Final Months Research Articles

Circumstellar interaction models for the early bolometric light curve of SN 2023ixf

Type II supernovae (SNe II) show growing evidence of an interaction with circumstellar material (CSM) surrounding their progenitor stars as a consequence of enhanced mass loss during the last years of the progenitor’s life, although the exact mechanism is still unknown. We present an analysis of the progenitor mass-loss history of SN 2023ixf, a nearby SN II showing signs of an interaction. First, we calculated the early-time (< 19 days) bolometric light curve for SN 2023ixf based on the integration of the observed flux covering ultraviolet, optical and near-infrared bands, and black-body extrapolations for the unobserved flux. Our calculations detected the sudden increase to maximum luminosity and temperature, in addition to the subsequent fall, displaying an evident peak. This is the first time that this phase can be precisely estimated for a SN II. We used the early-time bolometric light curve of SN 2023ixf to test the calibrations of bolometric corrections against colours from the literature. In addition, we included the observations of SN 2023ixf into some of the available calibrations to extend their use to earlier epochs. A comparison of the observed bolometric light curve to SN II explosion models with CSM interaction suggests a progenitor mass-loss rate of Ṁ = 3 × 10−3 M⊙ yr−1 confined to 12 000 R⊙ (∼8 × 1014 cm) and a wind acceleration parameter of β = 5. This model reproduces the early bolometric light curve, expansion velocities, and the epoch of disappearance of interacting lines in the spectra. This model indicates that the wind was launched ∼80 yr before the explosion. If the effect of the wind acceleration is not taken into account, the enhanced wind must have developed over the final months to years prior to the SN, which may not be consistent with the lack of outburst detection in pre-explosion images over the last ∼20 yr before explosion.

Massacres in the Arnsberg Forest (abstract)

In recent years, an historical reappraisal by one of us (MW) has been carried out on one of the worst crimes outside of prisons and concentration camps committed in Germany by the SS and Wehrmacht in the final months of the Second World War. In the Arnsberg Forest near Warstein and Meschede (southern Westphalia, western Germany), 208 forced labourers were massacred by the 'Division for Vengeance' (Division zur Vergeltung) of SS General Hans Kammler in March 1945. In the course of this joint project, archaeological research conducted by the Olpe Department of the LWL-Archäologie für Westfalen (Westphalian Archaeological Heritage Service) has pinpointed the exact location of the crime scenes and provided clues for the reconstruction of the course of events in the field (Warstein Langenbachtal, Suttrop, Meschede-Eversberg). It has also enabled the recovery of finds belonging to both the victims and perpetrators. We have also been able to locate and examine the two temporary cemeteries (Warstein Melkeplätzchen, Suttrop). This has provided information about the history of exhumation of the victims in 1964, as well as clarifying the whereabouts of the Soviet obelisk from the Melkeplätzchen, the provisional cemetery of the Langenbach victims located close to the crime scene. This work has also allowed a follow-up search in the temporary cemetery in Suttrop for seven victims who, according to the exhumation documents of 1964, are presumably still lying there. Between 2018 and 2021, almost all of aspects addressed above could be clarified with new insights gained. Our results were summarised at the EAC conference in Bonn 2023 (although not published in this theme). Several publications already report on them and they are listed below. In addition to several German language publications, there is also an extensive English language publication (Baales et al. 2022) where the essential aspects of the interdisciplinary project are presented. In addition, the historical context, research project and numerous images are presented on several websites listed below.

Impact of a hypocaloric dietary intervention on antral follicle dynamics in eumenorrheic women with obesity.

