Insurance Approval for Laparoscopic Sleeve Gastrectomy in Adolescents in the Midsouth

Background: Metabolic and bariatric surgery (MBS) has been shown to be safe and effective for the treatment of adolescent obesity, yet many providers express hesitance to refer adolescents for surgery due to concerns for insufficient insurance coverage. Methods: The Healthy Lifestyle Clinic, a pediatric weight management clinic, was established in 2014, and an adolescent MBS program was added in 2017. Patients 15 years or older who meet the selection criteria are eligible for the surgery track. A retrospective chart review was conducted to describe our experience obtaining insurance approval for laparoscopic sleeve gastrectomy (LSG) for our adolescent patients. Results: Almost all patients who were interested in and eligible for LSG ultimately received insurance approval. Most patients had public insurance (70%). Sixty-four percent of patients were approved after the initial application, 23% were approved after a peer-to-peer review, and 11% required an appeal for approval. There was no difference in the time from insurance application to insurance approval based on age, race/ethnicity, or type of insurance. Conclusions: Age <18 years and having public health insurance have not been demonstrated as barriers to insurance approval for LSG in our cohort. Providers should not delay referral for MBS for eligible adolescents based on concern for insufficient insurance coverage. Adolescent MBS programs would benefit from a patient advocate to help families navigate the insurance approval process and reduce barriers to surgery.

Waitlist management in a pediatric weight management clinic: implementing an orientation session

Background

This study evaluates implementation of an orientation session to address a waitlist of more than 2000 referrals to a pediatric weight management clinic in the Mid-South United States.

Methods

An hour-long group-based orientation to the pediatric weight management clinic was implemented to provide information about the structure and expectations of the clinic as well as education on healthy lifestyle recommendations. Families were contacted from the waitlist by telephone and invited to attend an orientation session prior to scheduling a clinic appointment.

Results

Of 2251 patients contacted from the waitlist, 768 scheduled an orientation session, of which 264 (34 %) attended. Of the 264 orientation participants, 246 (93 %) scheduled a clinic appointment. Of those, 193 (79 %) completed a clinic visit. Waitlist times decreased from 297.8 ± 219.4 days prior to implementation of orientation sessions to 104.1 ± 219.4 days after.

Conclusions

Orientation has been an effective and efficient way to triage patient referrals while maximizing attendance in limited clinic slots for patients and families demonstrating interest and motivation. Elements of this approach are likely generalizable to other pediatric clinical settings that must strategically manage a large volume of patient referrals.

Mindful Eating and Active Living: Development and Implementation of a Multidisciplinary Pediatric Weight Management Intervention

Pediatric overweight and obesity are significant individual and public health issues that require an innovative approach. While evidence suggests that intensive family-based behavioral lifestyle modification can improve weight status, practical and logistical realities limit the ability of primary healthcare providers to intervene effectively. MEALs (Multidisciplinary Engagement and Learning/Mindful Eating and Active Living) is a family-based mindfulness intervention developed to address pediatric overweight and obesity, while improving healthy lifestyle behaviors through cooking classes. The incorporation of mindfulness, a psychological strategy associated with increased awareness of internal experiences, allows for a focus on the importance of healthy eating along with safe and efficacious kitchen practices. The Template for Intervention Description and Replication (TIDieR) checklist and guide is used to describe the intervention with the intention of providing necessary details to implement the intervention in clinical practice or replicate the intervention for further study. Lessons learned from pilot iterations of the intervention are provided.

Psychosocial Functioning After One Year of Interdisciplinary Pediatric Weight Management

Youth with obesity are more likely than normal-weight peers to experience psychosocial problems. Empirically-based recommendations for addressing pediatric obesity include intensive interdisciplinary weight management comprising medical, behavioral health, nutrition, and exercise components. The present study examined changes in psychosocial functioning associated with frequency of participation in an interdisciplinary pediatric weight management program. Participants were 86 patients (55.8% females; median age = 11.5 years; 67.4% Non-Hispanic Black; median BMI percentile = 99.5) enrolled in an interdisciplinary pediatric weight management program for at least one year. Psychosocial functioning was measured with the Pediatric Symptom Checklist (PSC-17), a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention difficulties as well as global functioning. The PSC-17 was completed at the initial clinic visit (baseline) and repeated one-year later (annual). The Wilcoxon Signed Rank test indicated that annual PSC-17 scores were significantly lower than baseline scores across all domains. Spearman correlation coefficients revealed no significant association between total number of clinic visits and PSC-17 global or subscale scores. However, the number of visits for exercise-only sessions was significantly correlated with caregiver-reported improvement in internalizing behaviors. Findings suggest that participation in interdisciplinary pediatric weight management may improve psychosocial functioning in youth with obesity and that attending supervised exercise sessions may be especially beneficial for improving internalizing behavior symptoms.

Liquid Chromatographic Determination of Fumonisins B1, B2, and B3 in Corn: AOAC–IUPAC Collaborative Study

A liquid chromatographic (LC) method for simultaneous determination of fumonisins B1 (FB1), B2 (FB2), and B3 (FB3) in corn was subjected to a collaborative study involving 12 participants from 10 countries, in which the accuracy and reproducibility characteristics of the method were established. Mean analyte recoveries from corn ranged from 81.1 to 84.2% for FB1 (at a spiking range of 500 to 8000 ng/g), from 75.9 to 81.9% for FB2 (at a spiking range of 200 to 3200 ng/g), and from 75.8 to 86.8% for FB3 (at a spiking range of 100 to 1600 ng/g). The valid data were statistically evaluated after exclusion of outliers. Relative standard deviations for within-laboratory repeatability ranged from 5.8 to 13.2% for FB1, from 7.2 to 17.5% for FB2, and from 8.0 to 17.2% for FB3. Relative standard deviations for between-laboratory reproducibility varied from 13.9 to 22.2% for FB1, from 15.8 to 26.7% for FB2, and from 19.5 to 24.9% for FB3. HORRAT ratios, calculated for the individual toxin analogues, ranged from 0.75 to 1.73. The LC method for determination of fumonisins B1, B2, and B3 in corn (at concentrations of 800–12800 ng total fumonisins/g) has been adopted by AOAC INTERNATIONAL.

