The Impact of Health Coaching on Weight and Physical Activity in Obese Adults: A Randomized Control Trial

Health Coaching (HC) is an evidence-based, patient-centered approach to assisting individuals in achieving their health-related goals. Studies have generally shown positive effects of HC on weight loss in obese adults. However, limitations do exist, that if addressed would further clarify HC's viability as a clinical, obesity treatment approach. To examine the effects of HC on weight loss, moderate-to-vigorous physical activity (MVPA), and psychosocial constructs in obese adults. A randomized control trial with 44 [Mean body mass index (BMI) 36.5] middle-aged, White adults. Participants were randomly assigned to HC (n = 22) or control (n = 22) groups. A certified health coach provided bi-weekly, in-person and telehealth HC for 12 weeks. Percent excess weight loss was 15.7% in HC vs. 2.5% in controls (p< .001). The change in MVPA was significantly greater in HC (+50.3 min/wk) vs controls (+7.1 min/wk). Psychosocial constructs also changed more favorably in HC than controls. Health coaching is an effective approach for weight loss in obese adults. The results of this study support the consideration of HC as a treatment option for obese adults looking to lose weight.

Pregnant people's views and knowledge on prenatal screening for fetal trisomy in the absence of a national screening program

Multiple non-invasive prenatal tests (NIPT) are available to screen for risk of fetal trisomy, however, there is no national prenatal screening program in Republic of Ireland. This study aimed to analyze pregnant people's opinions on availability, cost, and knowledge of NIPT for fetal aneuploidy. An anonymous questionnaire on prenatal screening tests and termination of pregnancy was distributed to patients attending antenatal clinics at a tertiary hospital. Descriptive analyses and chi-squared tests were completed. Among respondents, 62% (200/321) understood the scope of prenatal screening tests, with 77% (251/326) and 76% (245/323) correctly interpreting low- and high-risk test results, respectively. Only 26% (83/319) of participants had heard of NIPT. Chi-square tests showed a higher proportion of these people were ≥40 years old (p-value, <0.001), had post-graduate education (p-value, <0.001), or attended private clinics (p-value <0.001). Over 91% (303/331) of participants said every pregnant person should be offered prenatal screening tests for aneuploidy and 88% (263/299) believed these should be free. While pregnant Irish individuals have reasonable understanding of screening test interpretation, most were unaware of screening options. Additionally, participants' views on availability and associated cost of tests show the need for a national prenatal screening program, including education on fetal aneuploidy. These findings have relevance for countries without screening policies and are pertinent for broader maternity services.

The associations between place-based measures of walkability and physical activity across a range of diverse streetscapes

Walkability relates to aspects of a physical environment that have the potential to influence walking in that environment. In 2019, the Environmental Protection Agency developed the National Walkability Index (NWI), an easily accessible, U.S. Census block-group-level indicator of walkability. Although the NWI could be the metric of choice for researchers and urban planners, there is a lack of empirical evidence for its validity. The current study examined the validity of the NWI and Walk Score for predicting physical activity (PA) occurring along urban streetscapes. A wearable video device (Gogloo E7 SMART eyewear) was used to capture videos of streetscapes in 24 U.S. Census block groups in three different sized cities. The block groups varied in walkability, income level, and minority composition. The videos, collected over 10 months during 2019 at different times on weekdays and weekends, were reviewed by experts to obtain counts of walkers/h and individuals performing leisure PA/h (dependent variables). The independent variables were the NWI, its components - transit stop proximity, intersection density, employment/household occupancy mix, and employment mix, and Walk Score. Block group was the level of analysis. Linear regression indicated Walk Score, employment/household occupancy mix, and employment mix were associated with walkers/h (p < .001) while only employment/household occupancy mix, and employment mix were associated with leisure PA/h (p < .001). The NWI did not account for a significant portion of the variance in PA outcomes. A place-based examination of PA and walkability indexes favors the use of Walk Score and a modified version of the NWI.