Do antral follicle dynamics change in women with obesity and regular ovulatory cycles after a 6-month hypocaloric dietary intervention? After a 6-month hypocaloric dietary intervention, women with obesity and regular ovulatory cycles displayed evidence of improved antral follicle dynamics defined by the emergence of more dominant follicles, larger ovulatory follicle diameter at selection, and increased luteal progesterone concentrations compared to pre-intervention. Precise events in antral folliculogenesis must occur in order for natural and regular monthly ovulation. In healthy women of reproductive age, antral follicles are recruited for growth in a wave-like fashion, wherein a subset of follicles are selected for preferential growth, and typically, one dominant follicle culminates in ovulation. Women with obesity and regular ovulatory cycles display evidence of suppressed antral follicle development, as evidenced by fewer recruitment events, fewer selectable and dominant follicles, smaller diameter of the ovulatory follicle at selection, and a higher prevalence of luteal phase defects. While improvements in gonadotropin and ovarian steroid hormone concentrations after weight loss have been documented in eumenorrheic women with obesity, the precise impact of weight loss on antral follicle dynamics has not been evaluated. A pre-post pilot study of 12 women who participated in a 6-month hypocaloric dietary intervention. Twelve women with obesity (total body fat ≥35%) underwent transvaginal ultrasonography and venipuncture every-other-day for one inter-ovulatory interval (IOI) both before (baseline) and during the final month (Month 7) of a six-month hypocaloric dietary intervention. Participants were aged 24-34 years and had a self-reported history of regular menstrual cycles (25-35 days). Follicle number and diameter (≥2 mm) were quantified at each study visit, and individual growth profiles for all follicles ≥7 mm were determined. Blood samples were assayed for reproductive hormones. Follicle dynamics and reproductive hormone concentrations were compared pre- and post-intervention. Further, post-intervention follicle and endocrine dynamics (Month 7 IOI) were compared to an age-matched reference cohort of lean women with regular ovulatory cycles (total body fat <35%, N = 21). Participants lost an average of 11% of their original body weight with the hypocaloric dietary intervention. More dominant follicles were detected (≥10 mm) at Month 7 compared to baseline (0. 3 ± 0.4 versus 0.4 ± 0.5 follicles, P = 0.001), and ovulatory follicles were selected at larger diameters post-intervention (7.3 ± 2.0 versus 10.9 ± 2.6 mm, P = 0.007). Luteal progesterone concentrations were increased at Month 7 compared to baseline (5.3 ± 3.65 versus 6.3 ± 4.74 ng/ml, P < 0.0001). However, risk for luteal phase dysfunction as judged by the prevalence of a luteal phase length <10 days, integrated luteal progesterone levels <80 ng/ml or peak progesterone <10 ng/ml did not differ pre- versus post-intervention (all, P > 0.05). In Month 7, follicle dynamics and endocrine profiles were similar to the reference cohort across all measures. This study does not inform on the earliest stages of ovarian follicle development and is limited to providing knowledge on the later stages of antral follicle development. This study cannot fully address causation between weight loss and sustained improvements in antral follicle dynamics. The data cannot be extrapolated to comment on potential improvements in fertility and fecundity with weight loss. The small group sizes limit statistical power. The increasing prevalence of obesity necessitates an understanding of the mechanisms that underlie potential improvements in reproductive health outcomes with weight loss. Women with obesity and regular ovulatory cycles who undertook a 6-month hypocaloric dietary intervention demonstrated improvements consistent with benefits of lifestyle intervention on reproductive health even in those without overt signs of reproductive dysfunction. Potential improvements in the cellular makeup of follicles, which may underlie the restoration of normal follicle development and amelioration of subfertility, require further investigation. Cornell University, President's Council of Cornell Women, United States Department of Agriculture (Grant No. 8106), and National Institutes of Health (R01-HD0937848). B.Y.J. and H.V.B. were supported by doctoral training awards from the National Institutes of Health (T32-DK007158) and Canadian Institutes of Health Research (Grant No. 146182), respectively. The authors have no competing interests. NCT01927432 and NCT01785719.

Impact of Medical School on the Relationship between Nutritional Knowledge and Sleep Quality-A Longitudinal Study of Students at Wroclaw Medical University in Poland.