One Health collaborations for zoonotic disease control in Ethiopia

Zoonotic diseases require a One Health approach for successful control and elimination due to the nature of their transmission between animals and humans. One Health recognises that the health of humans, animals, and the environment are all interconnected. Ethiopia has committed itself to controlling five prioritised zoonotic diseases (rabies, anthrax, brucellosis, leptospirosis and echinococcosis), using a One Health approach. The National One Health Steering Committee (NOHSC) provides a framework for national stakeholders to address gaps in multisectoral communication, coordination and collaboration. In addition, the NOHSC oversees the formation of several specialised disease-focused groups, referred to as 'Technical Working Groups' (TWGs). These TWGs are responsible for developing disease prevention and control strategies, as well as implementing disease-focused public health activities and providing recommendations to the NOHSC. Ethiopia's success using the One Health approach and its efficient control of zoonotic diseases will depend on the commitment of all member Ministries to support the NOHSC and TWGs, as well as to build capacity in Ethiopia's workforce and laboratories, a task supported by its many international partners.

A Randomized Study of Exercise and Fitness Trackers in Obese Patients After Total Knee Arthroplasty

Functional limitations persist in obese patients after total knee arthroplasty (TKA). This study assessed the effect of an exercise program (EP) and fitness trackers (FT) in obese patients with TKA. Sixty patients 1 year after orthopedic surgery were recruited and received a 16-week tailored EP; half were randomized to receive an FT. FT had no measurable effect compared with EP alone. EP improved knee range of motion, strength, and quality-of-life scores. This study provides preliminary evidence that a 16-week EP in obese individuals 1 year post TKA is feasible and effective in improving function and quality of life.

Interdisciplinary Management of Pediatric Obesity: Lessons Learned in the Midsouth

The Healthy Lifestyle Clinic (HLC) is an interdisciplinary weight management clinic conceived to address alarming rates of pediatric obesity and related comorbidities in the midsouth region of the United States. The clinical cohort presented is a subset of the 609 patients evaluated during the first 2 years of the HLC and comprises 380 patients with a minimum of 6 months of follow-up. The primarily non-Hispanic black (67.1%) cohort presented with severe obesity ( M_zBMI = 2.52 ± 0.41) and particularly high rates of insulin resistance, among other comorbidities. This article offers insight into the challenges of intervening with a cohort of youth and their families, many with limited resources to support intensive behavioral and lifestyle changes. Our experiences implementing a weight management clinic with a diverse clinical cohort provide guidance for emerging programs and impetus to investigate environmental and cultural factors that contribute to high attrition in the treatment of pediatric obesity.

Implications of new legislation (US FSMA) and guidelines (EC) on the establishment of management systems for agricultural water

This report summarizes key messages related to agricultural water quality as discussed by an ad hoc panel at the 1st International Symposium of Food Safety in Santiago, Chile. Participating representatives of the academia, industry and government of diverse geographical backgrounds and the audience discussed topics such as (1) implications of the US Food Safety Modernization Act (FSMA: www.fda.gov/Food/GuidanceRegulation/FSMA/ucm277706.htm) on the Agricultural Water Quality, (2) comparisons between MPN and CFU in analyzing water quality, (3) alternatives to fecal indicator bacteria (FIB) to be used as indicators to evaluate water quality, and (4) vegetative buffers as an alternative to reduce pathogen loads in agricultural surface waters. Panelists identified the following key messages for each topic discussed that are related to agricultural water quality: (1) the FSMA regulation and the new guidance document elaborated by the EC are highly relevant as they provide a definition of agricultural water and specific criteria for different water uses and circumstances; (2) FSMA supports modification from MPN to CFU; (3) Growers require more alternatives for treatment of agricultural water; (4) Vegetative buffers are a potential practical and feasible alternative for agriculture producers to reduce the pathogen and fecal pollution loads of in their agricultural waters.

Physical Function and Physical Activity in Obese Adults After Total Knee Arthroplasty

Obese patients are more likely to have osteoarthritis and total knee arthroplasty (TKA). This investigation sought to evaluate physical function, activity level, and quality of life (QOL). Obese participants near 1-year postsurgical follow-up appointment were recruited. Evaluation included QOL and activity questionnaire, medical histories, anthropometrics, strength, and aerobic capacity. Sixty participants completed assessments. Obese TKA patients have physical performance limitations and low physical activity levels 1 year after surgery and completion of postoperative rehabilitation.

Comparison of human and southern sea otter (Enhydra lutris nereis) health risks for infection with protozoa in nearshore waters

Cryptosporidium and Giardia spp. are waterborne, fecally-transmitted pathogens that cause economic loss due to gastroenteritis and beach closures. We applied quantitative microbial risk assessment (QMRA) to determine the health risks for humans and sea otters due to waterborne exposure of Cryptosporidium and Giardia spp. when swimming in three types of surface waters: river, stormwater and wastewater effluent during the wet and dry seasons in the central coast of California. This is the first application of QMRA to estimate both the probability of infection in Southern sea otters and the probability of illness in humans, using microbial source tracking (MST) as a variable. Children swimming close to stormwater discharges had an estimated Cryptosporidium-associated illness probability that exceeded the accepted U.S. EPA criteria (32 illnesses/1000 swimmers or 3.2%). Based on the assumption that sea otters are as susceptible as humans to Cryptosporidium infection, the infection probabilities were close to 2% and 16% when sea otters were swimming at the end of points of rivers and stormwater discharges, respectively. In the case of Giardia, infection probabilities of 11% and 23% were estimated for sea otters swimming at the end of point of wastewater discharges, assuming that sea otters are as susceptible as gerbils and humans, respectively. The results of this QMRA suggest that 1) humans and sea otters are at risk when swimming at outflow sites for rivers, stormwater and treated wastewater effluent; 2) reduced loads of viable protozoan cysts and oocysts in recreational water can lessen the probability of infection of humans and sea otters; and 3) the risk of infection of humans and sea otters can be reduced with the treatment of wastewater to decrease oocyst and cyst viability before effluent is released into the sea.