Small Business Support Is Associated with the Quantity, Quality, and Usage of Youth Physical Activity Opportunities in Urban, Low-Income, African American Neighborhoods

Evidence suggests small businesses could play a significant role in bringing quality youth physical activity opportunities (YPAOs) to urban areas. Knowing more about their involvement with YPAOs in African American neighborhoods would be of significant value given the relatively low PA rates of African American youth. The current study examined associations between small businesses and YPAOs in low-income, African American urban neighborhoods. Surveys were conducted with 46.4% (n = 223) of eligible small business owners/managers and 44.2% (n = 38) of eligible YPAO providers in 20 low-income, African American urban neighborhoods to ascertain business and YPAO characteristics. Audits were conducted at the YPAOs and parks (n = 28) in the study areas to obtain counts of users and data on amenities/incivilities. Analyses included multiple linear regression. Only 33.6% of all businesses were currently supporting YPAOs. The percentage of businesses supporting only local YPAOs (YPAOs near the business) was significantly associated with the number of YPAOs in the area, number of YPAO amenities, youth participants, teams, amenity quality, and the severity of incivilities after controlling for neighborhood demographics. Businesses supporting only local YPAOs were at their location longer, and their owners were more likely to have a sports background, children, and believe small businesses should support YPAOs than business not supporting local YPAOs. This study provides evidence that YPAOs in low-income, African American urban neighborhoods are improved by support from small businesses. Efforts to enhance PA among African American youth living in low-income urban neighborhoods could benefit from involving small businesses.

An interprofessional clinic for adults with Turner syndrome: the patient perspective

OBJECTIVES

This qualitative study assessed the value of a primary care-based interprofessional clinical team for adults with Turner syndrome (TS) utilizing patient perspectives.

METHODS

Ten patients within one institution's interprofessional adult TS clinic participated in one of two semi-structured focus groups. Content analysis was used to classify content provided by participants into themes and sub-themes using Dedoose software.

RESULTS

Participants found that their quality of care and life were both improved due to the presence of the interprofessional Adults with TS Clinic. Specifically, participants reported that the clinic helped address problems with finding knowledgeable providers and care gaps, made appointments more convenient and improved interprofessional communication. Participants also reported that the clinic helped them find a sense of community and increased personal confidence. Study participants suggested improvements to the clinic by expanding the scope of practice further, simplifying processes to schedule appointments, and potentially creating interprofessional clinics for other rare diseases as well.

CONCLUSION

Pursuing avenues to create interprofessional clinics for adults with rare diseases has value from the patient perspective. This value can translate to improved patient outcomes through improvements in patient knowledge of their diagnosis, adherence to evidence-based care and quality of life.

Perceptions of Weight Change Among Romantic Partners: Considering Body Image, Relationship Experiences, Gender, and Sexual Orientation

Romantic relationship experiences have been found to be relevant to body image and weight in adulthood. In this study, we investigated predictors of heterosexual, lesbian, and gay romantic partners' (N = 500, M_age = 29.3) perceptions of their own and their partners' weight at the beginning of their relationship and 4.8 years later, on average. Perceived changes in participants' own weight status was associated with greater body dissastisfaction and longer relationship length. Perceived changes in partners' weight status was associated with their partners' BMI, as well as relationship quality. We also found that gender was important in understanding some of these associations. Implications of weight perceptions for individuals' and their partners' health and well-being and the critical role of relationship quality are discussed in the context of the health regulation model.

Racial and Ethnic Disparities in Breast Cancer Survival: Emergence of a Clinically Distinct Hispanic Black Population

OBJECTIVE

To understand the impact of Black race on breast cancer (BC) presentation, treatment, and survival among Hispanics.

SUMMARY OF BACKGROUND DATA

It is well-documented that non-Hispanic Blacks (NHB) present with late-stage disease, are less likely to complete treatment, and have worse survival compared to their non-Hispanic White (NHW) counterparts. However, no data evaluates whether this disparity extends to Hispanic Blacks (HB) and Hispanic Whites (HW). Given our location in Miami, gateway to Latin America and the Caribbean, we have the diversity to evaluate BC outcomes in HB and HW.

METHODS

Retrospective cohort study of stage I-IV BC patients treated at our institution from 2005-2017. Kaplan-Meier survival curves were generated and compared using the log-rank test. Multivariable survival models were computed using Cox proportional hazards regression.

RESULTS

Race/ethnicity distribution of 5951 patients: 28% NHW, 51% HW, 3% HB, and 18% NHB. HB were more economically disadvantaged, had more aggressive disease, and less treatment compliant compared to HW. 5-year OS by race/ethnicity was: 85% NHW, 84.8% HW, 79.4% HB, and 72.7% NHB (P < 0.001). After adjusting for covariates, NHB was an independent predictor of worse OS [hazard ratio:1.25 (95% confidence interval: 1.01-1.52), P < 0.041)].

CONCLUSIONS

In this first comprehensive analysis of HB and HW, HB have worse OS compared to HW, suggesting that race/ethnicity is a complex variable acting as a proxy for tumor and host biology, as well as individual and neighborhood-level factors impacted by structural racism. This study identifies markers of vulnerability associated with Black race and markers of resiliency associated with Hispanic ethnicity to narrow a persistent BC survival gap.