The aim of this study was to investigate the impact of the first year of medical school on the relationship between nutritional knowledge and sleep. To achieve this, first-year medical students at Wroclaw Medical University were invited to participate in the study during both the initial and final months of their first academic year. The study included 570 students in the initial period and 705 in the latter. The research questionnaire comprised the KomPAN, assessing nutritional knowledge, and the Pittsburgh Sleep Quality Index (PSQI), evaluating sleep quality. The majority of students demonstrated at least sufficient nutritional knowledge, while approximately two-thirds of students experienced poor sleep in both periods. Notably, sleep quality further deteriorated in the second period (PSQI total score: 6.86 vs. 7.38, p = 0.0157). This change was influenced mainly by a decrease in sleep duration and an increase in the use of sleep medications (both p < 0.0001). The significant difference in overall sleep quality between different nutritional knowledge levels emerged only in the second semester, where students with the highest nutritional knowledge slept the best, while those with the lowest slept the worst (p = 0.0001). Crucially, in both periods, the use of sleep medications was highest among individuals with insufficient nutritional knowledge. Throughout the academic year, the usage increased for all except those with the highest nutritional knowledge, who exhibited the best sleep (p < 0.0001). The escalating use of sleep medications among medical students warrants greater attention, and leveraging the relationship between nutritional knowledge and sleep could prove beneficial, as positive habits in one domain may positively influence the other.

Perpetual Rewriting: Sylvia Plath’s Biographies

For almost four decades after she died, Sylvia Plath’s executors (The Sylvia Plath Estate) carefully guarded biographical details concerning the circumstances of the writer’s final months of life. As generations passed and archives opened, Plath scholarship was enriched with new perspectives feeding on new materials and documents. I shall explore the impact of archival elements on the constant revising and rewriting of Sylvia Plath’s biography, while also discussing the relevance of the unpublished manuscripts of some biographers. Despite their long and thorough documentation, they abandoned their projects, leaving, in sealed archives now open, massive amounts of research materials that can now be reevaluated.

Assessing the acclimatisation to the wild of stocked European graylings Thymallus thymallus by monitoring lipid dynamics and food consumption

This study investigated how 2+-year-old stocked pond-reared European graylings (Thymallus thymallus) acclimatised to a wild environment during six months (May–October 2019) after released. We examined the quantity and composition of lipids in the liver, muscles and visceral adipose tissues (VAT), as well as size parameters, condition factors and stomach contents. Our results showed a low post-stocking recapture rate (5.17%) of stocked fish after 6 months suggesting a poor acclimation to the wild environment. During the six months of monitoring, stocked fishes exhibited a sharp decrease in lipid content in all examined tissues, and, in the final month, lipid content was well below those of wild conspecifics. Stocked graylings preferred risky foraging behaviour and consumed numerous small drift preys with occasional hyperphagic events, thus experiencing strong bioenergetic challenges. Our study reveals that fish cultivated for extended periods struggle to acclimatise to the wild environment and that this commonly used stocking practice seems unsuccessful when aimed at strengthening wild grayling populations.

“It’s Like Coming Out of the Cave Into the Light”: The Role of Literacy Integration in Physical Education

Purpose: The purpose of this study was to examine pedagogies of teacher socialization for physical education teacher education candidates through the context of literacy integration. Method: We situated our data collection in qualitative case study methodology, emphasizing data from focus group interviews conducted during the final month of physical education teacher education candidates’ programs. Results: We demonstrate three primary insights and/or adjustments to their perceptions about literacy integration in physical education settings: (a) Literacy integration should support physical education objectives, (b) literacy integration could be easily implemented in a myriad of ways and for different age groups, and (c) literacy integration can improve student learning and outcomes. Discussion/Conclusion: Extending current teacher socialization literature, we emphasize three factors instrumental in shifting physical education teacher education candidate subjective theories and beliefs: movement-oriented literacy activities, reflection, and experiential applications.

