bluuebunny/crossref_metadata_2025 huggingface dataset:
The application of mHealth to monitor implementation of best practices to support healthy eating and physical activity in afterschool programs
Authors: Brazendale Keith , Beets Michael W. , Weaver Robert G. , Turner-McGrievy Brie , Brazendale Allison B. , Chandler Jessica L. , Moore Justin B. , Huberty Jennifer L. , Lemley Joshua , Brownson Ross C.
Published: May 2018

Background:

Childhood obesity continues to be a global epidemic and many child-based settings (e.g. school, afterschool programs) have great potential to make a positive impact on children’s health behaviors. Innovative and time-sensitive methods of gathering health behavior information for the purpose of evaluation and strategically deploying support are needed in these settings.

Purpose:

The aim is to (1) demonstrate the feasibility of mobile health (mHealth) for monitoring implementation of healthy eating and physical activity (HEPA) standards and, (2) illustrate the utility of mHealth for identifying areas where support is needed, within the afterschool setting.

Methods:

Site leaders ( N = 175) of afterschool programs (ASPs) were invited to complete an online observation checklist via a mobile web app (Healthy Eating and Physical Activity Mobile, HEPA m) once per week during ASP operating hours. Auto-generated weekly text reminders were sent to site leaders’ mobile devices during spring and fall 2015 and 2016 and spring 2017 school semesters. Data from HEPA m was separated into HEPA variables, and expressed as a percent of checklists where an item was present. A higher percentage for a given item would indicate an afterschool has higher compliance with current HEPA standards.

Results:

A total of 141 site leaders of ASPs completed 13,960 HEPA m checklists. The average number of checklists completed per ASP was 43 (range 1–220) for healthy eating and 50 (range 1–230) for physical activity. For healthy eating, the most common challenge for ASPs was ‘Staff educating children about healthy eating’, and for physical activity checklists, ‘Girls only physical activity is provided at ASP’.

Conclusion:

HEPA m was widely used and provided valuable information that can be used to strategically deploy HEPA support to ASPs. This study gives confidence to the adoption of mHealth strategies as a means for public health practitioners to monitor compliance of an initiative or intervention.
Why All Business Schools Should Teach Foresight: Perspectives from More Than a Decade at the University of Notre Dame
Authors: Miller Sam , Michel John , Balko Tim , Harms Chad
Published: May 2018

This article advocates that business schools include a formalized foresight educational experience more widely in their curriculums. As a group charged with educating business leaders of tomorrow, the cultivation of the skill-set and mind-set necessary for anticipating change and positioning organizations for future success and survival should no longer be left to chance. For the past decade, the Mendoza College of Business at the University of Notre Dame has required all undergraduate students to take a course titled Foresight in Business and Society. During this time, the Mendoza foresight faculty team has gained perspective on the design and value of a futures research learning experience for our students. Five underlying design principles are presented that have shaped the delivery and execution of the course these revolve around: developing great leaders, confronting ambiguous questions, experiential understanding, rigorous exploration, and anticipation as a force for good. As with any design-based perspective, the article concludes with challenges and pitfalls in recognition that the process is not always linear or smooth. But to other educators on this journey, the challenges are manageable and the promise and prospects for students makes it worthwhile.
Low testosterone levels are predictive for incident atrial fibrillation and ischaemic stroke in men, but protective in women – results from the FINRISK study
Authors: Zeller Tanja , Schnabel Renate B , Appelbaum Sebastian , Ojeda Francisco , Berisha Filip , Schulte-Steinberg Benedict , Brueckmann Burkhard-Ekkehart , Kuulasmaa Kari , Jousilahti Pekka , Blankenberg Stefan , Palosaari Tarja , Salomaa Veikko , Karakas Mahir
Published: May 2018

Background

Atrial fibrillation is the most common serious abnormal heart rhythm, and a frequent cause of ischaemic stroke. Recent experimental studies, mainly in orchiectomised rats, report a relationship between sex hormones and atrial electrophysiology and electroanatomy. We aimed to evaluate whether low testosterone levels are predictive for atrial fibrillation and/or ischaemic stroke in men and women.

Design and methods

The serum total testosterone levels were measured at baseline in a population cohort of 7892 subjects (3876 male, 4016 female), aged 25–74 years, using a commercially available immunoassay. The main outcome measure was atrial fibrillation or ischaemic stroke, whichever came first.

Results

During a median follow-up of 13.8 years, a total of 629 subjects (8.0%) suffered from incident atrial fibrillation ( n = 426) and/or ischemic stroke ( n = 276). Cox regression analyses, adjusted for age (used as time-scale), geographical region, total cholesterol (log), high-density lipoprotein-cholesterol (log), hypertension medication, known diabetes, smoking status, waist-hip-ratio, and time of blood drawn, documented differential predictive value of low sex-specific testosterone levels for atrial fibrillation and/or ischaemic stroke, in men and in women: Increasing levels were associated with lower risk in men (hazard ratio per one nmol/l increase 0.98 (95% confidence interval 0.93–1.00); p = 0.049). On the other hand, increasing testosterone levels were associated with higher risk in women (hazard ratio per one nmol/l increase 1.17 (95% confidence interval 1.02–1.36); p = 0.031).

