Large Increase Research Articles

Growth of Community Outpatient Care in the Veterans Affairs System After the MISSION Act.

The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 authorized a major expansion of purchased care in the community for Veterans experiencing access barriers in the Veterans Affairs (VA) health care system. To estimate changes in primary care, mental health, and emergency/urgent care visits in the VA and community fiscal years (FY) 2018-2021 and differences between rural and urban clinics. A national, longitudinal study of VA clinics and outpatient utilization. Clinic-level analysis was conducted to estimate changes in number and proportion of clinic visits provided in the community associated with the MISSION Act adjusting for clinic characteristics and underlying time trends. In total, 1050 VA clinics and 6.6 million Veterans assigned to primary care. Number of primary care, mental health, and emergency/urgent care visits provided in the VA and community and the proportion provided in the community. Nationally, community primary care visits increased by 107% (50,611 to 104,923), community mental health visits increased by 167% (100,701 to 268,976), and community emergency/urgent care visits increased by 129% (142,262 to 325,407) from the first quarter of 2018 to last quarter of 2021. In adjusted analysis, after MISSION Act implementation, there was an increase in community visits as a proportion of total clinic visits for emergency/urgent care and mental health but not primary care. Rural clinics had larger increases in the proportion of community visits for primary care and emergency/urgent care than urban clinics. After the MISSION Act, more outpatient care shifted to the community for emergency/urgent care and mental health care but not primary care. Community care utilization increased more in rural compared to urban clinics for primary care and emergency/urgent care. These findings highlight the challenges and importance of maintaining provider networks in rural areas to ensure access to care.

The Impact of Public Deliberation and Identity-Based Storytelling on Civic Empowerment among Latinx Communities on Environmental Issues

ABSTRACT Environmental issues already disproportionately impact communities of color in the U.S., where there is a long and well-established history of environmental racism. Despite efforts to diversify voices in deliberation, engaging marginalized populations remains a key challenge. Drawing from environmental communication, civic empowerment, and social identity literatures, this study conducted a field experiment within an environmental deliberative event among Latinx communities. We examined (1) to what extent deliberation affects process – and outcome-based empowerment, and (2) the impact of factual vs. storytelling deliberative material on empowerment. Our findings show that deliberation increased process-based, but not outcome-based, empowerment on environmental issues. We also found that participants exposed to storytelling had a larger increase in empowerment compared to those exposed to factual materials during the deliberation day. Implications for designing culturally responsive deliberations for environmental communication are discussed.

Abstract PS10-09: Development of an absolute risk prediction model for premenopausal breast cancer in an international consortium

Abstract Risk prediction models that have been developed for overall breast cancer risk are based on a limited number of premenopausal cases in individual cohorts. As some risk factors differ in their associations with pre- versus postmenopausal breast cancer, a distinct risk prediction model is needed for premenopausal breast cancer. We developed a risk prediction model for premenopausal breast cancer using 779,601 participants and 9,665 incident cases from 18 prospective studies within the Premenopausal Breast Cancer Collaborative Group (PBCCG), across North America (N=9), Europe (N=6), Australia (N=1), and Asia (N=2). Data were split, within each cohort, into training (2/3) and testing (1/3) datasets. Individual risk was assessed in five-year intervals, using variables reported at the start of the time interval. Cox proportional hazards regression was used to model risk factors in a backwards-selection method, stratified by cohort: age at menarche, age at first birth, parity, breastfeeding (months), height (cm), BMI (kg/m2), BMI at age 18, recent weight change (kg), alcohol consumption (drinks/week), first-degree family history of breast cancer, and personal history of benign breast disease. To enable the use of information from all cohorts despite differences in missing variables by design, cohorts were grouped by available variables and risk models were fit for each group. In cohorts with incomplete data, model coefficients were adjusted based on the correlation of covariates with the missing variables in the complete case dataset. Coefficients were meta-analyzed with inverse variance weighting to obtain final coefficients. Discrimination was evaluated in the testing dataset by calculation of the c-index. Work is ongoing to calibrate the model based on five-year absolute risk using GLOBOCAN continent- and age-specific incidence rates to represent baseline risk. The final model included age at menarche, parity, height, BMI, BMI at age 18, first-degree family history of breast cancer, and history of benign breast disease. Young adulthood BMI and BMI (at start of the 5-year risk interval) were associated with a decreased risk (Hazard Ratio (HR) (95% confidence interval (CI)) per 5 kg/m2 = 0.87 (0.81-0.93) and 0.90 (0.86-0.95), respectively) as was parity (HR (95% CI) = 0.92 (0.90-0.94)). Height was associated with increased risk (HR (95% CI) per 10 cm = 1.14 (1.07-1.21)), while history of benign breast disease and family history were associated with larger increases in risk (HR (95% CI) = 1.64 (1.30-2.06) and 1.76 (1.63-1.90), respectively). Model discrimination was higher than that reported for women under 50 years in existing breast cancer risk prediction models considering clinical factors (AUC (95% CI) = 0.61 (0.59-0.62)). Calibration of absolute 5-year risk is ongoing. Several factors driving risk prediction of postmenopausal breast cancer have similar influence on risk of premenopausal breast cancer, while family history has a stronger influence on premenopausal breast cancer risk. Our model demonstrates acceptable discrimination and will enable individual 5-year absolute risk prediction for premenopausal breast cancer. Citation Format: Kristen Brantley, Michael Jones, Minouk Schoemaker, Hazel Nichols, Anthony Swerdlow, Robert MacInnis, Roger Milne, Tess Clenenden, Yu Chen, Xiao-Ou Shu, Wei Zheng, Woon-Puay Koh, Jian-Min Yuan, Cari Kitahara, Martha Linet, Dale Sandler, Bernard A Rosner, Peter Kraft, A. Heather Eliassen. Development of an absolute risk prediction model for premenopausal breast cancer in an international consortium [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS10-09.

