes, as well as between the QFT-Plus TB1 and TB2 tubes (Pearson's correlation coefficients [ R ] > 0.95). Overall, we show comparable results between the QFT-GIT and QFT-Plus assays in our study population composed of subjects presenting with a diverse spectrum of TB infections. Our findings suggest that the necessary transition to the QFT-Plus assay will be associated with a minimal difference in assay performance characteristics.