Assessment Period Research Articles

PD12 An audit of the photodynamic therapy service at the Birmingham Skin Centre

Abstract Photodynamic therapy (PDT) is licensed in the UK for treating at least one nonmelanoma skin cancer and premalignant lesions. The PDT is a service offered at our centre but is anecdotally underutilized with no up-to-date outcome measures. The aim was to audit the PDT service at the Birmingham Skin Centre against the 2018 British Association of Dermatologists and British Photodermatology Group PDT guidelines, and make recommendations for improvement. Retrospective data were gathered on consecutive patients treated with topical PDT between 12 March 2019 and 28 August 2022 at the Birmingham Skin Centre and compared with the recommended audit points in the national guidelines. A clinician survey was conducted to assess service awareness, satisfaction and referral process. Thirty-four patients received topical PDT during the specified time period; two patients were excluded from data analysis as the last treatment fell within the 3-month assessment period (n = 32). Differentiation between ambulatory and standard PDT was not recorded. Treatment was licensed in all cases (n = 32): actinic keratosis (AK; n = 18), squamous cell carcinoma (SCC; n = 7) in situ, superficial basal cell carcinoma (BCC; n = 4), nodular BCC (n = 1) and other (n = 2). Clearance assessment at 3 months was recorded in 21 of 32 cases; accounting for this, the clearance rate for AK, SCC in situ and superficial BCC at 3 months after last treatment was 52% (n = 11/21; guideline recommendation ≥ 75%). Eleven of 32 patients treated for SCC in situ and superficial BCC within the data set were due 12-month clearance assessment. Four of 11 patients had clearance assessment recorded. Accounting for this, the clearance rate for SCC in situ and superficial BCC at 12 months after last treatment was 50% (n = 2/4; guideline recommendation ≥ 75%). No patient had an individual pain-management plan documented. Patient satisfaction of the service was recorded in 9% (n = 3/32) of cases; of these, 67% (n = 2/3) of patients were ‘very satisfied’ and 33% ‘satisfied’. Patient satisfaction of cosmetic result was recorded in one case as ‘excellent’. The PDT was a popular treatment method among the clinicians surveyed. Some clinicians asked for PDT-based teaching. The general consensus supported online referrals and documentation. The PDT is used for licensed indications and popular with clinicians in our department. Clearance rates at 3 (52%) and 12 (50%) months are below the national guideline recommendation of 75%. Limited documentation across audit points limits interpretation of clearance rates, patient satisfaction and adverse effects. We plan to implement a new standardized digital referral and documentation system to improve the service.

Challenges of social change: The 2021 Republic of Slovenia report card on physical activity of children and adolescents

BackgroundSlovenian children are facing considerable health challenges from the rapid social changes that influence their opportunity to engage in daily physical activity. ObjectiveTo overlay the social changes to the established Report Card model as a means of contextualising the extreme changes in physical activity and fitness observed over several years. MethodsBenchmarks were graded for 10 core indicators, plus two (Sleep, Seasonal Variations). Active Healthy Kids Slovenia members met (predominantly via zoom) liaising with team leader(s) on a flexible, individual basis, based on coronavirus disease 2019 (COVID-19) regulations, over the ∼2-year assessment period of the project. Data were separated to the years prior to, ‘pre’ 2018–2020, and ‘during’ the global pandemic (2020–2021). Where sufficient data existed for both timeframes, grades were averaged to produce an overall grade. ResultsGrade results are expressed as pre/during/final grade, where the final grade (bolded) is a straight average of the two preceding time epochs: Overall Physical Activity (A-/A-/A-), Organized Sport and Physical Activity (C+/C/C), Active Play (D/C+/C), Active Transport (C/INC/C), Sedentary Behaviour (B/C/C+), Physical Fitness (A+/A-/A), Family and Peers (B+/INC/B+), Schools (A/A/A), Community and Environment (A+/A+/A+), Government (A/F/D), Sleep (D-/INC/D-), Seasonal Variations (D/C-/D+). ConclusionAlthough Slovenia has some of the most consistently physically-active children in the world, the effects of the COVID-19 pandemic exerted significant reductions in physical activity opportunities, and especially when coupled with funding re-distributions, resulted in the steepest decline of child physical fitness observed within the >35-year history of Slovenia's well-established national fitness surveillance system.

