Time Point 1 Research Articles

Performance of Next Generation Sequencing for Minimal Residual Disease Detection for Pediatric Patients with Acute Lymphoblastic Leukemia: Results from the Prospective Clinical Trial DFCI 16-001

Performance of Next Generation Sequencing for Minimal Residual Disease Detection for Pediatric Patients with Acute Lymphoblastic Leukemia: Results from the Prospective Clinical Trial DFCI 16-001

Low-level laser therapy (LLLT) improves alveolar bone healing in rats.

The main objective of the present study was to evaluate the effect of low-level laser therapy (LLLT) in enhancing bone healing in irradiated alveolus post-tooth extraction. Sixty male Wistar rats (180 ± 10g) were used in the present study. The left maxillary first molars were extracted, and the alveolar region was irradiated by diode laser device (GaAlAs) immediately after extraction and for more 3-day daily applications. The animals were randomly assigned into two groups: control group (n = 30, with left maxillary molar extraction-CG) and experimental group (n = 30, with tooth extraction and low-level laser therapy applied to the dental alveolus for 42s-EG). These groups were divided into subgroups (five rats per subgroup) according to the observation time point-1, 2, 3, 5, 7, and 10days-post-tooth extraction. The maxillary bone was separated, and the specimens were stained with hematoxylin and eosin, Masson's trichrome, and picrosirius red and immunohistochemistry for RUNX-2. Parametric and nonparametric tests were used with a significance level of 5%. LLLT accelerated bone healing with mature collagen fiber bundles and early new bone formation. Histomorphometric analysis revealed an increase of osteoblast (RUNX-2) and osteoclast (TRAP) activity and in the area percentage of cancellous bone in the lased alveolus compared to the control group. This increase was statistically significant (p < 0.05). Application of LLLT with a GaAlAs diode laser device enhanced bone healing and mineralization on alveolar region.

Mindsets predict physical activity and management strategies in individuals with knee osteoarthritis

Mindsets predict physical activity and management strategies in individuals with knee osteoarthritis

Progression of Visual Pathway Degeneration in Primary Open-Angle Glaucoma: A Longitudinal Study.

Background: Primary open-angle glaucoma (POAG) patients exhibit widespread white matter (WM) degeneration throughout their visual pathways. Whether this degeneration starts at the pre- or post-geniculate pathways remains unclear. In this longitudinal study, we assess the progression of WM degeneration exhibited by the pre-geniculate optic tracts (OTs) and the post-geniculate optic radiations (ORs) of POAG patients over time, aiming to determine the source and pattern of spread of this degeneration.Methods: Diffusion-weighted MRI scans were acquired for 12 POAG patients and 14 controls at two time-points 5.4 ± 2.1 years apart. Fiber density (FD), an estimate of WM axonal density, was computed for the OTs and ORs of all participants in an unbiased longitudinal population template space. First, FD was compared between POAG patients and the controls at time-point 1 (TP1) and time-point 2 (TP2) independently. Secondly, repeated measures analysis was performed for FD change in POAG patients between the two time-points. Finally, we compared the rate of FD change over time between the two groups.Results: Compared to the controls, POAG patients exhibited significantly lower FD in the left OT at TP1 and in both OTs and the left OR at TP2. POAG patients showed a significant loss of FD between the time-points in the right OT and both ORs, while the left OR showed a significantly higher rate of FD loss in POAG patients compared to the controls.Conclusions: We find longitudinal progression of neurodegenerative WM changes in both the pre- and post-geniculate visual pathways of POAG patients. The pattern of changes suggests that glaucomatous WM degeneration starts at the pre-geniculate pathways and then spreads to the post-geniculate pathways. Furthermore, we find evidence that the trans-synaptic spread of glaucomatous degeneration to the post-geniculate pathways is a prolonged process which continues in the absence of detectable pre-geniculate degenerative progression. This suggests the presence of a time window for salvaging intact post-geniculate pathways, which could prove to be a viable therapeutic target in the future.

