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Karon S, Toth M, Palmer L, Bercaw L, Johnson R, Jones J, Love R. WHO LIVES WHERE? LIVING SITUATION AND COMPARATIVE NEEDS OF OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Woods D, Phillips L, Johnson R, Knox V. AN ANTIDOTE TO COMPASSION FATIGUE: DIRECT CARE STAFF USING CALM FOR ASSISTED LIVING RESIDENTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Berman R, Eisenstein A, Milstein L, Johnson R. SAGES IN EVERY SETTING: EVALUATING PATIENT ENGAGEMENT BUREAUS IN LONG TERM CARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Waite JH, Perryman RS, Perry ME, Miller KE, Bell J, Cravens TE, Glein CR, Grimes J, Hedman M, Cuzzi J, Brockwell T, Teolis B, Moore L, Mitchell DG, Persoon A, Kurth WS, Wahlund JE, Morooka M, Hadid LZ, Chocron S, Walker J, Nagy A, Yelle R, Ledvina S, Johnson R, Tseng W, Tucker OJ, Ip WH. Chemical interactions between Saturn’s atmosphere and its rings. Science 2018; 362:362/6410/eaat2382. [DOI: 10.1126/science.aat2382] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/10/2018] [Indexed: 11/03/2022]
Abstract
The Pioneer and Voyager spacecraft made close-up measurements of Saturn’s ionosphere and upper atmosphere in the 1970s and 1980s that suggested a chemical interaction between the rings and atmosphere. Exploring this interaction provides information on ring composition and the influence on Saturn’s atmosphere from infalling material. The Cassini Ion Neutral Mass Spectrometer sampled in situ the region between the D ring and Saturn during the spacecraft’s Grand Finale phase. We used these measurements to characterize the atmospheric structure and material influx from the rings. The atmospheric He/H2 ratio is 10 to 16%. Volatile compounds from the rings (methane; carbon monoxide and/or molecular nitrogen), as well as larger organic-bearing grains, are flowing inward at a rate of 4800 to 45,000 kilograms per second.
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Secombe PJ, Sutherland R, Johnson R. Morbid obesity impairs adequacy of thoracic compressions in a simulation-based model. Anaesth Intensive Care 2018; 46:171-177. [PMID: 29519219 DOI: 10.1177/0310057x1804600205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Adequate cardiopulmonary resuscitation is an important predictor of survival, however, obesity provides a significant physical barrier to thoracic compressions. This study explores the effect of morbid obesity on compression adequacy. We performed a prospective randomised controlled crossover study, assessing the adequacy of thoracic compressions on a manikin modified to emulate a morbidly obese patient. Participants recruited from critical care departments were randomised to perform continuous compressions for two minutes on each manikin. Accelerometers were used to measure thoracic wall movement. The primary endpoint was a composite measure of compression adequacy (rate, depth and recoil). Secondary endpoints were the individual components of the composite outcome and measures of perceived effectiveness, fatigue, and pain. One hundred and one participants were recruited. There was a significant difference between the obese and control groups in the composite endpoint (4% versus 30%, <i>P</i> <0.001), as well as the individual components of adequacy (<i>P</i> <0.01 for all). Quartile data showed significant deterioration in adequacy of depth and recoil in both groups, and this occurred significantly earlier in the obese group (<i>P</i> ≤0.001). Participants' perception of effectiveness was significantly lower (<i>P</i> ≤0.001) in the obese group, and levels of fatigue (<i>P</i> ≤0.001) and pain (<i>P</i> ≤0.001) significantly higher. Morbid obesity impairs the adequacy of thoracic compressions for trained rescuers in a simulation-based model. Participants were not fully aware of how ineffective compressions were. There is evidence of earlier fatigue further reducing effectiveness. These findings have significant implications for the training of rescuers in a clinically relevant population and the planning of future research.