Abstract PS10-01: Hormonal Contraception and Breast Cancer Risk for Carriers of Germline Pathogenic Variants in BRCA1 and BRCA2

Abstract BACKGROUND: Current use of hormonal contraception is associated with a 20-30% relative increase in the risk of breast cancer (BC) for women in the general population compared with never using. Longer duration of use is associated with higher risk, and the risk remains elevated above that of never users for at least 5 years after cessation. Most published data are for various formulations of the combined oral contraceptive pill, but associations are similar for progestogen-only contraceptives, including intrauterine devices. For women in the general population who use hormonal contraceptives in their 20s and 30s, when baseline BC risk for most women is low, these increased relative risks translate into only small increases in absolute risk. It is unclear whether use of hormonal contraceptives increases BC risk for women carrying a germline BRCA1 or BRCA2 pathogenic variant (PV). These women are at markedly higher risk of early-onset BC, so even slightly increased relative risks could translate to important increases in their absolute risk of BC. This study assessed the association between use of any hormonal contraception and BC risk for BRCA1 and BRCA2 PV carriers using individual participant data from four prospective cohorts. METHODS: Data from females born after 1920 with a PV in BRCA1 or BRCA2 and no history of cancer or bilateral mastectomy at cohort entry were analyzed. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for BC (invasive disease or ductal carcinoma in situ) associated with use of hormonal contraceptives for at least 1 year, with age as the timescale, entry at cohort enrolment, and censoring at the earlier of bilateral mastectomy, death, diagnosis of another cancer or last follow-up. Analyses were adjusted for study, birth cohort, first-degree family history of BC, parity, premenopausal bilateral oophorectomy and menopausal status. Current use of hormonal contraceptives was defined as use within the previous year, to account for cessation of use due to BC symptoms or clinical investigation. RESULTS: Of 3,882 BRCA1 and 1,509 BRCA2 PV carriers, 53% and 71%, respectively had ever used hormonal contraceptives (for at least one year). The median cumulative duration of hormonal contraceptive use was 4.8 and 5.7 years, respectively. Overall, 488 BRCA1 and 191 BRCA2 PV carriers developed incident BC during a median of 5.9 and 5.6 years of follow-up, respectively. For BRCA1 PV carriers, use of hormonal contraceptives for at least 1 year was associated with increased BC risk (HR [95% CI]: 1.29 [1.04-1.60] p=0.019). BC risk increased with longer cumulative duration of hormonal contraceptive use (HR [95% CI]: 1.13 [0.88-1.45] p=0.35, 1.48 [1.11-1.96] p=0.007 and 1.56 [1.13-2.17] p=0.007 for 1-5, 6-10 and >10 years of use, respectively), with an estimated proportional increase in risk of 3% (1%-5%, p=0.002) for each additional year of use. For BRCA2 PV carriers, there was no evidence that current or past use, or cumulative duration of use, were associated with increased risk of BC, but confidence intervals on the HRs were wide. CONCLUSION: Hormonal contraceptive use is associated with an increased risk of BC for women carrying PVs in BRCA1 and risk increases with cumulative duration of use. Hormonal contraceptives are an important healthcare option for women; they provide excellent contraceptive efficacy and reduce risks of ovarian and endometrial cancer. Decisions about use of hormonal contraceptives in women at increased risk for BC due to BRCA1 PVs need to carefully weigh the risks and benefits; while shorter-term use may result in only small increases, prolonged cumulative use may result in larger increases in absolute BC risk that may not be acceptable to some women. Citation Format: Kelly-Anne Phillips, Joanne Kotsopoulos, Susan Domchek, James Chamberlain, Julie Bassett, Amber Aeilts, Irene Andrulis, Saundra Buys, Wanda Cui, Mary Daly, Andrea Eisen, William Foulkes, Michael Friedlander, Jacek Gronwald, John Hopper, Esther John, Beth Karlan, Raymond Kim, Jan Lubiński, Kelly Metcalfe, Katherine Nathanson, Christian F. Singer, Heather Symecko, Nadine Tung, Steven Narod, Mary Beth Terry, Roger Milne. Hormonal Contraception and Breast Cancer Risk for Carriers of Germline Pathogenic Variants in BRCA1 and BRCA2 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS10-01.