Trends of antibiotic use at the end-of-life of cancer and non-cancer decedents: a nationwide population-based longitudinal study (2006–2018)

Abstract Objective: This study aimed to assess the actual burden of antibiotic use among end-of-life (EOL) patients in South Korea and to compare trends between cancer and non-cancer decedents. Design: Population-based mortality follow-back study. Setting: Data from the Korean National Health Insurance Database, covering the period from January1, 2006, to December 31, 2018, provided for research by the National Health Insurance Service (NHIS), were used. Participants: All decedents from 2006 to 2018 were included and categorized as cancer decedents or non-cancer decedents. Methods: Annual antibiotic consumption rates and prescription rates were calculated, and Poisson regression was used to estimate their trends. Results: Overall antibiotic consumption rates decreased slightly among decedents in their final month with a less pronounced annual decrease rate among cancer decedents compared to non-cancer decedents (0.4% vs 2.3% per year, P &lt;.001). Over the study period, although narrow spectrum antibiotics were used less, utilization and prescription of broad-spectrum antibiotics steadily increased, and prescription rates were higher in cancer decedents compared to non-cancer controls. Specifically, carbapenem prescription rates increased from 5.6% to 18.5%, (RR 1.087, 95% CI 1.085–1.088, P &lt;.001) in cancer decedents and from 2.9% to 13.2% (RR 1.115, 95% CI 1.113–1.116, P &lt;.001) in non-cancer decedents. Conclusions: Our findings show that patients at the EOL, especially those with cancer, are increasingly and highly exposed to broad-spectrum antibiotics. Measures of antibiotic stewardship are required among this population.

Treatment of Hereditary Haemorrhagic Telangiectasia with Bevacizumab - What More Needs to be Known?

Hereditary haemorrhagic telangiectasia (HHT) is a rare multi-organ vascular disease. It is characterised by mucocutaneous telangiectasia, epistaxis, and arteriovenous malformations. Some 70% of patients with HHT are thought to have issues with gastrointestinal (GI) bleeding. Traditional management of GI bleeding in HHT includes monitoring for iron deficiency anaemia, iron replacement, antifibrinolytic therapy and control of identifiable bleeding sites with argon photocoagulation during gastrointestinal endoscopy. Blood transfusion may also be required. Our case describes a man in his 40s with confirmed HHT, with transfusion-dependent anaemia secondary to GI bleeding. He was commenced on fortnightly bevacizumab (5 mg/kg) for 12 weeks in an attempt to reduce his blood transfusion requirement and manage his anaemia. In the months prior to starting bevacizumab, our patient's transfusion requirement ranged from 3-5 units of packed red cells per month to maintain an Hb >8 g/dl. He had a marked improvement in his symptoms within the first month of treatment and did not require any further blood transfusion during the three months of treatment. He was given one further IV iron infusion in the final month of his 3-month bevacizumab treatment and did not experience any adverse side effects from bevacizumab. HHT results from alterations to genes which encode proteins involved in blood vessel formation. This provides the rationale for using anti VEGF drugs such as bevacizumab. Current evidence for this treatment approach is limited. Bevacizumab can be an effective treatment option in patients with HHT refractory to traditional management. Gastrointestinal bleeding in hereditary haemorrhagic telangiectasia can be difficult to treat.Bevacizumab, an anti-vascular endothelial growth factor, can be used to treat refractory anaemia secondary to gastrointestinal bleeding in hereditary haemorrhagic telangiectasia.

Critical Thinking: A Program Review of Doctor of Audiology Students.

Critical thinking is a crucial component of health care, and its importance has been recognized in training medical professionals. This study reports critical thinking skills for entering doctor of audiology (AuD) students and the trajectory of the change in critical thinking skills measured 2 times over a period of 3 years. This longitudinal, descriptive, and exploratory design was implemented for programmatic review. Critical thinking skills were measured using the Health Sciences Reasoning Test (HSRT; Insight Assessment) upon entering the program and compared to measurements during the final month of academic coursework. Descriptive statistics, exploratory analyses of the HSRT scores among cohorts, the relationship of the HSRT to the graduate record examinations (GREs), and changes in the HSRT over time using a repeated measures multivariate analysis of variance were conducted. There were no significant differences in critical thinking skills between any of the cohort years. There was a significant correlation between the GRE verbal scores and OVERALL HSRT. Improvements in critical thinking skills were found between the time the students entered the graduate program and their final academic semester. Greater gains were reported for students who initially scored below the 50th percentile on the OVERALL HSRT. This program review showed improvement in the critical thinking skills of AuD students during their academic training program. Information regarding critical thinking skills may be useful for programs to monitor students' clinical thinking skills and possibly include clinical and didactical activities to promote critical thinking skills.

