Examination of Predictors of Pain at 12 Months Postdiagnosis in Head and Neck Cancer Survivors

OBJECTIVE

Pain following the completion of treatment is important but has received less attention in the head and neck cancer (HNC) literature. The present study sought to examine the prevalence and predictors of pain measured 12 months postdiagnosis and its impact on HNC-specific health-related quality of life (HRQOL) in 1038 HNC survivors.

STUDY DESIGN

Prospective observational study.

SETTING

Single-institution tertiary care center.

METHODS

Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing the worst pain possible. Self-reported depressive symptomatology was measured using the Beck Depression Inventory and self-reported problem alcohol use was measured by the Short Michigan Alcoholism Screening Test. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI).

RESULTS

Hierarchical multivariable linear regression analyses indicated that in addition to pain at 3 months postdiagnosis (β = .145, t = 3.18, sr2  = .019, p = .002), both depressive symptomatology (β = .110, t = 2.49, sr2  = .011, p = .015) and problem alcohol use (β = .092, t = 2.07, sr2  = .008, p = .039) were significant predictors of pain at 12 months postdiagnosis. Subgroup analyses suggest that across all 4 HNCI domains, those in the moderate and severe pain groups at 12 months postdiagnosis failed to reach 70 which is indicative of high functioning.

CONCLUSION

Pain in patients with HNC is a considerable issue at 12 months postdiagnosis, deserving further attention. Behavioral factors such as depression and problem alcohol use may be associated with pain and require systematic screening over time to identify and treat issues that impact optimal long-term recovery from HNC, including disease-specific HRQOL.

The special sauce of the Cancer Prevention and Control Research Network: 20 years of lessons learned in developing the evidence base, building community capacity, and translating research into practice

PURPOSE

The Cancer Prevention and Control Research Network (CPCRN) is a national network focused on accelerating the translation of cancer prevention and control research evidence into practice through collaborative, multicenter projects in partnership with diverse communities. From 2003 to 2022, the CPCRN included 613 members.

METHODS

We: (1) characterize the extent and nature of collaborations through a bibliometric analysis of 20 years of Network publications; and (2) describe key features and functions of the CPCRN as related to organizational structure, productivity, impact, and focus on health equity, partnership development, and capacity building through analysis of 22 in-depth interviews and review of Network documentation.

RESULTS

Searching Scopus for multicenter publications among the CPCRN members from their time of Network engagement yielded 1,074 collaborative publications involving two or more members. Both the overall number and content breadth of multicenter publications increased over time as the Network matured. Since 2004, members submitted 123 multicenter grant applications, of which 72 were funded (59%), totaling more than $77 million secured. Thematic analysis of interviews revealed that the CPCRN's success-in terms of publication and grant productivity, as well as the breadth and depth of partnerships, subject matter expertise, and content area foci-is attributable to: (1) its people-the inclusion of members representing diverse content-area interests, multidisciplinary perspectives, and geographic contexts; (2) dedicated centralized structures and processes to enable and evaluate collaboration; and (3) focused attention to strategically adapting to change.

CONCLUSION

CPCRN's history highlights organizational, strategic, and practical lessons learned over two decades to optimize Network collaboration for enhanced collective impact in cancer prevention and control. These insights may be useful to others seeking to leverage collaborative networks to address public health problems.

Re-visiting the call for translation of cancer survivorship research: collaborative multidisciplinary approaches to improve translation and dissemination

BACKGROUND

The number of cancer survivors in the US is dramatically increasing and survivors are living longer, making the ongoing care and quality of life in this growing population an important public health issue. Although there has been significant progress in cancer survivorship research, gaps in translating this research to real-world settings to benefit survivors remain.

METHODS

The number and type of cancer survivorship research activities in past and current projects were gathered in reports and work plans from the Cancer Prevention and Control Research Network (CPCRN). Additionally, current cross-center projects were aligned with common constructs in dissemination and implementation science to provide a narrative review of progress on translational research.

RESULTS

A review of historical activities in the CPCRN indicates that there has been consistent engagement in survivorship from multiple institutions over the last decade, generating 84 grants, 168 papers and 162 presentations. The current membership of the Survivorship Workgroup includes multiple disciplines and all 8 participating institutions. Together these Workgroup members have developed 6 projects, all of which address multiple domains in translational research such as feasibility, practicality, and organizational and cultural factors that affect implementation.