Lifestyle and metabolic syndrome in adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort Study

BACKGROUND

Childhood cancer survivors (CCS) are at an increased risk of developing metabolic syndrome (MetSyn), which may be reduced with lifestyle modifications. The purpose of this investigation was to characterize lifestyle habits and associations with MetSyn among CCS.

METHODS

CCS who were ≥ 10 years from diagnosis, aged > 18 years, and participating in the St. Jude Lifetime Cohort Study completed medical and laboratory tests and a food frequency questionnaire. The Third Report of the National Cholesterol Education Program Adult Treatment Panel criteria were used to classify participants with MetSyn. Anthropometric, food frequency questionnaire, and self-reported physical activity data were used to characterize lifestyle habits according to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations. Those who met ≥ 4 of 7 recommendations were classified as having followed guidelines. Sex-stratified log-binomial regression models were used to evaluate associations between dietary/lifestyle habits and MetSyn, adjusted for age, age at cancer diagnosis, receipt of cranial radiotherapy, education, and household income.

RESULTS

Among 1598 CCS (49.2% of whom were male, with a median age of 32.7 years [range, 18.9 years-60.0 years]), 31.8% met criteria for MetSyn and 27.0% followed WCRF/AICR guidelines. Females who did not follow WCRF/AICR guidelines were 2.4 times (95% confidence interval, 1.7-3.3) and males were 2.2 times (95% confidence interval, 1.6-3.0) more likely to have MetSyn than those who followed WCRF/AICR guidelines.

CONCLUSIONS

Adherence to a heart-healthy lifestyle is associated with a lower risk of MetSyn among CCS. There is a need to determine whether lifestyle interventions prevent or remediate MetSyn in CCS.

Emotional distress among adult survivors of childhood cancer

PURPOSE

The purposes of this study were to estimate the prevalence of emotional distress in a large cohort of adult survivors of childhood cancer and to evaluate the interrelationship of risk factors including cancer-related late effects.

METHODS

Adult survivors of childhood cancer (N = 1,863), median age of 32 years at follow-up, completed comprehensive medical evaluations. Clinically relevant emotional distress was assessed using the Brief Symptom Inventory 18 and was defined as T-scores ≥63. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression models to identify risk factors for distress. Path analysis was used to examine associations among identified risk factors.

RESULTS

Elevated global distress was reported by 15.1% of survivors. Cancer-related pain was associated with elevated distress (OR 8.72; 95% CI, 5.32-14.31). Survivors who reported moderate learning or memory problems were more likely to have elevated distress than survivors who reported no learning or memory problems (OR 3.27; 95% CI, 2.17-4.93). Path analysis implied that cancer-related pain has a direct effect on distress symptoms and an indirect effect through socioeconomic status and learning or memory problems. Similar results were observed for learning or memory problems.

CONCLUSIONS

Childhood cancer-related morbidities including pain and learning or memory problems appear to be directly and indirectly associated with elevated distress symptoms decades after treatment. Understanding these associations may help inform intervention targets for survivors of childhood cancer experiencing symptoms of distress.

IMPLICATIONS FOR CANCER SURVIVORS

A subset of long-term childhood cancer survivors experience significant emotional distress. Physical and cognitive late effects may contribute to these symptoms.

Measured versus self-reported physical function in adult survivors of childhood cancer

PURPOSE

Childhood cancer survivors (CCS) experience late effects that interfere with physical function. Limitations in physical function can affect CCS abilities to actively participate in daily activities. The purpose of this investigation was to evaluate the concordance between self-reported physical performance and clinically evaluated physical performance among adult CCS.

METHODS

CCS 18 yr or older and 10 yr or older from diagnosis who are participants in the St. Jude Lifetime cohort study responded to the physical function section of the Medical Outcome Survey Short Form (SF-36). Measured physical performance was evaluated using the Physical Performance Test and the 6-Minute Walk Test.

RESULTS

Individuals (N = 1778, 50.8% female) with a median time since diagnosis of 24.9 yr (range = 10.9-48.2) and a median age of 32.4 yr (range = 19.1-48.2) completed testing. Limitations in physical performance were self-reported by 14.1% of participants. The accuracy of self-report physical performance was 0.87 when the SF-36 was compared with the 6-Minute Walk Test or the Physical Performance Test. Reporting inaccuracies most often involved reporting a physical performance limitation. Poor accuracy was associated with previous diagnosis of a bone or CNS tumor, lymphoma, older age, and large body size.

CONCLUSIONS

These results suggest that self-report, using the physical performance subscale of the SF-36, correctly identifies CCS who do not have physical performance limitations. In contrast, this same measure is less able to identify individuals who have performance limitations.

Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer: a report from the St Jude Lifetime cohort study

PURPOSE

Frailty, a phenotype reported among 9.9% of individuals 65 years old and older (9.6% of women; 5.2% of men), has not been assessed among adult childhood cancer survivors (CCS). We estimated the prevalence of frailty and examined associations with morbidity and mortality.

METHODS

Participants included 1,922 CCS at least 10 years from original cancer diagnosis (men, 50.3%; mean age, 33.6 ± 8.1 years) and a comparison population of 341 participants without cancer histories. Prefrailty and frailty were defined as two and ≥ three of the following conditions: low muscle mass, self-reported exhaustion, low energy expenditure, slow walking speed, and weakness. Morbidity was defined as grade 3 to 4 chronic conditions (Common Terminology Criteria for Adverse Events version 4.0). Fisher's exact tests were used to compare, by frailty status, percentages of those with morbidity. In a subset of 162 CCS who returned for a second visit, Poisson regression was used to evaluate associations between frailty and new onset morbidity. Cox proportional hazards regression was used to evaluate associations between frailty and death.

RESULTS

The prevalence of prefrailty and frailty were 31.5% and 13.1% among women and 12.9% and 2.7% among men, respectively, with prevalence increasing with age. Frail CCS were more likely than nonfrail survivors to have a chronic condition (82.1% v 73.8%). In models adjusted for existing chronic conditions, baseline frailty was associated with risk of death (hazard ratio, 2.6; 95% CI, 1.2 to 6.2) and chronic condition onset (relative risk, 2.2; 95% CI, 1.2 to 4.2).