The Impact of Dragon Boating on Fatigue for Breast Cancer Survivors

Background: Fatigue following treatment for breast cancer has a profound impact on quality of life. Dragon boating is known to be beneficial because of its networking and social function. Objective: The objective of this study was to explore the effects of dragon boating on fatigue and health related quality of life. Intervention/Methods: Individual and Family Self-Management Theory guided the study. The methodology was a multiple point cohort panel design. Data were collected from breast cancer survivors (n=26) to measure fatigue, quality of life and upper arm functioning at the beginning of the racing season timepoint 1 (T1), midway through the programme, timepoint 2 (T2), and at the end of the dragon boat season, timepoint 3 (T3). Results: Fatigue levels fell significantly between T1and T2 (p&lt;.033) and from T2 to T3 (p&lt;.048). Similarly, upper limb functioning improved from T1 to T2 (p&lt;.002), but showed no significant change between T2 andT3 (p&lt;.58). Fatigue was significantly related to quality of life at each time point. Conclusion: While this was a small scale study, the findings suggest that dragon boating appears to have beneficial effects on well-being including reduction of fatigue, which impacts on health related quality of life for women post breast cancer. Implications for Practice: This study confirms the benefits of dragon boating in upper limb functioning and reduction of fatigue. Health care professionals could advise cancer survivors on the benefits of dragon boating exercise, post cancer treatment.

Real-World Patient-Reported Outcomes and Glycemic Results with Initiation of Control-IQ Technology.

Background: The t:slim X2™ insulin pump with Control-IQ™ technology, an advanced hybrid closed-loop system, became available in the United States in early 2020. Real-world outcomes with use of this system have not yet been comprehensively reported.Methods: Individuals with type 1 diabetes (T1D) (≥14 years of age) who had ≥21 days of pump usage data were invited via email to participate. Participants completed psychosocial questionnaires (Technology Acceptance Scale [TAS], well-being index [WHO-5], and Diabetes Impact and Devices Satisfaction [DIDS] scale) at timepoint 1 (T1) (at least 3 weeks after starting Control-IQ technology) and the DIDS and WHO-5 at timepoint 2 (T2) (4 weeks from T1). Patient-reported outcomes (PROs) and glycemic outcomes were reviewed at each timepoint.Results: Overall, 9,085 potentially eligible individuals received the study invite. Of these, 3,116 consented and subsequently 1,435 participants completed questionnaires at both T1 and T2 and had corresponding glycemic data available on the t:connect® web application. Time in range was 78.2% (70.2%–85.1%) at T1 and 79.2% (70.3%–86.2%) at T2. PROs reflected high device-related satisfaction and reduced diabetes impact at T2. Factors contributing to high trust in the system included sensor accuracy, improved diabetes control, reduction in extreme blood glucose levels, and improved sleep quality. In addition, participants reported improved quality of life, ease of use, and efficient connectivity to the continuous glucose monitoring system as being valuable features of the system.Conclusions: Continued real-world use of the t:slim X2 pump with Control-IQ technology showed improvements in psychosocial outcomes and persistent achievement of recommended TIR glycemic outcomes in people with T1D.

COVID-19-related social support service closures and mental well-being in older adults and those affected by dementia: a UK longitudinal survey

BackgroundThe COVID-19 pandemic has had a major impact on delivery of social support services. This might be expected to particularly affect older adults and people living with dementia (PLWD), and...

Geriatric assessment-driven interventions among hospitalized older adults with cancer (GAIN-HOSP): A prospective pilot study.