Conclusion

Our study indicates that low testosterone levels are associated with increased risk of future atrial fibrillation and/or ischaemic stroke in men, while they are protective in women.
Trends in incident acute myocardial infarction in Norway: An updated analysis to 2014 using national data from the CVDNOR project
Authors: Sulo Gerhard , Igland Jannicke , Vollset Stein Emil , Ebbing Marta , Egeland Grace M , Ariansen Inger , Tell Grethe S
Published: May 2018

Background

We updated the information on trends of incident acute myocardial infarction in Norway, focusing on whether the observed trends during 2001–2009 continued throughout 2014.

Methods

All incident (first) acute myocardial infarctions in Norwegian residents age 25 years and older were identified in the Cardiovascular Disease in Norway 1994–2014 project. We analysed overall and age group-specific (25–64 years, 65–84 years and 85 + years) trends by gender using Poisson regression analyses and report the average annual changes in rates with their 95% confidence intervals.

Results

During 2001–2014, 221,684 incident acute myocardial infarctions (59.4% men) were identified. Hospitalised cases accounted for 79.9% of all incident acute myocardial infarctions. Overall, incident acute myocardial infarction rates declined on average 2.6% per year (incidence rate ratio 0.974, 95% confidence interval 0.972–0.977) in men and 2.8% per year (incidence rate ratio 0.972, 95% confidence interval 0.971–0.974) in women, contributed by declining rates of hospitalisations (1.8% and 1.9% per year in men and women, respectively) and deaths (6.0% and 5.8% per year in men and women, respectively). Declining rates were observed in all three age groups. The overall acute myocardial infarction incidence rates continued to decline from 2009 onwards, with a steeper decline compared to 2001–2009. During 2009–2014, gender-adjusted acute myocardial infarction incidence among adults age 25–44 years declined 5.3% per year, contributed mostly by declines in hospitalisation rates (5.1% per year).

Conclusion

Acute myocardial infarction incidence rates continued to decline after 2009 in Norway in both men and women. The decline started to involve individuals aged 25–44 years, marking a turning point in the previously reported stagnation of rates during 2001–2009.
The origins and (failed) adaptation of a dominant party: The UMNO in Malaysia
Authors: Washida Hidekuni
Published: May 2018

Why do some ruling parties attain dominance and remain in power? Focusing on a key case of a dominant party, the UMNO in Malaysia, this article explores its origins and an adaptation strategy under declining dominance. Regarding the origins, the article argues that a leader’s credible commitment to providing electoral security for local elites enables collective action to develop resource and spatial advantages. Specifically, the first section revisits the historical process and explains how an initial electoral setback provided leaders with an opportunity to launch administrative reforms, which enabled them to overcome local reluctance and promote the party as a centrist patron. The second section explores why the UMNO declined since 2008 and how it tried to survive. Based on a survey data analysis, it argues that the UMNO found room to play a spatial strategy of “Rikerian Offence” to reinforce its role as a chauvinistic patron, even at the cost of abandoning the center.
Septic cardiomyopathy: The value of lactoferrin and CD15 as specific markers to corroborate a definitive diagnosis
Authors: Galassi Andrea , Turatello Liliana , De Salvia Alessandra , Neri Margherita , Turillazzi Emanuela , La Russa Raffaele , Viola Rocco V , Frati Paola , Fineschi Vittorio
Published: May 2018

Current scientific consensus about the physiopathology in the progression from severe sepsis to septic shock and death focuses on myocardial contractile dysfunction. Nevertheless, objective parameters to establish a pathological correlate of a fatal outcome are lacking; then a cause of death due to sepsis can remain an unsolved problem. We first reviewed all death cases recorded at our institutions during the period from 2007 until 2015. Then, we conducted a retrospective study of a selected autopsy series of people who had received “sepsis” as cause of death. Two pathologists re-examined the heart sections while the most suitable myocardial sample for each case was stained for immunohistochemistry with antibodies targeted for specific inflammatory-related molecules. We used specific antibodies for the following markers: alpha-smooth muscle actin (alpha-SMA); fibronectin; matrix metallopeptidase 9 (MMP-9); intercellular adhesion molecule 1 (ICAM-1); caspase-3; lactoferrin (LF); cluster differentiation 15 (CD15). The statistical significance of differences was assessed using student’s t-test for unpaired data or non-parametric Mann–Whitney or Wilcoxon tests for skewed variables or one-way analysis of variance and post hoc Scheffe’s test for continuous variables and Pearson’s χ2-test for discrete variables. Linear regression analysis was used to determine the presence of a correlation between continuous variables. At our institutions, 2220 deaths have been recorded during the period study. Sepsis accounted as a cause of death for the 20% of total. We finally enrolled 56 cases; of these, only 20 were positive for microbiological analysis. At histological examination, clear inflammation was detectable in the 32% of cases; otherwise, immunohistochemical reaction showed a positive reaction for LF and CD15 in more than a half cases (56%). We still ignore all the underlying mechanisms of sepsis and all its pathophysiological connections with cardiac metabolism; in this sense, we aim to corroborate the diagnostic value of anti-LF and anti-CD15 staining for the post-mortem detection of myocardial inflammation.
Role of Egr1 on Pancreatic Endoderm Differentiation
Authors: Tsugata Takako , Nikoh Naruo , Kin Tatsuya , Miyagi-Shiohira Chika , Nakashima Yoshiki , Saitoh Issei , Noguchi Yasufumi , Ueki Hideo , Watanabe Masami , Kobayashi Naoya , Shapiro Andrew M. James , Noguchi Hirofumi
Published: May 2018

