Discontinuing semaglutide after weight loss: strategy for weight maintenance and a possible new side effect

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) facilitate weight loss. Weight regain off therapy is concerning. We reported the case of a 35-year-old male prescribed oral semaglutide with 22.7 kg weight loss over 120 days. Herein, we describe the clinical course when discontinuing GLP-1 RA therapy, one approach to maintaining weight loss after discontinuation, and a possible new side effect. At day 120, we continued oral semaglutide 7 mg daily, down from 14 mg, for weight maintenance with subsequent weight regain. We re-increased semaglutide to 14 mg/day with weight re-loss within 1 month and weight maintance for a year. We then discontinued semaglutide; weight loss was maintained for 6 months. The patient reported lactose intolerance ∼13 months before starting semaglutide. During semaglutide therapy, the patient reported worsened lactose intolerance and new gluten intolerance. Food allergy/celiac testing were negative. Intolerances did not improve with semaglutide discontinuation. Six months after semaglutide discontinuation, the patient was diagnosed with small intestinal bacterial overgrowth, possibly worsened by semaglutide. Factors potentially supporting weight maintenance were early drug treatment for new-onset obesity, non-geriatric age, strength training, and diet modification. The case highlights tailoring approaches to maintain weight loss without GLP-1 RAs. Trials are needed to optimize weight maintenance strategies.

Quality of life in the digital age: young adult hematopoietic stem cell transplantation patients and healthcare providers' views of telehealth

PURPOSE

The COVID-19 pandemic shifted the healthcare field from in-person clinic visits to virtual-based telehealth appointments. This study explored young adult (YA) hematopoietic stem cell transplantation (HSCT) patient and physician communication preferences and quality of life.

METHODS

One researcher conducted semi-structured interviews with n = 10 YA HSCT patients and n = 10 healthcare providers (HPs). HPs included physicians (n = 5) and advanced practice provider (APP) (nurse practitioners and physician assistants) (n = 5). Interviews lasted approximately 10-15 min, were held over Zoom®, and were audio-recorded. Interviews were professionally transcribed verbatim, and two independent researchers conducted a thematic analysis using Dedoose®.

RESULTS

Common themes included the following: (1) convenience, (2) improved communication, (3) technology issues, and (4) quality of life for patients and physicians. In general, most patients (n = 7; 70%) preferred in-person visits over telehealth for initial appointments, stating they chose the "social connection" and "engagement" associated with in-person visits. For "check-ins" and follow-up appointments (n = 5; 50%), patients preferred hybrid appointments. Physicians (n = 4; 80%) preferred telehealth stating it was "convenient," "timesaving," and improved "compliance." In contrast, all APP staff (n = 5; 100%) preferred in-person visits, stating in-person improved "relationships" with patients and was more "convenient" than using electronic devices for telehealth.

CONCLUSION

Providers differed in preference. APP personnel preferred in-person visits and HSCT physicians preferred telehealth appointments. YA HSCT patients preferred in-person for initial appointments and hybrid clinic visits for follow-up appointments.

Training Promotoras to Implement a Mindfulness-based Healthy Lifestyle Program in Rural Communities

Partnering with promotoras to implement a healthy lifestyle intervention has proven efficacious in reaching community members whom they serve. However, there are no clearly defined guidelines for implementing promotora training, especially when it involves developing mindfulness skills in promotoras unfamiliar with this concept. This is a report about the facilitators and barriers to training promotoras to implement a mindfulness-enhanced healthy eating and physical activity intervention, ADAPT+, using the Train-the-Trainer model. Following this model, we laid the foundations for sustained implementation of ADAPT+ even after the training process. Future studies may examine how these guidelines help map promotora training in other mindfulness-related interventions.

Comparing Group Versus Individual Prenatal Care on Breastfeeding Practice and Motivational Factors

OBJECTIVE

Although breastfeeding in the first 6 months postpartum benefits both infants and mothers, breastfeeding rates remain low. This study examined whether group prenatal care was associated with an increased breastfeeding initiation and duration compared with those receiving usual, individual prenatal care. A secondary aim was to investigate whether sociodemographic and motivational factors were associated with breastfeeding initiation and duration across prenatal care groups.

METHODS

Pregnant women in their third trimester (n = 211) from an innercity university medical center participated. Prenatal care type was identified from the medical chart, and data on breastfeeding duration at 1, 3, and 6 months postpartum were collected. Breastfeeding motivational factors were assessed with a survey. Logistic regressions and independent-samples t tests were used for data analyses.

RESULTS

After controlling for demographic factors, group prenatal care was associated with increased breastfeeding at 6 months postpartum (odds ratio = 2.66; P = .045) compared with individual care. Breastfeeding intention (P < .001), competence (P = .003), and autonomous motivation (P < .001) were significantly higher, while amotivation (P = .034) was significantly lower in group compared with individual prenatal care.

CONCLUSIONS

Breastfeeding persistence was higher among women receiving group prenatal care, potentially due to motivational factors. Future studies should investigate how breastfeeding motivational factors could be effectively targeted in prenatal care to increase breastfeeding persistence.

Nutritional status and body mass index before hematopoietic stem cell transplantation (HSCT) and associated outcomes: a rapid review

PURPOSE

Hematopoietic stem cell transplantation (HSCT) recipients experience several post-HSCT complications affecting nutritional status, body mass index (BMI), and mortality that can potentially be mitigated by nutritional management. This rapid review examines the relationship between pre-HSCT nutritional status and BMI and post-HSCT survival.

METHODS

Articles were identified from PubMed, Scopus, and Embase. Two researchers independently completed the title, abstract, and full-text review. Inclusion criteria included the following: (1) randomized clinical trials or observational studies; (2) human subjects diagnosed with cancer and undergoing HSCT; (3) reported pre-HSCT nutritional status (e.g., diet recall, nutritional survey, dietitian session) or BMI; and (4) reported treatment related mortality and/or survival.

RESULTS

The initial search found 3036 articles, 28 were included in full-text review, and 18 met inclusion criteria. Articles had quasi-experimental (n = 2) and observational (n = 16) study designs. Of the studies, n = 5 reported nutritional intake decreased post-HSCT, and n = 2 reported nutrition intervention (i.e., controlled feeding) post-HSCT improved survival. Four studies reported having a BMI classified as underweight improved survival, while n = 5 reported having a BMI classified as overweight or obese improved survival.

CONCLUSION

Current research exploring the relationship between nutritional status and BMI with HSCT survival is mixed. Further research is needed to determine how nutritional status and BMI are associated withsurvival post-HSCT to inform future intervention work.

