Immunosensor for Assessing the Welfare of Trainee Guide Dogs

Cortisol is a well established biomarker hormone that regulates many processes in the body and is widely referred to as the stress hormone. Cortisol can be used as a stress marker to allow for detection of stress levels in dogs during the training process. This test will indicate if they will handle the stress under the training or if they might be more suitable as an assistant or companion dog. An immunosensor for detection of cortisol was developed using electrochemical impedance spectroscopy (EIS). The sensor was characterized using chemical and topographical techniques. The sensor was calibrated and its sensitivity determined using a cortisol concentration range of 0.0005 to 50 μg/mL. The theoretical limit of detection was found to be 3.57 fg/mL. When the immunosensor was tested on canine saliva samples, cortisol was detected and measured within the relevant physiological ranges in dogs.

Development of Plain Language Supplemental Materials for the Biobank Informed Consent Process

The US Department of Health and Human Services addresses clear communication in the informed consent process as part of the Notice of Proposed Rulemaking for revisions to the Common Rule. However, prior research has shown that participants may not fully comprehend research studies despite completion of an informed consent process. Our main goal was to provide plain language information about donation processes to a cancer biobank to supplement an informed consent form. We developed and conducted cognitive testing with supplemental brochures that clearly communicated information about three different models for consent (notice, broad and study-specific) to future use of biospecimens. During the brochure development process, we conducted qualitative, semi-structured, individual, in-person cognitive interviews among 14 women to examine participants' perceptions of the brochures. Each participant provided feedback regarding the understandability, graphics and layout, and cultural appropriateness of the brochures. Our findings demonstrate that these methods may be used to tailor consent form brochures, such as the ones developed here, to other populations. This study therefore adds to our understanding of how best to present content to help women from two different racial groups make informed decisions about participation in a cancer biobank.

Decision Aids Can Support Cancer Clinical Trials Decisions: Results of a Randomized Trial

BACKGROUND

Cancer patients often do not make informed decisions regarding clinical trial participation. This study evaluated whether a web-based decision aid (DA) could support trial decisions compared with our cancer center's website.

METHODS

Adults diagnosed with cancer in the past 6 months who had not previously participated in a cancer clinical trial were eligible. Participants were randomized to view the DA or our cancer center's website (enhanced usual care [UC]). Controlling for whether participants had heard of cancer clinical trials and educational attainment, multivariable linear regression examined group on knowledge, self-efficacy for finding trial information, decisional conflict (values clarity and uncertainty), intent to participate, decision readiness, and trial perceptions.

RESULTS

Two hundred patients (86%) consented between May 2014 and April 2015. One hundred were randomized to each group. Surveys were completed by 87 in the DA group and 90 in the UC group. DA group participants reported clearer values regarding trial participation than UC group participants reported (least squares [LS] mean = 15.8 vs. 32, p < .0001) and less uncertainty (LS mean = 24.3 vs. 36.4, p = .025). The DA group had higher objective knowledge than the UC group's (LS mean = 69.8 vs. 55.8, p < .0001). There were no differences between groups in intent to participate.

CONCLUSIONS

Improvements on key decision outcomes including knowledge, self-efficacy, certainty about choice, and values clarity among participants who viewed the DA suggest web-based DAs can support informed decisions about trial participation among cancer patients facing this preference-sensitive choice. Although better informing patients before trial participation could improve retention, more work is needed to examine DA impact on enrollment and retention.

IMPLICATIONS FOR PRACTICE

This paper describes evidence regarding a decision tool to support patients' decisions about trial participation. By improving knowledge, helping patients clarify preferences for participation, and facilitating conversations about trials, decision aids could lead to decisions about participation that better match patients' preferences, promoting patient-centered care and the ethical conduct of clinical research.