P–535 Machine learning classification algorithms can predict the ploidy status on day 5 and 6 with a 79% accuracy using evolutive morphological parameters and patient age

Study question

Can Machine Learning predict ploidy status from embryo evolutive morphological parameters in a non intrusive way?

Summary answer

Reporting cumulative embryo scoring from early development days and feed it to machine learning algorithms can help better predict the ploidy status of embryos

What is known already

Wiemer and Kelley showed morphological parameters and development rates were important parameters to consider during the embryo transfer process. Minasi et al. showed morphology assessment at blastocyst stage was correlated with ploidy status. Chavez-Badiola et al. showed a deep learning algorithm could predict the embryos ploidy with an accuracy of 70% and with positive predictive value of 0.79 using labeled blastocysts images.

Study design, size, duration

Study was a retrospective cohort analysis from 2019 to 2020 of 2520 biopsied embryos (669 cycles) cultured at POMA fertility clinic. Observations included all autologous embryos undergoing PGTA on day 5 or 6 with known PGTA status. Embryos from donors and with undefined PGTA results were excluded from the study. The embryos were classified as either euploid (n = 1528) or displaying a chromosomal anomaly (n = 992)

Participants/materials, setting, methods

Input of the machine learning model included patient age and 19 morphological parameters collected on days 1, 2, 3, 5 and 6 (symmetry, number of cells, blastocyst status, fragmentation, ICM and troph grades). An xgboost algorithm was trained on 80% of the data (n = 2016) and tested on 20% of blind data (n = 504).

Main results and the role of chance

Xgboost machine learning algorithm managed to predict ploidy status on the blind dataset with an accuracy of 79%, significantly higher than random chance (AUC= 0.71) and a positive predictive value of 87%.

Blastocyst stage parameters that are usually monitored to assess embryo quality (ICM, troph and blastocyst status on days 5 and 6) ranked high in the predictive power of the machine learning algorithm. It appeared that despite moderate to small individual correlation with the ploidy status, including parameters on day 1 (including number of PNs and number of cells on day1 PM check) to day 3 increased the performance of the classification algorithm from 70% accuracy to 79% accuracy. Machine learning algorithms are able to exploit evolution of morphological parameters during the development to improve the prediction.

Limitations, reasons for caution

Dataset was derived from one single clinic with manual annotations. Results should be validated on more clinics and inter-operator variation in morphological parameters annotation should be assessed to confirm robustness of the model and increase its predictive power.

Wider implications of the findings: Study shows the potential of detecting ploidy status in a non intrusive way and participating to embryo selection. Study confirms the importance of annotating morphological parameters of embryos in the early days of development.

Trial registration number

Not applicable

Axillary response rates to neoadjuvant chemotherapy in breast cancer patients with advanced nodal disease

PURPOSE

Utilization of sentinel lymph node biopsy (SLNB) in breast cancer patients with positive nodes after neoadjuvant chemotherapy (NAC) has increased. We examine axillary response rates after NAC in patients with clinical N2-3 disease to determine whether SLNB should be considered.

METHODS

Breast cancer patients with clinical N2-3 (AJCC 7th Edition) disease who received NAC followed by surgery were selected from our institutional tumor registry (2009-2018). Axillary response rates were assessed.

RESULTS

Ninety-nine patients with 100 breast cancers were identified: 59 N2 (59.0%) and 41 (41.0%) N3 disease; 82 (82.0%) treated with axillary lymph node dissection (ALND) and 18 (18.0%) SLNB. The majority (99.0%) received multiagent NAC. In patients undergoing ALND, cCR was observed in 20/82 patients (24.4%), pathologic complete response (pCR) in 15 patients (18.3%), and axillary pCR in 17 patients (20.7%). In patients with a cCR, pCR was identified in 60.0% and was most common in HER2+ patients (34.6%).

CONCLUSION

In this analysis of patients with clinical N2-3 disease receiving NAC, 79.3% of patients had residual nodal disease at surgery. However, 60.0% of patients with a cCR also had a pCR. This provides the foundation to consider evaluating SLNB and less extensive axillary surgery in this select group.

The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study

INTRODUCTION

Between 2017 and 2018 a national quality improvement initiative was introduced incorporating point-of-care viscoelastic haemostatic assays (VHA) to guide blood product transfusion. Laboratory coagulation profiles, use and results of VHA, and administration of blood products were investigated.

