Adolescent Young Adult Acute Lymphoblastic Leukemia Survivors Develop Innovative Solutions for Unmet Needs.

Adolescent young adult (AYA) cancer survivors continue to have substantive unmet needs. Literature and insights from a task force of survivors, caregivers, and survivor advocates convened by Servier Pharmaceuticals indicate desires for peer created and provided support. This secondary data analysis of information from the task force identified unmet needs in five domains and solutions explored for four prioritized needs. Ultimately, four actionable solution concepts were selected by the task force for further development. Through their work, many key insights about including survivors in creating solutions and the many approaches for best serving AYAs with cancer were revealed.

Treatment for Severe Coronavirus Disease 2019 With the Seraph-100 Microbind Affinity Blood Filter.

To determine whether Seraph-100 (Exthera Medical Corporation, Martinez, CA) treatment provides clinical benefit for severe coronavirus disease 2019 cases that require mechanical ventilation and vasopressor support. DATA SOURCES: The first two patients in the United States treated with the novel Seraph-100 device. These cases were reviewed by the Food and Drug Administration prior to granting an emergency use authorization for treatment of coronavirus disease 2019. STUDY SELECTION: Case series. DATA EXTRACTION: Vasopressor dose, mean arterial pressure, temperature, interleukin-6, C-reactive protein, and other biomarker levels were documented both before and after Seraph-100 treatments. DATA SYNTHESIS: Vasopressor dose, temperature, interleukin-6, and C-reactive protein levels declined after Seraph-100 treatments. Severe acute respiratory syndrome coronavirus 2 viremia was confirmed in the one patient tested and cleared by the completion of treatments. CONCLUSIONS: Seraph-100 use may improve hemodynamic stability in coronavirus disease 2019 cases requiring mechanical ventilation and vasopressor support. These findings warrant future study of a larger cohort with the addition of mortality and total hospital day outcomes.

Effective Use of Angiotensin II in Coronavirus Disease 19-Associated Mixed Shock State: A Case Report.

The rapid spread of Coronavirus Disease 2019 (COVID-19) has sparked a search for effective therapies. The discovery that the virus binds the angiotensin-converting enzyme 2 (ACE2) receptor has led to investigation of the renin-angiotensin system for possible therapeutic targets. We present a case of an elderly woman with multiple comorbidities who developed severe acute respiratory distress syndrome (ARDS), a cardiomyopathy, and vasodilatory shock secondary to COVID-19 and was treated with exogenous angiotensin II. She rapidly demonstrated significant hemodynamic improvement without noted adverse effects. Thus, we propose further investigation into possible benefits of angiotensin II in shock secondary to COVID-19.

Using behavioral economics to promote advanced directives for end of life care: a national study on message framing.

Advance directives (AD) are a crucial method for individuals to communicate their directions regarding medical decisions to their families and health care professionals when they are no longer able to make these decisions for themselves. However, not many individuals have an AD. We present the results of a survey-based experiment on how message framing (positive, negative and social norm) in educational videos affects (a) the individual's decision to acquire more information about an AD and (b) the change in stated likelihood of obtaining an AD. Our message framing is centered on the family burden aspect of end-of-life care. We also survey participants about which type of framing they view as more persuasive in terms of obtaining an AD. We find that participants who watched the negative framed video were more likely to request more information about ADs. However, for those who had not sought information on ADs prior to the study, positive framing has a small positive impact on the approximate change in stated likelihood of obtaining an AD. On average, positive framing is perceived as more convincing to obtain an AD. Ranking the positive framed video as first or second in terms of convincingness is correlated with self-reported creation of an AD, whereas ranking the negative framed video as first or second is correlated with not creating an AD.

Contextualizing inclusion: Developing a framework and measure for a military context.

Given recent changes and transitions occurring within the US military, it is imperative - now more than ever - that leaders find a way to leverage demographic and functional diversity in their units to support mission effectiveness. Academic researchers have found that fostering a climate for inclusion, where all individuals feel like they are fairly treated, valued, and included, can maximize the benefits of diversity, while minimizing potential disadvantages. However, no research has systematically explored what it means to assess and develop a climate for inclusion in the military context. The current research employs a multi-study approach comprised of both qualitative and quantitative methods to understand how a climate for inclusion manifests itself within the military, how to assess it, and the factors that contribute to inclusive environments. Across the three studies, over 700 US Army Soldiers provided input via focus groups or surveys, resulting in a 16-item climate for inclusion measure representing two dimensions - horizontal social inclusion and vertical information inclusion. This research, and the resulting climate for inclusion measure, provides the foundation that military leaders need to effectively leverage diversity in their units to yield performance improvements.

Porches as Enrichment for Singly Housed Cynomolgus Macaques (Macaca fascicularis).