Associations among educators' beliefs, intervention fidelity, and student outcomes in school-wide positive behavior interventions, and supports: A school-level moderated mediation analysis.

Existing literature has established the effectiveness of school-wide positive behavioral interventions and supports (SWPBIS) for improving school-level student behavioral and academic outcomes. Implementation of SWPBIS in uncontrolled settings is often suboptimal, leading to lackluster outcomes. Researchers have developed and validated several implementation strategies to improve individual-level implementation determinants (e.g., educators' supportive beliefs) to promote the successful delivery of universal programs (e.g., SWPBIS). However, empirical studies are needed to explore the mechanisms of change through which school-level educators' beliefs influence their delivery of SWPBIS. This school-level quasi-experimental study tested a mediational mechanism of change where changes in educators' beliefs work through their intervention fidelity of SWPBIS to influence student outcomes. We delivered the Supportive Belief Intervention (a school-wide implementation strategy used before training to promote educators' supportive beliefs about SWPBIS) and then Tier 1 SWPBIS training to 81 elementary schools serving diverse student populations. At the start of the academic year, school-level educators' beliefs were assessed before the Supportive Belief Intervention. At the end of the academic year, educators' beliefs, intervention fidelity, and rates of student reading proficiency and suspension were assessed. Conditional process analyses with nonparametric bootstrapping (mediational and first stage moderated mediational models) revealed that, at the school level, a larger increase in educators' supportive beliefs was associated with enhanced SWPBIS fidelity and better corollary student outcomes (increased reading proficiency and reduced suspension), while student socioeconomic status moderated the size of the mediation effect. Implications for research and practices about the implementation of SWPBIS and school context were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Global Increase in Nearshore Tropical Cyclone Intensification

AbstractTropical Cyclones (TCs) inflict substantial coastal damages, making it pertinent to understand changing storm characteristics in the important nearshore region. Past work examined several aspects of TCs relevant for impacts in coastal regions. However, few studies explored nearshore storm intensification and its response to climate change at the global scale. Here, we address this using a suite of observations and numerical model simulations. Over the historical period 1979–2020, observations reveal a global mean TC intensification rate increase of about 3 kt per 24‐hr in regions close to the coast. Analysis of the observed large‐scale environment shows that stronger decreases in vertical wind shear and larger increases in relative humidity relative to the open oceans are responsible. Further, high‐resolution climate model simulations suggest that nearshore TC intensification will continue to rise under global warming. Idealized numerical experiments with an intermediate complexity model reveal that decreasing shear near coastlines, driven by amplified warming in the upper troposphere and changes in heating patterns, is the major pathway for these projected increases in nearshore TC intensification.

Digitalization as a trigger for a rebound effect of electricity use

Digitalization has the potential to trigger energy consumption rebounds, while its size has often been disregarded. Using panel data from 283 Chinese cities during 2004-2019, this study adopts a panel smooth transfer regression (PSTR) to estimate the rebound effect of electricity use induced by digitalization from its composite index and sub-dimensions and identifies the individual differences and time-varying trends in the rebound effect. The findings indicate that digitalization has an inverted U-shaped influence on the rebound effect of electricity use, with the maximum increase in the rebound effect reaching 19% and stabilizing at approximately 13%. Second, in terms of the sub-dimensions, Internet connectivity and digital output, , cause the larger increases in rebound effects compared with digital technology. Third, the average digitalization-induced rebound effect in cities with high levels of digitalization, such as Beijing and Shanghai, is slightly lower than that in cities with medium levels of digitalization. Lishui, Chaozhou, and Taizhou have the largest digitalization-induced rebound effects on electricity use, reaching approximately 18% on average. Finally, the digitalization-induced rebound effect on electricity use in most provinces generally tends to increase over time. This study provides policy implications for reducing the energy rebound effects triggered by digitization and promoting the development of digitalization and greening.

Application of an egocentric social network approach to examine changes in social connections following treatment for anxiety and depression: A novel measurement tool for clinical trials research?