Differences in preferences for models of consent for biobanks between Black and White women

Biobanks are essential resources, and participation by individuals from diverse groups is needed. Various models of consent have been proposed for secondary research use of biospecimens, differing in level of donor control and information received. Data are needed regarding participant preferences for models of consent, particularly among minorities. We conducted qualitative semi-structured interviews with 60 women to examine their attitudes about different models of consent. Recruitment was stratified by race (Black/White) and prior biobank participation (yes/no). Two coders independently coded interview transcripts. Qualitative thematic analysis was conducted using NVivo 10. The majority of Black and White participants preferred "broad" consent (i.e., blanket permission for secondary research use of biospecimens), and the second most preferred model for both groups was "study-specific" consent (i.e., consent for each future research study). The qualitative analysis showed that participants selected their most preferred model for 3 major reasons: having enough information, having control over their sample, and being asked for permission. Least preferred was notice model (i.e., participants notified that biospecimens may be used in future research). Attitudes toward models of consent differed somewhat by race and prior biobank participation. Participants preferred models of consent for secondary research use of biospecimens that provided them with both specific and general information, control over their biospecimens, and asked them to give permission for use. Our findings suggest that it will be important for researchers to provide information about future uses of biospecimens to the extent possible and have an explicit permission step for secondary research use.

Health Insurance Information-Seeking Behaviors Among the Uninsured

As a result of the Affordable Care Act, millions of previously uninsured individuals are facing the daunting task of selecting health insurance. In order to better understand how to reach the uninsured and support their health insurance decision making, this study examined where the uninsured collect information about health insurance and the extent to which they trust those sources and media. We analyzed secondary data on health insurance information-seeking behaviors collected from a survey of 343 uninsured individuals. The Internet, mail, and television were among the most frequently used media, though all 3 had low trust scores. Participants sought information from health care providers and interpersonal sources less frequently but trusted it more than they trusted the media. Age, gender, race, and education were predictors of use and trust of different media and sources of health insurance information. Findings suggest that strategies that pair health care professionals, lay health advisors, or community liaisons with the ubiquity of the Internet may be a strong approach for delivering quality health insurance information to the uninsured. Tailoring messages might also be effective at reaching specific subgroups of the uninsured.

Abstract A04: Differences in preferences for models of informed consent may affect racial composition of biobanks

Biobanks are essential resources for advancing cancer research. Research conducted with stored biospecimens can provide critical societal benefits, including advancements in oncogenomics, pharmacogenetics, and enhanced medical treatments and improved health outcomes. In order for biobanks to provide broad societal benefits and address health disparities, participation by individuals from diverse groups is needed. Various models of informed consent have been proposed for future research use of biobanked specimens, differing in level of donor control and amount of information received. Data are needed regarding how different consent models might affect participation in biobanks, particularly for individuals from racial and ethnic minority groups. We therefore conducted semi-structured interviews with 60 women to examine their attitudes and preferences for different models of informed consent for secondary research uses of biospecimens. Recruitment was stratified by race (Black/White) and prior biobank participation (yes/no). Two coders independently coded all interview transcripts; analysis was based on consensus codes. The qualitative thematic analysis was conducted using NVivo. The results showed that the majority of Black and White participants preferred “broad” consent, which requires separate blanket permission for biospecimens to be used in multiple future research studies and provides participants with general information about possible future studies. More Black participants than White participants preferred “study specific” consent, which requires separate consent for each future research study and provides specific information about that study. We found that reasons for preferring a particular model of consent often differed by race. For example, Black participants more often spoke of the importance of being informed of what was happening with their sample, of research study activities, or being informed or notified if their sample was used. In reference to “study specific” consent, one Black participant said, “[Study-specific] continuously keeps you updated which is… you know you gotta be happy with constantly getting the updates.” In contrast, White participants often felt that giving permission once for their sample to be used in multiple future research studies (broad consent), rather than before each future study (study specific consent), was sufficient. In reference to why she liked “broad” consent, one White participant noted, “Well because they ask me once and then they have my permission to use my sample in multiple future studies.” Feeling respected was also an important factor affecting preferences among Black participants. One Black participant spoke about “broad” consent, “[Y]ou're being courteous, and you're asking me, 'Will you also say yes to this?' ” There were some common themes across racial groups. Both Black and White participants felt that the notice model, in which participants are notified that their biospecimens may be used in research, violated their rights. One White participant commented, “I don't think it respects the… individual and what right they have to do with their body or their own tissue.” These findings are essential to develop informed consent processes for biobanks that address the information most important to individuals from various racial and ethnic minority groups and allow them to make informed decisions about biobank participation.

Citation Format: Katherine Brown, Bettina Drake, Hannah Perkins, Leslie Wolf, James DuBois, Sarah Gehlert, Melody Goodman, Kimberly Kaphingst. Differences in preferences for models of informed consent may affect racial composition of biobanks. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A04.