EXAMPLES OF ENGAGING HARD-TO-REACH POPULATIONS IN CLINICAL RESEARCH

Abstract Individuals, communities, and settings that are systematically and historically under-represented in research are sometimes referred to as “hard-to-reach” populations. Investigators often face additional challenges to engaging hard-to-reach populations, as research commonly occurs in settings or situations where clinical science has not historically taken place. The perspectives of hard-to-reach participants are vital for moving toward health equity. Yet, investigators must be equipped with specific strategies and tools to conduct high-quality clinical research with hard-to-reach populations. In this symposium, a diverse panel of speakers will present examples of research with various hard-to-reach patient populations and settings. The first discusses research targeting socioeconomically disadvantaged short-stay skilled nursing residents and their care-partners. This presentation highlights challenges and solutions for partnership formation, budgeting, recruitment, and engaging community advisors in skilled nursing facilities. The second centers on research with Hispanic families caring for an elder living with dementia. This presentation highlights challenges and solutions for recruitment as well as language translation and cultural adaptation of study materials. The third discusses research with incarcerated older adults and those receiving treatment from outpatient substance use disorder clinics. This presentation highlights challenges and solutions for recruitment, assessment, and adapting protocols in these settings. The final discusses research with adults receiving Hospice care for advanced cancer. This presentation highlights practical, ethical, and cultural considerations for engaging participants in their final months of life. We conclude with a broader discussion of approaching clinical research with hard-to-reach populations, with the ultimate goal of inspiring investigators to enhance the reach of their science.

COVID-19, deaths at home and end-of-life cancer care

During the COVID-19 pandemic there was a period of high excess deaths from cancer at home as opposed to in hospitals or in care homes. In this paper we aim to explore whether healthcare utilisation trajectories of cancer patients in the final months of life during the COVID-19 pandemic reveal any potential unmet healthcare need. We use English hospital records linked to data on all deaths in and out of hospital which identifies the cause and location of death.Our analysis shows that during the periods of peak COVID-19 caseload, patients dying of cancer experienced up to 42% less hospital treatment in their final month of life compared to historical controls. We find reductions in end-of-life hospital care for cancer patients dying in hospitals, care homes/hospices and at home, however the effect is amplified by the shift to more patients dying at home. Through the first year of the pandemic in England, we estimate the number of inpatient bed-days for end-of-life cancer patients in their final month reduced by approximately 282,282, or 25%.For outpatient appointments in the final month of life we find a reduction in face-to-face appointments and an increase in remote appointments which persists through the pandemic year and is not confined only to the periods of peak COVID-19 caseload.Our results suggest reductions in care provision during the COVID-19 pandemic may have led to unmet need, and future emergency reorganisations of health care systems must ensure consistent care provision for vulnerable groups such as cancer patients.

The Wehrmacht’s Complicity in Late-War Genocide: The Palmnicken Massacre and the Military in East Prussia, 1944–1945

Abstract By examining the death marches from Stutthof’s East Prussian subcamps in January 1945 and the following “Palmnicken Massacre,” this article retraces the role of the Wehrmacht in late-war genocidal violence. Scholars have established the complicity of Wehrmacht soldiers in acts of genocide during their stay on the Eastern Front, and documented the racist mindset that underpinned their behavior. Yet no such research exists on the final year of the war. From Summer 1944 until May 1945, the Wehrmacht’s main task was to defend its home soil. Scholarship has thus focused more on the military’s defense of Germany rather than their willingness to support the regime’s genocidal demands. This article argues that many Wehrmacht commanders were fully aware of the genocide perpetrated in their midst during the war’s final months, and when called upon, different Wehrmacht commanders actively assisted the SS in carrying out the regime’s racist mission even at the very end of the war. Finally, the author reveals how the military attempted to conceal these acts of violence throughout the postwar years.