METHODS

A two-year prospective cohort study of maternal outcomes of women experiencing massive postpartum haemorrhage (PPH) >1000 mL in Wales. In this study, cases of massive PPH (≥2500 mL and/or ≥5 units red blood cell (RBC) transfusion) were identified.

RESULTS

Massive PPH occurred in 349 of 60 914 maternities (rate 5.7 per 1000). There were no deaths from PPH. Intensive care unit admission and/or hysterectomy occurred in 34/311 (10.9%) and 16/347 (4.6%), respectively. The leading cause of massive PPH was genital tract trauma (107/349, 30.6%). Two hundred and seventy-nine (80.6%) required RBC transfusion and 79/345 (22.9%) received at least one blood coagulation product. Results of VHA were recorded in 245/349 (70.2%), with 44/98 (44.9%) women tested in the first six months vs 63/77 (81.8%) in the final six months. Hypofibrinogenaemia (Clauss fibrinogen <2 g/L or FIBTEM A5 <12 mm) was observed in 56/328 (17.1%) of women, thrombocytopaenia (count <75 × 10⁹/L) in 17/334 (5.1%) and either PT or aPTT >1.5×reference range in 10/293 (3.4%).

CONCLUSION

In Wales, the use of VHA in cases of massive PPH increased over time, enabling clinicians to adopt a targeted, patient-specific approach to blood product administration, with only 22.9% of women receiving blood coagulation products and 17.1% having a documented clotting abnormality.

The effect of microvascular obstruction on the myocardial microstructure: a diffusion tensor imaging study

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Heart Research UK

Background

Diffusion tensor cardiac magnetic resonance (DT-CMR) imaging allows for characterising myocardial microstructure in-vivo using mean diffusivity (MD), fractional anisotropy (FA), secondary eigenvector angle (E2A) and helix angle (HA) maps. Following myocardial infarction (MI), alterations in MD, FA and HA proportions have previously been reported. E2A depicts the contractile state of myocardial sheetlets, however the behaviour of E2A in infarct segments, and all DTI markers in areas of microvascular obstruction (MVO) is also not fully understood. 

Purpose

We performed spin echo DTI in patients following ST-elevation MI (STEMI) in order to investigate acute changes in DTI parameters in remote and infarct segments both with and without MVO.

Method

Twenty STEMI patients (16 men, 4 women, mean age 59) had acute (5 ± 2d) 3T CMR scans. CMR protocol included: second order motion compensated (M012) free-breathing spin echo DTI (3 slices, 18 diffusion directions at b-values 100s/mm2[3], 200s/mm2[3] and 500s/mm2[12], reconstructed resolution was 1.66x1.66x8mm); cine and late gadolinium enhancement (LGE) imaging. Average MD, FA, E2A HA parameters were calculated on a  16 AHA segmental level. HA maps were described by dividing values into left-handed HA (LHM, -90° &lt; HA &lt; -30°), circumferential HA (CM, -30° &lt; HA &lt; 30°), and right-handed HA (RHM, 30° &lt; HA &lt; 90°) and reported as relative proportions. Segments were defined as infarct (positive for LGE) and remote (opposite to the infarct). 

Results

DTI acquisition was successful in all patients (acquisition time 13 ± 5mins). Ten patients had evidence of MVO on LGE images. MD was significantly higher in infarct regions in comparison to remote; MVO-ve infarct segments had significantly higher MD than MVO + ve infarct segments (MD remote= 1.46 ± 0.12x10-3mm2/s, MD MVO + ve = 1.59 ± 0.12x10-3mm2/s, MD MVO-ve  = 1.75 ± 0.12x10-3mm2/s, ANOVA p &lt; 0.01). FA was reduced in infarct segments in comparison to remote; MVO-ve infarct segments had significantly lower FA than MVO + ve infarct segments (FAremote= 0.37 ± 0.02, FA MVO + ve = 0.31 ± 0.02 x 10-3mm2/s, MD MVO-ve =0.25 ± 0.02, ANOVA p &lt; 0.01).

E2A values were significantly lower in infarct segments compared to remote; MVO + ve infarct segments had significantly lower values than MVO-ve. (E2A remote= 57.4 ± 5.2°, E2A MVO-ve = 46.8 ± 2.5°, E2A MVO + ve = 36.8 ± 3.1°, ANOVA p &lt; 0.001). RHM% (corresponding to subendocardium) was significantly lower in infarct segments compared to remote; MVO + ve infarct segments had significantly lower RHM% than MVO-ve. (RHM remote= 37 ± 3%, RHM RHM MVO-ve= 28 ± 7%, MVO + ve= 8 ± 5%, ANOVA p &lt; 0.001).