CONCLUSIONS

This review of past and ongoing activities in the CPCRN suggests that survivorship has been a consistent priority including the translation of evidence-based approaches into practice. Specific gaps in the translational research agenda that could be the focus of future investigations by Workgroup members and others include the practical and logistic aspects of interventions such as cost and policy.

Older adults' goals of care in the emergency department setting: A qualitative study guided by the 4Ms framework

Background

We sought to identify what matters to older adults (60 years and older) presenting to the emergency department (ED) and the challenges or concerns they identify related to medication, mobility, and mentation to inform how the 4Ms framework could improve care of older adults in the ED setting.

Methods

A qualitative study was conducted using the 4Ms to identify what matters to older adults (≥60 years old) presenting to the ED and what challenges or concerns they identify related to medication, mobility, and mentation. We conducted semi-structured interviews with a convenience sample of patients in a single ED. Interview guide responses and interviewer field notes were entered into REDCap. Interviews were reviewed by the research team (2 coders per interview) who inductively assigned codes. A codebook was created through an iterative process and was used to group codes into themes and sub-themes within the 4Ms framework.

Results

A total of 20 ED patients participated in the interviews lasting 30-60 minutes. Codes identified for "what matters" included problem-oriented expectation, coordination and continuity, staying engaged, being with family, and getting back home. Codes related to the other 4Ms (medication, mobility, and mentation) described challenges. Medication challenges included: non-adherence, side effects, polypharmacy, and knowledge. Mobility challenges included physical activity and independence. Last, mentation challenges included memory concerns, depressed mood, and stress and worry.

Conclusions

Our study used the 4Ms to identify "what matters" to older adults presenting to the ED and the challenges they face regarding medication, mobility, and mentation. Understanding what matters to patients and the specific challenges they face can help shape and individualize a patient-centered approach to care to facilitate the goals of care discussion and handoff to the next care team.

THE ROOM WHERE IT HAPPENS: ENGAGING EQUITABLY TO OPTIMIZE CANCER SURVIVORSHIP CARE

Cancer survivorship care programs, services, and research would benefit from including people living with a cancer history who have ceased their survivorship care in their engagement efforts. Our prior research with head and neck cancer survivors has shown that a considerable number of patients discontinue their post-treatment survivorship care despite still having care needs. Those patients who continue their care are also the ones most often engaged in research and community partnership; as the ones who are “in the room where it happens,” they consequently have the most influential voices in shaping survivorship care. In this paper, we underscore the necessity of including those who discontinue survivorship care in research and community engagement efforts. We use our work with head and neck cancer survivors as a model for strategizing ways to inclusively and respectfully do so.

Cardiac Adverse Events Associated With Chemo-Radiation Versus Chemotherapy for Resectable Stage III Non-Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results-Medicare Study

Background We compared cardiac outcomes for surgery-eligible patients with stage III non-small-cell lung cancer treated adjuvantly or neoadjuvantly with chemotherapy versus chemo-radiation therapy in the Surveillance, Epidemiology and End Results-Medicare database. Methods and Results Patients were age 66+, had stage IIIA/B resectable non-small-cell lung cancer diagnosed between 2007 and 2015, and received adjuvant or neoadjuvant chemotherapy or chemo-radiation within 121 days of diagnosis. Patients having chemo-radiation and chemotherapy only were propensity-score matched and followed from day 121 to first cardiac outcome, noncardiac death, radiation initiation by patients who received chemotherapy only, fee-for-service enrollment interruption, or December 31, 2016. Cause-specific hazard ratios (HRs) and competing risks subdistribution HRs were estimated. The primary outcome was the first of these severe cardiac events: acute myocardial infarction, other hospitalized ischemic heart disease, hospitalized heart failure, percutaneous coronary intervention/coronary artery bypass graft, cardiac death, or urgent/inpatient care for pericardial disease, conduction abnormality, valve disorder, or ischemic heart disease. With median follow-up of 13 months, 70 of 682 patients who received chemo-radiation (10.26%) and 43 of 682 matched patients who received chemotherapy only (6.30%) developed a severe cardiac event (P=0.008) with median time to first event 5.45 months. Chemo-radiation increased the rate of severe cardiac events (cause-specific HR: 1.62 [95% CI, 1.11-2.37] and subdistribution HR: 1.41 [95% CI, 0.97-2.04]). Cancer severity appeared greater among patients who received chemo-radiation (noncardiac death cause-specific HR, 2.53 [95% CI, 1.93-3.33] and subdistribution HR, 2.52 [95% CI, 1.90-3.33]). Conclusions Adding radiation therapy to chemotherapy is associated with an increased risk of severe cardiac events among patients with resectable stage III non-small-cell lung cancer for whom survival benefit of radiation therapy is unclear.