CONCLUSION

The prevalence of frailty among young adult CCS is similar to that among adults 65 years old and older, suggesting accelerated aging.

Exercise training in childhood cancer survivors with subclinical cardiomyopathy who were treated with anthracyclines

Childhood cancer survivors (CCS) treated with anthracyclines are at risk for cardiomyopathy. This case series evaluated the response of anthracycline exposed CCS with subclinical cardiomyopathy to aerobic and strength training. Body composition, strength and cardiopulmonary fitness were evaluated before and after the 12-week intervention. All equipment and materials were provided to five 10+ year CCS (3 males, mean age 38.0 ± 3.3 years) for a guideline-based home exercise program. All five completed the study with no adverse events. Compliance with exercise was 86%. These results suggest that exercise training may improve exercise capacity of CCS with subclinical cardiomyopathy. Pediatr Blood Cancer. © 2013 Wiley Periodicals, Inc.

Chemotherapy-related neuropathic symptoms and functional impairment in adult survivors of extracranial solid tumors of childhood: results from the St. Jude Lifetime Cohort Study

OBJECTIVES

To ascertain prevalence of peripheral sensory and motor neuropathy, and to evaluate impairments in relation to function.

DESIGN

St. Jude Lifetime Cohort Study, a clinical follow-up study designed to evaluate adverse late effects in adult survivors of childhood cancer.

SETTING

A children's research hospital.

PARTICIPANTS

Eligibility required treatment for an extracranial solid malignancy between 1962 and 2002, age ≥ 18 years, ≥ 10 years postdiagnosis, and no history of cranial radiation. Survivors (N=531) were included in the evaluation with a median age of 32 years and a median time from diagnosis of 25 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Primary exposure measures were cumulative doses of vinca-alkaloid and platinum-based chemotherapies. Survivors with scores ≥ 1 on the sensory subscale of the Modified Total Neuropathy Score were classified with prevalent sensory impairment. Those with sex-specific z scores of ≤-1.3 for dorsiflexion strength were classified with prevalent motor impairment. Participants completed the 6-minute walk test (endurance), the Timed Up & Go test (mobility), and the Sensory Organization Test (balance).

RESULTS

The prevalence of sensory and motor impairment was 20% and 17.5%, respectively. Vinca-alkaloid exposure was associated with an increased risk of motor impairment (adjusted odds ratio [OR]=1.66; 95% confidence interval [CI], 1.04-2.64) without evidence for a dose response. Platinum exposure was associated with increased risk of sensory impairment (adjusted OR=1.62; 95% CI, .97-2.72) without evidence of a dose response. Sensory impairment was associated with poor endurance (OR=1.99; 95% CI, .99-4.0) and mobility (OR=1.65; 95% CI, .96-2.83).

CONCLUSIONS

Vincristine and cisplatin exposure may increase risk for long-term motor and sensory impairment, respectively. Survivors with sensory impairment are at increased risk for functional performance limitations.

Global fitness in adult survivors of childhood acute lymphoblastic leukemia (ALL)

10022

Background: The extent to which adult survivors of childhood ALL may have impaired fitness has not been well documented. This study compared clinically assessed fitness between childhood ALL survivors and matched controls, and examined risk factors for impaired fitness among survivors. Methods: 365 survivors of childhood ALL diagnosed from 1980-2002, treated at St. Jude Children’s Research Hospital (SJCRH), 10+ years from diagnosis, and 18+ years old completed questionnaires, fitness testing and physical activity assessment (accelerometry). 365 friends/relatives of current SJCRH patients, frequency matched on age, race and sex, were recruited as controls. Data from fitness measures were combined into a composite (SJFIT) using factor analysis. Individual measures and SJFIT scores were compared between survivors and controls with two sample t-tests. Among survivors, associations between demographic, lifestyle, treatment variables and poor fitness, i.e. scoring in the lowest 10th percentile of controls on the SJFIT, were evaluated with logistic regression. Results: Survivors were 52% male (mean age 28±7 years, mean diagnosis age 6±5 years, mean survival 21±5 years), and scored lower than controls on individual fitness measures (Table) and the SJFIT composite. Female sex (OR 9.4, 95%CI 3.4-26.1) and fewer daily minutes of moderate and vigorous physical activity (OR 0.95, 95% CI 0.92-0.99) were associated with poor fitness after adjusting for diagnosis age, current age, cranial radiation, body fat and smoking. Conclusions: Childhood ALL survivors, particularly females, have fitness impairments when compared to matched controls. Poor fitness is associated with physical activity levels. Interventions to address impairments need to be tested and implemented. [Table: see text]

A preliminary evaluation into the performance of posterior resin bonded cast metal restorations (adhesive onlays)

Posterior resin bonded cast metal restorations (adhesive onlays) were used in a variety of clinical scenarios including: management of tooth wear and cracked tooth, as retainers for fixed bridge work, for correction of the occlusal plane and in providing cuspal coverage following endodontic treatment. The mean length in service for the examined onlays was 42 months, with a range of 9-75 months. Two restorations in two patients failed resulting in an overall success of 94%. Patient satisfaction was high at 95%. Such restorations seem to be a viable option for managing a number of clinical scenarios.

Surface properties of dental nanocomposites after finishing with rigid rotary instruments

This study evaluated the surface characteristics of three nanoparticle resin composites (Z350, Heritage 7 Nanohybrid, and Ice) using profilometry and scanning electronic microscopy (SEM) after subjecting them to sequential finishing procedures using rigid rotary instruments. Fifteen 8 mm × 8 mm × 2 mm specimens were fabricated for each tested composite and subjected to one of the following finishing regimens: finishing with green stones followed by white stones, finishing with 45-μm diamond followed by 15-μm diamond, finishing with a 12-fluted carbide followed by a 20-fluted carbide. After finishing, the surfaces were subjected to profilometric testing. Eight parallel tracings were used to scan the finished surface of each specimen. For each recorded profile, the average roughness (Ra) and extreme value descriptor (Rmax) were recorded. On completion of the profilometric testing, two specimens from each group were randomly selected for qualitative assessment by SEM. Profilometric data was analyzed using a one-way analysis of variance and post hoc Scheffe tests. The results demonstrated that the three control groups of the tested nanocomposites behaved as a coherent group with respect to surface roughness. With the exception of the nanohybrid Heritage 7 finished with the carbide instruments, all composites showed an increase in surface roughness. The Z350 and Ice finished with the carbide finishing instruments showed no statistically significant increase in Ra, but both of these composites showed significantly rougher surfaces when finished with diamonds compared with controls. The nanohybrids Ice and Heritage 7 demonstrated significantly higher roughness in terms of Rmax when finished with stones. The SEM correlated well with roughness measurements. The conclusion may be drawn that diamonds and stones produce unacceptable surfaces in terms of roughness on the tested nanocomposites whereas finishing carbides produce acceptable surfaces.