Conclusion

The presence of MVO results in a decrease in MD and increase in FA in comparison to surrounding infarct segments. However, the reduction in E2A and right-handed myocytes on HA in infarct segments is further exacerbated by the presence of MVO. Further study is required to investigate the underlying mechanisms for such alterations in signal intensity.

Abstract Figure. A case of transmural septal MI with MVO

Implementation of hepatic artery infusion (HAI) chemotherapy for unresectable colorectal liver metastases (CRLM): The University of Miami experience

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Background: In patients with unresectable liver-confined CRLM, regional chemotherapy via HAI in combination with modern systemic chemotherapy (CT) can achieve hepatic disease control and expand surgical resectability. We describe patient selection and early outcomes following implementation of a HAI program at our tertiary referral academic center. Methods: We analyzed demographics, previous systemic treatment, primary tumor location, molecular profiling, extent of hepatic/extrahepatic disease, perioperative HAI outcomes (toxicity, conversion to resection/ablation, radiographic response), and overall survival (OS) in CRLM patients selected for HAI treatment (01/2018—06/2020) after multidisciplinary review. Results: Of 35 patients with unresectable CRLM (primary: colon, n = 24; rectum, n = 11) selected for HAI, 57% were heavily pre-treated (with at least 2 lines of pre-HAI systemic chemotherapy), 71% had a Fong clinical risk score ≥3, 86% presented with synchronous disease, 80% had bilobar metastasis, and 86% had > 5 tumors. All tumors were microsatellite stable, with 20% harboring KRAS/NRAS mutations and none had class I/II BRAF mutations. HAI was initiated at a median 14 (IQR 3, 64) months after CRLM diagnosis, and administered for a median of 7 (range 2, 16) cycles; 91% of patients (31/34) received concurrent HAI and systemic chemotherapy. Although most (69%) patients experienced some degree of hepatic toxicity during HAI therapy resulting in FUDR dose reduction and steroid administration, biliary sclerosis requiring intervention was observed in only 3 (9%) of patients. The overall perioperative morbidity was 17%, and there were no surgical-related 90-day mortalities following HAI pump placement. Excluding patients who initiated HAI treatment within the last 3 months of the study period (n = 3), 13 of 32 patients (41%) were rendered disease-free in the liver following complete resection and/or ablation in combination with HAI/systemic chemotherapy; in the remaining 19 patients (59%), hepatic progression-free survival was 7.3 months (IQR 4, 12). At a median follow-up of 11.2 months, post-HAI median OS for the overall cohort was 12.3 (IQR 7, 20) months. Patients undergoing complete resection/ablation demonstrated improved survival compared with those with progressive disease (median 20 vs 12 months, respectively). Conclusions: Implementation of a HAI program for multimodality liver-directed management of unresectable CRLM is feasible and is associated with meaningful clinical outcomes unlikely to be achieved with systemic therapy alone in heavily pre-treated patients.

A review of stillbirth definitions: A rationale for change

Stillbirth definitions vary between countries around the globe. The purpose of this paper was to explore stillbirth definitions used by high income countries around the world, specifically compared to Ireland, their stillbirth and mortality rates and to examine how these rates are influenced by standards of care, especially resuscitation efforts within the delivery room for very preterm infants. A literature review was performed using PubMed, Academic Search Complete, MEDLINE, and CINAHL. These databases were searched with the terms "(stillbirth OR still birth OR stillborn) AND (definition OR registration OR registry)" and "(fetal OR neonatal OR neonate) AND Viability AND Gestational Age" in two separate searches. The database searches returned 1081 results involving stillbirths and 164 results for neonatal viability. After title, abstract, full text review, and reference review 33 papers remained for use in this study. Within the European Union (EU), 59.2 % (n = 16), 14.8 % (n = 4), 11.1 % (n = 3), and 3.7 % (n = 1) countries classify stillbirths at gestational ages of ≥22 weeks, ≥24 weeks, ≥28 weeks, and ≥180 gestational days respectively. The median stillbirth rate in Europe using ≥28 weeks gestational age as a cut-off was 2.7 per 1000 births, but this increased to 3.3 per 1000 births when stillbirths from 24 to 27 weeks gestation were included. Of the thirteen countries whose mortality data was examined, survival rates for liveborn infants ranged from 0-37.3 %, 1.1-64.5 %, 31.0-77.7 %, and 59.1-85.7 % for the gestational ages of 22, 23, 24, and 25 weeks, respectively. In 1995, survival rates for the United Kingdom and Ireland were only 26 % for those born at 24 weeks gestation, however this has almost doubled in Ireland to 56.6 % in 2014-2017. Survival rates have improved to the point that, in 2014-2017, the survival rate of infants born at 23 weeks gestation (32.3 %) was 6 % higher than the rate for those born at 24 weeks gestation in 1995. Due to the improvement in survival rates, multiple international organisations recommend recording stillbirths from 22 weeks gestation and/or 500 g. Based on the findings from this review, and due to improving survival rates for periviable infants, it is recommended the stillbirth definition in Ireland should be updated to ≥22 weeks' gestation and ≥400 g to comply with improved medical developments.