The low efficiency of in vitro differentiation of human embryonic stem cells (hESCs) or human-induced pluripotent stem cells (iPSCs) into insulin-producing cells is a crucial hurdle for the clinical implementation of human pluripotent stem cells (PSCs). Our previous investigation into the key factors for the differentiation of PSCs into insulin-producing cells suggested that the expression of GATA binding protein 6 (GATA6) and Gremlin 1 (GREM1) and inhibition of early growth response protein 1 (Egr1) may be important factors. In this study, we investigated the role of Egr1 in pancreas development. The transfection of small interfering RNA (siRNA) of Egr1 in the early phase induced the differentiation of iPSCs derived from fibroblasts (FiPSCs) into pancreatic endoderm and insulin-producing cells. In contrast, the downregulation of Egr1 in the late phase suppressed the differentiation of FiPSCs into pancreatic endoderm and insulin-producing cells. In addition, the overexpression of Egr1 suppressed the differentiation of iPSCs derived from pancreatic cells into pancreatic endoderm and insulin-producing cells. These data suggest that the downregulation of Egr1 in the early phase can efficiently induce the differentiation of iPSCs into insulin-producing cells.
Os Acromiale in Professional Tennis Players
Authors: Nourissat Geoffroy , Calò Michel , Montalvan Bernard , Parier Jacques
Published: May 2018

Background:

Os acromiale is a rare condition mostly reported in the literature through case reports, imaging studies, or reports of surgical treatment. This condition is the result of nonunion of growth plates of the acromion during the natural developmental process that occurs between 15 and 25 years of age. Its incidence is low, and few studies are available in the literature on athletes with high functional demands, and particularly on athletes within a specific sport.

Purpose:

To collect epidemiological data and to report the amount of time out of play as well as the type of treatment and its efficiency in professional tennis players.

Study Design:

Case series; Level of evidence, 4.

Methods:

We performed a retrospective study using the medical data of athletes within our national tennis league who complained about their shoulder between 2011 and 2016. Nine professional tennis players (mean age, 20 years) with painful shoulders were diagnosed with os acromiale; 3 of them played at an international level, with the other 6 playing at a national level. The diagnosis was confirmed using radiography, including the axillary view, and magnetic resonance imaging (MRI). One female player had associated subacromial bursitis.

Results:

All cases of os acromiale were classified as involving the mesoacromion, following the Lieberson classification. No patient underwent surgery, and no patient was treated with local or subacromial infiltration. Patients stopped competition and training throughout the rehabilitation period. All patients received medical treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), ice, and physical therapy with a specific rehabilitation program. All athletes returned to their former level of play after a mean of 37 days. No patient suffered from recurrent pain. One patient underwent MRI after 2 years, showing a normal bone signal and complete healing of the acromion.

Conclusion:

Conservative treatment including NSAIDs, rest, ice, and physical therapy allowed for good recovery and return to the former level of play. Surgical treatment is usually not indicated for os acromiale in the professional tennis player.
Primary Care Practice Workplace Social Capital: A Potential Secret Sauce for Improved Staff Well-Being and Patient Experience
Authors: Perzynski Adam T , Caron Aleece , Margolius David , Sudano Joseph J
Published: May 2018

Patient experiences with the health-care system are increasingly seen as a vital measure of health-care quality. This study examined whether workplace social capital and employee outcomes are associated with patients’ perceptions of care quality across multiple clinic sites in a diverse, urban safety net care setting. Data from clinic staff were collected using paper and pencil surveys and data from patients were collected via a telephone survey. A total of 8392 adult primary care patients and 265 staff (physicians, nurses, allied health, and support staff) were surveyed at 10 community health clinics. The staff survey included brief measures of workplace social capital, burnout, and job satisfaction. The patient-level outcome was patients’ overall rating of the quality of care. Factor analysis and reliability analysis were conducted to examine measurement properties of the employee data. Data were aggregated and measures were examined at the clinic site level. Workplace social capital had moderate to strong associations with burnout ( r = −0.40, P < .01) and job satisfaction ( r = 0.59, P < .01). Mean patient quality of care rating was 8.90 (95% confidence interval: 8.86-8.94) ranging from 8.57 to 9.18 across clinic sites. Pearson correlations with patient-rated care quality were high for workplace social capital ( r = 0.88, P = .001), employee burnout ( r = −0.74, P < .05), and satisfaction ( r = 0.69, P < .05). Patient-perceived clinic quality differences were largely explained by differences in workplace social capital, staff burnout, and satisfaction. Investments in workplace social capital to improve employee satisfaction and reduce burnout may be key to better patient experiences in primary care.
Effects of anterior cingulate cortex lesions on a continuous performance task for mice
Authors: Hvoslef-Eide Martha , Nilsson Simon R. O. , Hailwood Jonathan M. , Robbins Trevor W. , Saksida Lisa M. , Mar Adam C. , Bussey Timothy J.
Published: May 2018

Background:

Important tools in the study of prefrontal cortical -dependent executive functions are cross-species behavioural tasks with translational validity. A widely used test of executive function and attention in humans is the continuous performance task. Optimal performance in variations of this task is associated with activity along the medial wall of the prefrontal cortex, including the anterior cingulate cortex, for its essential components such as response control, target detection and processing of false alarm errors.