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Murphy M, Boardman F, Johnson R, Robertson W. 7.1-O8Parental beliefs of family health, diet, physical activity and weight: findings from a qualitative study in an ethnically diverse population in the UK. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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du Mez E, Johnson R, Kho D, Feisst V, Locke M, McIntosh J, Brooks A, Didsbury A, Graham S, Angel C. 939 Individual and cocktails of TLR ligands influence cytokine secretion by human skin explants. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yuan Q, Tang J, Penaflor B, Johnson R, Wu K, Piglowski D, Zhang R, Xiao B, Chai W, Anyanetu I, Sammuli B, Kostuk M. Upgrade of EAST plasma control system for steady-state advanced operation. FUSION ENGINEERING AND DESIGN 2018. [DOI: 10.1016/j.fusengdes.2018.02.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Messer LH, Johnson R, Driscoll KA, Jones J. Best friend or spy: a qualitative meta-synthesis on the impact of continuous glucose monitoring on life with Type 1 diabetes. Diabet Med 2018; 35:409-418. [PMID: 29247556 DOI: 10.1111/dme.13568] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 01/02/2023]
Abstract
AIMS This is a meta-synthesis of extant qualitative literature related to impact of continuous glucose monitoring (CGM). CGM has been available for a decade for the management of Type 1 diabetes and is the lynchpin of future artificial pancreas technologies. Clinical uptake of CGM is an important area of inquiry. The purpose of this meta-synthesis is to understand the impact of CGM on individuals with Type 1 diabetes and others (parents, significant others, providers) in order to design appropriate clinical interventions for adherence. METHODS Studies published in English between 2007 and 2017 were included, reflecting commercial CGM availability. PubMed, PsychINFO, CINALH, Web of Science and EMBASE databases were queried using search terms related to CGM, qualitative, experience and Type 1 diabetes. Included articles contained original qualitative or mixed-method research on CGM, sensor-augmented pump or closed-loop therapies. Articles underwent quality appraisal and thematic interpretive integration by a multidisciplinary team. RESULTS Nine articles (343 participants) met the inclusion criteria and were included in the synthesis. Six novel themes emerged: interacting with CGM, burden of living with CGM, feeling different from others, feeling empowered, interacting with glucose information and impact on relationships. CONCLUSION CGM affects physical, emotional and relational aspects of life. Clinicians can help minimize the burden of CGM with carefully delivered education and expectation-setting with individuals. Empowerment and relational partnerships in diabetes care can be explored to maximize satisfaction with CGM. Systematic interpretive synthesis of qualitative studies provides a comprehensive, contextual understanding of the impact of CGM on daily life and relationships.
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Larsen T, Urke HB, Holsen I, Anvik CH, Olsen T, Waldahl RH, Antonsen KM, Johnson R, Tobro M, Brastad B, Hansen TB. COMPLETE - a school-based intervention project to increase completion of upper secondary school in Norway: study protocol for a cluster randomized controlled trial. BMC Public Health 2018. [PMID: 29523124 PMCID: PMC5845360 DOI: 10.1186/s12889-018-5241-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drop out from upper secondary school represents a risk for the future health and wellbeing of young people. Strengthening of psychosocial aspects of the learning environment may be an effective strategy to promote completion of upper secondary school. This paper is a study protocol of a school based cluster randomized controlled trial (RCT) evaluating two school-based interventions, namely the Dream School Program (DSP) and the Mental Health Support Team (MHST). The interventions aim to improve psychosocial learning environments and subsequently school achievements and decrease drop-out and absence. METHODS/DESIGN The COMPLETE RCT is aimed at youth in upper secondary school, grade 1 (age 15-16 years), and examines the effect of the combination of the DSP and the MHST; and the DSP only, compared with a comparison group on the following primary outcomes: student completion, presence, average grade, and self-reported mental health. Seventeen upper secondary schools from four counties in Norway were randomized to one of the three arms: 1) DSP and MHST; 2) DSP; and 3) comparison (offered DSP intervention in 2018/2019). The study will evaluate the interventions based on information from two cohorts of students (cohort 1 (C1) and cohort 2 (C2)). For C1, data was collected at baseline (August 2016), and at first follow-up seven months later. Second follow-up will be collected 19 months after baseline. For C2, data was collected at baseline (August 2017), and first and second follow-up will be collected similarly to that of C2 seven and 19 months respectively after baseline. Process evaluations based on focus groups, interviews and observation will be conducted twice (first completed spring 2017). DISCUSSION The COMPLETE trial is a large study that can provide useful knowledge about what interventions might effectively improve completion of upper secondary school. Its thorough process evaluation will provide critical information about barriers and points of improvement for optimizing intervention implementation. Findings can guide school development in the perspective of improving psychosocial learning environments and subsequent completion of upper secondary schooling. TRIAL REGISTRATION The trial was retrospectively registered in the ClinicalTrials.gov register on December 22.2017: NCT03382080 .