Book Review: Communication for Successful Aging: Empowering Individuals Across the Lifespan

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Engagement in Primary Prevention Program among Rural Veterans With Osteoporosis Risk

A primary osteoporosis prevention program using a virtual bone health team (BHT) was implemented to comanage the care of rural veterans in the Mountain West region of the United States. The BHT identified, screened, and treated rural veterans at risk for osteoporosis using telephone and United States Postal Service communications. Eligibility was determined by regular use of Veterans Health Administration primary care, age 50 or older, and evidence of fracture risk. This study was conducted to identify demographic and clinical factors associated with the acceptance of osteoporosis screening and the initiation of medication where indicated. A cross-sectional cohort design (N = 6985) was utilized with a generalized estimating equation and logit link function to account for facility-level clustering. Fully saturated and reduced models were fitted using backward selection. Less than a quarter of eligible veterans enrolled in BHT's program and completed screening. Factors associated with a lower likelihood of clinic enrollment included being of older age, unmarried, greater distance from VHA services, having a copayment, prior fracture, or history of rheumatoid arthritis. A majority of veterans with treatment indication started medication therapy (N = 453). In this subpopulation, Fisher's exact test showed a significant association between osteoporosis treatment uptake and a history of two or more falls in the prior year, self-reported parental history of fracture, current smoking, and weight-bearing exercise. The BHT was designed to reduce barriers to screening; however, for this population cost and travel continue to limit engagement. The remarkable rate of medication initiation notwithstanding, low enrollment reduces the impact of this primary prevention program, and findings pertaining to fracture, smoking, and exercise imply that health beliefs are an important contributing factor. Efforts to identify and address barriers to osteoporosis screening and treatment, such as clinical factors, social determinants of health, and health beliefs, may pave the way for effective implementation of population bone health care delivery systems. Published 2022. This article is a U.S. Government work and is in the public domain in the USA. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

What Happens Next? Conducting Research With Cancer Survivors Who Discontinue Their Post-Treatment Care

Due to improvements in screening, diagnosis, and treatment, more cancer patients are surviving and living longer. For them, survivorship care provides critical support: surveillance and screening for recurrence and new cancers; physical and psychological symptom management; social and financial management support; management of other chronic conditions; and preventive health and health promotion support. Yet, our pilot data indicates that a substantial number of survivors discontinue their survivorship care with the treating oncology team, a team that often provides critical multidisciplinary support and expertise. While it is important to understand the experiences, outcomes, and needs of these survivors, they can be challenging to engage in research. In this presentation, we will discuss survivors who discontinue, why they might do so, and methods for engaging them in research, drawing upon our work with head and neck cancer survivors.

A hepatitis C elimination model in healthcare for the homeless organization: A novel reflexive laboratory algorithm and equity assessment

BACKGROUND

Reaching World Health Organization hepatitis C (HCV) elimination targets requires diagnosis and treatment of people who use drugs (PWUD) with direct acting antivirals (DAAs). PWUD experience challenges engaging in HCV treatment, including needing multiple provider and laboratory appointments. Women, minoritized racial communities, and homeless individuals are less likely to complete treatment.

METHODS

We implemented a streamlined opt-out HCV screening and linkage-to-care program in two healthcare for the homeless clinics and a medically supported withdrawal center. Front-line staff initiated a single-order reflex laboratory bundle combining screening, confirmation, and pre-treatment laboratory evaluation from a single blood draw. Multinomial logistic regression models identified characteristics influencing movement through each stage of the HCV treatment cascade. Multiple logistic regression models identified patient characteristics associated with HCV care cascade progression and Cox proportional hazards models assessed time to initiation of DAAs.