0384 Do Nurses with High Blood Pressure Have More Sleep Disturbances Than Their Peers?

Introduction

Nurses work in stressful environments and often have rotating work schedules, which may put them at risk for disturbed sleep and health. Poor quality and short sleep duration are strong risk factors for high blood pressure (HBP). Yet few studies have examined these associations in nurses, who may be a particularly at-risk sample. To address this gap, we examined group differences in self-reported and actigraphy-assessed sleep among nurses with and without self-reported HBP.

Methods

Participants were 392 nurses (91.8% female; 77.8% white, mean age = 39.54) recruited for a parent study. Participants completed baseline questionnaires including the Pittsburgh Sleep Quality Index (PSQI), followed by 14 days of actigraphy and sleep diaries to prospectively assess 14-day mean total sleep time (TST) and sleep efficiency (SE). An independent samples t-tests was used to assess group differences in sleep variables by HBP status. Linear regression was used to further examine the association between HBP status on sleep variables when controlling for age, race, gender, ethnicity, and body mass index (BMI).

Results

Twenty-nine (7%) nurses endorsed having clinically-diagnosed HBP. Nurses with HBP had higher global PSQI scores (indicating worse sleep quality; t=2.71, p=0.007), compared to nurses who did not report HBP, with a mean difference of 1.24. When adjusting for covariates, the association between HBP and the PSQI became marginally significant (p=0.054). There were no group differences in sleep diary or actigraphy TST or SE by HBP status, nor did HBP predict these sleep variables when controlling for covariates.

Conclusion

We found that nurses who reported having clinically diagnosed HBP had poorer global sleep quality. Although limited by self-reported history of HBP diagnosis, and low endorsement of HBP in our sample, our results corroborate other findings which suggest there is a strong association between high blood pressure and disturbed sleep. Future studies should examine these associations in larger samples, assess blood pressure directly, and experimentally examine the effects of HBP treatment on sleep quality.

Support

NIH/NIAID R01AI128359-01

0225 Do Associations Between Daily Stress and Sleep Vary by Work Shift? A Within-Person Analysis in Nurses

Introduction

Longitudinal studies have shown daily stress and sleep are bidirectionally associated. Nurses are particularly likely to experience sleep disturbances and high stress due to demanding work environments. Night shift work may be a unique stressor for nurses that exacerbates associations between stress and sleep. Using a within-person design, we examined the daily bidirectional associations between stress and sleep and moderation by nightly work shift (day/off shift vs. night shift) in a large sample of nurses.

Methods

Participants were 393 nurses (91% female; 77% white, mean age = 38.4 years) recruited from two hospitals. Participants completed 14 days of sleep diaries and actigraphy to assess total sleep time (TST) and sleep efficiency (SE). They simultaneously completed assessments of stress on the previous day (0 = “not at all” to 4 = “extremely”) and daily work schedule (day/off shift vs. night shift [work between 9pm-6am]).

Results

Results indicated greater daily stress was associated with shorter diary TST (b = -9.49, p&lt;.0001) and actigraphy TST (b = -4.48, p&lt;.01), as well as lower diary SE (b = -0.56, p&lt;.001). When examining reverse pathways of sleep predicting next day stress, both diary TST (b = -0.0004, p&lt;.0001) and actigraphy TST (b = -0.0002, p = .03) predicted higher next-day stress. Lower diary SE predicted higher next-day stress (b = -0.005, p&lt;.001). Only the association between daily stress and nightly diary SE was moderated by daily work shift: only when nurses worked a day or off shift did they have a negative association between daily stress and diary SE (b = -0.68, p&lt;.0001).

Conclusion

Daily stress and sleep disturbances occurred in a bidirectional fashion for night- and day-shift working nurses. Most associations were similar regardless of daily type of work shift. Objective and subjective short TST and low subjective SE may contribute to a cycle of increased stress and are prime targets for a tailored sleep intervention in nurses. More research is needed to develop interventions to address the unique sleep health challenges faced by nurses.