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Abrahamsen F, Fry CH, Min BR, Gurung NK, Stewart S, Means L, Shipp A, Johnson R. 125 Assessment of the Effect of Cracked Corn Energy Supplementation on Animal Performance, Rumen Fermentation and Carcass Traits in Grazing Goats during the Winter Months. J Anim Sci 2018. [DOI: 10.1093/jas/sky027.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Johnson R. Venom: the heroic search for Australia’s deadliest snake. BJ Murray. Echo Publishing, 2017. 385 pages. Price A$32.99 (paperback). ISBN 9781760405694 and Venom: the secrets of nature’s deadliest weapon. R Jenner and E Undheim. CSIRO Publishing, 2017. 208 p. Aust Vet J 2018. [DOI: 10.1111/avj.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hobson A, Johnson R, O’Quinn T, Boyle E, Gonzalez J, Vahl C, Houser T. Natural Hardwood Smoked Sugar Improves Oxidative and Flavor Stability of Naturally Cured, Aerobically Packaged, Food Service Bacon. MEAT AND MUSCLE BIOLOGY 2018. [DOI: 10.22175/rmc2018.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Wheeler PX, Johnson R, Horwood A, Lee J, Kelland N. 65Improving access to arrhythmia services: the role of the cardiac rhythm management specialist nurses. Europace 2017. [DOI: 10.1093/europace/eux283.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Osborne A, Rutz D, Ross M, Bodle C, Johnson R, Wheatley M. 81 The Effect of Compulsory Provider HEART Score Calculation on Chest Pain Patients Sent to Observation Units. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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O'Callaghan J, Holmes H, Powell N, Wells JA, Ismail O, Harrison IF, Siow B, Johnson R, Ahmed Z, Fisher A, Meftah S, O'Neill MJ, Murray TK, Collins EC, Shmueli K, Lythgoe MF. Tissue magnetic susceptibility mapping as a marker of tau pathology in Alzheimer's disease. Neuroimage 2017; 159:334-345. [PMID: 28797738 PMCID: PMC5678288 DOI: 10.1016/j.neuroimage.2017.08.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 01/15/2023] Open
Abstract
Alzheimer's disease is connected to a number of other neurodegenerative conditions, known collectively as 'tauopathies', by the presence of aggregated tau protein in the brain. Neuroinflammation and oxidative stress in AD are associated with tau pathology and both the breakdown of axonal sheaths in white matter tracts and excess iron accumulation grey matter brain regions. Despite the identification of myelin and iron concentration as major sources of contrast in quantitative susceptibility maps of the brain, the sensitivity of this technique to tau pathology has yet to be explored. In this study, we perform Quantitative Susceptibility Mapping (QSM) and T2* mapping in the rTg4510, a mouse model of tauopathy, both in vivo and ex vivo. Significant correlations were observed between histological measures of myelin content and both mean regional magnetic susceptibility and T2* values. These results suggest that magnetic susceptibility is sensitive to tissue myelin concentrations across different regions of the brain. Differences in magnetic susceptibility were detected in the corpus callosum, striatum, hippocampus and thalamus of the rTg4510 mice relative to wild type controls. The concentration of neurofibrillary tangles was found to be low to intermediate in these brain regions indicating that QSM may be a useful biomarker for early stage detection of tau pathology in neurodegenerative diseases.
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Isaac L, Stoler K, Wilcox T, Johnson R, Swirsky-Sacchetti T. C-66Recognition Discriminability (‘d): An Efficient Replacment for Forced-Choice Recogntion on the California Verbal Learning Test II (CVLT-II). Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kuwabara M, Niwa K, Hisatome I, Roncal-Jimenez C, Andres-Hernando A, Ishiwata S, Ouchi Y, Ohno M, Lanaspa M, Johnson R. P4556Obesity and serum uric acid as a risk factor for hypertension and diabetes mellitus: 5-year Japanese cohort study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Alamshah A, Spreckley E, Norton M, Kinsey-Jones JS, Amin A, Ramgulam A, Cao Y, Johnson R, Saleh K, Akalestou E, Malik Z, Gonzalez-Abuin N, Jomard A, Amarsi R, Moolla A, Sargent PR, Gray GW, Bloom SR, Murphy KG. l-phenylalanine modulates gut hormone release and glucose tolerance, and suppresses food intake through the calcium-sensing receptor in rodents. Int J Obes (Lond) 2017; 41:1693-1701. [PMID: 28792489 PMCID: PMC5678004 DOI: 10.1038/ijo.2017.164] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 05/26/2017] [Accepted: 06/21/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE High-protein diets (HPDs) are associated with greater satiety and weight loss than diets rich in other macronutrients. The exact mechanisms by which HPDs exert their effects are unclear. However, evidence suggests that the sensing of amino acids produced as a result of protein digestion may have a role in appetite regulation and satiety. We investigated the effects of l-phenylalanine (L-Phe) on food intake and glucose