The epidemic of loneliness and social isolation has been recognized as a public health crisis warranting the same prioritization as other public health issues today, such as obesity, substance use disorders, and tobacco use. Social disconnection is particularly prevalent and disabling among individuals with anxiety and depression, yet it is inadequately evaluated and addressed in most clinical psychology treatment research. Studies generally employ global measures of perceived connectedness, loneliness, or relationship satisfaction, limiting understanding about elements of one's social network that may change with treatment. This study examined changes in the degree (number of people nominated) and quality of one's social network from pre-to post-treatment using an egocentric social network approach in 59 adults (mean age = 30.8 years, range = 18 to 54) with clinically elevated anxiety or depression who were randomized to a cognitive and behavioral positive valence treatment versus waitlist. Participants (egos) named people in their lives (alters) with whom they discussed important issues or spent free time. For each alter, participants rated how close they felt, how close they thought the alter felt to them, and how frequently they communicated. Linear regressions, which included treatment group as a predictor, revealed no group differences in changes in network degree, perceived alter feelings of closeness, or communication frequency, despite prior findings from this sample indicating larger increases in perceived global connectedness in the treatment group. Unexpectedly, the control group reported a greater increase in perceived closeness to alters. Post-hoc analyses revealed this was explained by the treatment group identifying more distal social ties (e.g., extended family, colleagues, roommates) as alters following treatment – an outcome positively associated with global improvements in connectedness. This proof-of-concept study suggests egocentric social network surveys may provide unique information on treatment-related changes in social functioning. Suggestions are provided for adaptations to facilitate application of social network surveys to mental health treatment research.

Effects on physical activity, physical fitness and well-being in a 36-months randomized controlled study, comparing a multimodal hospital-based intervention programme for primary cardiovascular prevention with usual care

BackgroundCardiovascular disease is a major cause of mortality and morbidity worldwide, and primary prevention efforts are poorly developed in people at high cardiovascular risk. On this background, we performed the Hjerteløftet Study and demonstrated that participation over 36 months in a multimodal primary prevention programme, significantly reduced validated cardiovascular risk scores. In the current substudy we aimed to further explore several elements and effects following the intervention programme.MethodsA random sample from the original Hjerteløftet Study was included for further examinations (n = 255, 40% women), and these patients were already randomized to an intervention group (IG) (n = 127), or a control group (CG) (n = 128). We compared changes from baseline to 36-months follow-up in physical activity, cardiorespiratory fitness, psychological well-being (WHO-5), cardiovascular medication use, smoking habits, and cardiometabolic risk factors (blood pressure, lipids, blood glucose, HbA1c, Apolipoprotein A-I, Apolipoprotein B and high-sensitive C-reactive protein).ResultsSelf-reported physical activity increased significantly with absolute difference in mean delta Physical Activity Index score in the IG compared to the CG: 0.90, 95% CI: 0.10 to 1.70, p = 0.028 (ANCOVA). There were no corresponding differences in cardiorespiratory fitness. The participation resulted in psychological well-being improvement in both groups with a larger increase in the IG compared to the CG. The mean difference in delta WHO-5 score was 5.06, 95% CI: 0.68 to 9.45, p = 0.024, and 3.28, 95% CI: -0.69 to 5.25, p = 0.104 when controlled for baseline values (ANCOVA). The use of antihypertensive medication increased significantly more in the CG (p = 0.044). Only minor, nonsignificant changes were observed for traditional risk factors and cardiometabolic variables.ConclusionsParticipation in the Hjerteløftet Study intervention programme resulted in an improved physical activity level, but without changing cardiorespiratory fitness. Participation in the programme also tended to improve psychological well-being, possibly related to increased physical activity, less smoking and less use of cardiovascular medication. Concerning the metabolic status, no major differences were observed, but minor changes may have been concealed by a larger increase in cardiovascular medication use in the control group.Trial registrationClinicalTrials.gov (NCT01741428), 04/12/2012.

Atrial Shunt Device Effects on Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction

Although the results of A Study to Evaluate the Corvia Medical Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure (REDUCE LAP-HF II) trial were neutral overall, atrial shunt therapy demonstrated potential efficacy in responders (no latent pulmonary vascular disease and no cardiac rhythm management device). Post hoc analyses were conducted to evaluate the effect of shunt vs sham stratified by responder status. To evaluate the effect of atrial shunt vs sham control on cardiac structure/function in the overall study and stratified by responder status. This was a sham-controlled randomized clinical trial of an atrial shunt device in heart failure with preserved ejection fraction (HFpEF)/HF with mildly reduced EF (HFmrEF). Trial participants with evaluable echocardiography scans were recruited from 89 international medical centers. Data were analyzed from April 2023 to January 2024. Atrial shunt device or sham control. Changes in echocardiographic measures from baseline to 1, 6, 12, and 24 months after index procedure. The modified intention-to-treat analysis of the REDUCE LAP-HF II trial included 621 randomized patients (median [IQR] age, 72.0 [66.0-77.0] years; 382 female [61.5%]; shunt arm, 309 [49.8%]; sham control arm, 312 [50.2%]). Through 24 months, 212 of 217 patients (98%) in the shunt arm with evaluable echocardiograms had patent shunts. In the overall trial population, the shunt reduced left ventricular (LV) end-diastolic volume (mean difference, -5.65 mL; P <.001), left atrial (LA) minimal volume (mean difference, -2.8 mL; P =.01), and improved LV systolic tissue Doppler velocity (mean difference, 0.69 cm/s; P <.001) and LA emptying fraction (mean difference, 1.88 percentage units; P =.02) compared with sham. Shunt treatment also increased right ventricular (RV; mean difference, 9.58 mL; P <.001) and right atrial (RA; mean difference, 9.71 mL; P <.001) volumes but had no effect on RV systolic function, pulmonary artery pressure, or RA pressure compared with sham. In the shunt arm, responders had smaller increases in RV end-diastolic volume (mean difference, 5.71 mL vs 15.18 mL; interaction P =.01), RV end-systolic volume (mean difference, 1.58 mL vs 7.89 mL; interaction P =.002), and RV/LV ratio (mean difference, 0.07 vs 0.20; interaction P <.001) and larger increases in transmitral A wave velocity (mean difference, 5.08 cm/s vs -1.97 cm/s; interaction P =.02) compared with nonresponders randomized to the shunt, suggesting greater ability to accommodate shunted blood through the pulmonary circulation enabling LA unloading. In this post hoc analysis of the REDUCE LAP-HF II trial, over 2 years of follow-up, atrial shunting led to reverse remodeling of left-sided chambers and increases in volume of right-sided chambers consistent with the shunt flow but no change in RV systolic function compared with sham. Changes in cardiac structure/function were more favorable in responders compared with nonresponders treated with the shunt, supporting the previously identified responder group hypothesis and mechanism, although further evaluation with longer follow-up is needed. ClinicalTrials.gov Identifier: NCT03088033.