Support

NIAID R01AI128359-01

1063 Depression Moderates the Association Between Posttraumatic Stress Disorder and Nightmare Severity in Nurses

Introduction

Nurses report a higher prevalence of posttraumatic stress disorder (PTSD) than the general population, and approximately 18% of nurses report having depression. Nightmares are a common symptom of PTSD, and both nightmares and PTSD are correlated with depression. Nightmares may represent a possible clinical target for improving outcomes in both disorders. This study assessed associations between PTSD and depressive symptoms with nightmare severity, and whether depressive symptoms moderated associations between PTSD and nightmare severity.

Methods

Participants were 461 nurses (91% female; 77% white, mean age = 38.39 years) recruited from two hospitals for a parent study. Participants completed the Patient Health Questionnaire (PHQ-9), Post-traumatic Stress Disorder Checklist (PCL-5), and 14 days of sleep diaries to assess daily nightmare frequency and severity (on a scale of 0 = not at all severe to 3 = very severe).

Results

22.1% of participants reported at least one nightmare across the 14 days, with a mean daily nightmare frequency of 1.17 (SD = 2.15) and a mean severity of 0.11 (SD = 0.18). PCL-5 and PHQ-9 scores were significantly correlated with nightmare severity (r = 0.27; r = 0.24, respectively) and each other (r = 0.69). PHQ-9 scores moderated the association between PCL-5 scores and nightmare severity (β = -.01, SE = &lt;0.01, p = 0.015). For individuals 1 SD below the PHQ-9 mean, higher PCL-5 scores were associated with higher nightmare severity. For individuals 1 SD above the PHQ-9 mean, higher PCL-5 scores were associated with higher nightmare severity, but to a lesser degree.

Conclusion

Both depressive and PTSD symptoms were associated with more severe nightmares. Surprisingly, the association between PTSD symptoms and nightmare severity was stronger for those with lower depressive symptoms. Results suggest depression, PTSD, and nightmares may represent a partially overlapping symptom cluster. Research should investigate how nightmare treatment may reduce PTSD and depressive symptoms.

Support

NIAID R01AI128359-01

0398 Demographic Differences in the Degree of Discrepancy Between Sleep Diary and Actigraphy Measures of Sleep

Introduction

The accurate estimation of sleep is critical for understanding who is most at risk for sleep disorders and associated disease outcomes. Individuals who overestimate sleep disturbances may be at increased risk for insomnia. A few studies have shown demographic differences in the accuracy of sleep estimation when comparing subjective and objective measures; however, the previous literature is inconsistent and focuses primarily on older adults. We sought to replicate these studies in a large sample of nurses using 14 days of sleep diary and actigraphy measures.

Methods

Participants were 392 nurses (91.8% female; 77.8% white, mean age = 39.54) recruited for a larger study. Participants completed 14 days of actigraphy and sleep diaries to prospectively assess total sleep time (TST) and sleep efficiency (SE). Discrepancy between diary and actigraphy measures was calculated by subtracting actigraphy measures from diary measures. Linear regression was used to examine how age, race (0 = race other than white, 1 = white), gender (1 = male, 2 = female), ethnicity (1= non-Hispanic/Latinx, 2 = Hispanic/Latinx) predicted degree of sleep discrepancy.

Results

The average discrepancy between diary and actigraphy TST was 30.29 minutes (SD = 29.28), and the average discrepancy between diary and actigraphy SE was 4.16% (SD = 5.66). Race and ethnicity did not predict amount of TST or SE discrepancy. However, younger individuals had more discrepancy in both TST (b = -0.48, p &lt; .001) and SE (b = -0.09, p &lt; .001). Men also had a greater discrepancy in both TST (b = -10.90, p &lt; .05) and SE (b = -2.56, p &lt; .05).

Conclusion

Men and younger individuals had greater discrepancies between diary and actigraphy measures of sleep. This is in contrast to some previous research showing that elderly women tend to display greater discrepancies between subjective and objective measures of sleep. It is essential that future research explore the discrepancies between subjective and objective measures of sleep in larger and more demographically diverse samples. Establishing a better understanding of this relationship is crucial, as it may have significant implications for the diagnosis and treatment of insomnia.

