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Background: Healthcare providers play an important role in encouraging healthy behaviors and improving health-related quality of life (HRQoL). They are most effective when they partner with informed, engaged patients., Objective: To examine the impact of a new health-information technology intervention (FAST-Feedback) that provides patients with immediate, personalized, guideline-based feedback regarding tobacco use, physical activity, and HRQoL, and encourages patients to initiate discussions regarding these topics with their primary care physician., Design: A pilot, randomized controlled trial clustered by resident physician, with patients as the unit of analysis., Participants: Resident physicians and their out-patients in a single academic health center between May and October 2011., Intervention: Patients received (intervention) or did not receive (control) FAST-Feedback prior to the clinical encounter., Main Outcome Measures: Primary outcomes were patient reports of initiating any discussions regarding tobacco use, physical activity, and HRQoL. Subgroup analyses examined patient reports of discussions regarding tobacco use, physical activity, and HRQoL, respectively., Key Results: Thirty of the 36 eligible resident physicians (83%) agreed to participate; 173 of their 415 eligible patients (42%) expressed interest in the study and 99 (24%) consented to participate. Compared to controls, a higher percentage of intervention patients reported initiating any discussion with their resident physician, although this difference was not statistically significant (40% vs. 27%; p = 0.12). For subgroup analyses regarding specific topics of discussion, patients in the intervention group reported initiating more discussions regarding mental HRQoL than controls (23% vs. 0%; p = 0.02). There was no difference in patient reports of initiating discussions regarding smoking, physical activity or physical HRQoL., Conclusions: Providing patients with immediate, personalized, guideline-based feedback prior to the clinical encounter can increase patient-initiated discussions regarding mental HRQoL. Future work should test FAST-Feedback in a larger population and evaluate the impact on tobacco cessation, increased physical activity, and improvements in HRQoL.

West Nile virus (WNV) infection can result in severe neuroinvasive disease, particularly in persons with advanced age. As rodent models demonstrate that T cells play an important role in limiting WNV infection, and strong T cell responses to WNV have been observed in humans, we postulated that inadequate antiviral T cell immunity was involved in neurologic sequelae and the more severe outcomes associated with age. We previously reported the discovery of six HLA-A*0201 restricted WNV peptide epitopes, with the dominant T cell targets in naturally infected individuals being SVG9 (Env) and SLF9 (NS4b). Here, memory phenotype and polyfunctional CD8+ T cell responses to these dominant epitopes were assessed in 40 WNV seropositive patients displaying diverse clinical symptoms. The patients' PBMC were stained with HLA-I multimers loaded with the SVG9 and SLF9 epitopes and analyzed by multicolor flow cytometry. WNV-specific CD8+ T cells were found in peripheral blood several months post infection. The number of WNV-specific T cells in older individuals was the same, if not greater, than in younger members of the cohort. WNV-specific T cells were predominantly monofunctional for CD107a, MIP-1β, TNFα, IL-2, or IFNγ. When CD8+ T cell responses were stratified by disease severity, an increased number of terminally differentiated, memory phenotype (CD45RA+ CD27- CCR7- CD57+) T cells were detected in patients suffering from viral neuroinvasion. In conclusion, T cells of a terminally differentiated/cytolytic profile are associated with neuroinvasion and, regardless of age, monofunctional T cells persist following infection. These data provide the first indication that particular CD8+ T cell phenotypes are associated with disease outcome following WNV infection.