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for the INSITE study team IMPORTANCE Positive margins following breast-conserving surgery (BCS) are often identified on standard pathology evaluation. Intraoperative assessment of the lumpectomy cavity has the potential to reduce residual disease or reexcision rate following standard of care BCS in real time.OBJECTIVE To collect safety and initial efficacy data on the novel pegulicianine fluorescence-guided system (pFGS) when used to identify residual cancer in the tumor bed of female patients undergoing BCS. DESIGN, SETTING, AND PARTICIPANTSThis prospective single-arm open-label study was conducted as a nonrandomized multicenter controlled trial at 16 academic or community breast centers across the US. Female patients 18 years and older with newly diagnosed primary invasive breast cancer or ductal carcinoma in situ DCIS undergoing BCS were included, excluding those with previous breast cancer surgery and a history of dye allergies. Of 283 consecutive eligible patients recruited, 234 received a pegulicianine injection and were included in the safety analysis; of these, 230 were included in the efficacy analysis.

ImportanceCancer screening deficits during the first year of the COVID-19 pandemic were found to persist into 2021. Cancer-related deaths over the next decade are projected to increase if these deficits are not addressed.ObjectiveTo assess whether participation in a nationwide quality improvement (QI) collaborative, Return-to-Screening, was associated with restoration of cancer screening.Design, Setting, and ParticipantsAccredited cancer programs electively enrolled in this QI study. Project-specific targets were established on the basis of differences in mean monthly screening test volumes (MTVs) between representative prepandemic (September 2019 and January 2020) and pandemic (September 2020 and January 2021) periods to restore prepandemic volumes and achieve a minimum of 10% increase in MTV. Local QI teams implemented evidence-based screening interventions from June to November 2021 (intervention period), iteratively adjusting interventions according to their MTVs and target. Interrupted time series analyses was used to identify the intervention effect. Data analysis was performed from January to April 2022.ExposuresCollaborative QI support included provision of a Return-to-Screening plan-do-study-act protocol, evidence-based screening interventions, QI education, programmatic coordination, and calculation of screening deficits and targets.Main Outcomes and MeasuresThe primary outcome was the proportion of QI projects reaching target MTV and counterfactual differences in the aggregate number of screening tests across time periods.ResultsOf 859 cancer screening QI projects (452 for breast cancer, 134 for colorectal cancer, 244 for lung cancer, and 29 for cervical cancer) conducted by 786 accredited cancer programs, 676 projects (79%) reached their target MTV. There were no hospital characteristics associated with increased likelihood of reaching target MTV except for disease site (lung vs breast, odds ratio, 2.8; 95% CI, 1.7 to 4.7). During the preintervention period (April to May 2021), there was a decrease in the mean MTV (slope, −13.1 tests per month; 95% CI, −23.1 to −3.2 tests per month). Interventions were associated with a significant immediate (slope, 101.0 tests per month; 95% CI, 49.1 to 153.0 tests per month) and sustained (slope, 36.3 tests per month; 95% CI, 5.3 to 67.3 tests per month) increase in MTVs relative to the preintervention trends. Additional screening tests were performed during the intervention period compared with the prepandemic period (170 748 tests), the pandemic period (210 450 tests), and the preintervention period (722 427 tests).Conclusions and RelevanceIn this QI study, participation in a national Return-to-Screening collaborative with a multifaceted QI intervention was associated with improvements in cancer screening. Future collaborative QI endeavors leveraging accreditation infrastructure may help address other gaps in cancer care.

The study examined the morphology of the gastro-intestinal tract (GI) of growing pigs offered dry feed or liquid feed with differing water-to-feed ratios.  Twenty male pigs were randomly allocated to one of four treatment groups; treatments included a standard dry pelleted diet (D) or the same diet soaked in water at a feed-to-water ratio of 1:1.5 (T1:1.5), 1:3 (T1:3) or 1:3 with the addition of lactic acid to adjust the feed to pH 4 (T1:3[4]).  Animals were humanely slaughtered after 6 weeks to enable sampling and histological examination (light, scanning electron (LSEM) and binocular dissection microscope) of the GI tract. Samples were taken at the 2% position (duodenum), the 20% position and 50 % position (jejunum) along the small intestines (SI).  Liquid-fed pigs were heavier (P < 0.05) and exhibited improved feed conversion ratios (FCR) when compared to D animals. These differences in live weight were attributed to alterations in the weight and volume of the stomach and SI, which were also heavier and larger in liquid-fed pigs (P < 0.05).  However, these differences were no longer apparent when intestinal weights and stomach volumes were adjusted for animal live weight. Differences in villus type between the treatments were noted throughout, particularly in the duodenum and proximal jejunum sections. Mean villus height was taller in all liquid-fed animals when compared to D pigs (P<0.05); this was particularly apparent in T1:1.5 and T1:3[4] pigs. There were no differences in crypt depths between treatment groups at the 2% and 20 % positions, but at the 50 % position the T1:1.5 group crypts were deeper (P < 0.05) than those in the D and T1:3 pigs. It is concluded that liquid feeding alters the morphology of the GI tract, which may in part, explain the differences in growth performance observed between liquid and D fed pigs.  The inclusion of organic acid in the diets of T1:3[4] pigs appeared to exert an effect on villus height and crypt depth when compared to those pigs receiving the T1:3 diet.

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