Methods:

We assess the validity of a recently developed rodent touchscreen continuous performance task that is analogous to typical human continuous performance task procedures. Here, we evaluate the performance of mice with quinolinic acid -induced lesions centred on the anterior cingulate cortex in the rodent touchscreen continuous performance task following a range of task parameter manipulations designed to challenge attention and impulse control.

Results:

Lesioned mice showed a disinhibited response profile expressed as a decreased response criterion and increased false alarm rates. Anterior cingulate cortex lesions also resulted in a milder increase in inter-trial interval responses and hit rate. Lesions did not affect discriminative sensitivity d′. The disinhibited behaviour of anterior cingulate cortex -lesioned animals was stable and not affected by the manipulation of variable task parameter manipulations designed to increase task difficulty. The results are in general agreement with human studies implicating the anterior cingulate cortex in the processing of inappropriate responses.

Conclusion:

We conclude that the rodent touchscreen continuous performance task may be useful for studying prefrontal cortex function in mice and has the capability of providing meaningful links between animal and human cognitive tasks.
卜辞 “允” 字用法补说
Authors: 吴盛亚
Published: May 2018

摘要

本文围绕卜辞中 “允” 的用法, 讨论了以下三方面的内容: 一、考察 “允其+动词” 在卜辞中的位置, 结合 “其” 本身所含不确定的情态意义, 认为 “允其+动词” 只可能属于命辞而非验辞。二、尽管在大多数能够判断占卜者态度的正反对贞卜辞中, “允” 后记录的内容往往与占卜者所希望的一致, 但仅靠 “允” 无法窥测占卜者的态度。三、指出之所以会出现 “允甲雨” 这种较罕见的语序, 是受到了同时期卜辞中 “允夕雨” 等类化的影响。
Ammoniomathesiusite, a new uranyl sulfate–vanadate mineral from the Burro mine, San Miguel County, Colorado, USA
Authors: Kampf Anthony R. , Plášil Jakub , Nash Barbara P. , Marty Joe
Published: May 2018

The new mineral ammoniomathesiusite (NH4)5(UO2)4(SO4)4(VO5)·4H2O, was found in the Burro mine, San Miguel County, Utah, USA, where it occurs as a secondary phase on asphaltum/quartz matrix in association with ammoniozippeite, gypsum, jarosite and natrozippeite. The mineral forms pale yellow to greenish-yellow prisms, up to ~0.3 mm long, with pale-yellow streak and bright yellow–green fluorescence. Crystals are transparent and have vitreous lustre. The mineral is brittle, with Mohs hardness of 2½, stepped fracture and two cleavages: excellent on {110} and good on {001}. The calculated density is 3.672 g/cm3. Ammoniomathesiusite is optically uniaxial (–) with ω = 1.653(2) and ε = 1.609(2) (white light). Pleochroism is: O = green-yellow, E = colourless; O > E. Electron microprobe analyses yielded the empirical formula [(NH4)4.75(UO2)4(SO4)4(VO5)·4(H2.07O). The five strongest powder X-ray diffraction lines are [dobs Å(I)(hkl)]: 10.57(46)(110), 7.10(62)(001), 6.41(100)(101), 3.340(35)(240) and 3.226(44)(141). Ammoniomathesiusite is tetragonal, P4/n with a = 14.9405(9), c = 7.1020(5) Å, V = 1585.3(2) Å3 and Z = 2. The structure of ammoniomathesiusite (R1 = 0.0218 for 3427 I > 2σI) contains heteropolyhedral sheets based on [(UO2)4(SO4)4(VO5)]5– clusters. The structure is identical to that of mathesiusite, with ${\rm NH}_{\rm 4}^{\rm +} $ in place of K+.
When symptoms don't fit: A case series of conversion disorder in the pediatric otolaryngology practice
Authors: Caulley Lisa , Kohlert Scott , Gandy Hazen , Olds Janet , Bromwich Matthew
Published: May 2018

Background

Conversion disorder refers to functional bodily impairments that can be precipitated by high stress situations including trauma and surgery. Symptoms of conversion disorder may mimic or complicate otolaryngology diseases in the pediatric population.

Case presentation

In this report, the authors describe 3 cases of conversion disorder that presented to a pediatric otolaryngology-head and neck surgery practice. This report highlights a unique population of patients who have not previously been investigated. The clinical presentation and management of these cases are discussed in detail. Non-organic otolaryngology symptoms of conversion disorder in the pediatric population are reviewed. In addition, we discuss the challenges faced by clinicians in appropriately identifying and treating these patients and present an approach to management of their care.