52 Background: Older adults with cancer often have age-associated vulnerabilities and challenges, especially during hospitalization. Geriatric assessment (GA) can help identify such vulnerabilities, generate recommendations, and guide the choice of interventions. Recently, GA-driven interventions have been shown to decrease chemotherapy toxicity among older adults with cancer in the outpatient setting. However, few studies have examined its role in the inpatient setting. Our purpose was to evaluate the feasibility of GA-driven interventions among hospitalized older adults with cancer. Methods: Hospitalized patients, age 75+, with a solid tumor malignancy were eligible. Each patient completed a GA while hospitalized at T1 (Timepoint 1) and one-month post discharge T2 (Timepoint 2). An Advanced Practice Nurse (APN) reviewed the T1 GA, provided targeted care utilizing GA results and implemented interventions based on predefined triggers built into the GA’s various domains. An APN also completed follow-up visits by phone at 1 week and 1 month post discharge. The primary outcome was feasibility, defined as the percentage of participants who received GA-guided interventions and was pre-specified as successful if &gt; 80% were given recommendations. A secondary outcome of the study was to capture unplanned readmissions within 1 month post discharge. Results: Between 9/19/2017 and 5/3/2019, 49 patients were eligible and 40 were enrolled, an 82% participation rate. The median age was 80.5 years (range 75-88), 58% male, 63% Non-Hispanic white, 18% Hispanic, 15% Asian, 70% &gt; a high school education, 73% married/partner, and 48% had stage IV cancer. Most common cancer types: GI (28%), GU (23%), lung (20%). All 40 patients (100%) had ≥ 1 predefined trigger in the GA generating interventions and completed ≥ 2 follow-up visits with the APN. In total, 857 interventions were recommended, and the mean number of interventions generated per patient was 11. The top 4 interventions were Occupational Therapy/Physical Therapy (n = 66), Social Work (n = 52), Nutrition (n = 39), and Pharmacy (n = 36). Overall 89% of GA-guided interventions were implemented. Unplanned hospital readmission was low with only one patient readmitted within 30 days (3%). Conclusions: Among hospitalized adults over age 75 with cancer, using GA to identify vulnerability, and provide GA-driven multidisciplinary interventions is feasible. Further studies are warranted to examine the impact of GA-driven interventions on outcomes among hospitalized older adults with cancer.

AB1103 AUTOMATIC FINGER JOINT BONE EROSION SCORE PREDICTION CONSIDERING 2-TIME-POINT X-RAYS OF PATIENTS WITH RHEUMATOID ARTHRITIS BY DEEP LEARNING

Background:Medical image analysis using deep learning (DL) has been attracting attention. In previous research, we proposed a DL method for detection of joint region and evaluation for bone destruction at a single point in time in hand X-rays of patients with rheumatoid arthritis (RA) [1-2]. However, in the score of van der Heijde-modified total Sharp scores (mTSS) in X-rays, it is difficult to apply the method as it is. In mTSS, score difference between 2-time points is important, and there is a problem that the score at each time varies depending on the doctor who evaluates.Objectives:We aimed at developing an mTSS scoring method considering 2-time-point difference with a DL method.Methods:A total of 104 X-ray image sets of both hands at two time points with an interval of ≥1 year were randomly obtained from patients with RA who had visited our clinic in 2015. Well-trained doctors determined the erosion scores of MP and PIP/IP joints of each hand in X-rays according to mTSS. These evaluations of hand joints were performed using our developed annotation software tool. In the learning phase, joint images were randomly divided into five sets for 5-fold cross-validation. We utilized a convolutional neural network model, such as SSD [3], for detecting joint regions and classifying the scores (Fig 1).Figure1.The models for classification were designed in consideration of the difference in erosion scores of each patient between the 2-time points of X-rays. The loss function of the DL model was defined bellow;SCE: softmax cross entropyMSE: mean squared errort: training datay: output of DL model0: the former time point1: the latter time pointT: transpose of matrixHere, the coefficient γ is designed to reduce the error for another set of scores with equal differences. The first term of the loss function works to optimize the score at each time point, and the second term works to optimize the score difference at both time points. Thus, our method can be trained without being affected by characteristic training data.Results:The number of joints with differences in erosion score between the former and latter time points was 1 (-2 points), 9 (-1), 2015 (0), 32 (+1), 17 (+2), and 6 (+3). There were no joints with score changes of -5, -4, -3, +4, and +5 points.As a performance of predicting the difference in erosion score between the 2-time points of each patient’s X-ray, our models presented a mean error of 0.412 per each joint in one set for 5-cross validation as compared with physicians’ evaluation (Fig 2).Figure 2.Conclusion:Our DL-based models to predict hand joint erosion scores in X-rays were developed with relatively small samples. This suggests that the predictive performance may increase by collecting more training dataset. Next, we will apply our method to the prediction of joint space narrowing score.