Seedling drought responses governed by root traits, site-soil moisture regimes and overstory competition-facilitation

Periodic drought may interact with spatially patterned soil moisture regimes, canopy disturbance and species seedling traits to influence tree regeneration processes in northern temperate forests. In northern Michigan, USA, we assessed the effects of regional upland soil moisture regimes (six sites classified from dry to mesic) and tree canopy shading (% light) on planted-seedling dry mass, probability of mortality and functional traits for eight tree species varying in shade tolerance and natural distribution over soil moisture gradients (i.e., drought tolerance): Quercus velutina, Quercus alba, Quercus rubra, Prunus serotina, Acer rubrum, Acer saccharum, Fraxinus americana, and Betula alleghaniensis. The assessment period included droughts during the seedlings’ 2nd and 3rd growing seasons. High mortality (especially on drier-classified sites and in more open, high-light environments) and negative associations of soil water minima with mortality collectively suggest drought-driven mortality across sites. In contrast, canopy shade driven mortality occurred only on mesic sites at <10 % light. Overstory canopies facilitated seedling survival relative to more open environments, with survival maxima ranging from 3 to 20 % light among sites. Among species, probability of survival was 1) highest for Quercus species (∼0.70) and lowest for B. alleghaniensis (0.10), 2) positively and generally associated with drought tolerance, but not associated with shade tolerance, and 3) positively and strongly associated with species seed-size related differences in total dry mass, root dry mass and rooting depth. In turn, rooting depth (range 3–68 cm) was positively related to seedling water status, and water status to survival during drought. In summary, site soil moisture regimes, facilitation vs. competition via variation in canopy density, and size-related species traits drove patterns of young seedling mortality during an interval that included droughts. Results suggests current drought regimes likely have strong influence on canopy composition across the region’s spatially patterned dry to mesic soil gradients, and may have larger impacts if drought intensifies with climate change. Our results can aid development of planting strategies for assisted migration and other emerging needs, including planting 1) species more drought adapted than those dominating current overstories, 2) large stock with well-developed root systems, and 3) in microsites that maximize canopy facilitation.

Rumination as a moderator for discrimination and blood pressure in older African American adults

Discriminatory experiences pose a threat to cardiovascular health. Rumination (i.e., repetitive thought) has been shown to exacerbate discrimination and various health aspects associated with cardiovascular disease risk, such as heart rate variability and sleep. This study extends existing literature by examining whether the relationship between discrimination and blood pressure is moderated by rumination. The sample was drawn from the Health Among Older Adults Living in Detroit (HOLD) study, which investigates psychosocial predictors of healthy aging and cardiometabolic health among African American (AA) adults. The study included two home visits and a five-day assessment period. Questions regarding rumination were collected each day during the daily assessment period and then averaged across days. Habitual discrimination was measured with the Everyday Discrimination Scale. Systolic (SBP) and diastolic blood pressure (DBP) were recorded at the second home visit. Participants included 210 older AA adults (M = 67.6 yrs., SD= 8.42). Rumination was a significant moderator between discrimination and SBP. Simple slopes revealed a significant negative association between discrimination and SBP at low levels of rumination (-1 SD) and a significant positive association between discrimination and SBP at +2 SD from average rumination. Findings from the present study indicate that the relationship between discrimination and SBP varies as a function of daily levels of rumination, in the form of a disordinal (or crossover) interaction. Future studies should corroborate these findings by considering trait levels of rumination and by investigating different facets of rumination (e.g., reflective and brooding).

Predicting anxiety and depression over 12 months of the COVID-19 pandemic: A machine learning study.

The coronavirus disease 2019 (COVID-19) pandemic was associated with substantial increases in anxiety and depressive symptoms. To understand individual risk, we examined a large set of potential risk factors for anxiety and depression in the pandemic context. Adults in the United States (N = 1200) completed eight online self-report assessments over 12 months of the COVID-19 pandemic. Area under the curve scores summarized cumulative experiences of anxiety and depression over the assessment period. A machine learning approach to elastic net regularized regression was used to select predictors of cumulative anxiety and depression severity from a set of 68 sociodemographic, psychological, and pandemic-related baseline variables. Cumulative anxiety severity was most strongly explained by stress and depression-related variables (such as perceived stress) and select sociodemographic characteristics. Cumulative depression severity was predicted by psychological variables, including generalized anxiety and depressive symptom reactivity. Being immunocompromised or having a medical condition were also important. By considering many predictors, findings provide a more complete view than previous studies focused on specific predictors. Important predictors included psychological variables suggested by prior research and variables more specific to the pandemic context. We discuss how such findings can be used in understanding risk and planning interventions.

Pulse rate variability: An alternative to heart rate variability in adults with spinal cord injury.