Fuzzy clustering-based climatic zoning method for building climate responsiveness in Qinba region, China

Accurate climate zoning is crucial for enhancing energy efficiency. This study aims to further subdivide microclimate zones to enhance the precision of climate zoning and subsequently propose climate response strategies for the refined areas. The Qinba region, a climatic transition zone between northern and southern China, serves as the focal point of this study. The research employs a fuzzy clustering method, utilizing integrated weights on seven meteorological indicators spanning 40-year period, to delineate climate zones in the Qinba region. The results indicate that parts of Qinba region can be categorized into three clusters significantly correlated with altitude, which are closely consistent with the distribution of climate data and previous researches. Lower altitude areas experience hot summers and warm winters, while higher altitude regions have warm summers and cold winters with a larger increase in average annual temperature. Furthermore, this research confirms the alignment of climate zones with climate response strategies through investigation of over 30 traditional villages with climatic experience and simulation of three typical cities using climate software. Both sources emphasize the significance of sun shading, ventilation, and solar gain as key strategies applicable across all three zones. The proposed method accurately synthesizes various dimensions of meteorological data and is suitable for small-scale climate zoning. It can provide valuable insights for advancing climate-complex small-area zoning and climate-responsive strategies.

Association of age at diagnosis of diabetes with subsequent risk of age-related ocular diseases and vision acuity

BACKGROUND The importance of age on the development of ocular conditions has been reported by numerous studies. Diabetes may have different associations with different stages of ocular conditions, and the duration of diabetes may affect the development of diabetic eye disease. While there is a dose-response relationship between the age at diagnosis of diabetes and the risk of cardiovascular disease and mortality, whether the age at diagnosis of diabetes is associated with incident ocular conditions remains to be explored. It is unclear which types of diabetes are more predictive of ocular conditions. AIM To examine associations between the age of diabetes diagnosis and the incidence of cataract, glaucoma, age-related macular degeneration (AMD), and vision acuity. METHODS Our analysis was using the UK Biobank. The cohort included 8709 diabetic participants and 17418 controls for ocular condition analysis, and 6689 diabetic participants and 13378 controls for vision analysis. Ocular diseases were identified using inpatient records until January 2021. Vision acuity was assessed using a chart. RESULTS During a median follow-up of 11.0 years, 3874, 665, and 616 new cases of cataract, glaucoma, and AMD, respectively, were identified. A stronger association between diabetes and incident ocular conditions was observed where diabetes was diagnosed at a younger age. Individuals with type 2 diabetes (T2D) diagnosed at &lt; 45 years [HR (95%CI): 2.71 (1.49-4.93)], 45-49 years [2.57 (1.17-5.65)], 50-54 years [1.85 (1.13-3.04)], or 50-59 years of age [1.53 (1.00-2.34)] had a higher risk of AMD independent of glycated haemoglobin. T2D diagnosed &lt; 45 years [HR (95%CI): 2.18 (1.71-2.79)], 45-49 years [1.54 (1.19-2.01)], 50-54 years [1.60 (1.31-1.96)], or 55-59 years of age [1.21 (1.02-1.43)] was associated with an increased cataract risk. T2D diagnosed &lt; 45 years of age only was associated with an increased risk of glaucoma [HR (95%CI): 1.76 (1.00-3.12)]. HRs (95%CIs) for AMD, cataract, and glaucoma associated with type 1 diabetes (T1D) were 4.12 (1.99-8.53), 2.95 (2.17-4.02), and 2.40 (1.09-5.31), respectively. In multivariable-adjusted analysis, individuals with T2D diagnosed &lt; 45 years of age [β 95%CI: 0.025 (0.009,0.040)] had a larger increase in LogMAR. The β (95%CI) for LogMAR associated with T1D was 0.044 (0.014, 0.073). CONCLUSION The younger age at the diagnosis of diabetes is associated with a larger relative risk of incident ocular diseases and greater vision loss.