Serum alarmin S100A8/S100A9 levels and its potential role as biomarker in myocarditis.

AimsThe alarmin S100A8/S100A9 (S100A8/A9) is released by activated monocytes/macrophages and neutrophils in the setting lymphocytic myocarditis (MC). We recently demonstrated its therapeutic potential in experimental acute MC. Now, we investigated the diagnostic relevance of S100A8/A9 serum levels in patients with suspected acute and chronic MC and in patients with heart failure without cardiac inflammation.Methods and ResultsSerum S100A8/A9 levels were analysed in patients with a recent onset of MC [≤ 30 days, n = 32; ejection fraction (EF): 45.4 ± 12.9%], dilated cardiomyopathy patients with inflammation (n = 112; EF: 29.0 ± 11.4%), or without inflammation (n = 58; EF: 26.6 ± 9.3%), and controls (n = 25; EF: 68.5 ± 4.6%), by using specific ELISAs. Blood samples were collected at Time Point 1 (T1), where also endomyocardial biopsies (EMBs) were withdrawn. Patients with a recent onset of MC showed a 4.6‐fold increase in serum S100A8/A9 levels vs. controls (MC: 1948 ± 1670 ng/mL vs. controls: 426 ± 307 ng/mL; P < 0.0001). Serum S100A8/A9 correlated with the disease activity, represented by EMB‐derived counts of inflammatory cells (CD3: r = 0.486, P = 0.0047, lymphocyte function‐associated antigen‐1: r = 0.558, P = 0.0009, macrophage‐1 antigen: r = 0.434, P = 0.013), the EMB mRNA levels of S100A8, S100A9 (r = 0.541, P = 0.002), and left ventricular ejection fraction (LVEF: r = 0.498, P = 0.0043). EMB immunofluorescence co‐stainings display macrophages/monocytes and neutrophils as the main source of S100A8 and S100A9 in recent onset MC. The diagnostic value of serum alarmin levels (cut‐off 583 ng/mL) was characterized by a specificity of 92%, a sensitivity of 90.6%, positive predictive value of 93.5%, negative predictive value of 88.5%, and an accuracy of 0.949 (95% confidence interval [0.89–1]). In a subgroup of MC patients, S100A8/A9 serum levels and EMBs at T1 (n = 12) and a follow‐up visit (T2, n = 12, mean follow‐up 8.5 months) were available. A fall of serum S100A8/A9 (T1: 2208 ± 1843 ng/mL vs. T2: 888.8 ± 513.7 ng/mL; P = 0.00052) was associated with a reduced cardiac inflammation (CD3 T1: 70.02 ± 107.4 cells per square millimetre vs. T2: 59.18 ± 182.5 cells per square millimetre; P = 0.0342, lymphocyte function‐associated antigen‐1 T1: 133.5 ± 187.1 cells per square millimetre vs. T2: 74.12 ± 190.5 cells per square millimetre; P = 0.0186, and macrophage‐1 antigen T1: 132.6 ± 129.5 cells per square millimetre vs. T2: 54.41 ± 65.16 cells per square millimetre; P = 0.0015). Serum S100A8/A9 levels were only slightly increased in patients within the chronic phase of MC and in heart failure patients without inflammation vs. controls.ConclusionsSerum S100A8/A9 might serve as an additional tool in the diagnostic workup of suspected acute MC patients.