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Mediators of Social Acceptance Among Emerging Adult Survivors of Childhood Cancer

Purpose: Examine associations of social developmental factors (e.g., peer/parent social attachment, romantic relationships) and perceptions of social acceptance among emerging adult survivors of childhood cancer. Methods: A cross-sectional, within-group design was used. Questionnaires included the Multidimensional Body-Self Relations Questionnaire, Inventory of Parent and Peer Attachment, Adolescent Social Self-Efficacy Scale, Personal Evaluation Inventory, Self-Perception Profile for Adolescents, and demographics. Correlations were utilized to determine associations between general demographic, cancer-specific, and the psychosocial outcome variables. Peer and romantic relationship self-efficacy were assessed as potential mediators of social acceptance in three mediation models. Relationships between perceived physical attractiveness, peer attachment, parental attachment, and social acceptance were assessed. Results: Data were collected from N = 52 adult participants (Mage = 21.38 years, standard deviation = 3.11 years) diagnosed with cancer as a child. The first mediation model demonstrated a significant direct effect of perceived physical attraction on perceived social acceptance and retained significance after adjusting for indirect effects of the mediators. The second model demonstrated a significant direct effect of peer attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer relationship self-efficacy. The third model demonstrated a significant direct effect of parent attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer self-efficacy. Conclusion: Relationships between social developmental factors (e.g., parental and peer attachment) and perceived social acceptance are likely mediated by peer relationship self-efficacy in emerging adult survivors of childhood cancer.

A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

At least 70% of US adults have metabolic disease. However, less is done to address early disease (e.g., overweight, obesity, prediabetes) versus advanced disease (e.g., type 2 diabetes mellitus, coronary artery disease). Given the burden of advanced metabolic disease and the burgeoning pandemics of obesity and prediabetes a systematic response is required. To accomplish this, we offer several recommendations: (A) Patients with overweight, obesity, and/or prediabetes must be consistently diagnosed with these conditions in medical records to enable population health initiatives. (B) Patients with early metabolic disease should be offered in-person or virtual lifestyle interventions commensurate with the findings of the Diabetes Prevention Program. (C) Patients unable to participate in or otherwise failing lifestyle intervention must be screened to assess if they require pharmacotherapy. (D) Patients not indicated for, refusing, or failing pharmacotherapy must be screened to assess if they need bariatric surgery. (E) Regardless of treatment approach or lack of treatment, patients must be consistently screened for the progression of early metabolic disease to advanced disease to enable early control. Progression of metabolic disease from an overweight yet otherwise healthy person includes the development of prediabetes, obesity ± prediabetes, dyslipidemia, hypertension, type 2 diabetes, chronic kidney disease, coronary artery disease, and heart failure. Systematic approaches in health systems must be deployed with clear protocols and supported by streamlined technologies to manage their population's metabolic health from early through advanced metabolic disease. Additional research is needed to identify and validate optimal system-level interventions. Future research needs to identify strategies to roll out systematic interventions for the treatment of early metabolic disease and to improve the metabolic health among the progressively younger patients being impacted by obesity and diabetes.

Multi-Level Determinants of Food Insecurity among Racially and Ethnically Diverse College Students

Compared with the general population, the prevalence of food insecurity (FI) is higher among college students. The COVID-19 pandemic exacerbated FI disparities and highlighted the need for further research to better understand and address FI in this population. Although race and ethnicity are two of the strongest predictors of FI among college students, little research is available on the determinants of FI among racial/ethnic minority college students. A cross-sectional study (n = 588) based on the National Institute of Minority Health and Health Disparities research framework was examined to identify population-specific determinants of FI among racially/ethnically diverse college students through the assessment of multiple domains (behavioral, environmental, socio-cultural) and levels of influence (individual, interpersonal, and community levels). Discrimination was the sole predictor of FI for non-Hispanic Black students. Coping mechanisms for FI (savings, reduced intake) and body mass index (BMI) were predictors of FI for Hispanic and non-Hispanic White students. Additionally, decreased holistic support from faculty and staff was also observed as a predictor of FI in Hispanic students. Implications include the need for further research and the development of multi-level, tailored interventions to address FI among college students with the goal of decreasing disparities.

Delivering ADAPT+ to Latino Families Living in Rural Communities: Feasibility and Acceptability of Implementing a Health Promotion Program Including Mindfulness

BACKGROUND

Obesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities.

METHODS

In an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated.

RESULTS

Feasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up.

CONCLUSION

Study implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial.

CLINICAL TRIAL REGISTRATION

This trial was registered with ClinicalTrials.gov under identifier NCT04800432.

The Lived Experience of Young Adult Cancer Survivors after Treatment: A Qualitative Study

OBJECTIVE

The purpose of this qualitative study was to compare the lived experiences among extended (one year or less post-treatment) and long-term (three years or more post-treatment) young adult (YA) cancer survivors (ages 18-39 years old).

METHODS

Two trained researchers conducted semi-structured interviews inquiring about the overall lived experience of N = 24 YA cancer survivors (n = 12 extended and n = 12 long-term). The same two researchers independently completed line-by-line coding and thematic content analysis.

RESULTS

Interviews lasted an average of 41 min and revealed common themes of symptoms, psychosocial concerns, coping, and changes in health behaviors (e.g., nutrition and physical activity). All participants discussed symptoms impairing their quality of life and affecting their fear of recurrence. Specific psychosocial concerns among extended survivors were appearance-related (e.g., hair loss, weight gain) whereas concerns among long-term survivors included job loss, fertility, and financial stress. Coping strategies described by extended survivors were often distraction-based (e.g., watching television to "escape"), while long-term survivors described more active coping strategies (e.g., yoga, meditation, and seeking support from family and friends). Most survivors reflected on limited physical activity or unhealthy eating during treatment; however, nearly all declared healthy eating and physical activity post-treatment to improve well-being.

CONCLUSIONS

YA cancer survivors report differing symptoms, psychosocial concerns, and coping strategies across time since treatment. While survivors reported challenges with physical activity and nutrition during treatment, nearly all emphasized the importance of these health behaviors post-treatment. Thus, health behavior interventions could represent a preferred approach to address post-treatment challenges and improve quality of life for YA survivors.

Qualitative assessment of uptake retention and evaluation of prevention materials for skin cancer among Hispanics

OBJECTIVE

Examine retention and evaluation of incorporating melanocortin-1 receptor genetic risk information materials in a skin cancer prevention intervention conducted in Hispanics living near Tampa, Florida and Ponce, Puerto Rico.

METHODS

Two researchers applied thematic content analysis to identify major themes of open-ended responses (n = 1689) from 489 participants.

RESULTS

Five major thematic categories emerged: 1) intervention comments; 2) tips and tricks; 3) cancer prevention; 4) general information; and 5) risk factors and genetics. Responses captured under intervention comments (e.g., information was clear, easy to understand) and tips and tricks for sun protection (e.g., using sunscreen, wearing protective clothing) were most frequent. Participants noted the importance of conducting skin exams professionally or at home. English-preferring Tampa residents stated their individual risk factors, especially race and/or ethnicity, more frequently than Ponce residents and Spanish-preferring Tampa residents. Ponce residents were more likely to comment on wanting to share intervention materials with family and friends.

CONCLUSION

Findings suggest Hispanic participants implemented sun safety activities.

A qualitative study of stress experiences, health behaviors, and intervention preferences in young adult cancer survivors

PURPOSE

To inform behavioral intervention development, this study examined experiences and unmet needs related to stress, diet, and physical activity in young adult (YA) cancer survivors.

METHODS

Twenty-three semi-structured interviews were conducted with a purposive sample of YA cancer survivors (n = 12 aged 18-29 years; n = 11 aged 30-39 years; 57% racial or ethnic minority) between May and July 2022 via Zoom. Data were analyzed using a coding reliability approach to thematic analysis.