Conclusion

In this report, the authors highlight the importance of considering psychogenic illnesses in patients with atypical clinical presentations of otolaryngology disorders.
Cancer survivorship and diet: Is there a consensus? A narrative review.
Authors: Murthy Kalyani , Kamenetsky Dana , Gunturu Krishna Soujanya
Published: May 2018

100

Background: Diet and nutrition play a key role in the maintenance of health-related quality of life. Studies indicate cancer survivors evince a great interest in learning about nutrition and are willing to initiate life-style changes at the time of diagnosis. However recent survivor data indicates a lack of professional advice on nutrition. Given current guidelines by the American Cancer Society on increasing healthy eating awareness, we present a narrative review of published literature and discuss options for information dissemination. Methods: PubMed search from 2012-2017 was conducted. Studies on outcomes related to diet and nutrition in cancer survivors were included. We excluded general reviews, case reports, pediatric and complementary medicine abstracts. Results: Our initial search yielded 355 abstracts. We focused our review on 33 studies in breast, prostate and colo-rectal cancer care. Diet rich in saturated and trans-fats was detrimental in survivors (≈24%). Low-fat diet improved recurrence rates and overall mortality in 18% studies. Despite this high fat and dairy rich diet were noted in ≈18% studies. Data from studies (18%) incorporating fruits and vegetables indicated improvement in cognitive scores, post-cancer related fatigue and survival benefit. Adherence rates based on healthy-eating-index scores were low in survivors in a recent national survey. Vitamin D repletion is an area of debate. Studies have shown improvement in survival and mortality rates in breast and prostate cancer survivors. Conclusions: Data on survivor dietary preferences, changes and subsequent results are heterogeneous. Evidence suggests improvement in diet quality is positively associated with cancer and unrelated mortality. It is crucial to enforce the importance of healthy dietary changes to cancer survivors. Enabling access to key nutritional information to providers caring for survivors forms a major crux in this endeavor to empower survivors towards better health. Tools such as e-learning could be harnessed for this purpose. Ultimately recognition of optimal strategies and guidelines to assist, educate and motivate survivor adherence to such changes long-term needs further evaluation.
Effect and moderators of exercise on fatigue in patients with cancer: Meta-analysis of individual patient data.
Authors: van Vulpen Jonna , Sweegers Maike , Peeters Petra H.M. , Newton Robert Usher , Aaronson Neil K , Courneya Kerry S. , Jacobsen Paul , Verdonck-De Leeuw Irma , Brug Johannes , Buffart Laurien , May Anne Maria ,   POLARIS Study Group
Published: May 2018

104

Background: Fatigue is a common and disabling complaint in patients with cancer and can be reduced by exercise. To further personalize exercise prescriptions, moderators of exercise effects on fatigue should be investigated. However, most randomized controlled trials (RCTs) are not adequately powered to identify heterogeneity in responses to exercise. Therefore, we conducted a meta-analysis using individual patient data (IPD) of exercise RCTs to investigate the effect and moderators of exercise on cancer-related fatigue. Methods: Within the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium, principal investigators of 34 exercise RCTs worldwide have shared their IPD, including in total 4366 cancer patients. A 1-step IPD meta-analysis, using a linear mixed-effect model with a random intercept on study was undertaken to investigate effect on fatigue. The result, a between-group difference in standardized z-scores, corresponds to a Cohen’s d effect size. An interaction term was included in the model to assess potential moderators including demographic (sex, age, marital status, education), clinical (body mass index, distant metastasis), intervention-related (timing, delivery mode, duration) and exercise-related (type, frequency, intensity, duration) characteristics. Results: Exercise significantly reduced fatigue (β = -0.17, 95% CI -0.22;-0.12). The effect was not moderated by demographic, clinical or exercise-related characteristics. Supervised exercise had significantly larger effects on fatigue than unsupervised exercise (βdifference= -0.18, 95%CI -0.28;-0.08). Compared to the control group, supervised exercise significantly improved fatigue (β = -0.23, 95%CI = -0.29;-0.17), while unsupervised exercise did not (β = -0.04, 95%CI = -0.13;0.04). Conclusions: Exercise significantly reduces cancer-related fatigue across subgroups formed on the basis of demographic and clinical characteristics. The effect of exercise is significantly larger when performed under supervision. Hence, exercise, and preferably supervised exercise, represents a viable intervention for the prevention and treatment of fatigue among patients with cancer.
Fertility and cancer: Understanding the barriers to accessing information and resources.
Authors: Narayan Aditi , Bann Carla , Treiman Katherine , Soloe Cindy
Published: May 2018

116

Background: Some cancer treatments may lead to infertility in individuals diagnosed during their reproductive years. Infertility can affect a cancer survivor’s long-term quality of life by causing depression as well as reduced life satisfaction and increased anxiety. Addressing fertility concerns is a major component of survivorship care. Methods: In 2017 LIVESTRONG launched a national survey to assess whether patients are being informed about potential fertility risks due to a cancer diagnosis and/or related treatments; whether they are receiving necessary education and access to resources to make informed decisions about fertility preservation; and the financial burden of fertility preservation. A total of 1,064 people diagnosed with cancer between ages of 15-39 during 2006 to 2017 responded to the survey. Results: Seventy-nine percent of respondents said a health professional had discussed fertility issues with them, but only 51% were referred to a fertility specialist. Respondents diagnosed between 2011 and 2017 were more likely to report fertility discussions compared to those diagnosed between 2006 and 2010 (84% vs. 69%; p<.001), and to be referred to a fertility specialist (58% vs. 33%, p <.0001). More educated respondents and those with health insurance at time of diagnosis were more likely to report fertility discussions than those who did not (96% vs. 85%; p=.04). The most frequently discussed topics were possible risks to fertility (89%), methods of fertility preservation (70%), whether the respondent wanted any/or more children (64%), and timing for fertility preservation (50%). Insurance and financial issues were less frequently discussed: costs of fertility preservation (37%), insurance coverage (26%), and financial assistance (30%). Forty-four percent did not take steps to preserve their fertility. Conclusions: Many respondents reported not preserving fertility before treatment because they were not referred to a fertility specialist (30%) or insurance did not cover the costs (20%). All patients diagnosed in their reproductive years should be informed of infertility risks and receive information/resources on preservation options, regardless of education, income level, and insurance status.
Long-term consequences of exenterative surgery for people with pelvic cancer.
Authors: Young Jane , Solomon Michael , Steffens Daniel , Koh Cherry
Published: May 2018