RTHP-43 (LTBK-02). MULTI-TIME POINT EVALUATION OF PERIPHERAL BLOOD MYELOID-DERIVED SUPPRESSOR CELL AND LYMPHOCYTE POPULATIONS IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA RECEIVING ADJUVANT THERAPY

Abstract Alterations in peripheral blood cell populations, including myeloid cell subsets and lymphocytes, have been associated with poor prognostic outcomes in patients with glioblastoma (GBM). To date, evaluation of these populations has largely been on freeze-thawed samples at a limited number of time points. The purpose of our study is to identify the frequency and activation status of tumor-supportive myeloid and lymphocyte subsets during the course of standard adjuvant therapy in patients with GBM in fresh peripheral blood samples. We hypothesize that dysfunctional myeloid and lymphocyte populations expand during standard care temozolomide (TMZ)/radiation therapy (RT). We prospectively enrolled 16 patients with a new diagnosis of GBM that underwent maximal safe surgical resection. Twelve received standard adjuvant therapy consisting of six weeks of TMZ/RT. Four received alternative therapies: one experimental chemotherapeutic/three alternative radiation schemes. Peripheral blood was obtained seven times over the course of adjuvant therapy: prior to starting adjuvant therapy, five during treatment, and once one month after completion of therapy. Eleven patients completed all seven time points. Peripheral blood samples were analyzed by flow cytometry, focusing on immune checkpoints and critical markers of activation of systemic immunity. Available preliminary data demonstrate a median increase of 2.1% (-21.2–27.4%) in the frequency (%fx) of myeloid-derived suppressor cells (MDSC) after commencement of adjuvant therapy at time point 2 (TP2), compared to baseline. To date, 7/16 patients are alive and without evidence of recurrent disease on imaging. The majority of these patients had a decrease in %fx of MDSC at TP2, after starting adjuvant therapy, compared to baseline. The %fx of CD8+ T cells was greatest at TP7 (range: 21.7%-67.0%), one month after TMZ/RT, for most patients. PD-1 and FOXP3 expression by lymphocytes was variable across time points, suggesting the importance of additional factors which will be explored through future analyses. These early findings suggest that the immune response changes throughout the course of TMZ/RT. An understanding of these changes in the peripheral blood, termed immunodynamics in the context of our studies, may be valuable future tool to aid in optimizing immunity in patients with GBM.

QUANTITATIVE PROFILING OF OXYLIPINS IN PATIENTS PRESENTING WITH ST ELEVATION MYOCARDIAL INFARCTION (STEMI)

Previous studies have shown that there is persistent oxidative stress after myocardial infarction (MI) and percutaneous coronary intervention (PCI). Oxylipins are lipid oxidation products that can be generated mainly by enzymatic oxidation through cyclooxygenase (COX), lipoxygenase (LOX) and cytochrome P450 (CYP P450) pathways. The aim of this study was to profiling oxylipins before and in various time points after PCI in STEMI patients. Blood samples were collected from subjects with STEMI (n=17) at five time points including prior to PCI (time point 1), and 2h (time point 2), 24h (time point 3), 48h (time point 4) and 30 day (time point 5) following PCI. As controls, blood samples were also collected from subjects (n=20) with non-obstructive coronary artery disease after diagnostic angiography. Oxylipins identification and quantification were performed using high-performance electrospray mass spectrometry and dueterated internal standards. Seventy six oxylipins were identified in STEMI patients which were derived from LOX and CYP pathways and non-enzymatic oxidation. No COX derived oxylipins were identified in patients. The average levels of total oxylipins were 0.08 ± 0.04 and 0.05±0.02 ng/ul of plasma of STEMI patients and controls, respectively. Oxylipins that derived from arachidonic acid (AA) were the most abundant oxylipins in STEMI patients which constituted about 60% of all identified/quantified oxylipins. Oxylipins derived from linoleic acid (LA) were the second most abundant oxylipins which accounted for 28% of all identified/quantified oxylipins in STEMI patients. 20-carboxy-arachidonic acid (20-COOH-AA), which is a metabolite of 20-hydroxyeicosatetraenoic acid (20-HETE) and derived from AA, along with 9-HODE and 12- HODE, which derived from LA, were three most abundant oxylipins in all STEMI groups. One way ANOVA analysis showed that the levels of oxylipins derived from LOX pathway decreased significantly at 24h and 48h after PCI (time point-3 and 4) compared with pre and post PCI (Time point-1, 2). Further analysis revealed that 5-HETE and 9-HODE, were the two LOX derived oxylipins that decreased significantly in this group of oxylipins (p < 0.05). However, other oxylipins derived from CYP pathway or non-enzematic oxidation did not differ significantly between STEMI groups. At 30 day following PCI, levels of oxylipins slightly increased, although it was not significant. This is the first study to determine the oxylipin profile in STEMI patients. As these compounds have potent cardiovascular activities, our data may guide future therapeutics that aim to modulate oxylipins after MI.