RESULTS

Stressor-related themes included health and health care, economic stability, social and community context, and balancing responsibilities. Transition to independent adulthood was discussed among younger participants (18-29 years). Coping-related themes included letting go, keeping anchored in faith, and distraction. Older participants (30-39 years) reported more diverse coping strategies. Routine and consistency and the impact of stress were themes aligning with health behaviors. Control was a cross-cutting theme regarding stressors, coping, and health behaviors. Themes related to intervention preferences included individualized approach, expert-based content, peer support, integrative self-care, and manageability. Younger participants preferred multiple intervention formats (e.g., website, tracking logs).

CONCLUSIONS

Findings highlighted unmet needs regarding social and environmental stressors in YA cancer survivors and a preference for individualized, expert-based content and peer support in stress management-enhanced behavioral interventions. Such interventions may be tailored for specific age groups to account for differences in stress experiences and intervention preferences.

Challenges and adaptations for a cluster-randomized control trial targeting parents of pediatric cancer survivors with obesity during the COVID-19 pandemic

Although the COVID-19 pandemic has increased the importance of digital technology in clinical trial implementation, there is a dearth of literature reporting on challenges and strategies related to multi-site randomized controlled trials (RCTs) among pediatric cancer survivors during the pandemic. This paper discusses challenges faced in the implementation of the NOURISH-T+ trial so far (December 2019-March 2022) and describes adaptations made as a result of these disruptions in the areas of recruitment, data collection, and overall engagement. This reflection is based on a multisite cluster-RCT that aims to examine whether an intervention targeting parents as agents of change to promote healthy eating and physical activity in pediatric cancer survivors, NOURISH-T+ (Nourishing Our Understanding of Role modeling to Improve Support and Health for Healthy Transitions), reduces body mass and improves health behaviors compared to Brief NOURISH-T (Enhanced Usual Care/EUC). The COVID-19 pandemic has created and exacerbated challenges for our trial related to participant recruitment and engagement, technology access and literacy, and data collection and management, as well as COVID-related challenges (e.g., Zoom fatigue). Strategies used to address these challenges might prove helpful in future virtual or hybrid RCTs, including developing trust and rapport with participants, providing support through multiple routes of dissemination, and using data management applications (e.g., REDCap™) for automation and project management. Extra efforts to build families' trust and rapport, offering multiple routes of support, and automating as many tasks as possible are critical to ensuring the continuation of high-quality clinical trials during the COVID-19 pandemic.

Lifestyle Interventions with Mind-Body or Stress-Management Practices for Cancer Survivors: A Rapid Review

This rapid review examined current evidence on lifestyle interventions with stress-management or mind-body practices that assessed dietary and/or physical activity outcomes among cancer survivors. Searches were conducted in PubMed, Embase, and PsycINFO based on Cochrane Rapid Reviews Methods Group rapid review recommendations using the keywords "diet," "physical activity," "mind-body," "stress," and "intervention." Of the 3624 articles identified from the initial search, 100 full-text articles were screened, and 33 articles met the inclusion criteria. Most studies focused on post-treatment cancer survivors and were conducted in-person. Theoretical frameworks were reported for five studies. Only one study was tailored for adolescent and young adult (AYA) cancer survivors, and none included pediatric survivors. Nine studies reported race and/or ethnicity; six reported that ≥90% participants were White. Many reported significant findings for diet and/or physical activity-related outcomes, but few used complete, validated dietary intake methods (e.g., 24-h recall; n = 5) or direct measures of physical activity (e.g., accelerometry; n = 4). This review indicated recent progress on evaluating lifestyle interventions with stress-management or mind-body practices for cancer survivors. Larger controlled trials investigating innovative, theory-based, personalized interventions that address stress and health behaviors in cancer survivors-particularly racial/ethnic minority and pediatric and AYA populations-are needed.

Microvascular tissue perfusion after postcatheterization pseudoaneurysm treatment

BACKGROUND

Femoral pseudoaneurysm (PSA) is a severe complication after endovascular procedures. Ultrasound-guided manual compression (MC) and percutaneous thrombin injection (TI) are frequently used treatments. MC is less effective, TI may cause thromboembolic events.

OBJECTIVE

Up to date, there is no data regarding impairment of microvascular tissue perfusion after PSA treatment.

METHODS

In this single-center, prospective study 22 patients with PSA were included. We compared macro- and microcirculatory perfusion in the treated and untreated leg at baseline before, after and one day after treatment. Leg perfusion was assessed with ultrasound and ankle-brachial index (ABI). Microcirculatory perfusion of the feet was measured with a near-infrared spectroscopy (NIRS) camera generating StO2-tissue-maps.

RESULTS

Successful PSA thrombosis was achieved in 16 (100%) patients in TI group and in 4 (66.7%) patients in MC group. There was no evidence of arterial thrombi on ultrasound and the ABI did not differ between groups. NIRS StO2-tissue-maps of the feet showed no significant difference in both groups concerning the treated (p = 0.121) or the untreated (p = 0.198) leg during follow up.

CONCLUSIONS

In this small exploratory study, there was no evidence of micro- and macrovascular tissue perfusion impairment after treatment of postcatheterization femoral pseudoaneurysm with thrombin injection underscoring the safety of this approach.

Exploration of Multilevel Barriers and Strategies That Affected Early COVID-19 Vaccination and Testing in Rural Latino Communities in Southwest Florida

The COVID-19 pandemic has disproportionately impacted multiple racial and ethnic minority groups, including Latinos residing in rural communities. Low rates of vaccination and testing combined with social determinants of health have contributed significantly to this disparate impact. Given the needs and constraints unique to rural Latino migrant and immigrant communities, this qualitative study examined multilevel barriers and strategies that affect COVID-19 vaccination and testing uptake among these communities in southwest Florida. Four focus groups (n = 25) were conducted between March and April 2021 with various key stakeholders, including rural Latino community members, local leaders, and community health workers ('Promotoras de Salud'). Themes that aligned with barriers to COVID-19 vaccination and testing included fear, lack of control, misinformation, lack of accessibility, and institutional/policy issues; themes that aligned with strategies to improve COVID-19 vaccination and testing uptake included faith, taking care of self, and community and family resilience. Recommendations for improving future pandemic responses for rural Latino communities include incorporating multiple levels of intervention, such as consideration of the role of the family, involving trusted community members, and ensuring the development and implementation of fair and consistent policies.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

A nutrition education intervention to improve eating behaviors of children with autism spectrum disorder: Study protocol for a pilot randomized controlled trial

Autism spectrum disorder (ASD) is a developmental disorder that affects communication and social behaviors. Children with ASD often experience mealtime behavior challenges and selective eating behaviors. They also tend to consume fewer fruits and vegetables and more high-energy dense foods, compared to neurotypical peers. A nutrition intervention was designed to prevent the development of feeding disorders and the long-term negative health impacts associated with poor dietary intake. This randomized controlled trial will evaluate the feasibility and preliminary efficacy of the nutrition education intervention for children with ASD and their parents through the Early Intervention (EI) services. We will recruit EI providers and parent-child dyads (n = 48) from EI programs, and randomly assign them into Autism Eats intervention (n = 24) or enhance usual care (EUC) comparison group (n = 24). The Autism Eats is 10 weekly sessions delivered individually as part of EI, while the EUC group will receive only 1 nutrition education session and then weekly parent handouts. The Autism Eats integrates ASD-specific feeding strategies and behaviorally-focused intervention strategies such as goal setting. Feasibility indicators include reach/participation, attrition, completion, fidelity, compatibility, and qualitative participant feedback. Outcome measures include dietary intakes and mealtime behaviors of children with ASD using 3-day food records and a validated questionnaire, the Brief Autism Mealtime Behavior Inventory (BAMBI). We will examine whether there are differences in children's food intakes, variety, diet quality, and mealtime behaviors between Autism Eats and EUC groups at post-intervention and 5-month follow-up assessment. This study will provide critical data to inform a full-scale randomized controlled trial.