Pulse rate variability (PRV) is often used as an alternative to heart rate variability (HRV) to measure psychophysiological function. However, its validity to do so is unclear, especially in adults with spinal cord injury (SCI). This study compared PRV and HRV in adults with higher-level SCI (SCI-H, n = 23), lower-level SCI (SCI-L, n = 22), and able-bodied participants (AB n = 44), in a seated position as a function of performance in a reactivity task (Oxford Sleep Resistance Test: OSLER). PRV and HRV was measured using reflective finger-based photoplethysmography (PPG) and electrocardiography, respectively, at baseline, immediately post-OSLER, and after five-minute recovery. Agreement between PRV and HRV was determined by Bland-Altman analysis and differences between PRV and HRV over time by linear mixed effects model (LMM) analysis. Concurrent validity was assessed through correlation analyses between PRV and HRV. Additional correlation analyses were performed with psychosocial factors. Results indicated insufficient to moderate agreement between PRV and HRV. LMM analyses indicated no differences over time for standard deviation of normal-to-normal intervals and low-frequency power but significant differences for root mean square of successive differences and high frequency power. Nevertheless, PRV and HRV were highly correlated (Median r = .878 (.675-.990)) during all assessment periods suggesting sufficient concurrent validity. Similar correlation patterns were also found for PRV and HRV with psychosocial outcomes. While differences existed, results suggest PRV derived from reflective finger-based PPG is a valid proxy of HRV in tracking psychophysiological function in adults with SCI and could therefore be used as a more accessible monitoring tool.

Corrected numbers and assumptions for understanding MSC certified fishery withdrawals: Commentary on Pierucci et al.

Pierucci et al.’s 2022 paper titled “A global review of MSC certification: Why fisheries withdraw?” states that 96 % of fisheries leave the MSC program during the assessment period or first two years of certification. The authors suggest deficiencies in the pre-assessment process or “the high initial costs of certification” may explain the high rate of withdrawal during the assessment period. Our response highlights methodological flaws in their study that bias estimates of withdrawn fisheries by nearly two-fold and subsequently invalidate their conclusions relating to fisheries not yet certified. Here we provide a detailed understanding of the multiple, intersecting improvement pathways that a fishery might take before and after certification to help clarify which barriers to certification are most likely to be at play during different stages of engagement with a sustainable seafood certification scheme. We explore how these barriers vary for different types of fisheries and in geographies with different markets, including disproportionate challenges to sustainable fisheries management, and how global efforts are required to address these inequities.

First-in-human study of ZG19018, targeting KRAS G12C, as monotherapy in patients with advanced solid tumors.

e15127 Background: ZG19018 tablet is a selective KRAS G12C inhibitor that inhibits the activation of KRAS G12C and multiple downstream signaling pathways. It showed very promising anti-tumor effects in preclinical studies. Here we report the preliminary results from a phase 1 dose escalation study that assessed the tolerability, safety, pharmacokinetics and efficacy of ZG19018 in patients (pts) with advanced solid tumors. Methods: This is an open-label, multi-center study in pts with KRAS G12C mutated solid tumors and progressed following prior standard therapies. The study consisted of a rapid dose-escalation phase for the low-dose groups (50 mg qd and 150 mg qd, orally) and a standard 3+3 design phase for the high-dose groups (300 mg qd, 300 mg bid and 450 mg bid, orally). The first treatment cycle (21 days) was defined as the dose-limiting toxicity (DLT) assessment period. Patients could continue to receive ZG19018 until one of the treatment discontinuation criteria was met. Tumor response was assessed by the investigator per RECIST1.1 criteria. Pharmacokinetics profiles were also assessed in all pts. Results: As of January 31st, 2023, 14 pts (8 males and 6 females) completed the DLT assessments, with a median age of 65 years. Of them, 11 (78.6%) were non-small cell lung cancer (NSCLC) pts, 2 (14.3%) with colorectal cancer (CRC), and 1 (7.1%) with cervical cancer (CESC); 12 pts (85.7%) had received ≥ 1 line of stand therapies and 2 pts (14.3%) had received ≥ 3 lines. The dose group of 450 mg bid was determined as the maximally administered dose, where 2 pts experienced a DLT (grade 3 γ-GGT elevation and grade 3 ALT elevation, respectively), therefore an additional dose group of 400 mg bid has been added and is currently undergoing. Treatment-related adverse events (TRAEs) occurred in 13 pts (92.9%), most frequent in nausea (42.9%), diarrhea (42.9%), vomiting (35.7%), AST elevation (35.7%), γ-GGT elevation (35.7%), ALT elevation (28.6%), hypertriglyceridemia (28.6%), blood creatine phosphokinase MB elevation (21.4%) and ALP elevation (21.4%). No SAE was reported. In 12 pts evaluated for the best overall responses, 2 (16.7%) had PR (1 NSCLC, 1 CRC), 6 (50%) had SD (4 NSCLC, 1 CRC，1 CESC) and 4 (33.3%) had PD (4 NSCLC). The maximum drug exposure of ZG19018 is 8 months in 1 patient with colorectal cancer who is SD and remaining in the study. The Cmax and AUC0-t increased from 50 mg qd to 450 mg bid approximately in dose proportion. Conclusions: ZG19018 is tolerable and demonstrates a good safety under the dose level of 450 mg bid. It also demonstrates preliminary antitumor effects in pts with solid tumors, with reasonable PK profiles. Clinical trial information: ChiCTR20220296 .