homeostasis in rodents. METHODS We investigated the effects of the aromatic amino-acid and calcium-sensing receptor (CaSR) agonist l-phenylalanine (L-Phe) on food intake and the release of the gastrointestinal (GI) hormones peptide YY (PYY), glucagon-like peptide-1 (GLP-1) and ghrelin in rodents, and the role of the CaSR in mediating these effects in vitro and in vivo. We also examined the effect of oral l-Phe administration on glucose tolerance in rats. RESULTS Oral administration of l-Phe acutely reduced food intake in rats and mice, and chronically reduced food intake and body weight in diet-induced obese mice. Ileal l-Phe also reduced food intake in rats. l-Phe stimulated GLP-1 and PYY release, and reduced plasma ghrelin, and also stimulated insulin release and improved glucose tolerance in rats. Pharmacological blockade of the CaSR attenuated the anorectic effect of intra-ileal l-Phe in rats, and l-Phe-induced GLP-1 release from STC-1 and primary L cells was attenuated by CaSR blockade. CONCLUSIONS l-Phe reduced food intake, stimulated GLP-1 and PYY release, and reduced plasma ghrelin in rodents. Our data provide evidence that the anorectic effects of l-Phe are mediated via the CaSR, and suggest that l-Phe and the CaSR system in the GI tract may have therapeutic utility in the treatment of obesity and diabetes. Further work is required to determine the physiological role of the CaSR in protein sensing in the gut, and the role of this system in humans.
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Gilmore-Bykovskyi A, Hovanes M, Johnson R, Kind A. COMMUNICATION OF DEMENTIA SYMPTOMS AND CARE NEEDS DURING HOSPITAL TO NURSING FACILITY TRANSITIONS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shabalala S, Muller C, Louw J, Johnson R. Polyphenols, autophagy and doxorubicin-induced cardiotoxicity. Life Sci 2017; 180:160-170. [DOI: 10.1016/j.lfs.2017.05.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 01/07/2023]
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Walker B, Flynn S, Johnson R. RELIABILITY AND VALIDITY OF HEALTH IN MOTION© FALLS SCREENING TOOL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Loomis E, Greenfield SR, Luo SN, Johnson R, Shimada T, Cobble J, Seifter A, Montgomery DS. The Dynamics of Thermal Expansion in Single Crystal Beryllium from Nanosecond X-Ray Irradiation. FUSION SCIENCE AND TECHNOLOGY 2017. [DOI: 10.13182/fst09-a4068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Johnson R, Robertson W, Towey M, Stewart-Brown S, Clarke A. Changes over time in mental well-being, fruit and vegetable consumption and physical activity in a community-based lifestyle intervention: a before and after study. Public Health 2017; 146:118-125. [PMID: 28404463 DOI: 10.1016/j.puhe.2017.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/02/2016] [Accepted: 01/06/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is a theoretical basis for believing that healthy lifestyle interventions can improve mental well-being and evidence to show that mental well-being is protective of future health. This study contributes to the evidence base by examining changes in mental well-being associated with the One Body One Life (OBOL) healthy lifestyle programme in a community setting in the West Midlands. STUDY DESIGN Quantitative, before and after the evaluation. METHODS We conducted a before and after study of the lifestyle intervention 'OBOL', a multi component intervention that includes exercise and healthy eating education. Mental well-being was measured with the Warwick-Edinburgh Mental Well-being Scale. Physical activity and fruit and vegetable consumption were self-reported. Measures were collected before and after the 12-week intervention and three months post completion. Non-parametric tests were used to assess differences between groups, and linear mixed models were used to assess change over time. RESULTS Four hundred and eighty-one (81% of attendees) adult participants completed a valid Warwick-Edinburgh Mental Well-being Scale before starting OBOL; of whom, 63.8% completed the Warwick-Edinburgh Mental Well-being Scale immediately post intervention and 25.2% at three months. Mental well-being levels increased significantly (P < 0.001) over the course of the intervention and were sustained at the three-month follow-up (baseline median Warwick-Edinburgh Mental Well-being Scale score = 48 [interquartile range 41-55], completion = 53 [interquartile range 46-57], 3-month follow-up = 52 [interquartile range 46-56]). Change in mental well-being was clinically significant after accounting for age and gender. Changes in both fruit and vegetable consumption and physical activity appeared to explain some but not all of the variation in mental well-being. CONCLUSION We found significant improvements in mental well-being among participants directly after the intervention which were sustained at the three-month follow-up. These findings contribute to a growing body of knowledge on the contribution of lifestyle interventions to promoting and sustaining mental well-being.