A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured

BACKGROUND

The Affordable Care Act allows uninsured individuals to select health insurance from numerous private plans, a challenging decision-making process. This study examined the effectiveness of strategies to support health insurance decisions among the uninsured.

METHODS

Participants (N = 343) from urban, suburban, and rural areas were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. We administered measures assessing knowledge (true/false responses about key features of health insurance), confidence in choices (uncertainty subscale of the Decisional Conflict Scale), satisfaction (items from the Health Information National Trends Survey), preferences for insurance features (measured on a Likert scale from not at all important to very important), and plan choice.

RESULTS

Although we did not find significant differences in knowledge, confidence in choice, or satisfaction across condition, participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features. In addition, those with adequate health literacy skills as measured by the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) had higher knowledge overall ([Formula: see text] = 6.1 v. 4.8, P < 0.001) and preferred the plain language table to the visual (P = 0.04) and visual to narrative (P = 0.0002) conditions, while those with inadequate health literacy skills showed no preference for study condition. A similar pattern was seen for those with higher subjective numeracy skills and higher versus lower education with regard to health insurance knowledge. Individuals with higher income felt less confident in their choices ([Formula: see text] = 28.7 v. 10.0, where higher numbers indicate less confidence/more uncertainty; P = 0.004).

CONCLUSIONS

Those developing materials about the health insurance marketplace to support health insurance decisions might consider starting with plain language tables, presenting health insurance terminology in context, and organizing information according to ways the uninsured might use and value insurance features. Individuals with limited health literacy and numeracy skills and those with lower education face unique challenges selecting health insurance and weighing tradeoffs between cost and coverage.

Abstract A04: Preferences for models of informed consent for secondary research uses of biospecimens among diverse women

Background: Research with stored biospecimens can provide substantial societal benefits. Yet achieving translational research goals and reducing health disparities require the participation of large numbers of people from diverse populations in biobanks. One key ethical issue with biobanks is informed consent for secondary research use of biospecimens. Various models of consent have been proposed for using biospecimens for studies not planned when samples are collected. These models differ in the level of donor control and the amount of information received. Limited empirical data exist regarding the attitudes of potential biospecimen donors related to different models of consent, particularly from groups underrepresented in research, including individuals from racial and ethnic minority groups.

Methods: We conducted semi-structured individual interviews with 60 women seeking breast health services in the St. Louis region, stratifying recruitment by race (Black/White) and prior biobank participation. The interviews focused on participant preferences for four different models of informed consent for secondary research uses of biospecimens (i.e., study-specific, broad, opt-out, notice models of consent), factors affecting consent model preferences, and perceived benefits and concerns of donating biospecimens for research. Two independent coders are coding each interview transcript; the qualitative thematic analysis is based on consensus codes.

Results: Participants prefer models of informed consent that allow for more control and provide more information, irrespective of race. The least preferred model, notice model, informs participants that their samples may be used in future research. The most preferred model, broad consent, allows for future use of samples in multiple research studies once participants have given their permission. Preliminary analysis has shown that Black and White women had many similar reasons for preferring this model, citing their trust in research and desire to help others. However, while White women mentioned their trust in research and the importance of research as factors affecting their consent model preference, Black women put greater emphasis on the importance of consent and being asked permission. One White participant noted for broad consent, “That's when you feel that you're confident with the individuals that you've donated to will follow a strict protocol and do the best they can for a goal that's written, well documented.” One Black participant noted for broad consent, “I don't need to have any control over the, over it. The only control I needed was to be able to make the decision that said, sure you can use it.”

Conclusion: The most widely used consent model (notice model) is the least preferred among both Black and White women, while consent models providing more control and information ranked higher. These qualitative data will be used to develop educational materials with the purpose of making the informed consent process more accessible for prospective biobank participants. Recently, the US Department of Health and Human Services sought input on their proposal to change regulations governing the type of consent processes that can be used for research use of biospecimens. Findings from this study investigating preferences for consent for biobank participation among a diverse sample can therefore be used to inform future policy.