Long-term outcomes of the livelihoods of displaced households after hydropower dam construction: A case study in Thua Thien Hue Province, Vietnam

Abstract Millions of people have been displaced and resettled worldwide to build hydroelectric dams. Most of the previous studies show that the livelihoods of the resettled people have been getting worse, but these studies have only been evaluated over a short time frame and only selected two-time periods for assessment, including before and after displacement. Few follow-up and evaluation studies have been conducted for periods longer than 10 years. Therefore, this study conducted a study that was long-term at a resettlement site for hydropower construction in Vietnam to observe the change in livelihoods over more than 12 years of the people that were resettled. Both quantitative and qualitative methods were used in the research to determine livelihood outcomes and to explain the causes of changes in livelihood pathways after resettlement. Our findings indicate that the loss of productive land for upland rice and dry crops was the greatest challenge for displaced households. Households which were headed by women, or those that were handicapped, were more susceptible to land loss. Displaced people also lost their traditional jobs and faced food insecurity because they did not have productive land for cultivating rice and cassava crops. As a result of this significant reduction in economic and food conditions, displaced households could not maintain their culture and religion, and the coherence of Bo Hon, the study village gradually decreased. However, displaced households made a faster recovery in income generation than other communities displaced by hydropower dams in Vietnam after 12 years. They could generate more income because they live near Hue city and receive strong support from local authorities. Through this study, it has been shown that the selection and arrangement of a suitable resettlement site with good access to the job market will be a prerequisite to help displaced households to adapt and develop their livelihoods after resettlement in conditions of limited access to natural resources.

The Declaration and Assessment Period for Estate Tax on Confiscated Property

The Declaration and Assessment Period for Estate Tax on Confiscated Property

Feasibility of frequent self‐administered mobile cognitive assessments in adults with and without cognitive impairment

AbstractBackgroundTraditional paper and pencil approaches measure cognitive performance at one time point. Early indications of cognitive impairment often appear irregularly, suggesting diagnoses derived from a single session can fail to characterize normal fluctuations and lead to inaccurate conclusions. Mobile applications enable brief cognitive assessments to be completed frequently and remotely. However, the feasibility of older adults adhering to a schedule of repeated self‐administered cognitive assessments is unclear. We tested the repeated use of a mobile assessment among older adults as a potential method for collecting cognitive performance data to detect early signs of cognitive impairment.MethodThe current study included 33 participants (n = 23 cognitively unimpaired, n = 10 cognitively impaired) recruited from the Boston University Alzheimer’s Disease Center. A remote practice session using the Digital Automated Neurobehavioral Assessment (DANA) mobile application was completed prior to beginning an assessment schedule consisting of three assessments within the first week (segment 1) and one assessment per week during the following three weeks (segment 2). Feasibility was measured via schedule adherence across segments, stratified by age and cognitive status. Cognitive efficiency, a derived measure of speed and accuracy, was compared for the Procedural Reaction Time (PRT) task at the first assessment and longitudinally across segments 1 and 2. Demographics including age, sex, race, education, and mobile device type were also collected (Table 1).ResultAcross all segments, 90.9% of participants adhered to the assessment schedule with a ±1 day grace period applied. Adherence was similar between each segment, and by cognitive status and age group (Table 2). No significant differences in cognitive efficiency were observed on the PRT task between cognitive groups (Figures 1‐2, Table 3).ConclusionOur findings suggest that older adults, including those with cognitive impairment, are capable of completing self‐administered remote smartphone assessments at a high‐frequency. Traditional analytic methods failed to differentiate cognitive groups based on mean cognitive performance; however, between‐group comparisons could mask within‐person fluctuations characteristic of cognitive impairment. Therefore, further study with a longer longitudinal assessment period and larger sample size will be required to determine whether more advanced analyses can distinguish impairment status based on cognitive performance patterns.