RESULTS

Of 11,035 clients engaged in services between May 2017 and March 2020, 3,607 (32.7%) were screened. Of those screened, 1,020 (28.3%) were HCV PCR positive. Of those with detectable RNA, 712 (69.8%) initiated treatment and 670 (94.1%) completed treatment. Of those initiating treatment, 407 (57.2%) achieved SVR12. There were eight treatment failures and six reinfections. In the unadjusted model, the bundle intervention was associated with increased care cascade progression, and in the survival analysis, decreased time to initiation; these differences were attenuated in the adjusted model. Women were less likely to complete treatment and SVR12 labs than men. Homelessness increased likelihood of screening and diagnosis but was negatively associated with completing SVR12 labs. Presence of opioid and stimulant use disorder diagnoses predicted increased care cascade progression.

CONCLUSIONS

The laboratory bundle and referral pathways improved treatment initiation, time to initiation, and movement across the cascade. Despite overall population improvements, women and homeless individuals experienced important gaps across the HCV care cascade.

Association of depressive symptomatology with problem alcohol use in rural head and neck cancer patients at diagnosis

PURPOSE

Problem alcohol use is a risk factor for the development of head and neck cancer (HNC) and continued use is associated with poor outcomes; depressive symptoms may be associated with this behavior.

DESIGN

Exploratory cross-sectional study examined depressive symptoms as a correlate of self-reported problem alcohol use at diagnosis.

SAMPLE/METHODS

Multivariable linear regression examined depressive symptoms as a correlate of problem alcohol use in a sample of rural HNC patients (N = 249).

FINDINGS

Over half (55.2%) of rural patients with potentially problem alcohol use exhibited mild to moderate depressive symptomatology. Regression models controlling for age, cancer site, stage, sex, tobacco use, and treatment modality indicated that depressive symptoms at diagnosis were associated with self-reported problem alcohol use scores at diagnosis (ß = .186, sr² = .031, p < .01). Follow-up subgroup analyses demonstrated that depressive symptoms at diagnosis were significantly associated with self-reported problem alcohol use in male patients, those with advanced stage disease, and of older age.

CONCLUSIONS/IMPLICATIONS

HNC patients should be screened for alcohol use and depression at diagnosis. Access to behavioral health treatment and/or referral options may be lacking in rural areas thus additional ways of connecting rural patients to specialty care should be explored. These may include telehealth and multimodal interventions to address complex behavioral health cases. Additional research in important patient subgroups such as older patients and those presenting with advanced disease is also warranted.

Problem alcohol use among rural head and neck cancer patients at diagnosis: Associations with health-related quality of life

OBJECTIVE

Problem alcohol use in persons with head and neck cancer (HNC) is associated with poor outcomes, including survival. Some evidence suggests that individuals living in rural areas may be at greater risk of problem alcohol use. The present exploratory cross-sectional study sought to examine problem alcohol use at diagnosis in a sample of HNC patients by rural versus urban status.

METHODS

Self-reported problem alcohol use as measured by the Short Michigan Alcoholism Screening Test (SMAST) was examined in rural and urban HNC patients at diagnosis (N = 454). Multivariable linear regression analysis was conducted to examine correlates of problem alcohol use. Subgroup analyses examined HNC-specific health-related quality of life (HRQOL) by problem drinking status at diagnosis and 3- and 12-month postdiagnosis in rural patients.

RESULTS

Multivariable linear regression analysis controlling for age, cancer site, cancer stage, depressive symptoms at diagnosis, and tobacco use at diagnosis indicated that rural residence was significantly associated with SMAST scores at diagnosis such that rural patients were more likely to report higher scores (ß = 0.095, sr2  = 0.010, p = 0.04). Covariate-adjusted subgroup analyses suggest that rural patients with self-reported problem alcohol use may exhibit deficits in HNC-specific HRQOL at diagnosis and 3- and 12-month postdiagnosis.

CONCLUSIONS

HNC patients should be screened for problem alcohol use at diagnosis and counseled regarding the deleterious effects of continued drinking during treatment and beyond. Because access to treatment and referral options may be lacking in rural areas, additional ways of connecting rural patients to specialty care should be explored.

Triangulating Qualitative Methods to Evaluate Survivorship Care

With 16.9 million survivors in the US, survivorship is an increasingly important aspect of oncologic care. As the number increases, we need to provide evidence-based, standardized survivorship care, yet the evidence base is lacking and guidelines are variably implemented. This multi-sited study documented the survivorship care practices of five head and neck cancer (HNC) programs in order to identify survivorship care practices, provider preferences, practice variability, and the facilitators and barriers to effective survivorship care implementation. To ensure rich, contextual data, the study utilized multiple qualitative methods: 1) program characteristics questionnaire; 2) semi-structured interviews with providers involved in treatment and survivorship care, 3) on-site observation and clinic workflow mapping, and 4) collection of survivorship materials. Triangulating data collection provided evidence of potentially promising HNC survivorship care practices, aligned with the vision of comprehensive survivorship care, that can be used to evaluate practices and develop interventions on a larger scale.