Dietary intake and metabolic syndrome in adult survivors of childhood cancer

9526

Background: Childhood cancer survivors (CCS) are at increased risk for metabolic syndrome (MetSyn) and increased morbidity and mortality from cardiovascular disease. Following a heart healthy diet may decrease this risk. The purpose of this investigation was to characterize dietary patterns and to evaluate the association between diet and MetSyn among CCS. Methods: CCS who were 10+ year survivors of childhood cancer, who were older than 18 years of age, and participating in the St. Jude Lifetime Cohort Study (SJLIFE). They completed a medical assessment based on Children’s Oncology Group screening guidelines, and a food frequency questionnaire (FFQ). Laboratory and physical measures were obtained to determine MetSyn status using the NCEP-ATPIII criteria. Participants were classified as having MetSyn if they met the criteria for ≥3 components of MetSyn. Data from the FFQ were used to score dietary patterns according to WCRF/AICR recommendations. Those who met ≥4 of the 7 recommendations were classified as following a “healthy diet.” A stratified analysis by sex using log-binomial regression models was undertaken to evaluate associations between diet and MetSyn, adjusted for age, age at diagnosis, cranial radiation, education, household income, and smoking status. Results: Among 1421 participating CCS (49.3% male, median age 33.0 years, range, 18.9-60.0 years), 31.5% met the criteria for MetSyn and 25.8 % followed a healthy diet according to the WCRF/AICR recommendations. In multiple regression models stratified by sex, females who followed a “healthy diet” were 2.1 (95% CI 1.5-2.9) times less likely and males who followed a “healthy diet” were 2.2 (95% CI 1.5-3.1) times less likely to have MetSyn than those who reported following a “healthy diet”. Conclusions: Heart healthy diets in CCS are associated with decreased risk for MetSyn. Dietary interventions may be warranted in CCS with MetSyn.

Physical activity among cancer survivors and those with no history of cancer- a report from the National Health and Nutrition Examination Survey 2003-2006

INTRODUCTION

Cancer survivors are at greater risk for chronic diseases that make regular physical activity a challenge. The purpose of this manuscript was to compare physical activity levels among five-year cancer survivors and those with no history of cancer, and to determine risk factors for physical inactivity.

METHODS

Participants who completed the physical activity monitoring portion of the National Health and Nutrition Examination Survey (NHANES) in 2003-04 and 2005-06 were included in these analyses. Physical activity collected via accelerometer was used to determine who completed recommended amounts of physical activity according to Centers for Disease Control (CDC) guidelines. Associations between physical activity and cancer status were evaluated with multiple logistic regressions.

RESULTS

95.5% of five-year cancer survivors and 87.3% of those with no cancer history did not meet the CDC guidelines. After adjusting for sex, age, race, education and chronic conditions, cancer survivors were 1.7 (95% CI: 1.0, 2.9) times more likely than those with no cancer history to fail to meet CDC guidelines for physical activity.

CONCLUSIONS

Neither the general population nor cancer survivors met the CDC guidelines for physical activity. Cancer survivors were less likely to meet recommendations and may need tailored interventions designed to take into account comorbid conditions to increase their physical activity levels.

Oxidative stress in response to forearm ischemia-reperfusion with and without carnitine administration

We have recently noted a decrease in lipid peroxidation with oral intake of glycine propionyl-L-carnitine (GPLC). However, these findings were observed at rest, and in previously sedentary subjects.

METHODS

We determined the effect of GPLC on oxidative stress biomarkers at rest and in response to reactive hyperemia in exercise-trained men. Using a double-blind, crossover design, 15 healthy men were assigned to a placebo and GPLC (4.5 g/day) in random order, for four weeks, with a two-week washout between assignments. Blood samples were collected at rest and at 0, 3, and 10 minutes following a protocol of ischemia-reperfusion, and analyzed for lactate, malondialdehyde (MDA), F(2)-isoprostanes (F(2)-iso), hydrogen peroxide (H(2)O(2)), xanthine oxidase activity (XO), hypoxanthine (HYPO), total (TGSH) and oxidized (GSSG) glutathione, and Trolox-equivalent antioxidant capacity (TEAC).

RESULTS

No condition or condition by time interaction effects were noted (p>0.05). Time effects were noted for lactate (p<0.0001), MDA (p=0.02), H(2)O(2) (p=0.0003), XO (p=0.03), HYPO (p<0.0001), TGSH (p=0.02), and GSSG (p<0.0001), with peak values noted at 0 minutes post for lactate, MDA, TGSH, and GSSG, at 3 minutes post for H(2)O(2) and XO, and at 10 minutes post for HYPO. F(2)-iso and TEAC were unaffected by treatment or protocol (p>0.05).

CONCLUSION

Short-term ischemia-reperfusion in trained men results in a modest and transient increase in selected blood oxidative stress biomarkers. Oral GPLC supplementation does not attenuate the increase in these biomarkers.

Repeated bout effect is absent in resistance trained men: an electromyographic analysis

A prior bout of exercise is well known to confer protection from subsequent eccentric bouts (i.e. repeated bout effect; RBE), which may be fostered through neural adaptations, specifically a shift in the frequency content of the surface electromyogram (EMG). It is currently not clear whether chronically resistance trained men are capable of a RBE driven by neural adaptations. Eleven resistance trained men (23.5+/-3.4 yrs) performed 100 eccentric actions of the barbell bench press exercise, followed by an equivalent bout 14 days later. Indirect markers of muscle damage (i.e. force production, soreness) along with surface EMG were measured before and through 48 h of recovery. Median frequency and maximal isometric force demonstrated time main effects (p>0.05), but no RBE. A prior bout of eccentric exercise does not confer a RBE for indirect markers of muscle injury or elicit changes in the frequency content of the EMG signal in resistance trained men.