Phase 2 trial of zolbetuximab in combination with mFOLFOX6 and nivolumab in patients with advanced or metastatic claudin 18.2-positive, HER2-negative gastric or gastroesophageal junction adenocarcinomas.

TPS4173 Background: Zolbetuximab, a chimeric immunoglobulin G1 monoclonal antibody, binds to claudin 18.2 (CLDN18.2) and mediates tumor cell death through antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity. In the pivotal phase 3 SPOTLIGHT study, zolbetuximab with modified FOLFOX6 (mFOLFOX6; leucovorin [folinic acid], fluorouracil [5-FU], and oxaliplatin) significantly prolonged progression-free survival (PFS) and overall survival (OS) in patients with CLDN18.2-positive, HER2-negative gastric and gastroesophageal junction (G/GEJ) adenocarcinomas. The phase 2 ILUSTRO trial is investigating the efficacy and safety of zolbetuximab, alone and in multiple combinations, in patients with CLDN18.2-positive, HER2-negative advanced/metastatic G/GEJ adenocarcinomas. Methods: The ILUSTRO trial is enrolling two new cohorts, 4A (safety cohort) and 4B, with approximately 12 and 50 patients planned, respectively, to assess safety and efficacy of the first-line combination of zolbetuximab, mFOLFOX6, and nivolumab in G/GEJ adenocarcinomas. Both cohorts are enrolling patients whose tumors are HER2-negative with high or intermediate CLDN18.2 positivity (moderate to strong immunohistochemistry staining intensity in ≥75% of tumor cells [high] or ≥50% but &lt;75% of tumor cells [intermediate]). In Cohort 4A, patients will receive a loading dose of 800 mg/m2 of zolbetuximab with 240 mg of nivolumab and mFOLFOX6 on cycle 1 day 1, followed by 400 mg/m2 of zolbetuximab with 240 mg of nivolumab and mFOLFOX6 every 2 weeks (on days 15 and 29 of each 42-day cycle). Up to 12 mFOLFOX6 treatments (4 cycles) will be administered; patients may continue to receive folinic acid and 5-FU alongside zolbetuximab and nivolumab. Tolerability and safety of the combination of zolbetuximab, mFOLFOX6, and nivolumab will be evaluated during a 2-week dose-limiting toxicity assessment period. If the 800 mg/m2 loading dose of zolbetuximab was assessed as not tolerable, patients were to be de-escalated to 600 mg/m2 as their loading dose but received the same subsequent 400 mg/m2 doses of zolbetuximab every 2 weeks. Cohort 4B will receive this combination at the dose level determined in Cohort 4A. Efficacy endpoints include objective response rate, disease control rate, duration of response, PFS, and OS. Safety and tolerability, pharmacokinetics, immunogenicity, and health-related quality of life will also be evaluated. Currently, 20+ sites are recruiting in 6 countries (France, Italy, Japan, Korea, Taiwan, United States); more US sites are planned. Clinical trial information: NCT03505320 .

Effect and safety of combining bevacizumab and fractionated stereotactic radiotherapy for brain metastases in patients with non-small cell lung cancer: A phase II trial.

e21132 Background: W e aimed to assess the efficacy and safety of c ombining b evacizumab and fractionated stereotactic radiotherapy ( FSRT ) for brain metastases (BMs) in non-small cell lung cancer ( NSCLC ) patients with stable extracranial disease status in this study. Methods: NSCLC patients with BMs were recruited between J anuary 20 20 and J anuary 202 2 . P atients were assigned to receive FSRT of 40Gy in 10 fractions (BED 56eGy) or 30Gy in 5 fractions (BED 48eGy). Meanwhile, bevacizumab was administered before FSRT (d1) and after FSRT (d21) with a dosage of 7.5mg/Kg. The primary endpoint of the study is intra-cranial progression-free survival (IPFS) . The secondary endpoints contained overall survival (OS), progression-free survival (PFS) , quality of life (QOL) score and toxicities. All time-to-event endpoints (IPFS, OS and PFS) were measured from the end of radiotherapy. Results: From J anuary 2020 and J anuary 202 2, 108 patients were recruited with a median follow-up duration was 15.2 months . The 1-year IPFS and OS rate were 82.9% ( 95% confidence interval (CI), 79.6%-86.2% ) and 80.4% ( 95% CI, 76.8%-84.0% ), respectively . The median PFS was 15.0 months ( 95% CI, 9.50-20.50 months ). The median IPFS and OS had not been reached at the time of the last follow-up. The treatment-related toxicities were mild with low incidence. Reversible mild hypertension and cerebral radio-necrosis were observed in 2 and 1 patients, respectively. No signs of ex tra-lesional haemorrhage and progression of peri-lesional oedema was found during the assessment period of treatment response. More importantly, significant improvent of QOL was observed in symptomatic patients. Conclusions: The combination of FSRT with bevacizumab in patients with NSCLC was well tolerated and achieved promising intracranial disease control. Patients maintained satisfactory QOL after receiving the combined regimen with low incidence of cerebral radio-necrosis. Clinical trial information: NCT04345146 .