Citation Format: Katherine Brown, Bettina F. Drake, Sarah Gehlert, Leslie Wolf, James DuBois, Hannah Perkins, Melody S. Goodman, Kimberly Kaphingst. Preferences for models of informed consent for secondary research uses of biospecimens among diverse women. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A04. doi:10.1158/1538-7755.DISP13-A04

What can health communication science offer for ACA implementation? Five evidence-informed strategies for expanding Medicaid enrollment

CONTEXT

Implementing the Affordable Care Act (ACA) in 2014 will require effective enrollment and outreach efforts to previously uninsured individuals now eligible for coverage.

METHODS

From 1996 to 2013, the Health Communication Research Laboratory conducted more than 40 original studies with more than 30,000 participants to learn how to improve the reach to and effectiveness of health information for low-income and racial/ethnic minority populations. We synthesized the findings from this body of research and used them to inform current challenges in implementing the ACA.

FINDINGS

We found empirical support for 5 recommendations regarding partnerships, outreach, messages and messengers, life priorities of low-income individuals and families, and the information environment. We translated these into 12 action steps.

CONCLUSIONS

Health communication science can inform the development and execution of strategies to increase the public's understanding of the ACA and to support the enrollment of eligible individuals into Medicaid or the Health Insurance Marketplace.

Evaluation of a universal point-of-issue assay for bacterial detection in buffy coat platelet components

Bacterial contamination of platelet concentrates poses a major post-transfusion infectious risk. This study was aimed at evaluating the efficacy of the BacTx(®) assay (Immunetics Inc.) for bacterial detection in leucocyte-reduced buffy coat platelet pools and for its sensitivity in detecting clinical isolates, including bacteria that form surface-attached aggregates (biofilm positives). Platelet pools were inoculated at bacterial concentrations of 0·8-13 CFU/ml. The BacTx(®) assay detected all species at concentrations ≥10(3)  CFU/ml within 20-69 h of platelet incubation. Detection of slow-growing and biofilm-forming strains was delayed in comparison with the other strains. This assay could be used as a point-of-issue method to increase the safety of the platelet supply.

Changes in immune cell populations in the periphery and liver of GBV-B-infected and convalescent tamarins (Saguinus labiatus)

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GBV-B infection of tamarins is a valuable model for acute HCV infection.

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We observed distinct expression patterns of PD-1, a marker of T-cell activation, on peripheral and hepatic lymphocytes.

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Differential PD-1 expression is coincident with reduction in peripheral GBV-B.

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Liver-associated viral RNA in the absence of peripheral viraemia indicates maintenance of occult infection.

Flaviviruses related to hepatitis C virus (HCV) in suitable animal models may provide further insight into the role that cellular immunity contributes to spontaneous clearance of HCV. We characterised changes in lymphocyte populations in tamarins with an acute GBV-B infection, a hepatitis virus of the flaviviridae. Major immune cell populations were monitored in peripheral and intra-hepatic lymphocytes at high viraemia or following a period when peripheral virus was no longer detected. Limited changes in major lymphocyte populations were apparent during high viraemia; however, the proportions of CD3⁺ lymphocytes decreased and CD20⁺ lymphocytes increased once peripheral viraemia became undetectable. Intrahepatic lymphocyte populations increased at both time points post-infection. Distinct expression patterns of PD-1, a marker of T-cell activation, were observed on peripheral and hepatic lymphocytes; notably there was elevated PD-1 expression on hepatic CD4⁺ T-cells during high viraemia, suggesting an activated phenotype, which decreased following clearance of peripheral viraemia. At times when peripheral vRNA was not detected, suggesting viral clearance, we were able to readily detect GBV-B RNA in the liver, indicative of long-term virus replication. This study is the first description of changes in lymphocyte populations during GBV-B infection of tamarins and provides a foundation for more detailed investigations of the responses that contribute to the control of GBV-B infection.

Test of a Weight Gain Prevention Intervention in Stage II and III Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

Purpose: Weight gain is common in women with breast cancer and is worrisome, as it may affect prognosis and risk of other chronic diseases. This randomized pilot test was conducted to evaluate the feasibility and preliminary effectiveness of a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy.

Method: Breast cancer patients receiving neoadjuvant chemotherapy were randomized to the weight gain prevention intervention or usual care. The intervention used a size acceptance approach, which emphasized changes in diet (low energy density food) and exercise behavior (resistance training) rather than focusing on weight loss. It was administered in weekly sessions delivered in-person and by telephone. Assessments were done at baseline, mid-chemotherapy, end of chemotherapy, after surgical recovery, after a post-surgical booster intervention, and 6 months after surgery. The data from baseline (BL), mid-chemotherapy (MC), and end of chemotherapy (EC) are presented.