Vulnerability to mood degradation during sleep deprivation is influenced by white-matter compactness of the triple-network model

Sleep deprivation (SD) is often associated with significant shifts in mood state relative to baseline functioning. Prior work suggests that there are consistent trait-like differences among individuals in the degree to which their mood and performances are affected by sleep loss. The goal of this study was to determine the extent to which trait-like individual differences in vulnerability/resistance to mood degradation during a night of SD are dependent upon region-specific white and grey matter (WM/GM) characteristics of a triple-network model, including the default-mode network (DMN), control-execution network (CEN) and salience network (SN). Diffusion-weighted and anatomical brain data were collected from 45 healthy individuals several days prior to a 28-h overnight SD protocol. During SD, a visual analog mood scale was administered every hour from 19:15 (time point1; TP1) to 11:15 (TP17) the following morning to measure two positive and six negative mood states. Four core regions within the DMN, five within the CEN, and seven within the SN were used as regions of interest (ROIs). An index of mood resistance (IMR) was defined as the averaged differences between positive and negative mood states over 12 TPs (TP5 to TP16) relative to baseline (TP1 to TP4). For each ROI, characteristics of WM – quantitative anisotropy (QA) and mean curvature index (WM-MCI), and GM – cortical volume (CV) and GM-MCI were estimated, and used to predict IMR. WM characteristics, particularly QA, of all of regions within the DMN, and most of the regions within the CEN and SN predicted IMR during SD. In contrast, most ROIs did not show significant association between IMR and any of the GM characteristics (CV and MCI) or WM MCI. Our findings suggest that greater resilience to mood degradation induced by total SD appears to be associated with more compact axonal pathways within the DMN, CEN and SN.

“It’s a lifeline”: Generating a sense of social connectedness through befriending parents of disabled children or children with additional need

ObjectivesThis study explored the influence of a parent-to-parent peer support scheme on the wellbeing of parents of disabled children or children with additional need who joined a befriending scheme. MethodsA longitudinal concurrent mixed methods (qualitative and quantitative) research design collected data (telephone interviews, Footsteps Tool, Resilience Scale-14) with 33 befriendees (1:1 or group support) and 33 befrienders at time-point 1 (TP1). TP2 data were collected from 20 befriendees and 16 befrienders 6–9 months after recruitment. ResultsThere was some improvement on average scores between TP1 and TP2 on both tools. The strongest evidence of change - ‘a sense of positivity and hope’ and ‘connection, belonging and sharing’ - was in the parents' reports of how the scheme helped them to build secure and valued social connections within a community of other parents who understood their lives. ConclusionBoth the befriendees and befrienders reported the sense of hope and a feeling of belonging as key benefits that resulted from the social connections they gained from the scheme. Practice implicationsSocial connectedness is likely to be a more useful concept than resilience in examining change.

Intrinsic brain activity changes associated with adjuvant chemotherapy in older women with breast cancer: a pilot longitudinal study.