0147 Does Sleep Regularity Link Child Maltreatment to Depressive Symptoms among Incoming First-Year College Students?

Abstract Introduction Sleep patterns may partially account for associations between early life adversity and poor health outcomes; however, few studies have empirically tested this hypothesis. We examined whether an index of sleep regularity mediated associations between child maltreatment (CM) and depression symptoms among emerging adults undergoing the major life transition of starting college. Methods First-year college students (N=731; 41% male; 48% Non-Hispanic White, 21% Non-Hispanic Asian, 15% Hispanic all races, 5% Non-Hispanic Black, and 11% Non-Hispanic other races) completed daily sleep diaries (DSDs) for 9 weeks and completed the Childhood Trauma Questionnaire (CTQ) and Center for Epidemiologic Studies Depression Scale (CES-D) following DSD completion. DSD data were used to compute participants’ Sleep Regularity Index (SRI). We used a nonparametric SEM bootstrap approach to examine whether sleep regularity mediated associations between childhood trauma and depressive symptoms, controlling for sex, race/ethnicity, and US vs. international status. Separate models were run for CTQ total score and five CTQ subscale scores: emotional, physical, and sexual abuse, and physical and emotional neglect. Results The prevalence of moderate to severe CM was 20.7%, and 40% reported clinically significant depressive symptoms at the end of the assessment period. Significant indirect effects of CTQ total score (estimate=0.02, 95% CI=0.003, 0.036); emotional abuse (0.06 [0.004, 0.107]); physical abuse (0.08 [0.003, 0.164]); sexual abuse (0.06 [0.014, 0.114]); emotional neglect (0.04 [0.002, 0.075]) on greater depression symptoms through lower sleep regularity were observed; and we saw no significant indirect effect of physical neglect (0.04 [-0.015, 0.089]). The percentage of the total effect of CM (i.e., CTQ total score and subscale scores) on greater depressive symptoms accounted for by lower sleep regularity were CTQ total score: 6%; physical abuse: 24%; sexual abuse: 19%; emotional abuse: 7%; and emotional neglect: 5%. Conclusion Variable sleep patterns account, in part, for associations between CM and depressive symptoms among first-year college students, with the largest effects observed for physical and sexual abuse. Sleep regularity should be included as a target in student health interventions on college campuses and may help buffer against poor mental health outcomes for students with CM. Support (if any) P20GM139743, MH079179, T32HD101392, P20GM139767.

Intra- and inter-observer reliability of Dias-Tachdjian classification in pediatric ankle fractures: do clinical experience and expertise matter?