Retention and Evaluation of Precision and Generic Prevention Materials for Melanoma: A Qualitative Study Comparing Young Adults and Adults

A randomized trial was conducted to examine whether providing precision prevention materials incorporating melanocortin-1 receptor genetic risk information would increase intention to practice melanoma preventive behaviors. Here, we determine retention/evaluation of prevention materials for adolescent and young adults (AYA) 18 to 39 years old versus adults aged 40+ at 6 and 12 months as an a priori adjunct analysis to the primary research question. Using qualitative methodology, open-ended questions probing most important information from prevention materials and additional comments were collected at 6 and 12 months after baseline. Descriptive statistics were performed on demographic/self-reported characteristics. Two independent researchers applied qualitative thematic content analysis to identify major themes in open-ended questions. Of the 1,134 participants randomized, 906 completed at least one of the follow-up surveys and contributed to analyses of intervention efficacy. Five major thematic categories emerged from the open-ended response data: (i) tips and tricks for sun protection; (ii) cancer prevention; (iii) risk factors and genetics; (iv) general information; and (v) intervention comments. Across all ages, the most important information retained were sun protection techniques in the generic prevention materials group and identifying the importance of genetic risk factors/implementing lifestyle behavior changes in the precision prevention materials group. For additional comments, AYA participants in the generic prevention materials group preferred more scientific information including statistics and citations for references while adults were more likely to state they already knew cancer prevention techniques. Results provide unique qualitative evaluation of AYA versus adult retention of prevention materials for melanoma that enhance quantitative findings.

PREVENTION RELEVANCE

It is important to evaluate information within groups defined by periods of the life trajectory, e.g., AYA and adults, to best inform preferences, knowledge, and motivation for behavior change. By assessing retention, evidence-based interventions can be designed to better support public health messaging and encourage positive health behaviors.

Integrated Nutrition Education Through the Part C Early Intervention Services for Children With Autism Spectrum Disorder: Material Reviews Involving Providers and Parents

Objectives

To collect provider and parent feedback on feasibility of a nutrition education intervention, Autism Eats, for children with ASD through the Part C Early Intervention (EI) Services, and to refine the manual and intervention materials based on the feedback.

Methods

A formative survey study was conducted. EI providers (n = 9) and parents of children with ASD (n = 7) reviewed the 10-lessons of Autism Eats intervention and provided their feedback online. The survey consisted of seven Likert-type (1 = strongly disagree to 5 = strongly agree) questions on the following aspects: (1) the amount of preparation time; (2) clarity of instructions; (3) the amount of allocated time for lesson procedure; (4) relevance of activities to the goal and objectives; (5) feasibility of families’ completing activities; (6) satisfaction with provider notes; and (7) relevance to improving nutrition in children with ASD. Additionally, participants completed three open-ended questions to provide written feedback. Descriptive statistics for quantitative data and content analysis for open-ended responses were used.

Results

The mean of overall scores for all lessons was 4.4 ± 0.5 from the EI providers and 4.1 ± 0.2 from the parent participants, on a 5-point scale, indicating that both providers and parents perceived the intervention materials as feasible and acceptable. The mean of each of seven aspects of the lessons ranged from 3.9 (the amount of allocated time) to 4.5 (relevance to improving nutrition in children with ASD) on a 5-point scale. Common themes for the qualitative analysis included reducing technical terms, condensing instructions, reordering the lesson sequence, improve clarity, more visuals, more elaboration/explanation on certain parts, and positive feedback. One of the parent participants commented, “Introducing anything new to a child with autism could be really hard. This handbook has really helped in way I didn't think of working with my son with ASD.”

Conclusions

Based on the findings, Autism Eats intervention materials have been revised. The final intervention includes10-weekly nutrition sessions, two-monthly booster sessions, and social media components. These updates will be utilized for the pilot randomized controlled trial in 2022–2023.

Funding Sources

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Mindfulness in Adolescent and Young Adult (AYA) Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT): A Qualitative Study

Simple Summary

Previous research in adolescent and young adult (AYA) patients suggests that patients undergoing hematopoietic stem cell transplantation (HSCT) experience severe physiological stress and social challenges. Therapeutic mindfulness interventions have been associated with improved well-being; however, we are unaware of any study that has examined AYA HSCT patients’ therapeutic interests in improving quality of life. The goal of this study was to identify unmet needs, interests, and preferences for mindfulness and quality of life prior to, immediately following, and three months post HSCT to inform the development of a mindfulness-based stress reduction intervention. Results suggest a mindfulness-based intervention may be beneficial in improving quality of life and enhancing social engagement, particularly immediately following HSCT. Future AYA research may benefit from employing mindfulness-based techniques to improve quality of life and psychosocial outcomes in HSCT patients.

Abstract

Previous adolescent and young adult (AYA) research suggests patients undergoing hematopoietic stem cell transplantation (HSCT) experience severe physiological stress. The goal of this study was to identify unmet needs, interests, and preferences for mindfulness to inform the development of a mindfulness-based stress reduction intervention. Semi-structured interviews were conducted at three time points: prior to (n = 20), immediately after (n = 13), and three months post HSCT (n = 16) in the same AYA patients. Interviews assessed stress reduction strategies used, interest in mindfulness, and current quality of life. Three major thematic categories emerged from interview data across all time points: Concerns, Coping Strategies, and Mindfulness Activities. Prior to HSCT, two additional themes emerged including: Hope for the Future and Getting the Body Moving-Physical Activity. Most participants were not familiar with the term “mindfulness” prior to HSCT; but after being provided the definition of mindfulness, participants expressed interest in an online mindfulness-based intervention (e.g., ZOOM), stating: “I think it’s necessary” and “It would definitely be useful”. Participants suggested an intervention immediately following HSCT may decrease isolation concerns stating: “[in the hospital] You kind of feel like a hamster in a cage” and “you obviously have a lot of time to just be sitting by yourself in a hospital room”. The results suggest that a mindfulness-based online intervention is of interest to AYA HSCT patients and may be beneficial in decreasing physiological stress and improving quality of life.

Physical activity interventions in pediatric, adolescent, and young adult cancer survivors: a systematic review

PURPOSE

The aim was to summarize the current literature for the effectiveness of physical activity interventions on physical functioning, body composition, and quality of life (QOL) in pediatric, adolescent and young adult cancer survivors.

METHODS

We conducted systematic structured searches of PubMed and Web of Science databases. Two independent researchers selected against inclusion criteria: (1) lifestyle intervention including physical activity and/or physical activity interventions for pediatric, adolescent, and young adults with any cancer diagnosis; (2) measured QOL, physical functioning (e.g., strength, activities of daily living), or body composition (e.g., changes in weight, percent body fat); and (3) randomized controlled trials.