Structural and IgE binding analyses of recombinant Der p 2 expressed from the hosts Escherichia coli and Pichia pastoris

BACKGROUND

The house dust mite allergen Der p 2 is one of the most important indoor allergens associated with allergic disease. Recombinant Der (rDer) p 2 with high IgE binding activity can be readily produced in Escherichia coli and Pichia pastoris, but the structure and IgE binding of the different methods of preparation have not been compared.

METHODS

Secondary structure was assessed by circular dichroism (CD). Intrinsic fluorescence and hydrophobic probe (1-anilinonaphthalene 8-sulphonic acid, ANS) were used to study the Der p 2 hydrophobic cavity. IgE binding was assessed by ELISA inhibition.

RESULTS

CD analysis showed the expected secondary structure for both nDer p 2 and refolded Der p 2 prepared from E. coli inclusion bodies but primarily random structure for Der p 2 secreted from P. pastoris. The secreted product, however, had disulphide bonding and could be refolded to a similar structure to natural Der (nDer) p 2 after precipitation with trichloro-acetic or ammonium sulphate. ANS binding and intrinsic Trp92 fluorescence showed that all recombinant proteins were different to nDer p 2 and that the allergen secreted from P. pastoris did not form a hydrophobic cavity. Despite the marked structural changes, all preparations of Der p 2 had similar IgE binding to nDer p 2.

CONCLUSION

Despite almost identical IgE binding, rDer p 2 prepared from both E. coli and P. pastoris showed structural differences to nDer p 2. Der p 2 secreted from P. pastoris lacked most of the natural structure, but refolding could induce the natural structure.

Glycine Propionyl-L-carnitine Modulates Lipid Peroxidation and Nitric Oxide in Human Subjects

Objective: To determine the efficacy of glycine propionyl-L-carnitine (GPLC) to decrease lipid peroxidation, elevate nitric oxide, and improve blood lipid profiles in human subjects. Methods: Thirty untrained, normolipidemic subjects performed eight weeks of supervised aerobic exercise while supplementing GPLC at one of two doses (1 or 3 grams daily of PLC + glycine) or placebo, following random assignment in a double-blind manner. Fasting blood samples were analyzed at rest for malondialdehyde, nitric oxide, and lipids before and after the intervention. Results: Malondialdehyde was decreased (p<0.05) from pre- to post-intervention with 1 g GPLC (1.08±0.24 vs. 0.69±0.25 µmol·L -1) and 3 g GPLC (0.94±0.18 vs. 0.66±0.17 µmol·L -1), but did not change statistically (p>0.05) with placebo (1.12±0.21 vs. 1.03±0.23 µmol·L -1). Nitric oxide was increased (p<0.05) from pre- to post-intervention with 3 g GPLC (21.34±2.27 vs. 29.46±3.61 µmol·L -1), but did not change statistically (p>0.05) with 1 g GPLC (23.22±4.13 vs. 26.24±4.32 µmol·L -1) or placebo (24.31±3.90 vs. 26.14±4.11 µmol·L -1). No main effects or interaction effects were noted for blood lipids (p>0.05). Conclusion: GPLC supplementation combined with eight weeks of aerobic exercise decreases lipid peroxidation and elevates nitric oxide, but does not further improve blood lipid profiles in normolipidemic subjects.

Transcranial magnetic stimulation in ALS: utility of central motor conduction tests

OBJECTIVE

To investigate transcranial magnetic stimulation (TMS) measures as clinical correlates and longitudinal markers of amyotrophic lateral sclerosis (ALS).

METHODS

We prospectively studied 60 patients with ALS subtypes (sporadic ALS, familial ALS, progressive muscular atrophy, and primary lateral sclerosis) using single pulse TMS, recording from abductor digiti minimi (ADM) and tibialis anterior (TA) muscles. We evaluated three measures: 1) TMS motor response threshold to the ADM, 2) central motor conduction time (CMCT), and 3) motor evoked potential amplitude (correcting for peripheral changes). Patients were evaluated at baseline, compared with controls, and followed every 3 months for up to six visits. Changes were analyzed using generalized estimation equations to test linear trends with time.

RESULTS

TMS threshold, CMCT, and TMS amplitude correlated (p < 0.05) with clinical upper motor neuron (UMN) signs at baseline and were different (p < 0.05) from normal controls in at least one response. Seventy-eight percent of patients with UMN (41/52) and 50% (4/8) of patients without clinical UMN signs had prolonged CMCT. All three measures revealed significant deterioration over time: TMS amplitude showed the greatest change, decreasing 8% per month; threshold increased 1.8% per month; and CMCT increased by 0.9% per month.

CONCLUSIONS

Transcranial magnetic stimulation (TMS) findings, particularly TMS amplitude, can objectively discriminate corticospinal tract involvement in amyotrophic lateral sclerosis (ALS) from controls and assess the progression of ALS. While central motor conduction time and response threshold worsen by less than 2% per month, TMS amplitude decrease averages 8% per month, and may be a useful objective marker of disease progression.

Efficacy of prior eccentric exercise in attenuating impaired exercise performance after muscle injury in resistance trained men

Previous research has demonstrated that prior exercise may reduce the magnitude of muscle soreness and impaired function (i.e., repeated bout effect [RBE]) observed during subsequent eccentric exercise. Previous investigations have predominantly used research designs that include single-joint exercise performed by untrained individuals. It is unknown how resistance trained individuals respond to novel multi-joint eccentric actions of the upper body and whether prior exercise offers protection. Thirty-one resistance trained men (23.4 +/- 3.5 y, 177.2 +/- 5.1 cm, 86.4 +/- 16.5 kg, mean +/- SD) were randomly assigned to repeated bout ([RB] N = 15) or single bout ([CON] N = 16) conditions. Both groups performed 100 eccentric actions of the bench press ([ECC] at 70% concentric 1 repetition maximum) to induce muscle injury. Bilateral maximal isometric force, dynamic exercise performance (e.g., bench press throws), and muscle soreness were measured before, immediately after, and at 24 and 48 hours post-ECC. Total work, percent fatigue, and rating of perceived exertion (ECC) data were collected during ECC. Those assigned to RB condition exhibited less fatigue (9.5 vs. 22.6%) and lower RPE (14.8 vs. 17.1) during ECC. A significant interaction (p < 0.05) was found such that RB individuals experienced less soreness at 24 (6.5 vs. 4.9) and 48 (6.6 vs. 3.9) hours postexercise than the CON condition. No significant group differences (p < 0.05) were found for any measured performance variable. Although soreness, fatigue, and RPE suggest a RBE, this was not found in regards to exercise performance. It appears that in trained men, performing a strenuous high-volume eccentric exercise bout 2 weeks prior to an identical future bout offers no additional amelioration of impaired exercise performance.