Investigating Head and Neck Cancer Survivors’ Experience of Survivorship Care

Head and neck cancer (HNC) accounts for 4% of all cancers diagnosed in the US, with 75% in adults over 55 years of age. HNC survivors must deal with the long-term consequences of the cancer and its treatments, which can have significant long-term physical, psychosocial, and financial consequences, dramatically impacting survivors’ lives. While research has identified the unmet needs of HNC survivors, there has been little examination of HNC survivors’ experiences living with a cancer history and engaging in survivorship care. To explore survivors’ experiences and their attitudes toward their survivorship care, we conducted in-depth, semi-structured interviews with 22 HNC survivors whose survivorship care was managed within the HNC program of an academic tertiary care institution. Participants’ mean age was 65 years old, ranging from 33 to 86. The majority of the participants were male (68%), white (96%), married (81%), and had some college education or a higher degree (81%). One third of participants (n=7) had rural residence, as defined by the Rural-Urban Continuum Codes. Participants reported a wide range of experiences based on multiple factors: cancer site, staging, and treatment; their expectations prior to treatment; and personal and social context. They varied in their approaches toward understanding and incorporating the impacts of their cancer experience, from physical side effects of treatment to social impacts. They described the importance of survivorship care both in physical and social terms. We discuss the implications of these results for future interventions to improve HNC survivorship care delivery.

Patient Experience of an Osteoporosis Telemedicine Clinic

Rural Veterans at risk of fracture due to osteoporosis remain underdiagnosed and undertreated, in part due to location-related barriers to accessing care. Despite lowered cost and travel barriers to osteoporosis care through implementation of a telehealth model directed at rural at-risk Veterans that took advantage of many strengths of the VA’s healthcare system, only 30% of eligible Veterans accepted care. To understand low acceptance, we conducted 39 semi-structured telephone interviews with Veterans eligible for the clinic, including 19 who accepted screening and treatment, 12 who completed screening but declined treatment, and 8 who declined screening and treatment. Veterans who opted to be screened and/or treated for osteoporosis did so because: it was recommended by the VA; they were interested in learning more about their health; thought they may be at risk of osteoporosis; or believed screening would not cause them harm. Conversely, Veterans refused screening or treatment because of past negative experiences with medications, both bone and non-bone; a wish to not put anything else into their bodies; or the belief that their bone loss is not severe enough to warrant treatment. Outside medical professionals and peers influenced Veterans’ decisions to not take or alter their treatment. Cost and travel distance remained a barrier for Veterans who did not live near a VA facility with the necessary screening and treatment infrastructure. Many barriers to osteoporosis care remain despite efforts to remove them. Delivery systems must account for both instrumental and social access to care to reduce fracture risk.

THE UNINTENDED CONSEQUENCES OF SEAMLESS IMPLEMENTATION OF A RURAL TELEMEDICINE CLINIC

Osteoporosis is largely undetected and untreated in older men who are at-risk, with even lower rates of detection and treatment in rural communities. In this presentation we report the consequences for primary care providers (PCPs) of the implementation of an osteoporosis telemedicine clinic that targeted rural patients and is purposefully designed to minimize PCP workload. Analysis of qualitative interviews with PCPs who co-managed patients with the telemedicine clinic confirmed that implementation strategies used by the telemedicine clinic were successful at minimizing workload and had a positive impact on PCPs’ work. However, the clinic’s seamless approach may have contributed to unintended consequences of low PCP awareness of program care processes and selection criteria and a missed opportunity for PCPs to reinforce osteoporosis care goals in the primary care setting.

Highlights on novel technologies for the detection of antibodies to Ro60, Ro52, and SS-B

OBJECTIVE

We aimed to compare a chemiluminescent immunoassay (CIA, QUANTA Flash) on BIO-FLASH with a multiplex flow immunoassay (MFI) on BioPlex 2200 for the detection of antibodies to Ro60, Ro52, and SS-B.