RESULTS

Searches identified 4770 studies. Following the removal of duplicates and title and abstract screening, 83 full-text articles were assessed, and 9 studies met the inclusion criteria. Childhood and adolescent cancer survivors encompassed n = 7 studies while young adult cancer survivors were included in n = 2 studies. Three studies reported using a theoretical framework and six did not. Interventions ranged from 1 week to 6 months. Across all studies reviewed, n = 2 reported improvements in physical activity, n = 5 studies reported partial improvements, and n = 2 reported no improvements.

CONCLUSIONS

Interventions to improve physical activity behaviors reported mixed results. Only two physical activity interventions incorporated young adults with cancer; thus, physical activity interventions for young adult cancer survivors should be further explored. Future research should focus on personalized physical activity components encouraging behavior change techniques to maximize physical health and QOL improvements.

Desynchronous learning in a physics-driven learning network

In a neuron network, synapses update individually using local information, allowing for entirely decentralized learning. In contrast, elements in an artificial neural network are typically updated simultaneously using a central processor. Here, we investigate the feasibility and effect of desynchronous learning in a recently introduced decentralized, physics-driven learning network. We show that desynchronizing the learning process does not degrade the performance for a variety of tasks in an idealized simulation. In experiment, desynchronization actually improves the performance by allowing the system to better explore the discretized state space of solutions. We draw an analogy between desynchronization and mini-batching in stochastic gradient descent and show that they have similar effects on the learning process. Desynchronizing the learning process establishes physics-driven learning networks as truly fully distributed learning machines, promoting better performance and scalability in deployment.

Sources for constellation errors in modulated dispersion interferometers

Dispersion interferometry (DI) is being employed on an increasing number of fusion experiments to measure the plasma density with a minimal sensitivity to vibrations. DIs employed in high-density experiments use phase modulation techniques up to several hundred kilohertz to enable quadrature detection and to be unaffected by variations of the signal amplitude. However, the evaluation of the temporal interferogram can be a significant source for phase errors and does not have an established processing method. There are two non-approximation-based methods currently in use: one using the ratio of amplitudes in the signal's Fourier spectrum and the other using its sectioned integration. Previously, the methods could not be used simultaneously since they differ in their respective calibration point. In this paper, we present a technique to use both phase evaluation methods simultaneously using quadrature correction methods. A comparison of their strengths and weaknesses is presented based on identical measurements indicating one to be more reliable in a more static measurement scenario, while the other excels in highly dynamic ones. Several comparative experiments are presented, which identify a significant error source in the phase measurement induced by polarization rotation. Since the same effect may be induced by Faraday rotation, the results may have direct consequence on the design of the ITER dispersion interferometer/polarimeter as well as the European DEMO's interferometer concept.

Impact of peripheral angioplasty on wound oxygenation measured with near-infrared spectroscopy in patients with critical limb ischemia

 

Impact of peripheral angioplasty on wound oxygenation measured with near-infrared spectroscopy in patients with critical limb ischemia

Abstract

Background

Near-infrared Spectroscopy (NIRS) has been proposed as a promising noninvasive tool for the assessment of hemoglobin oxygen saturation (StO2) in complex wounds in patients with critical limb ischemia (CLI).

Objective

Up today, NIRS measurements are undertaken at single points near the wound, but not in the wound.

Methods

In this prospective, single center study, 34 patients with PAD Rutherford stage 4–6 were included. We analyzed StO2 maps in and around the wound at baseline one day before and one day after angioplasty using a NIRS camera; macrovascular function was assessed by Doppler ultrasound with spectral analysis including ankle-brachial index (ABI).

Results

Baseline StO2 of the wound area was 63% (± 3.66 [SE]) and 34% in the wound (± 4.8 [SE]). After successful angioplasty, wound area StO2 significantly increased to 71% (± 3.09 [SE]; p&lt;0.001) and wound StO2 increased even more pronounced to 42% (± 4,77 [SE]; p&lt;0.001). Likewise, ABI increased in the treated leg (before 0.74±0.03 [SE]; after 0.87±0.02 [SE]; p=0.008).

Conclusion

This is the first study to assess oxygenation in the wound using a NIRS camera after peripheral angioplasty. NIRS monitoring of wound oxygenation in patients undergoing endovascular treatment is a promising tool to monitor tissue perfusion.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany

Angioplasty of flow limiting stenosis improves left ventricular diastolic dysfunction in patients with peripheral artery disease

Background

Peripheral artery disease (PAD) is associated with hypertension and left ventricular diastolic dysfunction (LVDD).

Objective

We hypothesized that endovascular treatment of flow limiting peripheral stenosis may improve LVDD.

Methods

In this prospective single center trial, 23 patients with PAD Rutherford stage 2–4 were included. Augmentation index (AIx), central systolic blood pressure (cSBP) and ankle brachial index (ABI) were measured at baseline one day before, one day after and at follow up 4 months after angioplasty. LVDD was assessed by echocardiography at baseline and at follow up.

Results

Mean E/E' ratio was significantly lower at follow up (11.9±4.4 to 10.2±4.4; p&lt;0.01). Likewise, left atrial size (17.2±5.3 to 13.6±4.7 mm; p=0.014) decreased significantly, but not left atrial volume index (LAVI, 49.73±21.6 to 38.29±17.3 mL/m2; p=0.062). ABI acutely increased in the intervened leg and remained stable at follow up (0.71±0.13 to 0.84±0.13 to 0.89±0.18; p&lt;0.001). AIx (from 30.5±6.1 to 26.5±9.2; p=0.03) and cSBP (from 133±21 to 126±20 mmHg; p=0.05) acutely decreased after angioplasty. At follow up, there was no significant change in central hemodynamics (AIx, cSBP) as compared to baseline.

Conclusion

Chronic effects of angioplasty are associated with favorable improvement of diastolic function but not central hemodynamics.

Funding Acknowledgement

Type of funding sources: None.

Food Insecurity and the Hispanic Population during the COVID-19 Pandemic

Historically, food insecurity has been a problem for the Hispanic/Latino population in the United States. Variations in food insecurity exist among this population by origin, immigration status, household composition, and region. The coronavirus pandemic has exacerbated existing vulnerabilities this population faces with food insecurity including limited economic resources, reliance on programs unprepared for atypical circumstances, closure of avenues providing access to meals, and unemployment. This paper reviews key factors related to the current rate of food insecurity among the Hispanic/Latino population in the mainland United States and is an exemplar of similar variability found in Puerto Rico. Recommendations for reducing food insecurity in this population are provided. (word count:109).

A Review of Food Insecurity and Chronic Cardiovascular Disease: Implications during the COVID-19 Pandemic

Cardiovascular disease is the leading cause of death and disability globally. Self-management of cardiovascular disease includes the consumption of nutrient-dense foods and prudent dietary patterns, such as the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean Diet to decrease inflammation and stress. Over the last few decades, there has been a growing interest in food insecurity and health outcomes in the United States. While it is well established that diet plays a role in the development of cardiovascular disease, there is little known regarding the role of food insecurity and cardiovascular disease. As a result of unprecedented unemployment rates during and following the global COVID-19 pandemic, all dimensions of food insecurity have been impacted, including declines in food availability, accessibility, utilization, and stability. This paper summarizes the existing quantitative and qualitative literature exploring the social determinants of health (economics/poverty, employment, limited access to health care, and food) that affect the self-management of cardiovascular disease, including healthy nutrition, highlighting special considerations during the COVID-19 global pandemic.