Effective environmental enrichment is used by animals, promotes species-typical behavior, and decreases abnormal behavior. Porches attached to the front of an animal's cage provide additional space, perching opportunities, and a better view of the surroundings. Here we assessed the effectiveness of porches as a form of enrichment and identified characteristics of the animals most likely to use the porches. We videorecorded and scored the behavior of 18 (9 male, 9 female) singly housed cynomolgus macaques (Macaca fascicularis) during 3 observation intervals (15 min each) the week before, during, and after exposure to the porches. Changes in abnormal and tension-related behaviors (pacing, yawning, scratching) and speciestypical behaviors were compared across the 3 wk of observation. Novel object temperament tests were performed before and after the study. During observation periods, subjects spent an average of 75% of time in the porch. No changes in pacing or tension-related behaviors occurred, but activity decreased during and after porch exposure, rest increased during the porch exposure, and consumption decreased afterward. Eight subjects were categorized as having a bold temperament, and the remaining 10 subjects had an intermediate temperament. Sex and a temperament×cage location interaction were predictors of porch usage. Males used the porches more than did females, and those with an intermediate temperament were less likely to use the porches when they were located in the lower cages. Porches are beneficial in that they are used for extensive periods of time, but the benefits can vary according to the individual animal.

Bringing Menu Labelling to Independent Restaurants: Findings from a Voluntary Pilot Project in Toronto.

Toronto Public Health conducted a pilot project to assess the feasibility of menu labelling by independent restaurants. The pilot project was informed by consultations with the industry and other jurisdictions that have implemented a similar initiative. Public Health Dietitians worked closely with these restaurants to help them work toward posting calories and sodium on their menus. This paper reports on the findings of a feasibility assessment that took a mixed-methods approach resulting in a comprehensive process evaluation. Results showed that having highly motivated restaurants and early adopters of menu labelling is a necessary starting point. However, this alone is not sufficient to make voluntary menu labelling successful. It may be feasible only for select independent restaurants who: (i) are highly motivated and ready to make a substantial time commitment; (ii) value offering healthy food choices; (iii) have fairly standardized recipes to begin with; (iv) receive extensive specialized, individualized support; and (v) receive incentives, cost offsetting, and recognition. Full-scale implementation of a menu labelling program with Toronto independent restaurants was not justified given the current level of interest and capacity.

A novel device for accurate and efficient testing for vision-threatening diabetic retinopathy.

AIMS: To evaluate the performance of the RETeval device, a handheld instrument using flicker electroretinography (ERG) and pupillography on undilated subjects with diabetes, to detect vision-threatening diabetic retinopathy (VTDR). METHODS: Performance was measured using a cross-sectional, single armed, non-interventional, multi-site study with Early Treatment Diabetic Retinopathy Study 7-standard field, stereo, color fundus photography as the gold standard. The 468 subjects were randomized to a calibration phase (80%), whose ERG and pupillary waveforms were used to formulate an equation correlating with the presence of VTDR, and a validation phase (20%), used to independently validate that equation. The primary outcome was the prevalence-corrected area under the receiver operating characteristic (ROC) curve for the detection of VTDR. RESULTS: The area under the ROC curve was 0.86 for VTDR. With a sensitivity of 83%, the specificity was 78% and the negative predictive value was 99%. The average testing time was 2.3 min. CONCLUSIONS: With a VTDR prevalence similar to that in the U.S., the RETeval device will identify about 75% of the population as not having VTDR with 99% accuracy. The device is simple to use, does not require pupil dilation, and has a short testing time.

A Model for Osteonecrosis of the Jaw with Zoledronate Treatment following Repeated Major Trauma.

This study aims to develop a reproducible rat model for post-traumatic bisphosphonate-related osteonecrosis of the jaw (BRONJ). In our previous studies using dental extraction as an inducing factor, only 30%-60% of zoledronate-treated animals fulfilled the definition of clinical BRONJ. We modified the zoledronate regimen and introduced repeated surgical extraction to illicit quantifiable BRONJ in all animals. Eighty retired-breeder female Sprague-Dawley rats were divided between the treatment (i.v. zoledronate; 80 µg/kg/week for 13 weeks) and control (saline) groups. On week 13, the left mandibular first molar was surgically extracted, followed by the second molar a week later. Animals were euthanized at 1-week, 2-weeks, and 8-weeks following extraction. The occurrence and severity of BRONJ were scored in each animal based on gross and MicroCT analysis. Parameters of bone formation and osteoclast functions at the extraction site were compared between groups. All zoledronate-treated animals developed a severe case of BRONJ that fulfilled the clinical definition of the condition in humans. Osteoclast attachment continued to be defective eight weeks after stopping the treatment. There were no signs of kidney or liver toxicity. Our data confirmed that repeated surgical extraction (major trauma) by itself consistently precipitated massive bone necrosis in ZA-treated animals, eliminating the need to induce pre-existing infection or comorbidity. These results will be the basis for further studies examining the in-vivo pathogenesis and prevention of BRONJ.

The price they paid.

BACKGROUND: Several individuals integral to the development of evidence-based medicine endured hardship for their efforts and beliefs. CASE PRESENTATION: We present the history of three individuals who were integral to the formation of evidence-based medicine. All three individuals suffered as a result of resistance to change from colleagues as well as from within the profession. CONCLUSION: Individual and professional collegiality in the face of change should be maintained. The efforts of our predecessors are honored and provide us with inspiration.

Immediate changes in temporomandibular joint opening and pain following vibration therapy: a feasibility pilot study.