Results: 38 participants were randomized to the intervention (n = 19) or usual care (n = 19). 68% had stage II and 32% had stage III breast cancer. Their mean age was 50.0 (SD = 11.0), and 55% were premenopausal. Mean BMI was 29.1 (SD = 6.2) and 69% were physically inactive. The sample was diverse with regard to self-reported ethnicity (58% white, 27% African-American, 8% Hispanic, 6% other). Data collected at MC and EC indicated a trend toward greater reduction in BMI in the intervention than the control group (intent to treat analysis, P = 0.10). When the analysis was conducted without the 4 intervention participants who attended less than 60% of the sessions (analyze as treated) the differences were more marked (group difference: 0.5 kg/m2 at MC and 0.9 kg/m2 at EC, P = 0.025). Similar results were found for waist circumference and SF-36 physical component score, but no differences were found in the SF-36 mental component score.

Conclusions: Based on a preliminary analysis, there was a trend toward improvements in body composition and physical aspects of quality of life from a diet and exercise intervention based on the size acceptance approach. These results indicate this intervention should be tested in a larger randomized controlled trial.

Fitness and quality of life in endometrial cancer survivors and controls

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Background: It has been suggested that sedentary behavior during cancer treatment or effects of the treatment itself may decrease cardiorespiratory fitness in cancer survivors. However, few studies have tested whether cancer survivors actually have impaired cardiorespiratory fitness compared to similarly aged individuals who have not had cancer. We investigated whether endometrial cancer survivors had poorer fitness than women of similar age and activity level with no cancer history. Methods: The sample included endometrial cancer survivors in a pilot exercise study; all had been diagnosed with Stage I-IIIa disease and were at least 6 months post- treatment. Controls were recruited from a local multi-speciality clinic. Both groups had no contraindications to exercise and were sedentary. Cardiorespiratory fitness was measured by predicted maximal myocardial oxygen carrying capacity (MV02 max) on a submaximal ramped cycle ergometer test. Quality of life was measured using the SF-36 (physical and mental component scores). Results: The study accrued 20 survivors (Mean age=58.6, SD=7.9; Mean BMI=30.5, SD=7.7) and 13 controls (Mean age=55.8, SD=7.6; Mean BMI=30.3, SD=7.0). In t-tests comparing survivors and controls, there were significant differences in predicted MV02 max (p=0.044) and physical aspects of quality of life (p=0.004), but not mental aspects of quality of life. After adjusting for age and BMI using ANCOVA, the p value for predicted MV02 max increased to 0.068, but differences in physical quality of life remained significant (see Table 1 ). Conclusions: Endometrial cancer survivors have diminished quality of life in the physical domain compared to women who have not had cancer; similar results were found for cardiorespiratory fitness, although the effect was attenuated after adjusting for BMI and age. The results suggest endometrial cancer survivors could benefit from exercise interventions to improve fitness and physical functioning. Table 1 : Fitness and quality of life of endometrial cancer survivors and controls.

[Table: see text]

No significant financial relationships to disclose.

Sequence mapping of the Californian MSW strain of Myxoma virus

Partial sequence mapping of the MSW Californian strain of Myxoma virus was performed by cloning EcoRI and SalI restriction fragments of viral DNA and sequencing the ends of these. In this way, regions of 74 MSW open reading frames were sequenced and mapped onto the complete genome sequences of the related leporipoxviruses South American Myxoma virus and Rabbit fibroma virus to form a partial map of the MSW strain. In general, gene locations and sequences were conserved between the three viruses. However the Californian Myxoma virus was more closely related to South American myxoma virus than to Rabbit fibroma virus based on sequence comparisons and the presence of three genes that have been lost from the Rabbit fibroma virus genome. Compared to the other two viruses, the main difference found in the MSW genome was that the terminal inverted repeats were extended with the duplication of 5 complete open reading frames (M151R, M152R, M153R, M154L, M156R) and partial duplication of one open reading frame (M150R). This rearrangement was associated with the loss of the majority of the M009L open reading frame. Three known virulence genes, including the serine proteinase inhibitor (SERPIN) genes M151R and M152R and leukemia associated protein (LAP) gene M153R, and the potential virulence gene M156R are now present in two copies.