OP0132 EFFECT OF IBERDOMIDE ON CUTANEOUS MANIFESTATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS OF A 24-WEEK, PLACEBO-CONTROLLED, PHASE 2 STUDY

Background:

Iberdomide is a high-affinity cereblon ligand that promotes proteasomal degradation of Ikaros (IKZF1) and Aiolos (IKZF3), transcription factors involved in innate and adaptive immune cell development and homeostasis, and linked to the genetic risk for systemic lupus erythematosus (SLE). A phase 2, placebo-controlled study evaluated the efficacy and safety of iberdomide in patients (pts) with moderate to severe SLE.

Objectives:

To examine the effect of iberdomide on cutaneous manifestations in SLE pts.

Methods:

Adult autoantibody-positive SLE pts with a SLE Disease Activity Index 2000 (SLEDAI 2K) score ≥6 were randomized (2:2:1:2) to oral iberdomide (0.45, 0.3, 0.15 mg) or placebo once daily (QD) for 24 weeks while continuing standard background lupus medications. The Cutaneous Lupus Area and Severity Index Activity score (CLASI-A) was assessed every 4 weeks through week 24. As prespecified, exploratory analyses, change from baseline and the proportion of pts who achieved ≥50% reduction from baseline (CLASI-50) were evaluated for all pts, pts with baseline CLASI-A ≥8, and by cutaneous lupus subtypes (acute [ACLE], subacute [SCLE], chronic [CCLE]). CLASI-A outcomes were also evaluated post hoc for subgroups with high baseline expression of IKZF3 or the type 1 interferon (IFN) gene signatures in the blood.

Results:

Of 288 randomized pts, the mean and median (range) baseline CLASI-A scores were 6.9 and 5.0 (0-49), with 28% of pts having a score ≥8. 56% of pts had ACLE, 29% CCLE, and 16% SCLE. CLASI-50 responses were not significantly different comparing iberdomide to placebo in all pts and pts with baseline CLASI-A ≥8 at week 24, where high placebo response rates were observed (Table). Numerically greater mean improvement from baseline in CLASI-A scores in pts with baseline CLASI-A ≥8 was observed for iberdomide 0.45 mg vs placebo beginning at week 4, with continuous improvement through week 24. For pts with SCLE or CCLE, CLASI-50 response rates were significantly higher with iberdomide 0.45 mg vs placebo (P<0.04; Table). SCLE pts had significantly greater mean change and median percent improvement in CLASI-A from baseline with iberdomide 0.45 mg vs placebo at week 24 (P<0.03). Treatment differences in CLASI-A between iberdomide 0.45 mg and placebo were larger for SCLE and CCLE subgroups with high baseline IKZF3 or type 1 IFN gene signatures, with statistical significance achieved for SCLE pts but not CCLE pts (Figure).

Table 1.

CLASI-50 Response Rates by Subgroups at Week 24

0.15 mg QD0.3 mg QD0.45 mg QD(n=42)(n=82)(n=81)PlaceboSubgroup(n=83)0.15 mg QD vs Placebo0.3 mg QD vs Placebo0.45 mg QD vs Placebon/m (%)n/m (%)Str Diff in % (95% CI)P valuen/m (%)Str Diff in % (95% CI)P valuen/m (%)Str Diff in % (95% CI)P valueAll pts37/83 (44.6)19/42 (45.2)0.4 (-17.33, 18.55) P=0.96141/82 (50.0)5.3 (-9.93, 20.11) P=0.49945/81 (55.6)10.9 (-4.30, 25.51) P=0.163CLASI-A ≥810/20 (50.0)8/13 (61.5)15.9 (-17.42, 45.45) P=0.39913/24 (54.2)12.1 (-17.57, 39.97) P=0.45816/24 (66.7)15.1 (-15.51, 42.49) P=0.368ACLE23/50 (46.0)15/30 (50.0)4.8 (-17.22, 26.31) P=0.66220/43 (46.5)-3.3 (-22.95, 16.67) P=0.73817/38 (44.7)-3.0 (-23.20, 17.65) P=0.782SCLE9/17 (52.9)5/9 (55.6)2.6a (-33.04, 36.33) P=0.9663/9 (33.3)-6.6 (-38.98, 31.86) P>0.99911/12 (91.7)38.7a(4.54, 61.75) P=0.035CCLE5/18 (27.8)7/14 (50.0)22.2a (-10.51, 50.00) P=0.19810/23 (43.5)23.8 (-6.89, 48.88) P=0.12918/29 (62.1)34.1 (4.43, 56.16) P=0.029

CI, confidence interval; Str Diff, stratified difference.

aUnstratified difference.

Conclusion:

Iberdomide showed beneficial effects on skin manifestations in pts with SLE. Efficacy appears to be more pronounced in pts with SCLE and CCLE skin subtypes, and in pts with high IKZF3 or IFN gene expression signatures.

Δ, treatment difference of adjusted means; CCLE, chronic cutaneous lupus erythematosus; CLASI-A, Cutaneous Lupus Erythematosus Disease Area and Severity Index-activity score; IFN, interferon; SCLE, subacute cutaneous lupus erythematosus.

Acknowledgements:

This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Peloton Advantage, LLC, an OPEN Health company, and funded by Bristol Myers Squibb.

Disclosure of Interests:

Victoria Werth Consultant of: Bristol Myers Squibb, Grant/research support from: Bristol Myers Squibb, Joan Merrill Consultant of: UCB, GlaxoSmithKline, AbbVie, EMD Serono, Remegen, Celgene/Bristol Myers Squibb, AstraZeneca, Lilly, Immupharma, Amgen, Janssen, Resolve, Alpine, Aurinia, Astellas, Alexion, and Provention, Grant/research support from: GlaxoSmithKline and AstraZeneca, Richard Furie Consultant of: Bristol Myers Squibb, Grant/research support from: Bristol Myers Squibb, Thomas Dörner Consultant of: support for clinical studies and honoraria for scientific advice: AbbVie, Bristol Myers Squibb Company, Celgene, Eli Lilly, Janssen, Novartis, Roche, Employee of: Charite Universitätsmedizin, Berlin and DRFZ Berlin, Germany, Ronald van Vollenhoven Speakers bureau: UCB, AbbVie, Galapagos, Janssen, Pfizer, Paid instructor for: support for educational programs: Pfizer, Roche, Consultant of: AstraZeneca, Biogen, Biotest, Celgene, Gilead, Servier, UCB, AbbVie, Galapagos, Janssen, Pfizer, Grant/research support from: Bristol Myers Squibb, GlaxoSmithKline, Eli Lilly, UCB, Peter Lipsky Employee of: RILITE Foundation, Michael Weiswasser Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Shimon Korish Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Peter Schafer Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Mark Stern Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Zhaohui Liu Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Shaojun Tang Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Nikolay Delev Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

Developing Adaptando Dieta Y Acción Para Todos (ADAPT): An Intervention to Improve Healthy Lifestyle Behaviors Among Latino Parents and Children Living in Rural Communities

Latino migrant farmworkers are at great risk of obesity and its concomitant negative health impacts. Obesity interventions for this underserved, minority population are limited. We expanded upon our prior intervention work in childhood obesity to develop a multi-family, behavioral intervention, ADAPT. We conducted three phases in the development of the ADAPT program: Phase 1, a needs assessment, Phase 2, in-depth focus groups with Latino parents, their children, and stakeholders, and Phase 3, a feasibility and acceptability trial to inform program optimization. Acceptability and feasibility of ADAPT promoting healthier eating and physical activity behaviors was found. Each phase of the project led to implementation changes to ADAPT, resulting in greater intervention optimization. Participants reported key facilitators and barriers to our intervention, expressing great interest in participation. They particularly liked our mindfulness session. We are currently examining the feasibility of integrating mindfulness to optimize ADAPT efficacy.