118

Background: For people with recurrent or locally advanced pelvic cancer with no evidence of metastatic spread, pelvic exenteration (PE) surgery that achieves clear (R0) resection margins is the only potentially curative treatment option. This extensive, radical surgery can involve removal of the pelvic organs, muscles, nerves and bone, resulting in significant impairment for patients. The aim of this study is to describe the long-term quality of life outcomes for this procedure, specifically to investigate levels of pain, vitality, depression and ability to achieve personal goals among survivors three or more years after surgery. Methods: The Royal Prince Alfred Hospital in Sydney is a national referral center for PE in Australia. Patient-reported outcome measures, including generic (SF36) and colorectal cancer-specific (FACT-C) measures of quality of life (QoL), pain, vitality, depression and self-reported ability to achieve personal goals are assessed pre-surgery, every six months to three years and then annually. Consecutive patients who were three or more years after PE comprised the sample for this study. Trajectories for patient reported outcomes were plotted and the proportion of survivors who experienced ongoing pain, vitality and depression at each time point were calculated. Results: Among 241 patients who were 3 years post-PE, 63 (26%, 95% CI: 21-32%) had died and 3-year QoL assessments were completed by 65 (51%) of survivors. Three years after surgery, mean QoL scores were similar to baseline and remained fairly stable among survivors to 5 years. There was a small decrease over time in the proportion of survivors reporting ongoing pain. From 3 years onwards, approximately 70% (95% CI: 58-79%) of survivors reported ongoing pain and 44% (95% CI: 34-57%) reported some level of depression. However, SF-36 vitality scores increased slightly from a mean of 46.2 pre-PE to 54.0 at 3 years. Conclusions: Despite the extensive nature of PE surgery, the majority of survivors achieved reasonable long-term quality of life. However, high levels of chronic pain and depression indicate ongoing needs for supportive care in this patient group.
Identifying specific risk factors for the development of atrial fibrillation on ibrutinib.
Authors: Lentz Robert , Akhter Nausheen
Published: May 2018

128

Background: Ibrutinib is a tyrosine kinase inhibitor that has proven benefit in B-cell malignancies. Previous studies have shown that the overall incidence of atrial fibrillation (AF) while on ibrutinib is 6-16%. We investigated specific risk factors for the development of AF while on ibrutinib in an open-label single center study. Methods: We conducted a retrospective study of patients treated with ibrutinib between July 2012 and August 2017. ECGs were manually reviewed to document AF. Patients with existing AF or valvular heart disease were excluded. Patients were followed for incident AF until the end of the medical record, death, or August 2017. The presence or absence of AF risk factors and duration of ibrutinib treatment were documented. Statistical analysis used chi-square tests for categorical variables and t-tests for continuous variables. Results: 161 patients were included in the analysis. Mean age was 65.5 years, 70.8% were men, and 60.9% had CLL (13.0% Waldenstrom macroglobulinemia, 10.6% mantle cell lymphoma, and 15.5% other). After a mean follow up of 686 days, the incidence of AF was 9.9%. Combined systolic or diastolic heart failure (HF) was statistically associated with incident AF (p = 0.00454). Ibrutinib treatment length (p =0.09698), age (p = 0.08181), obesity, (p = 0.30800), coronary artery disease (CAD, p = 0.16422), hypertension (HTN, p = 0.65447), diabetes mellitus (DM, p = 0.58836), and male sex (p = 0.30800) were not associated with incident AF (Table 1). Of those with heart failure, 29.4% developed incident AF. Conclusions: In this large retrospective open-label cohort study, the incidence of AF on ibrutinib was higher in patients with heart failure. Duration of ibrutinib treatment was not associated with incident AF. Ibrutinib should be used with caution in patients with heart failure and these patients should be closely monitored for incident AF. [Table: see text]
Cancer and non-cancer pain opioid utilization in Medicare and Medicaid populations.
Authors: Datto Catherine J. , Hu Yiqun , Wittbrodt Eric , Fine Perry G.
Published: May 2018