A precursor plateau and pre-maximum [O ii] emission in the superluminous SN2019szu: a pulsational pair-instability candidate

ABSTRACT We present a detailed study on SN2019szu, a Type I superluminous supernova at z = 0.213 that displayed unique photometric and spectroscopic properties. Pan-STARRS and ZTF forced photometry show a pre-explosion plateau lasting ∼40 d. Unlike other SLSNe that show decreasing photospheric temperatures with time, the optical colours show an apparent temperature increase from ∼15 000 to ∼20 000 K over the first 70 d, likely caused by an additional pseudo-continuum in the spectrum. Remarkably, the spectrum displays a forbidden emission line (likely attributed to λλ7320,7330) visible 16 d before maximum light, inconsistent with an apparently compact photosphere. This identification is further strengthened by the appearances of [O iii] λλ4959, 5007, and [O iii] λ4363 seen in the spectrum. Comparing with nebular spectral models, we find that the oxygen line fluxes and ratios can be reproduced with ∼0.25 M⊙ of oxygen-rich material with a density of $\sim 10^{-15}\, \rm {g\, cm}^{-3}$. The low density suggests a circumstellar origin, but the early onset of the emission lines requires that this material was ejected within the final months before the terminal explosion, consistent with the timing of the precursor plateau. Interaction with denser material closer to the explosion likely produced the pseudo-continuum bluewards of ∼5500 Å. We suggest that this event is one of the best candidates to date for a pulsational pair-instability ejection, with early pulses providing the low density material needed for the formation of the forbidden emission line, and collisions between the final shells of ejected material producing the pre-explosion plateau.

Evaluating the effects of velocity models and array configuration on induced seismic event locations in the Permian Basin

In the final months of 2022, two substantial earthquakes with magnitudes exceeding ML 5.0 hit West Texas, USA, causing widespread public concerns about the effect of industrial activities on human and environmental safety. The monitoring of earthquakes in this region is largely based on the data of the public regional seismic array, which consists of stations spaced typically tens of kilometers apart. Accurate hypocenter determination of these induced events is crucial as it provides insight into the triggering mechanism, enabling operators and regulators to develop effective mitigation strategies. However, there are debates regarding the accuracy of the publicly reported induced event data due to discrepancies between public reports of event hypocenters and those determined using local dense arrays operated by private companies. The primary objective of this study is to identify the underlying causes of the discrepancies between results obtained from the public regional array in West Texas and local dense arrays. Through modeling and analysis of field data collected by a local dense array in the Permian Basin, we determine that three critical factors influence the reliability of induced event results. First, the accuracy of the velocity model used for the event location is the most crucial factor. Second, the distance between a station and an event plays a crucial role in determining the sensitivity of the data to the hypocenter depth. Finally, consistency between the observed and modeled wave propagation behavior is crucial for ensuring the validity of the objective function in the inversion. Our findings indicate that it is challenging to obtain reliable hypocenters using a regional sparse array with station spacing on the order of tens of kilometers. The best practice for obtaining an accurate event hypocenter and magnitude is to monitor induced seismicity using a local dense array and process the data with a velocity model that fully characterizes the local basin’s geology.

Jew in France after the Holocaust: Piotr Rawicz in Paris, 1947–1982

In 1961, the Polish/Ukrainian/Jewish writer Piotr Rawicz published his debut novel, ‘Blood from the Sky’. Written in French (“Le Sang du ciel”) and published by Gallimard, Rawicz’s novel belongs to the ‘first wave’ of fictional works on the Holocaust that appeared in France in the years immediately following World War II. Well reviewed at the time, scholars of Holocaust literature have continued to refer to Blood from the Sky in recent works on the subject. But the author himself has received much less attention. Born in Lviv in 1919 into an acculturated Jewish family, Rawicz survived the final months of the Second World War in two Nazi concentration camps (Auschwitz and Leitmeritz); then emigrated to Paris in 1947, where he established himself as a writer.The article delves into the timeframe of 1947–1982, encapsulating Piotr Rawicz’s transition to Paris and his life until his passing. It places notable emphasis on the diverse environments that shaped Rawicz’s life and writing. Particularly, the article pays close attention to Rawicz’s connections within Jewish social circles and explores how his experiences and resilience during the Holocaust and his pre-war life in Lviv influenced his approach to forging new identities after settling in France.