A cluster-randomized control trial targeting parents of pediatric cancer survivors with obesity: Rationale and study protocol of NOURISH-T

Approximately 40-50% of pediatric cancer survivors (PCS) are overweight or obese; increasing their risk for metabolic syndrome and other negative long-term physical health complications. Using our successful pilot trial testing the preliminary feasibility and efficacy of NOURISH for Healthy Transitions (NOURISH-T), we refined our intervention, now NOURISH-T+, and will implement these refinements in this larger, multi-site randomized control trial. Parents of PCS with overweight/obesity (BMI ≥ 85th%ile), age 5-12, ≥6 months off treatment are randomly assigned to the NOURISH-T+ intervention or Enhanced Usual Care (EUC) comparison. Parents in NOURISH-T+ will participate in a 6-session, manualized intervention, with an additional dietician session and 2 PCS sessions, as well as post-intervention booster sessions. EUC consists of a one-time informational session, nationally available brochures and follow-up check-ins. Both study conditions will be conducted remotely via a videoconferencing platform. Parents and PCS will be assessed on anthropometric measures, physical activity (PA) and dietary behaviors at baseline, 3-, 6-, and 12-months post-intervention. We will enroll a diverse group of 260 parents/PCS dyads from four pediatric oncology clinics with the aim of evaluating the efficacy of our intervention across diverse pediatric oncology clinics. Our main aim is to compare the impact of NOURISH-T+ with EUC on PCS BMI z-score. Secondary aims are to compare intervention impact on PCS PA and eating behaviors and parent BMI and behaviors as well as to explore potential moderators of the intervention. Our longer-term goal is to establish a framework for future translation and dissemination of NOURISH-T+.

Design and rationale for ADAPT+: Optimizing an intervention to promote healthy behaviors in rural, Latino youth with obesity and their parents, using mindfulness strategies

Latino youth living in rural areas represent an ethnic and geographical minority population at increased risk for obesity and obesity-related complications. We previously modified our child obesity intervention to be a multi-family behavioral intervention, Adaptando Dieta y Acción Para Todos (ADAPT), to better meet the needs of our target population, rural Latino youth with obesity (8-12 years old) and their parents. Recognizing the role of parent stress on obesity, the main goal of this study is to 1) further refine and optimize the original ADAPT multi-family behavioral obesity intervention protocol to include mindfulness parent stress reduction strategies (now called ADAPT+) and then 2) assess the feasibility of ADAPT+ implementation via a small randomized control trial (RCT) with rural Latino families. Two aims guide the study. For Aim 1 we conduct a series of focus groups with stakeholders and parents, and then conduct a one-arm trial with both parents and their children to obtain feedback for further refining each of our eight integrated ADAPT+ sessions. Aim 2 tests the acceptability and feasibility of our intervention with multi-family groups of Latinos in two rural communities over time (pre-intervention, post-intervention, 3-month follow-up) in a randomized pilot trial (ADAPT+ vs. Enhanced Usual Care [EUC] comparison). This study is intended to set the groundwork for a larger clinical trial to test ADAPT+'s efficacy to improve rural Latino families' eating and physical activity behaviors.

Comparison of two simple treatment algorithms for iatrogenic femoral artery pseudoaneurysm: ultrasound guided manual compression vs. ultrasound guided thrombin injection

Background

Postcatheterization femoral pseudoaneurysm (PSA) is a common access site related complication after endovascular procedures with potentially deleterious effect on patient outcome. There is still lack of consensus about the optimal treatment.

Objective

We analyze the incidence of PSA in a large cohort of patients undergoing state of the art procedures in current cardiology, identify independent risk factors for PSA formation and assess our experience in PSA treatment comparing two simple treatment algorithms: ultrasound guided manual compression vs. ultrasound guided thrombin injection as a first line treatment.

Methods and results

In this single-centre, retrospective study 29.802 patients from January 2013 to May 2018 underwent femoral artery catheterization. Sheath removal was carried out according to standard operating procedures of the clinic. In 228 patients, a PSA was diagnosed. Thus, overall incidence of PSA amounted to 0.8%.

Of 228 patients with a PSA, 117 (51%) patients were primarily treated with ultrasound guided manual compression with an overall success rate of 34% at next day follow up. All other patients (n=111, 49%) were primarily treated with ultrasound guided thrombin injection with an overall success rate of 99% at next day follow up. Low rates of periprocedural complications were noted with either hemostasis technique.

Analysis of laboratory characteristics revealed that efficacy of ultrasound guided manual compression is dependent on INR whereas efficacy of ultrasound guided thrombin injection is independent of INR (p=0.0253). There was also a higher rate of significant hemoglobin drop with ultrasound guided manual compression versus ultrasound guided thrombin injection (0.78 mg/dl ± 0.09 vs 0.26 mg/dl ± 0.08, p=0.038). Time to mobilization was significantly shorter after ultrasound guided thrombin injection (UGTI: mean time 23.4 h ± 3.1 h, UGMC: mean time 27.1 h ± 10.2 h, p=0.0002).

Multivariate logistic regression analysis revealed that female gender, age (&gt;75 years), oral anticoagulation and anemia are independent risk factors for PSA formation.

Conclusions

Almost 0.8% of patients undergoing cardiac catheterization via femoral access acquire PSA, for which independent risk factors could be identified. Interventional cardiologist operated ultrasound guided thrombin injection is highly effective and safe as a first line treatment and reduces blood loss compared to ultrasound guided manual compression.

Funding Acknowledgement

Type of funding source: None

The Developmental Chronnecto-Genomics (Dev-CoG) study: A multimodal study on the developing brain

Brain development has largely been studied through unimodal analysis of neuroimaging data, providing independent results for structural and functional data. However, structure clearly impacts function and vice versa, pointing to the need for performing multimodal data collection and analysis to improve our understanding of brain development, and to further inform models of typical and atypical brain development across the lifespan. Ultimately, such models should also incorporate genetic and epigenetic mechanisms underlying brain structure and function, although currently this area is poorly specified. To this end, we are reporting here a multi-site, multi-modal dataset that captures cognitive function, brain structure and function, and genetic and epigenetic measures to better quantify the factors that influence brain development in children originally aged 9-14 years. Data collection for the Developmental Chronnecto-Genomics (Dev-CoG) study (http://devcog.mrn.org/) includes cognitive, emotional, and social performance scales, structural and functional MRI, diffusion MRI, magnetoencephalography (MEG), and saliva collection for DNA analysis of single nucleotide polymorphisms (SNPs) and DNA methylation patterns. Across two sites (The Mind Research Network and the University of Nebraska Medical Center), data from over 200 participants were collected and these children were re-tested annually for at least 3 years. The data collection protocol, sample demographics, and data quality measures for the dataset are presented here. The sample will be made freely available through the collaborative informatics and neuroimaging suite (COINS) database at the conclusion of the study.