Older cancer patients are at increased risk of cancer-related cognitive impairment. The purpose of this study was to assess the alterations in intrinsic brain activity associated with adjuvant chemotherapy in older women with breast cancer. Chemotherapy treatment (CT) group included sixteen women aged ≥ 60years (range 60-82years) with stage I-III breast cancers, who underwent both resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological testing with NIH Toolbox for Cognition before adjuvant chemotherapy, at time point 1 (TP1), and again within 1month after completing chemotherapy, at time point 2 (TP2). Fourteen age- and sex-matched healthy controls (HC) underwent the same assessments at matched intervals. Three voxel-wise rs-fMRI parameters: amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity, were computed at each time point. The changes in rs-fMRI parameters from TP1 to TP2 for each group, the group differences in changes (the CT group vs. the HC group), and the group difference in the baseline rs-fMRI parameters were assessed. In addition, correlative analysis between the rs-fMRI parameters and neuropsychological testing scores was also performed. In the CT group, one brain region, which included parts of the bilateral subcallosal gyri and right anterior cingulate gyrus, displayed increased ALFF from TP1 to TP2 (cluster p-corrected = 0.024); another brain region in the left precuneus displayed decreased fALFF from TP1 to TP2 (cluster level p-corrected = 0.025). No significant changes in the rs-fMRI parameters from TP1 to TP2 were observed in the HC group. Although ALFF and fALFF alterations were observed only in the CT group, none of the between-group differences in rs-fMRI parameter changes reached statistical significance. Our study results of ALFF and fALFF alterations in the chemotherapy-treated women suggest that adjuvant chemotherapy may affect intrinsic brain activity in older women with breast cancer.

Salt Preference and Ability to Discriminate between Salt Content of Two Commercially Available Products of Australian Primary Schoolchildren.

Australian children consume too much salt, primarily from processed foods where salt is often used to enhance flavour. Few studies have assessed children’s salt preference in commercially available foods. This study aims to assess (1) children’s preference and ability to discriminate between salt levels in two commercially available foods and (2) if preference or ability to discriminate between salt levels changes after an education program. Chips and corn flakes were tasted at three levels of salt concentration. Children ranked which they liked best (preference) and which was saltiest (ability to discriminate). The proportion of children across categorical responses was assessed (Chi squared and McNemar’s test) together with changes in preference and ability to discriminate between salt levels from timepoint 1 (T1) to timepoint 2 (T2). Ninety-two children (57% female, mean age 9.1 years (SD 0.8)) participated. At T1 approximately one-half and two-thirds of children preferred the highest salt chip and cornflake, respectively, (both p < 0.05). Fifty-seven percent and 63% of children identified the highest level of salt in chips and cornflakes as the saltiest, respectively. Preference and ability to discriminate between salt levels were unchanged between timepoints. Results support product reformulation to decrease salt content of foods provided to children.

Marathon Kids UK: study design and protocol for a mixed methods evaluation of a school-based running programme

IntroductionSchools are promising settings for physical activity promotion; however, they are complex and adaptive systems that can influence the quality of programme implementation. This paper presents an evaluation of a...

Improvement of carcinoid syndrome (CS) symptoms and quality of life (QoL) in CS patients treated with somatostatin analogs (SSAs): Results from longitudinal patient surveys.