Childhood trauma and hair cortisol response over the year following onset of a chronic life event stressor

ObjectiveChildhood trauma may contribute to poor lifelong health in part through programming of the HPA-axis response to future life stressors. To date, empirical evidence shows an association of childhood trauma with dysregulation of the HPA-axis and blunted cortisol reactivity to acute stressors. Here, we conduct an initial examination of childhood trauma as a moderator of changes over time in perceived stress levels and HPA-axis response to a major chronic stressor in adulthood. MethodsParticipants were 83 maternal caregivers of children newly diagnosed with cancer who completed the Childhood Trauma Questionnaire (CTQ), and who, over the year following their child’s cancer diagnosis, had hair samples collected up to 7 times for the assessment of cortisol and completed monthly measures of perceived stress. ResultsCTQ scores were in the expected range for a community sample and associated with changes in perceived stress and cortisol concentration over time (γ =.003, p =.002; γ = −.0004, p =.008, respectively) independently of age, education, treatment intensity and randomization to stress management intervention. Maternal caregivers who endorsed lower childhood trauma showed a steeper decline in perceived stress and a larger increase in cortisol levels across the year than caregivers who recalled more childhood trauma. ConclusionsFindings extend animal models and studies that examine cortisol reactivity to acute stressors and suggest that childhood trauma may program a phenotype that is more psychologically reactive but shows a blunted HPA-axis response to chronic stress. While adaptive in the short-term, this early life programming may incur long-term costs for health. Further work is warranted to examine this possibility.

High-intensity interval training (HIIT) and slow breathing interventions alleviate premature ejaculation (PE) symptoms

BackgroundPhysical exercise may alleviate premature ejaculation symptoms, a prevalent male sexual dysfunction linked to a series of negative outcomes for men and their partners. ObjectiveWe investigated the effectiveness of high-intensity interval training (HIIT) and slow breathing interventions on premature ejaculation symptoms and their relation to autonomic activity and attention regulation. MethodChinese adult men (N = 76, M = 21.89, SD = 3.32) with premature ejaculation completed one of the two-week interventions in their homes or as participants in a normal breathing control group; they reported their age, height, weight, physical activity level, premature ejaculation symptoms, and attention regulation. In the HIIT group, 26 participants engaged in a 7-minute HIIT each day. In the slow breathing group, 25 participants performed 7-minute slow breathing exercises per day while the 25 participants in the normal breathing group similarly performed normal breathing exercises. All participants measured their heart rate once before and five times (with one-minute intervals) after the intervention. When participants had penile-vaginal sex with their partners, they measured their heart rate once after ejaculation. ResultsTime × Intervention interaction was significant with lower levels of premature ejaculation symptoms on Days 12, 13, and 14 in the HIIT group (M ± SD = 16.19 ± 3.45, 15.96 ± 3.43, and 15.15 ± 3.62) compared to the normal breathing group (M ± SD = 17.68 ± 3.06, 17.68 ± 3.15, and 17.44 ± 3.25). Higher levels of attention regulation were associated with fewer premature ejaculation symptoms. We also found that a larger increase in heart rate from resting to after sex was associated with fewer premature ejaculation symptoms. ConclusionCompared to the control group, the efficacy of two weeks of HIIT exercise in mitigating PE symptoms suggests its potential as a novel treatment for PE.

Variability of External Load Measures During Soccer Match Play: Influence of Player Fitness or Pacing?

The aims of this study were to examine the variability of selected external load metrics within 15-minute intervals during soccer match play and examine their relationship with players' high-intensity intermittent fitness. A total of 18 male soccer players were monitored for their external load metrics during 26 matches, which included total distance, high-metabolic-load distance, and mechanical work (defined as the sum of accelerations and decelerations >3m2). Additionally, players completed the 30-15 Intermittent Fitness Test. Total distance had lower coefficients of variation than high-metabolic-load distance and mechanical work (effect size [ES]: 5.2 to 6.4; very large). Within-player Δ-15min showed moderate to large decreases (ES: -0.7 to -1.6) and increases (ES: 0.9 to 1.8) in absolute and coefficient-of-variation values, respectively. Large relationships (r = .55 to .61) were observed between the Intermittent Fitness Test and 15-minmean and 15-minbest in all selected external load metrics. However, small to moderate (0.27 to 0.41) associations were observed between the Intermittent Fitness Test and Δ-15min in selected external load metrics. These findings suggest that players with relatively lower intermittent running capacity might show lower variability during matches, as evidenced by smaller reductions in high-intensity actions during the final 15minutes. We attribute these observations to players' possessing better pacing strategies.