A Pilot Study of a Sleep Intervention Delivered through Group Prenatal Care to Overweight and Obese Women

OBJECTIVES

We sought to investigate the feasibility of a behavioral sleep intervention for insomnia, delivered through group prenatal care and the relationship of this intervention to improvements in insomnia symptoms and sleep quality.

PARTICIPANTS

Women receiving prenatal care and reporting a pre-pregnancy BMI of ≥25 kg/m² and sleep duration of <6.5 h per night.

METHODS

Participants were randomized to group prenatal care or group prenatal care with a behavioral sleep intervention, adapted from cognitive behavioral therapy for insomnia (CBT-I) online program Go! to Sleep®. In the second trimester (T1), late third trimester (T2) and 6-8 weeks postpartum (T3) study assessments were completed including the Insomnia Severity Index, Pittsburgh Sleep Quality Index, fasting glucose and insulin and weight and height. Data were analyzed using independent samples t-tests, chi-square tests, correlations, and two-way repeated measures ANOVA where appropriate. P < .05 was set as the level of significance.

RESULTS

From May 2014 to April 2015, 311 women were evaluated for inclusion and 53 women were randomized to participate (27 intervention; 26 control), 15% were lost to follow up. The intervention group had lower third trimester and postpartum levels of moderate to severe insomnia (T2 50.0% vs 85.0% (p = .018) and T3 13.6% vs 52.4% (p-.008)) and mean insomnia severity scores (T2 (14.7 (±6.6) vs 19.3 (± 6.0) p = .02) and T3 (9.7 (±5.4) vs 15.1(±7.2) p = .01)) when compared to the control group.

CONCLUSION

A randomized controlled trial of a behavioral sleep intervention for insomnia delivered through group prenatal care led to improvements in insomnia symptoms.

Effects of Bariatric Surgeries on Male and Female Fertility: A Systematic Review

BACKGROUND

Morbid obesity has been known to decrease fertility in both men and women. This review aimed to examine current evidence of the effects of bariatric surgeries on fertility parameters including sex hormones in both men and women, seminal outcomes in men, menstrual cycle, PCOS symptoms, and pregnancy in women, and sexual function in both men and women.

METHODS

Three databases (PubMed, Web of Science, and Academic Search Premier) were used with key terms of bariatric surgery, bariatric surgical procedures, infertility, reproductive health, pregnancy, and fertility. Studies with male and/or female patients were included. Study types included retrospective chart reviews, observational, qualitative, cross-sectional, cohort, and longitudinal studies published in January 2008-June 2018. The search was performed on June 21-26, 2018. Quality assessment and data synthesis were conducted.

RESULTS

A total of 18 articles were included in the final review. Seven studies included only men, ten included only women, and one included both men and women. Bariatric surgery significantly improved hormonal balance and sexual functions in both males and females, sperm count in males, and pregnancy in females. The strongest evidence was found on bariatric surgery's effects on sex hormones. No study with males asked whether the participants actually conceived a child with their partners after the bariatric surgery. Most weaknesses in all articles reviewed were lack of discussion on confounding variables and many did not differentiate surgical types.

CONCLUSION

Bariatric surgery most effectively improved sex hormones. Further research is needed on direct pregnancy outcomes for both men and women.

Blood CD9+ B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24^hi CD38^hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24^hi CD38^hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9⁺ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24^hi CD38^hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.

P4702Blood pressure lowering by peripheral arterial angioplasty

Objective

We hypothesized that the endovascular treatment of flow limiting peripheral stenosis may decrease arterial blood pressure (BP).

Methods

We prospectively enrolled 381 consecutive patients with PAD scheduled for PTA. Clinical baseline characteristics and BP responses to PTA or angiography were analyzed. In a subgroup of 30 patients, we analyzed intra-procedural central aortic BP before and after PTA of iliac (n=15) and femoropoliteal arteries (n=10) and diagnostic angiography (n=5).

Results

Systolic BP (SBP) decreased after PTA of iliac (−19 mmHg, 95% CI: −15, −23 mmHg), femoropopliteal (−12 mmHg, 95% CI: −9, −15 mmHg), and BTK arteries (−7 mmHg, 95% CI: −1, −14 mmHg) but not after diagnostic angiography (−2 mmHg, 95% CI: 2, −6 mmHg) as compared to baseline. Diastolic BP (DBP) decreased after iliac (−5 mmHg, 95% CI: −2, −9 mmHg) and femoropopliteal (−4 mmHg, 95% CI: −1, −6 mmHg) angioplasty, but not after BTK PTA (1 mmHg, 95% CI: 6, −8 mmHg) or angiography (5 mmHg, 95% CI: −10, 12 mmHg). Mean central BP (CBP) acutely decreased after iliac (−20 mmHg [95% CI: −12, −32 mmHg] / −7 mmHg [95% CI: −6, −9 mmHg]) and femoropopliteal artery PTA (−9 mmHg [95% CI: −8, −12 mmHg] / −4 mmHg [95% CI: −3, −6 mmHg]) but not after diagnostic angiography.

Iliac PTA achieved the most pronounced peripheral and central SBP lowering effect (p<0.05, iliac PTA vs. all other).

Baseline clinical and demographic characteristics of overall study population and break-down according to most proximal flow limiting stenosis (a) Baseline characteristics Total Iliac Fempop. BTK Diagnostic n (%) 381 (100) 119 (31) 208 (55) 39 (10) 15 (4) Age (yrs) 70±11 66±11 74±9 70±12 67±12 Male (%) 275 (72) 85 (71) 146 (70) 32 (82) 12 (80) Smoker (%) 241 (63) 98 (83) 114 (55) 20 (50) 9 (60) Hypertension (%) 337 (88) 106 (89) 187 (90) 32 (82) 12 (80) Hyperlipidemia (%) 290 (76) 100 (84) 149 (71) 29 (75) 12 (80) CAD (%) 268 (70) 91 (76) 144 (69) 24 (61) 9 (60) Diabetes (%) 207 (54) 30 (25) 142 (68) 26 (68) 9 (60) Renal failure (%) 167 (44) 38 (32) 101 (48) 22 (57) 6 (40) Antihypertensive treatment (%) 350 (92) 108 (90) 194 (93) 33 (86) 15 (100) Baseline ABI 0.53±0.10 0.56±0.12 0.53±0.1 0.48±0.09 0.54±0.14 ABI before discharge 0.9±0.12 0.94±0.12 0.92±0.11 0.86±0.14 0.54±0.14

pBP baseline vs. post PTA/Angio

Conclusion

Endovascular treatment of proximal PAD lowers significantly central and peripheral blood pressure. Effect size increases with more proximal lesions.