Facilitating and understanding the family's choice of injection device for growth hormone therapy by using conjoint analysis

BACKGROUND

Conjoint analysis involves the measurement of consumer preferences between choice alternatives.

AIMS AND OBJECTIVES

To investigate the use of conjoint analysis in facilitating and understanding choice of growth hormone injection devices.

METHOD AND SUBJECTS

56 patients and their parents participated in an electronic, computer-based interview. The interview took a median time of 18 min (range 12-30) and allowed an immediate matching of injection devices to the family's preferences.

RESULTS

Amongst the key drivers of choice, lack of bruising was rated highest and designated an index of 100. Compared to this, the remaining attributes in order of desirability were: auto-injector (98), lack of pain (93), lightweight (88), silent (82), ready-mixed (77), ease of holding (69), telephone helpline (66), needle-free (62), small size (60), nurse support (47), hidden needle (45), stored in fridge (13) and home delivery (6). Out of the 17 families who had already chosen a device previously by discussion with the clinic nurse, the computer model placed their device either as first or second out of seven devices tested.

CONCLUSION

Adaptive or interactive conjoint analysis applied at the patient level can facilitate the choice-making process whilst providing an insight into the relative importance of the key features that influence choice.

Glycine propionyl-L-carnitine increases plasma nitrate/nitrite in resistance trained men

: We have recently demonstrated that oral intake of glycine propionyl-L-carnitine (GPLC) increases plasma nitrate/nitrite (NOx), a surrogate measure of nitric oxide production. However, these findings were observed at rest, and in previously sedentary subjects.

PURPOSE

In the present study, we sought to determine the impact of oral GPLC on plasma NOx at rest and in response to a period of reactive hyperemia in resistance trained men.

METHODS

Using a double blind, crossover design, 15 healthy men (24 +/- 4 years) were assigned to GPLC (3 g/d PLC + 1044 mg glycine) and a placebo in random order, for a four-week period, with a two-week washout between condition assignment. Blood samples were taken from subjects at rest and at 0, 3, and 10 minutes following an ischemia-reperfusion protocol (six minutes of upper arm cuff occlusion at 200 mmHg followed by rapid reperfusion with cuff removal). Blood samples were taken from a forearm vein from the same arm used for the protocol and analyzed for total nitrate/nitrite. Data are presented as mean +/- SEM.

RESULTS

A condition main effect (p = 0.0008) was noted for NOx, with higher values in subjects when using GPLC (45.6 +/- 2.8 mumol.L-1) compared to placebo (34.9 +/- 1.2 mumol.L-1). No time main effect was noted (p = 0.7099), although values increased approximately 12% from rest (37.7 +/- 2.7 mumol.L-1) to a peak at 10 minutes post protocol (42.3 +/- 3.3 mumol.L-1). The interaction effect was not significant (p = 0.8809), although paired time contrasts revealed higher values for GPLC compared to placebo at 3 (48.2 +/- 6.7 vs. 34.9 +/- 2.4 mumol.L-1; p = 0.033) and 10 (48.8 +/- 5.9 vs. 35.7 +/- 2.1 mumol.L-1; p = 0.036) minutes post protocol, with non-statistically significant differences noted at rest (41.8 +/- 4.5 vs. 33.6 +/- 2.5 mumol.L-1; p = 0.189) and at 0 minutes (43.6 +/- 5.1 vs. 35.4 +/- 2.7 mumol.L-1; p = 0.187) post protocol. An analysis by subject (collapsed across time) indicated that 11 of the 15 subjects experienced an increase in NOx with GPLC treatment.

CONCLUSION

These findings indicate that short-term oral GPLC supplementation can increase NOx in resistance trained men. However, as with many dietary supplements, there exist both "responders" and "non-responders" to treatment. Future work may focus on the mechanisms for the discrepancy in response to GPLC supplementation for purposes of NOx elevation.

Prior exercise and antioxidant supplementation: effect on oxidative stress and muscle injury

Background

Both acute bouts of prior exercise (preconditioning) and antioxidant nutrients have been used in an attempt to attenuate muscle injury or oxidative stress in response to resistance exercise. However, most studies have focused on untrained participants rather than on athletes. The purpose of this work was to determine the independent and combined effects of antioxidant supplementation (vitamin C + mixed tocopherols/tocotrienols) and prior eccentric exercise in attenuating markers of skeletal muscle injury and oxidative stress in resistance trained men.

Methods

Thirty-six men were randomly assigned to: no prior exercise + placebo; no prior exercise + antioxidant; prior exercise + placebo; prior exercise + antioxidant. Markers of muscle/cell injury (muscle performance, muscle soreness, C-reactive protein, and creatine kinase activity), as well as oxidative stress (blood protein carbonyls and peroxides), were measured before and through 48 hours of exercise recovery.

Results

No group by time interactions were noted for any variable (P > 0.05). Time main effects were noted for creatine kinase activity, muscle soreness, maximal isometric force and peak velocity (P < 0.0001). Protein carbonyls and peroxides were relatively unaffected by exercise.

Conclusion

There appears to be no independent or combined effect of a prior bout of eccentric exercise or antioxidant supplementation as used here on markers of muscle injury in resistance trained men. Moreover, eccentric exercise as used in the present study results in minimal blood oxidative stress in resistance trained men. Hence, antioxidant supplementation for the purpose of minimizing blood oxidative stress in relation to eccentric exercise appears unnecessary in this population.