Protocol update and baseline characteristics for the TRIal to slow the Progression of Diabetes (TRIPOD) randomized controlled trial

BackgroundType 2 diabetes (T2D), a major risk factor for cardiovascular disease and other adverse health conditions, is on the rise in Singapore. TRIPOD is a randomized controlled trial aimed to determine whether complementing usual care with an evidence-based diabetes management package (DMP) —comprising access to an evidence-based app, health coaching, pedometer, glucometer and weighing scale, with or without a financial rewards scheme (M-POWER rewards), can improve mean HbA1c levels at months 6 and 12.MethodsThe protocol was published in Trials, accessible via https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3749-x1. This manuscript updates the protocol with changes to the study design due to challenges with recruitment and presents baseline characteristics. Key updates include changing the arm allocation ratio from 1:1:1 (Arm 1-Usual Care: Arm 2-DMP: Arm 3-DMP+M-POWER rewards) to 10:1:10, the sample size from 339 to 269, the intervention period from two to one year, and the primary hypothesis to focus solely on differences between Usual Care and DMP+M-POWER rewards. Recruitment for the study began on 19 October 2019 and ended on 4 June 2022.ResultsThe average age of participants was 55.0 (SD9.7) years old and 64.2% were male. The majority of participants (76.8%) were Chinese, 4.9% Malay and 18.3% Indian and of other ethnicities. 67.0% had a monthly household income of SGD$4000 or more. The mean baseline HbA1c was 8.10% (SD 0.95) and the mean body mass index was 26.8 kg/m2 (SD 5.3).DiscussionThe final participant completed month 12 follow-up data collection on 8 June 2023. All pre-planned analyses will be conducted and final results reported.Trial registrationClinicalTrials.govNCT03800680. Registered on 11 January 2019.

Spending Responses to the Child Tax Credit Expansions

This article summarizes research literature that has studied how people used the advance Child Tax Credit (CTC) payments that were disbursed by the IRS in 2021. Four primary findings emerge. The ways in which families used the advance CTC payments varied: during the first few months the payments were being distributed, families reported paying down debt more frequently; and in the final months of the payments, families reported more frequent spending. Families primarily used the monthly CTC on household necessities and child-related spending. There was heterogeneity in the spending response across income and race. Lastly, the CTC helped families deal with rising inflation. We discuss these four findings from the extant research in detail.

Remote cognitive behavioral therapy utilizing an in-home virtual reality toolkit (Vx Therapy) reduces pain, anxiety, and depression in patients with chronic cervical and lumbar spondylytic pain: A potential alternative to opioids in multimodal pain management

Background ContextVirtual reality (VR) reduces pain through visual and auditory distraction without narcotic-related side effects or dependency. Cognitive behavioral therapy (CBT) improves pain-related disability and quality of life, but patient access remains a challenge. We hypothesized that in-home weekly CBT coordinated with daily use of a proprietary VR toolkit will reduce pain, anxiety, and depression for patients with non-operative chronic cervical and lumbar spondylitic pain with and without radiculopathy. MethodsA total of 145 patients with chronic spondylitic pain (63 cervical, 46 noradicular lumbar, 36 radicular lumbar) were enrolled into a guided 14-week VR+CBT program (Vx Therapy) consisting of weekly encounters with a trained therapist and 50 modules. Pain/anxiety severity scores and time to pain recurrence were recorded prospectively by patients. PROMIS measures of overall daily pain intensity, behavior, interference, anxiety, and depression were recorded at baseline and conclusion of the program. ResultsA total of 52% of the 145 patients were male. The average (SD) age of the cohort was 51 (10.7) years (range: 24–76 years). Mean score for all PROMIS domains were significantly improved after 14 weeks of Vx Therapy (pain intensity 36±24 vs. 28±21, interference 39±25 vs. 24±21, behavior 35±21 vs. 25±16, anxiety 51±28 vs. 41±26, depression 58±32 vs. 48±32) for the entire cohort and each diagnosis group. Virtual reality acutely reduced pain on average by 33% (4.5±2.5 vs. 6.7±2.2, p<.05) across all 14 weeks, lasting a mean 2.8 hours after use. Duration of pain relief increased by the final vs. first month (4.5 hours vs. 2.5 hours, p<.05). Virtual reality acutely reduced anxiety on average by 46% (3.5±3 vs. 6.4±2, p<.05) across all 14 weeks lasting a mean 2.7 hours after use. The effect was similar for all 3 groups. ConclusionsFourteen weeks of a remote CBT guided in-home VR toolkit provided effective and sustained pain, anxiety, and depression relief in patients with chronic degenerative neck/back pain with and without radiculopathy. The non-invasive, non-pharmacological nature of Vx Therapy makes it an ideal option for pain management in the post-opioid epidemic era.