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Farrugia DJ, Landmann A, McAuliffe PF, Diego EJ, Johnson R, Bonaventura M, Soran A, Dabbs DJ, Clark B, Lembersky BC, Puhalla SL, Brufsky A, Jankowitz R, Davidson NE, Ahrendt GM, Bhargava R. Abstract P6-09-14: Prognostic significance of a modified residual disease in breast and nodes (mRDBN) algorithm after neoadjuvant therapy for breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients achieving pathologic complete response to neoadjuvant chemotherapy have excellent disease free and overall survival. For patients with residual disease, the residual disease in breast and lymph node (RDBN) method provides useful prognostic information. RDBN is calculated as follows: 0.2*tumor size (in cm)+lymph node status (0-3) + tumor grade (1-3). pCR, low, intermediate and high risk of recurrence categories correspond to RDBN index of 0, 0.1 to 2.9, 3 to <4.4, and ≥ 4.4, respectively. We hypothesized that the prognostic accuracy of RDBN may be improved by also taking into account the residual tumor cellularity.
Methods: Retrospective review of 614 consecutive patients who underwent neoadjuvant therapy for breast cancer was performed. At our institution, tumor size/volume reduction in the breast is determined using the equation:
Estimated % tumor size reduction = [(pre-therapy clinical size – “revised” pathology tumor size)/pre-therapy clinical size]*100.
“Revised” pathology tumor size is calculated by multiplying the largest dimension of the gross tumor bed by the invasive tumor cellularity of the tumor bed (in comparison to the pre-therapy core biopsy sample). For example, if a 3 cm tumor bed has only 50% cellularity for invasive cancer (in comparison to pre-therapy core biopsy), the revised tumor size is 1.5 cm. Hence, we were able to use the “revised tumor size” for calculating the modified RDBN index (mRDBN). We also used gross tumor bed size for gross RDBN (gRDBN) to compare with mRDBN. mRDBN and gRDBN could be calculated on 459 of the 514 cases. Chi-Square statistical analysis was performed.
Results: Mean follow up was 33.1 months (median 31, range 4-70).
The results are shown in Table 1 & 2.
Table 1. Overall Recurrence and MortalityRDBN Score Category Overall Recurrence Mortality nn (%)RR95% CI; pn (%)RR95% CI; pmRDBN (n=459)High5829 (50.0)19.63[7.22, 53.40]; p=<0.000118 (31.0)16.24[4.97, 53.10]; p=<0.0001Intermed16433 (20.1)7.9[2.86, 21.78]; p=<0.000115 (9.1)4.79[1.41, 16.21]; p=0.006Low803 (3.8)1.47[0.34, 6.42]; p=0.694 (5.0)2.62[0.60, 11.41]; p=0.23pCR1574 (2.5)REF 3 (1.9)REF gRDBN (n=459)High8131 (38.3)15.02[5.49, 41.09]; p=<0.000119 (23.5)12.28[3.74, 40.26]; p=<0.0001Intermed14932 (21.5)8.43[3.05, 23.26]; p=<0.000116 (10.7)5.62[1.67, 18.89]; p=0.003Low722 (2.8)1.09[0.20, 5.82]; p=12 (2.8)1.45[0.25, 8.51]; p=1pCR1574 (2.5)REF 3 (1.9)REF
Table 2; Reclassification of gRDBN categoriesgRDBN mRDBN ReclassificationClassificationnLow (%)Intermed (%)High (%)Low7272 (100)0 (0)0 (0)Intermed1498 (5.4)140 (93.9)1 (0.7)High810 (0)24 (29.6)57 (70.4)
Conclusions: Both mRDBN and gRDBN provide prognostic information; however, separation of categories is improved with mRDBN (Table 1). mRDBN reclassified 30% of the high risk-gRDBN patients into intermediate risk category with a recurrence rate of 20%, leaving the 'true' high risk subgroup with a revised recurrence rate of 50% (Table 2). RDBN index also identified a group of low risk patients who have prognosis similar to patients with pCR.
Citation Format: Farrugia DJ, Landmann A, McAuliffe PF, Diego EJ, Johnson R, Bonaventura M, Soran A, Dabbs DJ, Clark B, Lembersky BC, Puhalla SL, Brufsky A, Jankowitz R, Davidson NE, Ahrendt GM, Bhargava R. Prognostic significance of a modified residual disease in breast and nodes (mRDBN) algorithm after neoadjuvant therapy for breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-14.
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