Studies of self-incompatibility in wild tomatoes: I. S-allele diversity in Solanum chilense (Dun.) Reiche [corrected] (Solanaceae)

We characterized the molecular allelic variation of RNases at the self-incompatibility (SI) locus of Solanum chilense Dun. We recovered 30 S-RNase allele sequences from 34 plants representing a broad geographic sample. This yielded a species-wide estimate of 35 (95% likelihood interval 31-40) S-alleles. We performed crosses to confirm the association with SI function of 10 of the putative S-RNase allele sequences. Results in all cases were consistent with the expectation that these sequences represent functional alleles under single-locus gametophytic SI. We used the allele sequences to conduct an analysis of selection, as measured by the excess of nonsynonymous changes per site, and found evidence for adaptive changes both within the traditionally defined hypervariable regions and downstream, near the 3'-end of the molecule.

Physical work-induced oxidative stress is exacerbated in young cigarette smokers

Both cigarette smoking and strenuous physical work are associated with increased oxidative stress, which is implicated in the pathogenesis of cardiovascular disease. No study to date has measured oxidative stress in response to graded exercise in cigarette smokers. We compared oxidative stress biomarkers before and after strenuous exercise (Bruce treadmill protocol) in 14 cigarette smokers and 15 nonsmokers of similar age (24+/-6 years) and fitness status. Plasma protein carbonyls (PC), malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG) were measured pre- and postexercise. Smoking status (p<.01) and time (p<.01) effects were noted for PC with values higher for smokers than nonsmokers and increasing from pre- to postexercise (52% vs. 25%, respectively). The smoking statusxtime interaction for PC approached statistical significance (p=.07). The change in PC from pre- to postexercise was positively correlated with the number of cigarettes smoked per day (r=.5782, p=.03). A smoking statusxtime interaction was noted for MDA (p<.01), with values increasing 37% from pre- (0.6140+/-0.0708 micromol/L) to postexercise (0.8440+/-0.0687 micromol/L) for smokers and remaining relatively unchanged for nonsmokers (from 0.7664+/-0.0901 to 0.7419+/-0.0776 micromol/L). 8-OHdG was unaffected by smoking status (p=.43) or exercise (p=.40). These findings indicate that young cigarette smokers experience an exaggerated oxidative stress response to strenuous physical work, compared with nonsmokers of similar age. These results highlight yet another detrimental impact of cigarette smoking on human health. Future investigations should focus on older, more established smokers.

Social marketing: an overview of approach and effects

This paper reviews the applicability of commercial and social marketing to teen driving safety. It draws on a wide range of information, including evaluation studies of specific programs as well as standards of practice within these two professions. Social marketing has been widely applied for more than three decades in the fields of public health, environmental protection, and political marketing with significant success. The paper attempts to distinguish between the practice of commercial marketing, whose goal is profit, and the practice of social marketing, whose goal is societal benefit. Issues of sustainability, segmentation, differences in behavioral characteristics, and cultural competence are discussed with specific examples drawn from the transportation safety literature. The paper suggests that social marketing represents a viable companion to control and education approaches to behavior change to promote teen driving safety.

Oxidative Stress Response in Trained Men following Repeated Squats or Sprints

PURPOSE

The purpose of this investigation was to measure the oxidative stress response to similarly matched work bouts of squat and sprint exercise.

METHODS

Twelve anaerobically trained men performed six 10-s sprints and, on a separate occasion, repeated barbell squats to approximately equal the amount of work performed during the sprints. Blood lactate, heart rate, and perceived exertion was measured before and following each exercise bout. Muscle soreness, muscle force, and creatine kinase activity was determined preexercise and through 48 h of recovery. Desmin cytoskeletal protein was determined via muscle biopsy of the vastus lateralis before and at 24 h following each exercise. Plasma protein carbonyls (PC) and malondialdehyde (MDA) were measured as biomarkers of oxidative stress.

RESULTS

Heart rate and perceived exertion was not different between exercise sessions (P > 0.05), although lactate was higher following sprinting compared with squatting (P = 0.002). Muscle soreness was greater for squatting than sprinting (P = 0.003) and reached a peak immediately postexercise for both sessions (P = 0.0003). Muscle force was unaffected by either exercise session (P > 0.05), and creatine kinase activity was elevated to a similar extent following both sessions. Desmin-negative fibers were virtually nonexistent after either exercise bout, indicating no loss of this cytoskeletal protein. Neither PC nor MDA was affected by the exercise (P > 0.05).

CONCLUSION

These results suggest that in anaerobically trained men, the oxidative stress and muscle injury response to similarly matched anaerobic exercise bouts is minimal, and not different between exercise modes. Furthermore, when compared with previous literature on untrained subjects, the response is significantly attenuated, possibly because of adaptations occurring as a result of chronic, strenuous anaerobic training.

Collected nondimensional performance of rotary dynamic blood pumps

"Nonpulsatile" or "continuous flow" blood pumps are a relatively new application of the rotary dynamic blood pumping principle. They fall outside the normal envelop of pumps, considering their small size, viscosity of the fluid pumped, need for particularly good internal flow patterns, and desire for high efficiency. This article establishes the state of the art in the field of blood pump performance. Trends in efficiency, shut off pressure coefficient, and nondimensional power behavior as a function of nondimensional flow are identified. Blood pumps show agreement with the published effects of low Reynolds numbers in conventional pumps.

Short exposure time sensitivity of white cells to shear stress

White cells are a critical functional element circulating in blood. This study sheared fresh whole bovine blood in stainless steel and polymeric capillary tubes of various lengths and diameters. Flow rate was constant, resulting in a range of exposure times and shear stresses. White cell count, cell integrity (trypan blue exclusion), and phagocytic index (latex bead ingestion) were assayed. It was found that cell function declined at lower stresses than cell count. White cell count was maintained at higher stress levels at the short exposure times used here compared with the published results at longer times. This study suggests that function, not count, is the critical parameter when studying shear effects on white cells, and that, like red cells, there may be an exposure time effect and that white cell function is impacted at stresses lower than are required for hemolysis.