FRI427 Hypocaloric Dietary Intervention Reduces Excessive Follicle Recruitment In Women With PCOS

Abstract Disclosure: F. Carter: None. N. Lee: None. A. Reich: None. B.Y. Jarrett: None. H. Vanden Brink: None. A. Oldfield: None. M.E. Lujan: None. Introduction: Disordered antral follicle development in polycystic ovary syndrome (PCOS) is characterized by excessive recruitment, early or absence of follicle selection and decreased incidence of dominance and ovulation. Whether lifestyle interventions aimed at weight loss improve defects in antral folliculogenesis to promote ovulation in women with PCOS and comorbid obesity is unknown. Objective: To test the hypothesis that a hypocaloric dietary intervention improves antral follicle development in a subset of women with PCOS and obesity as evidenced by decreased recruitment, and increased selection, dominance, and ovulation. Methods: Preliminary analysis of women with PCOS and obesity (7 out of 20) who participated in a hypocaloric dietary intervention was conducted. The study protocol consisted of every-other-day visits to a clinical research center for ovarian ultrasonography and venipuncture over a 4-week baseline period (pre-intervention), followed by a 12-week commercial hypocaloric dietary meal plan intervention aimed at achieving 1-2 lbs of weight loss per week. Anthropometry, DEXA, hirsutism scoring, and oral glucose tolerance testing were conducted at baseline and during the final month of the intervention in the follicular phase. The number and diameter of all follicles ≥ 2 mm at each visit were recorded offline, and individual follicles ≥ 7 mm were tracked using the Identity Method throughout the 16-weeks. Clinical, morphologic, and endocrine markers were compared using paired t-tests pre- vs. post-intervention, and linear mixed models assessed changes in recruitment, selection, dominance, and ovulation. Results: The hypocaloric dietary intervention resulted in mean weight loss of 8.8 ± 2.9% and significant reductions in waist (-13 ± 9 cm) and hips (-10 ± 3 cm) circumference, body mass index (-3.4 ± 1.4 kg/m2), and percent total body fat (-1.5 ± 1.3%; all p&amp;lt;0.02). Glucoregulatory status, menstrual cycle lengths, reproductive hormone (LH, FSH, E2, P4, TT, AMH) concentrations, and hirsutism scores did not differ pre- vs. post-intervention. The number of follicle recruitment events decreased with percent weight loss during the intervention (p=0.01), as did the average number of follicles recruited per cohort (p=0.01). By contrast, the frequency of follicle selection, dominance, and ovulation did not change with weight loss (p&amp;gt;0.05). Higher pre-intervention LH was associated with fewer follicles recruited per cohort during the intervention (p=0.03). No other metabolic or endocrine marker was correlated with changes in follicular events. Conclusion: Clinically meaningful weight loss induced by a hypocaloric dietary intervention resulted in improvements in early stages of antral follicle development in women with PCOS, albeit these changes did not affect ovulatory follicle dynamics or the frequency of ovulation Presentation: Friday, June 16, 2023