Transfusion reactions: the changing priorities

Over the last dozen years the relative frequencies of specific transfusion reactions have markedly altered, in general for the better. Although AIDS remains the Public's primary concern, the risk of AIDS from a transfusion is extremely low at this point. Hepatitis remains the most common infectious complication of blood transfusion, but only 1 in 6,000 units now carry a risk, whereas in the early 1980's the risk is believed to have been close to 10% per patient. Transmission of HTLV-I/II has also been markedly reduced by tests of donor sera. In contrast, cytomegalovirus has become of increased importance in view of the large number of patients immunosuppressed for transplantation and cancer therapy; bacterial growth in blood components appears to be increasingly common; and Chagas disease is likely to become a serious transfusion problem in this country. More widespread use of filters which remove three logs or more of white blood cells from components should play a major role in reducing transfusion reactions further.

Characterization of factors affecting the stability of frozen heparinized plasma

The use of heparin rather than citrate as primary anticoagulant has been shown to significantly improve the initial activity, stability and recovery of factor VIII:C from human plasma, cryoprecipitates or factor VIII concentrates if the plasma was initially frozen at -80 degrees C and subsequently stored at this temperature. If frozen and stored at progressively warmer temperatures however, increasing amounts of insoluble protein aggregates, termed storage precipitates (SPs), were recovered in the thawed plasma and cryoprecipitate fractions. Plasma recovery by centrifugation at 7,000 g for 7 min [Method I (MI)], 2 x 10 min (MII) or 15 min (MIII) had little effect on SP formation after 1 month at any storage temperature. After 4 months at -20 degrees C, more SP was recovered from MIII plasma whereas at -40 degrees C, more SP was recovered from MI plasma. Also, the preparation method had little or no effect on factor VIII:C activity at equivalent storage times or temperatures. A trend towards improved factor VIII recoveries was noted at lower freezing and storage temperatures however. SP formation was associated with reduced fibrinogen levels in the recovered plasma without loss of antithrombin-III or increased fibrinopeptide-A. Western blots showed polymerization of A alpha or gamma-chains of fibrinogen. SP formation was reduced or eliminated with factor XIII inhibitors, antibody to the active factor XIII a subunit or adjustment of heparinized plasma to 5-10 mM sodium citrate before initial freezing and storage. Although plasma factor VIII:C recoveries were only slightly affected at these citrate concentrations under most conditions, its recovery in cryoprecipitates was substantially improved owing to the reduction or absence of SPs.

Development of a heat-treated factor VIII/von Willebrand factor concentrate prepared from heparinized plasma

A high yield, intermediate purity factor VIII concentrate derived from heparinized plasma has been developed which can be heat-treated at 60 degrees C, 68 degrees C or 80 degrees C/72 h to permit inactivation of viral contaminants which may be present. After cold reprecipitation of the heparinized cryoprecipitate (CRC), the resolubilized CRC precipitate was adjusted to 25-30 mg/ml protein and pH 6.35 +/- 0.1 and incubated for 1 h at 8 degrees C. After centrifugation to remove the precipitated fibrinogen and fibronectin, a factor VIII-rich supernatant can be recovered which contains greater than 500 units of VIII:C per liter of starting plasma (Method I product) at a purity of 1.5 U/mg protein. Adjusted to 50 mM glycine and pH 6.8, the product can be lyophilized and heat-treated at 60 degrees C/72 h without a significant loss of VIII:C activity. However, at 68 degrees C or 80 degrees C/72 h, temperatures now reported to be more effective in viral inactivation, the recoveries were reduced to 68 and 33% respectively. Significantly improved recoveries after heat-treatment (HT) at 68 degrees C or 80 degrees C/72 h were achieved if the 8 degrees C supernatant product was prepared by a modified procedure (Method II). This further reduces the fibrinogen content of the product while maintaining VIII:C yields greater than 500 U/l at a purity of 1.9 U/mg. When adjusted to 50 mM glycine and 1-2% (w/v) sucrose (pH 6.8), lyophilized and heat treated at 60 degrees C, 68 degrees C or 80 degrees C/72 h, the VIII:C recoveries of Method II product were 88-100%, 79-84% and 80-83% of pre-HT levels respectively. The yield of VIII:C was greater than 400 U/l at a purity of 1.6-1.4 U/mg at 1-2% (w/v) sucrose even after the severe heat-treatment at 80 degrees C. In addition, the von Willebrand factor multimers are similar in size and triplet pattern to those observed in routine cryoprecipitate preparations.