METHODS

The study included 241 samples, from patients suffering from systemic autoimmune diseases (n = 108) as well as disease controls (n = 133). All samples were tested for anti-Ro52, anti-Ro60, and anti-SS-B (La) antibodies on QUANTA Flash (INOVA Diagnostics, San Diego, USA) and BioPlex 2200 (Bio-Rad Laboratories Inc., Hercules, USA). Discrepant samples were tested by two independent methods: BlueDot/ANA and QUANTRIX Microarray (both D-tek, Belgium).

RESULTS

The overall qualitative agreements were 95.4% (95% confidence interval, CI 92.0-97.7%) for anti-Ro52, 98.8% (95% CI 96.4-99.7%) for anti-Ro60, and 91.7% (95% CI 87.5-94.9%) for anti-SS-B antibodies. There were 34 discrepant samples among all assays (20 anti-SS-B, 11 anti-Ro52, 3 anti-Ro60). 30/33 of retested samples (by D-tek dot blot) agreed with the QUANTA Flash results. Similar findings were obtained with QUANTRIX Microarray kit.

CONCLUSION

QUANTA Flash and BioPlex 2200 show good qualitative agreement. The clinical performances were similar for anti-Ro52 and anti-Ro60 autoantibodies while differences were observed for anti-SS-B (La) antibodies.

The 2009 Late Blight Pandemic in the Eastern United States - Causes and Results

The tomato late blight pandemic of 2009 made late blight into a household term in much of the eastern United States. Many home gardeners and many organic producers lost most if not all of their tomato crop, and their experiences were reported in the mainstream press. Some CSAs (Community Supported Agriculture) could not provide tomatoes to their members. In response, many questions emerged: How did it happen? What was unusual about this event compared to previous late blight epidemics? What is the current situation in 2012 and what can be done? It's easiest to answer these questions, and to understand the recent epidemics of late blight, if one knows a bit of the history of the disease and the biology of the causal agent, Phytophthora infestans.

Intra-cellular and extra-cellular growth of L. monocytogenes in chick embryo fibroblast cell culture

The growth of L. monocytogenes in isolated chick embryo fibroblast cell culture was studied. Hanks balanced salt solution and Eagles minimal essential medium were shown to support a limited growth of L. monocytogenes. Extra-cellular growth on the maintenance medium occurs for 48 h prior to the establishment of intra-cellular organisms. As the uptake of the parasite by the cell culture takes place, intra-cellular replication begins with subsequent release of the organisms into the surrounding medium. The organism continues to replicate intra-cellularly until all the cell culture is destroyed.

The effect of progesterone on the growth and virulence of Listeria monocytogenes

Progesterone was examined for action on the virulence of Listeria monocytogenes and the toxicity of its haemolysin. Progesterone at concentrations between 5 and 20 micrograms/ml reduced the numbers of L. monocytogenes over the first two hours of growth. Virulence and haemolysin toxicity were assessed using the allantoic sac route of inoculation into embryonated hens eggs. Increasing the concentrations of progesterone in the culture medium resulted in a decrease in the mortality of chick embryos inoculated with either organisms, or cell-free extracts or purified haemolysin. Progesterone had no effect on the lethality of pre-formed haemolysin.

Role of haemolysin and temperature in the pathogenesis of Listeria monocytogenes in fertile hens' eggs

The haemolysin produced by Listeria monocytogenes at 37 degrees C and 4 degrees C was examined in fertile hens' eggs. Organisms, cell free extracts and purified haemolysin derived from broth cultures grown at the lower temperature were more pathogenic for chick embryos, induced higher mortality with toxic changes in the embryos. These effects were most pronounced with the purified haemolysin as shown by LD50 determinations and following inoculation of constant haemolytic doses. Pathological changes induced by the haemolysin included sub-cutaneous haemorrhage due to endothelial damage, hepatosplenomegaly with macroscopic and histological lesions in heart, spleen and liver in the absence of an inflammatory response. At the cellular level, the myocardial tissue, and hepatocyte structure were destroyed with intravascular haemolysis, fatty degeneration of mitochondria, dilation of endoplasmic reticulum and distortion of liver cell nuclear membranes evident. The mortality and morphological data showed an increase in virulence for Listeria after culture at 4 degrees C compared with 37 degrees C and suggested a more cytotoxic component of the haemolysin which was activated at lower temperatures.