Support

NIH/NIAID R01AI128359-01

Routine Analysis of Proteins by Kjeldahl and Dumas Methods: Review and Interlaboratory Study Using Dairy Products

The Kjeldahl and Dumas (combustion) methods were compared in 11 laboratories analyzing samples of milk, skim milk powder, whole milk powder, whey protein concentrate, infant formula, casein, caseinate, 2 reference compounds (glycine and EDTA), and a secondary reference skim milk powder. The comparison was conducted by using international standards where applicable. Overall means were 8.818 g N/100 g by the Kjeldahl method and 8.810 g N/100 g by the Dumas method. No evidence was found for a consistent bias between methods that may be of concern in the trading of dairy produce. A review of more than 10 related trials revealed a lack of consensus in the bias between the 2 methods, suggesting that differences in methodology and sources of systematic error may be contributors. For samples containing &gt;2 g N/100 g, the Dumas relative repeatability and reproducibility standard deviations were consistently about 0.35 and 0.75%, respectively, whereas the corresponding Kjeldahl values declined generally with N content and were significantly larger. The Dumas precision characteristics may be due to the dominance of Leco analyzers in this trials, and in most other recent trials, rather than an inherent method attribute. Protein determination methods for dairy products need to be reviewed and updated. The Dumas method needs Codex Alimentarius status as a recognized test method.

Synthetic Small Molecule Characterization and Isomer Discrimination Using Gas-Phase Hydrogen-Deuterium Exchange IMS-MS

Ion mobility spectrometry-mass spectrometry (IMS-MS) combined with gas-phase hydrogen-deuterium exchange has been used to characterize novel psychoactive substances (NPSs) which are small synthetic compounds designed to mimic the effects of other illicit substances. Here, NPSs containing labile heteroatom hydrogens were evaluated for HDX reactivity in the presence of either deuterated water (D₂O) or ammonia (ND₃) within the drift tube. An initial evaluation of exchange propensity was performed for six NPSs. Five compounds exchanged in the presence of ND₃ while only one NPS (benzyl piperazine) exchanged with D₂O. The exchange mechanism of D₂O requires stabilization with a nearby charged site; the diamine ring of benzyl piperazine provided this charge site at a fixed length. Three disubstituted benzene isomers ( o-, m-, and p-fluorophenyl piperazine) containing the diamine ring structure and a fluorine atom were subsequently analyzed. Having identical isotopic composition and nearly identical drift time distributions, these isomers could not be distinguished by IMS-MS alone. However, upon undergoing HDX in the drift tube, a t test of means (α = 0.05) showed that discrimination was possible if the exchange data from both reagent gases were included. Molecular dynamics simulations show that the proximity of the fluorine to the diamine ring hinders the dihedral angle rotation between the benzene and the diamine ring; this may partially account for the observed exchange differences.

Utility of radiation after neoadjuvant chemotherapy for surgically resectable esophageal cancer

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Background: Neoadjuvant chemotherapy (NAC) is the gold standard approach for locally advanced esophageal cancer (EC), however the addition of radiation remains largely controversial. We sought to investigate the role of neoadjuvant radiation in resectable EC by comparing outcomes of patients who underwent neoadjuvant chemotherapy with (NACR) or without radiation (NAC) using a large nationwide cohort. Methods: National Cancer Data Base (NCDB) was queried for patients with non-metastatic EC between 2010 and 2014. Kaplan-Meier, log-rank and Cox multivariable regression analysis were performed to calculate overall survival (OS). Logistic regression was used to identify factors associated with 90-day mortality and complete pathological response (pCR). Results: A total of 12,546 EC patients who underwent neoadjuvant therapy were included: the majority were males (84%), Caucasians (90.3%), and had adenocarcinoma (81.1%), cT3 (60.6%) and cN1 (49.1%). 11,269 (89.8%) patients had NACR, whereas 969 (7.7%), NAC alone. pCR rate was 14.1% (19.2%, NACR vs. 6.3%, NAC, p < 0.001). Neoadjuvant radiation was an independent predictor for improved pCR [HR 0.305, 95% CI 0.205-0.454, p < 0.001], however OS was similar in patients undergoing NAC with or without radiation (35.9 vs. 37.6 months, respectively, p = 0.393). This persisted regardless of tumor staging. There was a trend towards worse 90-day mortality after radiation (8.2%, NACR vs. 7.7%, NAC; HR 1.410, 95% CI 0.975-2.038, p = 0.068). In Cox regression, controlling for patient and disease-related factors, neoadjuvant radiation was an independent predictor of worse OS (HR 1.322, 965% CI 1.177-1.485, p < 0.001). Conclusions: This is the largest study comparing NACR versus NAC in resected EC. The addition of radiation to neoadjuvant chemotherapy is associated with improved pathological response rates, however it had deleterious effects in long-term and possibly, short-term survival. Our findings suggest that NAC without radiation may be the optimal neoadjuvant therapy in resectable EC, however further evidence with randomized clinical trials is warranted.