139

Background: Limited data exist comparing opioid use patterns in Medicare and Medicaid patients with cancer-related (CP) and non-cancer-related pain (NCP). Methods: A retrospective analysis of Medicare and Medicaid claims data (MarketScan Research Databases) investigated opioid use patterns in patients with CP and NCP. Adults (age ≥18 yr) with ≥1 pharmacy claim for an opioid (index date), continuous plan eligibility for 6 months pre- and 12 months post-index date, and duration of opioid use of ≥4 weeks were identified. CP patients were identified by medical claim for a cancer diagnosis within 30 days before index date. Results: A total of 4,009 Medicare and 551 Medicaid patients with CP and 98,631 Medicare and 25,163 Medicaid patients with NCP were analyzed. The most common cancer diagnoses were breast, lung, prostate, and colorectal. Medicare patients with CP and NCP had similar mean age; in the Medicaid cohort, patients with CP were older than those with NCP. In the Medicare cohort, NCP patients were more likely to be women; sex distribution was similar among Medicaid patients. Higher rates of comorbidity in the CP cohorts were observed in both datasets. Median index and post-index opioid doses were consistent between the CP and NCP cohorts. The post-index pattern of change in opioid dose was consistent between CP and NCP in both Medicare and Medicaid patients. The most common pattern observed was up to a doubling of index dose. Conclusions: Similar opioid utilization patterns in Medicare and Medicaid populations, including dose escalation, were observed regardless of pain etiology (cancer or non-cancer). [Table: see text]
Material and behavioral financial hardship as predictors of health-related quality of life in a diverse cohort of cancer survivors.
Authors: Hastert Theresa A. , Harper Felicity W. K. , Beebe-Dimmer Jennifer Lynn , Baird Tara , Schwartz Ann G.
Published: May 2018

145

Background: Financial hardship is common among cancer survivors, but its association with health-related quality of life (HRQOL) unknown. Methods: We utilized data from 570 black participants the Detroit Research on Cancer Survivors (ROCS) cohort study diagnosed with breast, colorectal, lung or prostate cancer since 1/1/13 and diagnosed or treated at the Karmanos Cancer Institute, and 402 white survivors meeting the same criteria. HRQOL was measured using the functional assessment of cancer therapy-general (FACT-G) and its subscales of physical, social, emotional and functional wellbeing, and site-specific measures. We fit linear regressions to estimate associations between material (debt, borrowing, selling assets, reduced income) and behavioral (skipping medication, not seeing a doctor, refusing treatment due to cost) financial hardship (MFH and BFH, respectively) and HRQOL. Adjusted models include demographic, socioeconomic, and treatment-related factors. Results: Overall, 50.3% of participants experienced material and 17.6% experienced behavioral financial hardship. In unadjusted models, HRQOL scores were 0.39 (95% CI 0.27, 0.51) standard deviations (SD) lower in those reporting any MFH. MFH was associated with significantly lower physical, emotional, and functional wellbeing scores, and with lower scores on breast-, colorectal-, and prostate-specific HRQOL measures. Total HRQOL was 0.68 SD (95% CI 0.52, 0.84) lower for participants who reported BFH than those who did not, and BFH was inversely associated with each subscale and each cancer-specific measure. In adjusted models, HRQOL scores were 0.15 (95% CI 0.03, 0.27) SD lower among participants reporting MFH and remained inversely associated with physical and functional wellbeing. BFH was associated with 0.42 (95% CI 0.27, 0.57) SD lower HRQOL scores and remained inversely associated with physical, social, emotional, and functional wellbeing; and with breast- and prostate-specific measures. Conclusions: MFH and BFH are associated with lower HRQOL among diverse cancer survivors. Addressing BFH in particular may improve HRQOL among survivors, particularly those with breast and prostate cancer.
Seeking a no-regrets decision: Women's rationale for choosing contralateral prophylactic mastectomy (CPM).
Authors: Bloom Diane , Wheeler Stephanie B. , McGuire Kandace P , Lee Clara , Weinfurt Kevin , Rosenstein Donald , Plichta Jennifer K , Hwang Eun-Sil Shelley
Published: May 2018

152

Background: More women with early-stage unilateral breast cancer and low genetic risk are opting for CPM, despite their low risk of developing cancer in their healthy breast and evidence to demonstrate that CPM improves neither survival nor quality of life, while increasing the risk of surgical complications. Little is known about the factors that motivate this irreversible decision. Methods: We conducted comprehensive qualitative interviews with 42 women at low risk for contralateral breast cancer (CBC) who had CPM in the last 10 years. We recorded and transcribed the interviews and analyzed them using a grounded theory approach. Results: Contrary to hypotheses that newly diagnosed women overestimate their CBC risk, study patients knew of the low risk of cancer in their healthy breast, but still chose CPM. Statistics were unpersuasive; given healthy lifestyles and lack of risk factors, they felt unlucky to get breast cancer and feared they would be unlucky again. They believed CPM would give them more peace of mind and the fewest regrets should cancer return. Avoiding mammograms was important, given the potential for callbacks, biopsies, and more bad news. Avoiding radiation and wanting matching breasts were cited less often. Most were mainly focused on reducing their cancer risk and could not recall having critical information about CPM’s potential harms. A few knew of likely harms but misjudged their impact. When told of CPM’s higher risk of complications, most dismissed this as a disclaimer, believing they would get through surgery well. Despite experiencing negative effects of CPM, 38 of 42 stated they would make the same decision again. Conclusions: When choosing CPM, most women felt confident in making their decision, although many had incomplete knowledge of potential long-term impacts. Nevertheless the majority of women who chose CPM did not regret their decision, suggesting that women who elect CPM are selecting a treatment option that is consistent with their long-term personal values and preferences. While important to ensure women know potential long-term harms, our findings suggest they may not necessarily be dissuaded from CPM by more data, though they may be better prepared for it’s aftermath.
The hidden burden of anxiety and depression in ovarian cancer: A prospective study from diagnosis.
Authors: Webb Penelope M , Beesley Vanessa , deFazio Anna , Obermair Andreas , Grant Peter T. , Nagle Christina , Friedlander Michael ,   The OPAL Study Group
Published: May 2018