The Dias-Tachdjian classification is the most commonly used system for the classification of pediatric ankle fractures, but its inter- and intra-observer reliability has not been studied in detail. Also, the impact of the clinician's experience and expertise on the reliability of this system is unknown. This study aimed: (1) to determine the intra- and inter-observer reliability of the Dias-Tachdjian classification and (2) to investigate the effect of the clinician's experience and expertise on the reliability of this system. Anteroposterior and lateral ankle radiographs of 56 children (34 male, 22 female) with ankle fractures, aged between 3 and 14 years, with open growth cartilages, were retrospectively identified and included in the study. Each patient radiograph was examined by 10 observers from two different specialties with different levels of clinical experience (two orthopedic surgeons with interest in pediatric orthopedics, three orthopedic surgeons with no interest in pediatric orthopedics, three orthopedic residents, and two radiology specialists) from two different specialties (orthopedics and radiology). All observers were then asked to classify pediatric ankle fractures at 6-week intervals per the Dias-Tachdjian classification system. Overall, intra-observer reliability as substantial to very good (κ = 0.77-0.95, P < 0.01), but inter-observer reliability as fair for both assessments (κ = 0.21, P < 0.01 and κ = 0.20, P < 0.01 for the first and second occasions, respectively). Inter-observer reliability among pediatric orthopedic surgeons as very good (κ = 0.90, 95% CI = 0.86-0.94, P < 0.01 and κ = 0.82, 95% CI = 0.71-0.93, P < 0.01 for the first and second occasions, respectively). Orthopedic surgeons with no special interest in pediatric orthopedics demonstrated substantial agreement in the first occasion (κ = 0.63, 95% CI = 0.53-0.72, P < 0.01) but moderate in the second one. Orthopedic residents exhibited moderate levels of agreement in each assessment period (κ = 0.58, 95% CI = 0.47-0.68, P < 0.01 and κ = 0.44, 95% CI = 0.37-0.51, P < 0.01 for the first and second occasion, respectively). Considering that the specialists dealing with pediatric orthopedics show very good consistency for Dias-Tachdjian classification, both within and between observers, consistency in the identification of the ankle fracture models increases as the interest in the field of pediatric orthopedics intensifies.

A prospective study of the impact of COVID-19-related restrictions on activities and mobility upon physical activity, travel behaviour and attitudes

Background and aimsPublic health measures adopted to contain the spread of COVID-19 included restrictions on activities and mobility as people were asked to stay at home and schools moved to online learning. This may have increased risk of non-communicable disease by limiting recreational and transport-related physical activity. Building on an existing study, we assessed changes in self-reported and device-measured physical activity and travel behaviour before, during and after the peak of local COVID-19 outbreak and restrictions (March–July 2020). We examined beliefs in effectiveness of strategies to increase active and public transport after restrictions were reduced. MethodsA longitudinal study of adult infrequent bus users (average ≤ 2 trips per week; n = 70; 67% women) in Hobart, Australia. One-week assessment periods at four separate timepoints (before, during, 0–3 months after, and 3–6 months after the peak restrictions period) involved wearing an accelerometer, daily transport diaries, online surveys and tracking bus smartcard boardings. ResultsPhysical activity (especially among older participants), bus use and private motor vehicle use declined significantly during or 0–3 months after the peak restrictions period and returned to pre-restrictions levels by 3–6 months after the peak restrictions period, except bus use which remained significantly lower. Retrospective surveys overstated declines in bus use and active transport and self-reports understated declines in physical activity. Social distancing and improving service efficiency and frequency were seen as effective strategies for increasing bus use after restrictions but belief in effectiveness of distancing decreased over time. ConclusionsWhen restrictions on mobility are increased, supportive health promotion measures are needed to prevent declines in physical activity, particularly for older adults. Public transport systems need capacity to implement temporary distancing measures to prevent communicable disease transmission. Providing convenient, flexible, and efficient options for public transport may help to replenish public transport use after restrictions are reduced.

Comparison between the Effects of Allopurinol and Febuxostat on the Survival of Patients on Maintenance Hemodialysis

Introduction: There were insufficient pieces of evidence regarding the effect of the two drugs (allopurinol and febuxostat) on patient survival in hemodialysis (HD) patients. Herein, we aimed to compare the efficacy of uric acid-lowering drugs (ULDs) or the type of the drug on patient survival using a representative sample of maintenance HD patients in South Korea. Methods: This study used data from a national HD quality assessment program and the claims data. Use of ULDs was defined as more than one prescription during the 6 months of each HD quality assessment period. The patients were divided into three groups. Patients who were not prescribed allopurinol or febuxostat were included in group 1 (n = 43,251); patients who were prescribed allopurinol were included in group 2 (n = 9,987); and patients who were prescribed febuxostat were included in group 3 (n = 2,890). Results: Kaplan-Meier curves showed that the survival rate was greatest in group 3 and worst in group 1 among the three groups. Multivariable analysis showed that group 2 had better patient survival compared to group 1; however, there was no significant difference in patient survival between groups 2 and 3. In addition, patients with hyperuricemia or gout had better patient survival compared to those without these diseases. Conclusions: Our study showed that survival in patients receiving ULDs was not inferior to that of those not receiving ULDs. Patient survival between patients on HD receiving allopurinol and those receiving febuxostat was similar.