OBJECTIVE: The purpose of this pilot study was to determine the scientific and process feasibility in an effort to direct future larger trials. METHODS: Scientific Feasibility: Twelve subjects were randomly allocated to an intervention and a control group. The intervention protocol consisted of intraoral vibration therapy on the muscles of mastication bilaterally for a period of 1 minute per muscle. Process Feasibility: Several feasibility outcomes were examined including recruitment and retention rates and consent. RESULTS: Scientific Feasibility: Large effect sizes were generated for both mouth opening and VAS in favour of the intervention group. Process Feasibility: a recruitment ratio of 2.3 respondents to 1 participant was determined, along with a retention to loss ratio of 13:1 and a consent to loss ratio of 12:0. CONCLUSION: Scientific Feasibility: The scientific results should be interpreted with caution due to the small sample sizes employed. The study seems to support the scientific feasibility of a future larger single treatment trial. Process Feasibility: Recruitment and retention rates and ratios seem to support future studies. Utilizing the feasibility results of the current study to direct a future larger multiple treatment trial consistent with other comparable TMD studies however is limited.

OBJECTIF: L'objectif de ce projet pilote était de déterminer la faisabilité scientifique et la faisabilité du processus afin de planifier des essais cliniques de plus grande envergure. MÉTHODES: Faisabilité scientifique : Douze sujets étaient répartis de manière aléatoire dans un groupe intervention et un groupe témoin. Le protocole d'intervention comprenait la thérapie par vibration intraorale appliquée bilatéralement durant une minute par muscle sur les muscles de mastications. Faisabilité du processus : Plusieurs mesures de faisabilité ont été estimées, incluant les taux de recrutement, de rétention et de consentement. RÉSULTATS: Faisabilité scientifique : Des effets de grandes tailles ont été observés dans le groupe d'intervention pour l'ouverture de la bouche et l'échelle analogue de douleur (VAS). Faisabilité de processus : Le ratio de recrutement était de 2.3 répondants pour 1 participant, le ratio de rétention et de perte de 13:1 et de consentement et de perte de 12:0. CONCLUSION: Faisabilité scientifique : Les résultats doivent être interprétés avec prudence considérant le petit échantillon de sujets. L'étude semble appuyer la faisabilité de mener un essai clinique de plus grande envergure avec une intervention unidimensionnelle. Faisabilité du processus : Les taux et ratios de recrutement et de rétention observés semblent également appuyer les études futures. Cependant, l'emploie des résultats du présent projet de faisabilité dans le but d'élaborer un futur essai clinique avec une intervention multidimensionnelle similaire à d'autres études comparables sur les désordres temporomandibulaires est limité.

Healthy fish consumption and reduced mercury exposure: counseling women in their reproductive years.

OBJECTIVE: To provide family physicians with a practical, evidence-based approach to counseling women about healthy fish eating. SOURCES OF INFORMATION: MEDLINE was searched for articles published between 1999 and 2008. Most studies described in this article provide level II or III evidence. MAIN MESSAGE: Fish is an important component of a healthy diet for women in their reproductive years owing to the beneficial effects of omega-3 fatty acids on the neurologic development of the fetus. However, some fish species contain considerable methylmercury, which crosses the placenta and has harmful effects on neurobehavioural development. As many jurisdictions have issued fish consumption advisories, which can be confusing, women would benefit from individualized assistance from a trusted source, their family physicians, to clarify the risks and benefits of eating fish. CONCLUSION: We recommend that family physicians counsel women in their reproductive years about healthy choices regarding fish in their diet, and provide appropriate resources.

From voice to agency: guiding principles for participatory action research with youth.

This article begins by examining current crises facing historically marginalized youth, which necessitate more critical approaches to youth development and empirical investigations into the challenges that young people face. This requires not only listening to their voices, but actively engaging them in investigations of and interventions into social problems that affect their lives. Researching with youth raises particular dilemmas, however. The authors discuss strategies, within three guiding principles, that they found effective in conducting participatory action research with marginalized youth for the purposes of social and educational transformation.

Comparison of Wooden and Polyethylene Cutting Boards: Potential for the Attachment and Removal of Bacteria from Ground Beef †.

The potentials for removal of beef bacterial microflora from unscored polyethylene and hardwood cutting boards were compared. Ground beef was placed for 0 to 90 min onto cutting boards at room temperature and then removed; the surfaces were swabbed and the bacteria were enumerated. The boards were cleaned with various cleaning agents and then analyzed for bacterial removal. In addition, aqueous extracts from eight hardwoods were incubated with Escherichia coli O157:H7 for 0 to 30 h at 37°C to determine their inhibitory potential. Differences between the bacterial levels on wooden and plastic boards were not significant regardless of contact time. Washing with any cleaner, including water, removed most bacteria from either type of board. White ash extracts reduced E. coli O157:H7 levels to undetectable within 24 h; black cherry and red oak exhibited low inhibitory activity. Slight growth was observed in extracts from all other hardwoods, including hard maple, suggesting that aqueous extractable agents that are active against E. coli O157:H7 are not generally present in hardwoods. This study demonstrates the need to control cutting board sanitation regardless of composition.