Playing with Low Amounts of Expanded Graphite for Melt-Processed Polyamide and Copolyester Nanocomposites to Achieve Control of Mechanical, Tribological, Thermal and Dielectric Properties.

Polyamide 11 (PA11) and copolyester (TPC-E) were compounded through melt extrusion with low levels (below 10%) of expanded graphite (EG), aiming at the manufacturing of a thermally and electrically conductive composite resistant to friction and with acceptable mechanical properties. Thermal characterisation showed that the EG presence had no influence on the onset degradation temperature or melting temperature. While the specific density of the produced composite materials increased linearly with increasing levels of EG, the tensile modulus and flexural modulus showed a significant increase already at the introduction of 1 wt% EG. However, the elongation at break decreased significantly for higher loadings, which is typical for composite materials. We observed the increase in the dielectric and thermal conductivity, and the dissipated power displayed a much larger increase where high frequencies (e.g., 10 GHz) were taken into account. The tribological results showed significant changes at 4 wt% for the PA11 composite and 6 wt% for the TPC-E composite. Morphological analysis of the wear surfaces indicated that the main wear mechanism changed from abrasive wear to adhesive wear, which contributes to the enhanced wear resistance of the developed materials. Overall, we manufactured new composite materials with enhanced dielectric properties and superior wear resistance while maintaining good processability, specifically upon using 4-6 wt% of EG.

Associations of Increased WIC Benefits for Fruits and Vegetables With Food Security and Satisfaction by Race and Ethnicity.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition support for racially and ethnically diverse populations. In 2021, the monthly cash value benefit (CVB) for the purchase of fruits and vegetables increased from $9 to $35 and was later adjusted to $24. This study investigated, by racial and ethnic groups, whether CVB increases were associated with increases in CVB redemption, household food security, child fruit and vegetable intake, satisfaction with CVB amount, and likelihood of continued participation in WIC if the CVB returned to $9 per month. We conducted a longitudinal study of WIC participants (N = 1,770) in southern California at 3 time points, from April 2021 through May 2022; the CVB amount was $9 at baseline, $35 at Survey 2, and $24 at Survey 3. Racial and ethnic groups were Hispanic English-speakers, Hispanic Spanish-speakers, non-Hispanic Asian, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. We used mixed-effect and modified Poisson regressions to evaluate outcomes by group. At baseline, groups differed significantly in dollars of CVB redeemed, percentage of CVB redeemed, household food security, and satisfaction with CVB amount. After the increase in CVB, we found increases in all groups in CVB redemption, household food security, and satisfaction. Non-Hispanic Black and Hispanic English-speaking groups, who had low levels of satisfaction at baseline, had larger increases in satisfaction than other groups. Reported likelihood of continued WIC participation if the monthly CVB returned to $9 also differed significantly by group, ranging from 62.5% to 90.0%. The increase in CVB for children receiving WIC benefited all racial and ethnic groups. Continued investment in an augmented CVB could improve health outcomes for a racially and ethnically diverse WIC population.

Critical material requirements and recycling opportunities for US wind and solar power generation

AbstractThe deployment of renewable energy generation technologies, driven primarily by concerns over catastrophic climate change, is expected to increase rapidly in the United States. Rapid increases in the deployment of wind and solar energy will translate to increases in critical material requirements, causing concern that demand could outstrip supply, leading to mineral price volatility and potentially slowing the energy transition. This study presents a detailed demand‐side model for wind and solar in the United States using dynamic material flow analysis to calculate the requirements for 15 elements: Cr, Zn, Ga, Se, Mo, Ag, Cd, In, Sn, Te, Pr, Nd, Tb, Dy, and Pb. Results show that transitioning to a completely decarbonized US energy system by 2050 could require a five‐to‐sevenfold increase in critical material flow‐into‐use compared with business as usual (BAU), with some materials requiring much larger increases. Rare earth elements (REEs) could require 60–300 times greater material flows into the US power sector in 2050 than in 2021, representing 13%–49% of the total global REE supply. Te requirements for reaching net zero by 2050 could exceed current supply, posing challenges for widespread deployment of cadmium‐telluride solar. We also investigate several strategies for reducing material requirements, including closed‐loop recycling, material intensity reduction, and changing market share of subtechnologies (e.g., using crystalline silicon solar panels instead of cadmium telluride). Although these strategies can significantly reduce critical material requirements by up to 40% on average, aggressive decarbonization will still require a substantial amount of critical material.