400 Background: Limited information is available on the longitudinal impact of CS symptoms and QoL in CS patients (pts) who received SSAs in real-world setting. This study aimed to examine change in CS symptoms and QoL in CS pts treated with SSAs using the validated FACT-G instrument. Methods: Pts with CS symptoms in the US were recruited through an advocacy group to complete a two-part, anonymous online survey. Time point 1 (T1) survey was fielded from July-October 2016 and time point 2 (T2) was administered 6 months later. Eligible pts were ≥ 18 years old with CS symptoms and treated with SSA or non-SSA. Analyses were performed to assess change in FACT-G QoL scores between T1 and T2. Severity ratings of CS symptoms in the past month were classified as mild, moderate, severe, or not applicable. Duration of SSA treatment was categorized as ≤ 2, &gt; 2-5, and &gt; 5 years. Results: Among 89 pts who completed T1 and T2 surveys, 98% were treated with SSA (T1 or T2; median duration of 5 years). Higher proportion of pts in T2 did not report diarrhea (16% vs. 7%, p &lt; 0.05) or flushing (28% vs. 18%, p &lt; 0.05) vs. T1. Among pts treated with SSAs for ≤ 2, &gt; 2-5 and &gt; 5 years, mean change in FACT-G total score was +3.7, 0.0, and -1.2, respectively. Pts treated with SSAs for ≤ 2 years showed a clinically relevant improvement in QoL on FACT-G by exceeding the minimal important difference (MID) of &gt; 3.0. Additionally, in a subgroup of pts who experienced improvement in flushing (N=17) and diarrhea (N=31), a mean change of +3.0 in FACT-G total score was observed for flushing, indicating better QoL, whereas a nominal mean change was reported for diarrhea. Pts whose flushing and diarrhea symptoms worsened had a mean change of -2.2 and -1.2 in FACT-G total score, respectively, showing worsened QoL. Conclusions: This longitudinal survey study showed that improvement in flushing resulted in positive benefit in QoL, while worsening of flushing/diarrhea resulted in decline in QOL. Improvement in CS symptoms and QoL was most pronounced in the early years after SSA treatment initiation. Less impact on change in QoL may be observed in later years possibly due to disease progression and late-effects of cancer treatment.

Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? A cross-lagged analysis

BackgroundBereavement can precipitate different forms of psychopathology, including prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD) symptoms. How these symptoms influence each other is unclear. The aim of this study was to examine the temporal relationship of symptoms of PGD and PTSD following bereavement. MethodsWe included 204 individuals, confronted with the loss of a loved one within the past year, who completed self-report measures of PGD and PTSD and again completed these measures one year later. We conducted a cross-lagged analysis to explore cross-lagged and autoregressive relationships. ResultsA significant cross-lagged relationship was found between PGD symptoms at time point 1 (T1) and PTSD symptoms at time point 2 (T2) (β−=0.270, p<0.001). Furthermore, PGD symptoms at T1 predicted PGD symptoms at T2 and PTSD symptoms at predicted PTSD symptoms at T2 (β−=0.617 and β−=0.458, ps<0.001, respectively). In addition, PGD and PTSD symptoms were significantly correlated on both time points. ConclusionsWe found that PGD symptoms predict PTSD symptoms after a loss. Potentially, this could help to design new strategies and interventions for bereaved individuals. Additionally, PGD symptom levels predicted PGD symptom levels one year later, independently of the PTSD levels. This finding adds to the accumulating evidence that PGD is a distinct disorder.

Promoting the Shared-Care Model for Adolescent and Young Adults With Cancer: Optimizing Referrals and Care Coordination With Primary Care Providers.

The "shared-care model" for patients with cancer involves care coordination between primary care providers (PCPs) and oncologists, with the goal of optimizing survivorship care. However, a high proportion of adolescent and young adult (AYA) cancer survivors do not have a PCP. Study objectives were to increase the percentage of AYAs with a PCP documented in the electronic medical record (EMR) via the use of a best practice advisory (BPA) or "stopgap" intervention; to increase communication between providers by the number of routed clinic notes; and to assess oncology providers' attitudes/beliefs about the model and intervention. Data were collected for the 6 months before implementation of the BPA to determine the percentage of AYAs with a PCP and the number of notes routed to providers (time point 1 [T1]). The same data were collected at time point 2 (T2) after the BPA had been implemented for 6 months. Oncology providers participated in an education video module and an online survey at T1 and a survey at T2. At T1, 47.1% of 756 AYAs had a documented PCP in the EMR. At T2, the percentage increased to 55.1% (P<.002). The number of routed notes did not change significantly from T1 to T2. Providers that completed the intervention survey agreed/strongly agreed that the shared-care model is a desirable model of care (T1 = 86%; T2 = 93%) and that a BPA is useful for facilitating PCP referrals (T1 = 76%; T2 = 39%). This BPA is feasible for increasing the percentage of AYAs with a PCP documented in the EMR and could potentially lead to increased PCP referral and communication among providers for the benefit of long-term survivorship care. Providers generally agree with the shared-care model; however, the BPA implementation requires modification.