Role of lipid in butylatedhydroxyanisole (BHA) resistance of Listeria monocytogenes

The lipid content of Listeria monocytogenes 5214m was increased by successive subculturing in a glycerol medium. Fattened cells showed considerably greater resistance to Butylatedhydroxyanisole (BHA). Polar lipids and fatty acid composition of four cultures with different BHA sensitivity were analysed. They are basically similar but the resistant cultures had a lower percentage of unsaturated and anteiso to saturated and iso fatty acids.

Pathogenesis and growth of Listeria monocytogenes in fertile hens' eggs

The LD50 for 15-day old chicken embryos inoculated with Listeria monocytogenes into the allantoic sac was determined. The growth cycle of the organism was investigated in different tissues and fluids derived from embryonated eggs following inoculation with a suspension of L. monocytogenes equivalent to the LD50. Eggs receiving doses of 100 and 1000 times the LD50 were used to examine the effect of high doses on the pathogenesis and growth of Listeria in ovo. The pattern of growth of the organism in embryonic blood showed two distinct peaks and correlated with these was the development of large and small pock lesions on the chorioallantoic membrane. Bacterial growth in the internal organs exhibited a single peak. Histological and electron microscopic evidence indicated that the primary cellular damage was due to a soluble haemolysin present prior to the establishment of the organism within the tissues.

Pathogenicity of natural and experimental listeriosis in newly hatched chicks

The pathogenicity of Listeria monocytogenes for newly hatched chickens exposed to natural infection was examined. Organisms entered through the alimentary tract and dissemination followed bacteraemia. Among a number of symptoms recorded were unilateral and bilateral toe paralysis. In addition to gross abnormalities in the following tissues, histological lesions were seen in the liver, spleen, heart and kidneys of all infected chicks but brain lesions were observed only in birds with central nervous system involvement. The organism was recovered from some tissues derived from apparently healthy chicks as well as those with listeriosis. The use of trypsin in the isolation process increased the probability of a positive result from tissues, reduced the storage time needed and had no adverse effect on the rate of organism growth.

Infection, haemorrhagia and death of chick embryos experimentally inoculated with Listeria monocytogenes by the intra-allantoic route

When allantoic sacs of embryonated (SPF) chicken eggs were inoculated with different doses to investigate the pathogenicity of two strains of Listeria monocytogens (4379 and NCTC 5214), infection resulted which spread rapidly throughout the embryonated eggs. When low doses were used small pock lesions on the chorio-allantoic membrane (CAM), generalized haemorrhage (especially on the head region) and deaths of the embryos with necrotic foci on the liver and heart were observed. Neither the pock lesions nor the haemorrhage were detected in embryos dying from high doses of the bacterium. Bacteria were recovered from the CAM's, allantoic fluids, amniotic fluids and selected organs of the dead embryos. The pathogenicity was shown to be strain dependent, strain 4379 being more pathogenic than strain NCTC 5214. In vitro studies indicated that brain homogenates of uninoculated chicken embryos are not inhibitory to Listeria monocytogenes at 37 degrees C and will increase the viable count.

The adsorption of phage by Staphylococcus spp

Phages for coagulase-negative staphylococci were adsorbed to heat-killed cells. The phages showed equal affinities for all the cells, which appeared to have an equal number of binding sites for all the phages tested. This number is estimated at 1.2 x 10(6) sites/cell. Competition for binding sites could be demonstrated between a pair of phages. It is concluded that coagulase-negative staphylococci have only a single series of binding sites for phage, probably the outer 20% or so of the wall teichoic acids. These organisms therefore bind all 'coagulase-negative' phages whether or not they are sensitive to them.

Immunofluorescent identification of Listeria monocytogenes

A fluorescent antibody technique for the rapid diagnosis and identification of L. monocytogenes in smears, impression smears from tissues of animals dead from listeriosis, and in meat and milk is described. The technique could well be exploited for detecting L. monocytogenes in meat and meat products, animal tissues, and in milk provided that it is supplemented with adequate controls. The technique has been compared with conventional cultural technique and found to be superior as far as the time factor is concerned. The use of the technique also demonstrates the possibility of actually determining the serological type concurrently.

Ascospore germination in Byssochlamys nivea

Germination of the ascospores of Byssochlamys nivea required a heat shock at 75° for 5 min, and acetate ion. Aeration and pH 4.0–4.5 further enhanced germination. No other trichloroacetic acid cycle compounds were stimulatory, and a survey of 18 amino acids and a number of miscellaneous compounds did not reveal any other germination factors. Extreme variation throughout the investigation suggested that other undisclosed factors were involved.