In what settings and social contexts do young adults vape or smoke cannabis? Findings from a web-based diary pilot study

BackgroundVaping is an increasingly common mode of cannabis use among young adults. Despite potential to inform targeted prevention, settings and social contexts where young adults vape and/or smoke cannabis have rarely been investigated. We addressed this question in a diverse young adult sample. MethodsData were collected weekly in a web-based daily diary format for six weeks. The analytic sample consisted of the 108 participants (of the 119 enrolled) who used cannabis during the assessment period (mean age = 22.06; 23.78% college students; 65.74% female; 5.56% Asian, 22.22% Black, 16.67% Latinx, 2.78% Multi-racial or Other and 52.77% White). Cannabis use was queried separately for vaping and smoking; respondents reported all settings (14 options) and social contexts (7 options) where they used. ResultsFor both vaping and smoking cannabis, the most common settings were home (vaping: 56.97%, smoking: 68.72% [significantly lower for vaping]), friend’s home (vaping: 22.49%, smoking: 21.49%), and car (vaping: 18.80%, smoking: 12.99%). The most common social contexts were with friends (vaping: 55.96%, smoking: 50.61%), with significant other (vaping: 25.19%, smoking: 28.53%), and alone (vaping: 25.92%, smoking: 22.62%). Compared to non-students, college students reported vaping on a significantly higher proportion (27.88% vs. 16.50%) of cannabis use days. ConclusionsVery similar patterns in settings and social contexts were observed for vaping as smoking and in prevalence of vaping and smoking cannabis across demographic groups. The few notable exceptions have implications for vaping related public health measures: targeting reducing vaping outside the home, particularly in cars, and implementing prevention programming on college campuses.

Mobile Acceptance and Commitment Therapy With Distressed First-Generation College Students: Microrandomized Trial

Extant gaps in mental health services are intensified among first-generation college students. Improving access to empirically based interventions is critical, and mobile health (mHealth) interventions are growing in support. Acceptance and commitment therapy (ACT) is an empirically supported intervention that has been applied to college students, via mobile app, and in brief intervals. This study evaluated the safety, feasibility, and effectiveness of an ACT-based mHealth intervention using a microrandomized trial (MRT) design. Participants (N=34) were 18- to 19-year-old first-generation college students reporting distress, who participated in a 6-week intervention period of twice-daily assessments and randomization to intervention. Participants logged symptoms, moods, and behaviors on the mobile app Lorevimo. After the assessment, participants were randomized to an ACT-based intervention or no intervention. Analyses examined proximal change after randomization using a weighted and centered least squares approach. Outcomes included values-based and avoidance behavior, as well as depressive symptoms and perceived stress. The findings indicated the intervention was safe and feasible. The intervention increased values-based behavior but did not decrease avoidance behavior. The intervention reduced depressive symptoms but not perceived stress. An MRT of an mHealth ACT-based intervention among distressed first-generation college students suggests that a larger MRT is warranted. Future investigations may tailor interventions to contexts where intervention is most impactful. ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/show/NCT04081662. RR2-10.2196/17086.

Comparing the physical and mechanical properties of different biocompatible three-dimensional resin materials in possible use of dental appliances: An in vitro study.

This study aimed to assess the colour stability, water sorption, microhardness and water contact angle of two different 3D printing systems (SLA and DLP) in a possible use of producing paediatric and orthodontic dental appliances. SLA and DLP printer systems produced a total of 160 disk samples with a diameter of 15.00 mm and a height of 2.00 mm. Colour changes of 64 samples were assessed in distilled water, coffee, coke and cherry juice and Vicker's microhardness tests were also conducted. Solubility and water sorption were held following the water contact angle assessment. Statistical analyses were performed using the SPSS software. Mann-Whitney-U test, Friedman test and Bonferroni post hoc Multiple Comparison Test were performed. In DLP and SLA groups, coffee had a statistically significant colouring effect regarding the assessment periods (P = .001, 20.09 ± 2.96, 22.09 ± 3.51, respectively), and the discolouration effect of coffee was higher in the SLA group at all endpoints (P < .05). At the same time, DLP was more affected by coke solution in T0-T1 and T0-T7 (P < .05). The values of water sorption showed statistically significant differences in the group of DLP compared to the SLA (P = .01, 121.11 ± 10.54, 92.78 ± 8.70, respectively). No statistical significance was detected between the solubility values and water contact angle of SLA and DLP groups. The SLA printer's microhardness values revealed statistically significantly higher values than the DLP group (P = .001) and a decrease was detected following the immersion period in the microhardness values of the SLA group (P = .022). The compared groups exposed to staining solutions revealed colour changes above the clinically acceptable values at all periods (ΔE00 = 2.25).