Reinforcement Learning as a Parsimonious Alternative to Prediction Cascades: A Case Study on Image Segmentation

Deep learning architectures have achieved state-of-the-art (SOTA) performance on computer vision tasks such as object detection and image segmentation. This may be attributed to the use of over-parameterized, monolithic deep learning architectures executed on large datasets. Although such large architectures lead to increased accuracy, this is usually accompanied by a larger increase in computation and memory requirements during inference. While this is a non-issue in traditional machine learning (ML) pipelines, the recent confluence of machine learning and fields like the Internet of Things (IoT) has rendered such large architectures infeasible for execution in low-resource settings. For some datasets, large monolithic pipelines may be overkill for simpler inputs. To address this problem, previous efforts have proposed decision cascades where inputs are passed through models of increasing complexity until desired performance is achieved. However, we argue that cascaded prediction leads to sub-optimal throughput and increased computational cost due to wasteful intermediate computations. To address this, we propose PaSeR (Parsimonious Segmentation with Reinforcement Learning) a non-cascading, cost-aware learning pipeline as an efficient alternative to cascaded decision architectures. Through experimental evaluation on both real-world and standard datasets, we demonstrate that PaSeR achieves better accuracy while minimizing computational cost relative to cascaded models. Further, we introduce a new metric IoU/GigaFlop to evaluate the balance between cost and performance. On the real-world task of battery material phase segmentation, PaSeR yields a minimum performance improvement of 174% on the IoU/GigaFlop metric with respect to baselines. We also demonstrate PaSeR's adaptability to complementary models trained on a noisy MNIST dataset, where it achieved a minimum performance improvement on IoU/GigaFlop of 13.4% over SOTA models. Code and data are available at github.com/scailab/paser.

Abstract 7017: Increased epigenetic age acceleration in young adult and early onset colorectal cancer patients post-treatment: A ColoCare Pilot Study

Abstract Introduction: Advanced biological age relative to chronological age has been observed in individuals with colorectal cancer (CRC), and there is growing evidence that cancer treatments can further accelerate biological aging. However, the influence of age at diagnosis on these relationships has yet to be examined in detail. This pilot study used data from the ColoCare Study to explore pre- and post-treatment differences in age acceleration by chronological age at CRC diagnosis. Methods: The ColoCare Study is a prospective cohort study of newly-diagnosed CRC patients enrolled across seven U.S. and European sites. Participants in this pilot study were from the ColoCare site in Tampa, Florida who had available pre-treatment blood DNA. Young adult (YA, aged 18-39) and early onset (EO, aged 40-49) participants were matched with average onset (AO, aged 50-64) and late onset (LO, aged &amp;gt;64) participants on stage, sex, race and microsatellite instability status. Genome-wide DNA methylation profiles were assayed on buffy coat DNA using MethylationEPIC v2 BeadChips. PhenoAgeAccel and GrimAgeAccel were calculated on all samples to quantify the difference between DNA methylation-predicted biological age and chronological age (i.e., age acceleration). Linear regression models were used to estimate the associations of age at diagnosis and treatment with PhenoAgeAccel and GrimAgeAccel, adjusted for sex, race, and site (rectal, colon). Results: The sample (n=60) included n=19 YA, n=15 EO, n=11 AO, and n=15 LO participants with pre-treatment blood DNA. Over half (n=15 YA/EO, n=20 AO/LO) had a paired post-treatment blood sample available. Half of participants were female and had colon tumors, and 76% were diagnosed with stage I-III disease. Pre-treatment, PhenoAgeAccel and GrimAgeAccel were similar across age groups (P &amp;gt; 0.05). In the subset of participants with pre- and post-treatment samples, age acceleration appeared to increase post-treatment (pre- and post-treatment differences, PhenoAgeAccel: 1.44, SD: 5.55, P= 0.13; GrimAgeAccel: 0.92, SD: 2.80, P= 0.06). Increases were largest among YA/EO participants. In adjusted models, the predicted differences in pre-to post-treatment PhenoAgeAccel were 2.89 (95% CI: -0.13, 5.90) in YA/EO and 0.36 (95% CI: -2.25, 2.96) in AO/LO (P-difference= 0.20). The predicted differences in GrimAgeAccel were 1.75 (95% CI: 0.25, 3.25) in YA/EO and 0.30 (95% CI: -1.00, 1.60) in AO/LO (P-difference= 0.15). Conclusions: In this pilot study of CRC patients, pre-treatment age acceleration did not vary by age at diagnosis. Post-treatment, patients diagnosed at age 49 or younger had larger increases in age acceleration than patients diagnosed at age 50 or older. These findings warrant further investigation in larger samples and to determine if increases in post-treatment age acceleration as associated with patient outcomes and treatment response. Citation Format: Erin M. Siegel, Jacob K. Kresovich, Amanda M. Bloomer, Anders Berglund, Esther Jean-Baptiste, Gillian Trujillo, Rachel Carmella, Julaxis Love, Seth Felder, Jennifer Ose, Biljana Gigic, Christopher I. Li, Jane C. Figueiredo, Adetunji T. Toriola, Cornelia M. Ulrich, David Shibata, Laura B. Oswald. Increased epigenetic age acceleration in young adult and early onset colorectal cancer patients post-treatment: A ColoCare Pilot Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7017.