155

Background: Women with ovarian cancer (OC) report high rates of anxiety (A) and depression (D), but most studies have used a cross-sectional design at a single time-point, not considered prior history and not included affected women who are symptom-free due to medication. Our goals were to quantify (i) the total burden of A and D among women with newly diagnosed OC; the proportions who (ii) experience symptoms only after their OC diagnosis and (iii) with persistent symptoms; and (iv) use of appropriate medication/services by those affected. Methods: The OPAL (Ovarian Cancer Prognosis & Lifestyle) Study is a prospective study of Australian women diagnosed with OC from 2012-15 who agreed to complete questionnaires at baseline, 3, 6, 9, 12, 24, 36 & 48 months after diagnosis. At baseline, they were asked if they had ever been diagnosed with A or D and if they took medication for this in the year before their OC diagnosis. At follow-up they completed the Hospital Anxiety and Depression Scale (HADS) and were asked about current medication use. Results: Of 893 women with data for ≥1 time point, 216 (24%) reported clinical levels (HADS > 10) of anxiety (18%) and/or depression (15%) on at least one occasion during the first 3 years after diagnosis, with another 157 (18%) reporting use of anxiolytic or antidepressant medications. A further 167 (19%) reported subclinical (HADS 8-10) A or D. Of those with clinical levels of A/D and/or taking medication, 225 (60%) reported this at ≥3 time-points, 216 (58%) reported no prior history of A or D, and 271 (73%) reported no use of anxiolytic/antidepressant medication in the year before diagnosis. When women reported clinical levels of A or D, only 45% reported taking medication (37%) and/or seeing a psychiatrist or psychologist (19%). Conclusions: More than 40% of women with OC experienced clinical levels of A or D during treatment or the first 3 years of follow-up, for 25% this persisted. For 24% this was their first experience of distress and > 50% of those affected did not receive appropriate medication or psychological support. The hidden burden of anxiety and depression in this population is much greater than previously reported but is amenable to effective intervention if recognized.
Family medicine providers' perceptions of their ability to provide evidence-based survivorship care.
Authors: Rodriguez Maria Alma , Palos Guadalupe R. , Gilmore Katherine Ramsey , Lewis-Patterson Paula A. , Foxhall Lewis E. , Shay Laura Aubree
Published: May 2018

16

Background: Opportunities for medical students and primary care providers to learn about evidence-based cancer survivorship care remains limited. To fill this void, we created an innovative curriculum using ECHO, a tele-mentoring approach, to teach faculty and residents in family medicine programs about the core principles and skills of survivorship care. Our objective was to explore participants' perceptions about their self-efficacy to deliver high quality care to survivors. Methods: Subjects were recruited from 3 academic centers with medical residency programs collaborating with our cancer center in a state-funded education grant to develop a tele-mentoring training program. The survey, which was developed by the research team, measured self-efficacy and satisfaction. Subjects were asked to rate their confidence in their abilities to offer evidence-based care after completing the program. Descriptive statistics were used to report results. REDCap, a web-based application, was used to manage the development and distribution of the survey. Results: A total of 116 surveys were sent out electronically with 59 returned (50.9%). Table 1 indicates most participants reported the ECHO program increased their knowledge, clinical skills, and expertise to provide comprehensive survivorship care. Conclusions: Overall, the participants’ perceptions of their expertise to offer optimal survivorship care were positive. There is room for improvement to maximize the learning experience for all participants.[Table: see text]
When will I feel normal again? Quality of life trajectories after first-line chemotherapy for ovarian cancer.
Authors: Webb Penelope M , Beesley Vanessa , Nagle Christina , Grant Peter T. , deFazio Anna , Obermair Andreas , Friedlander Michael ,   OPAL Study Group
Published: May 2018

172

Background: Patients often ask if/when they will feel normal again following treatment for ovarian cancer (OC). There is a paucity of data on the trajectories of quality of life (QoL), physical (PWB), social (SWB), emotional (EWB) and functional (FWB) wellbeing over time following chemotherapy and especially regarding those who have persistent problems. Our aim was to quantify the proportion of women with significantly lower QoL/wellbeing than the general population at the end of treatment and determine if/when they return to normal. Methods: The OPAL (Ovarian cancer Prognosis & Lifestyle) Study is a prospective study of Australian women diagnosed with invasive OC from 2012-15 who agreed to complete regular questionnaires after diagnosis. 580 participants who received ≥3 cycles of platinum-based chemotherapy as primary treatment and completed a questionnaire while on or < 6 weeks after completing chemotherapy (baseline) were included. FACT-G data came from questionnaires at baseline and ~3, 6, 9 & 18 months post-baseline. Group-based trajectory models were used to identify groups with distinct patterns of QoL/wellbeing over time. Results: Overall, 44% (254) of women had QoL scores significantly lower than the general population at baseline; 35% (88) returned to normal by 3 months after treatment, 73% by 6 months and 27% (69) had not returned to normal by 18 months. The Table shows the comparable figures for the wellbeing subscales. Conclusions: While > 50% of women with OC can expect similar QoL, FWB and EWB to the general population at the end of chemotherapy, PWB was compromised in 3 of 4 women. For most, wellbeing recovered within 6 months but a substantial proportion reported ongoing deficits. A particularly prolonged impact was seen for those with poor EWB at baseline, warranting early intervention in this subset. [Table: see text]