Identification of HIV-infected transfusion recipients: the utility of crossreferencing previous donor records with AIDS case reports

An expanded "look-back" program has been developed, in which patients who may have been exposed to HIV through blood transfusion were identified via three triggers: the blood that they received was donated by persons who 1) have subsequently been reported to local health departments as meeting the diagnostic criteria for AIDS, 2) have donated since the introduction of anti-HIV screening and tested positive, or 3) have been found to be infected during investigation of reported transfusion-associated HIV infections. In comparing triggers, cross-referencing the list of patients reported to have AIDS (AIDS case list) proved to be the most efficient approach for identifying HIV-infected donors and transfusion recipients. Of the 7973 AIDS patients reported in eight Northern California counties as of December 1988, 316 (4.0%) were determined to have donated at Irwin Memorial Blood Centers between 1977 and 1985. Despite the logarithmic increase in reported cases of AIDS in the San Francisco Bay area over the last 5 years, the rate of detection of previous donors from AIDS case lists remained between 3.3 and 5.4 percent. These persons accounted for 69 percent of the identified infected donors, and their identification led to notification of 60 percent of potentially exposed recipients and 51 percent of known infected recipients. The crossreferencing of AIDS case listings with blood bank records was equally efficient for regions with low and high AIDS prevalence. National adoption of AIDS case list crossreferencing is recommended as an effective means of identifying previously unidentified infected recipients in an effort to limit the secondary spread of HIV infection.

Monitoring blood donors for HIV-2 infection by testing anti-HIV-1 reactive sera

Anti-HIV-1 EIA tests currently used for screening blood donors in the United States are estimated to detect 55 to 91% of HIV-2 infections; Western blots for HIV-1 antibodies may be positive, negative or indeterminate with HIV-2-positive sera. We reasoned that we could exploit the cross-reactivity of the anti-HIV-1 EIA as a means to monitor the blood supply for the appearance of HIV-2 infected or co-infected persons, and thus decide if and when routine HIV-2 screening should be adopted. We tested 913 anti-HIV-1-reactive donor sera using an anti-HIV-2 screening EIA, with confirmation by an anti-HIV-2 env-peptide EIA and an anti-HIV-2 Western blot. These 913 sera were derived from anti-HIV-1 screening of approximately 242,000 donations over a three year period. No HIV-2 infections were identified. This approach may warrant adoption in blood centers serving populations with persons from countries where HIV-2 is prevalent.

The National Marrow Donor Program: how it works, accomplishments to date

As the use of bone marrow transplantation increases, the lack of a suitable matched sibling donor for approximately 60% of patients is a growing problem. Recently, marrow transplantation has been done successfully using HLA-matched unrelated donors. In an effort to provide more donors, the National Marrow Donor Program (NMDP) was established. It involves 50 blood banks and 20 marrow transplant centers throughout the United States. More than 20,000 HLA-typed apheresis donors from these blood banks have agreed to be listed in the NMDP registry. A preliminary search for donors has been carried out for 1,116 patients. Donors suitably matched for HLA-A and B antigens were located for 99% of the patients.

Clinical, immunologic, and serologic findings in men at risk for acquired immunodeficiency syndrome. The San Francisco Men's Health Study

Forty-nine percent of homosexual/bisexual men were positive for antibody to the human immunodeficiency virus (HIV) in a population-based probability sample of 1034 single men recruited from San Francisco. All heterosexual men were negative. Among seropositive men, marked lymphadenopathy was present in 29%, and 16% had at least two other symptoms or signs suggestive of HIV infection. However, lymphadenopathy alone failed to indicate severity of immune impairment. The occurrence of two or more clinical signs and symptoms, except for marked lymphadenopathy, correlated with HIV infection, diminished skin test reactivity, and reduction in Leu 3a T cells. Twenty-nine percent of seropositive men had fewer than 400 absolute Leu 3a T helper cells per microliter (less than 0.4 X 10(9)/L). Seronegative homosexual/bisexual men did not differ from heterosexual men in any clinical or laboratory variables except for increased numbers of suppressor Leu 2a T suppressor cells per microliter.