Communication around palliative care principles and advance care planning between oncologists, children with advancing cancer and families.

BACKGROUND: In medical oncology, palliative care principles and advance care planning are often discussed later in illness, limiting time for conversations to guide goal-concordant care. In pediatric oncology, the frequency, timing and content of communication about palliative care principles and advance care planning remains understudied. METHODS: We audio-recorded serial disease re-evaluation conversations between oncologists, children with advancing cancer and their families across the illness trajectory until death or 24 months from last disease progression. Content analysis was conducted to determine topic frequencies, timing and communication approaches. RESULTS: One hundred forty one disease re-evaluation discussions were audio-recorded for 17 patient-parent dyads with advancing cancer. From 2400 min of recorded dialogue, 119 min (4.8%) included discussion about palliative care principles or advance care planning. Most of this dialogue occurred after frank disease progression. Content analysis revealed distinct communication approaches for navigating discussions around goals of care, quality of life, comfort and consideration of limiting invasive interventions. CONCLUSIONS: Palliative care principles are discussed infrequently across evolving illness for children with progressive cancer. Communication strategies for navigating these conversations can inform development of educational and clinical interventions to encourage earlier dialogue about palliative care principles and advance care planning for children with high-risk cancer and their families.

Structure and Conductivity of Semiconducting Polymer Hydrogels.

Poly(fluorene-alt-thiophene) (PFT) is a conjugated polyelectrolyte that self-assembles into rod-like micelles in water, with the conjugated polymer backbone running along the length of the micelle. At modest concentrations (∼10 mg/mL in aqueous solutions), PFT forms hydrogels, and this work focuses on understanding the structure and intermolecular interactions in those gel networks. The network structure can be directly visualized using cryo electron microscopy. Oscillatory rheology studies further tell us about connectivity within the gel network, and the data are consistent with a picture where polymer chains bridge between micelles to hold the network together. Addition of tetrahydrofuran (THF) to the gels breaks those connections, but once the THF is removed, the gel becomes stronger than it was before, presumably due to the creation of a more interconnected nanoscale architecture. Small polymer oligomers can also passivate the bridging polymer chains, breaking connections between micelles and dramatically weakening the hydrogel network. Fits to solution-phase small-angle X-ray scattering data using a Dammin bead model support the hypothesis of a bridging connection between PFT micelles, even in dilute aqueous solutions. Finally, time-resolved microwave conductivity measurements on dried samples show an increase in carrier mobility after THF annealing of the PFT gel, likely due to increased connectivity within the polymer network.

POLARON DYNAMICS. Long-lived photoinduced polaron formation in conjugated polyelectrolyte-fullerene assemblies.

The efficiency of biological photosynthesis results from the exquisite organization of photoactive elements that promote rapid movement of charge carriers out of a critical recombination range. If synthetic organic photovoltaic materials could mimic this assembly, charge separation and collection could be markedly enhanced. We show that micelle-forming cationic semiconducting polymers can coassemble in water with cationic fullerene derivatives to create photoinduced electron-transfer cascades that lead to exceptionally long-lived polarons. The stability of the polarons depends on the organization of the polymer-fullerene assembly. Properly designed assemblies can produce separated polaronic charges that are stable for days or weeks in aqueous solution.

Lifestyle intervention and cardiovascular risk reduction in the Illinois WISEWOMAN Program.

BACKGROUND: The Illinois WISEWOMAN Program (IWP) was designed to address the disproportionate risk of cardiovascular disease (CVD) among disadvantaged, low-income women. In total, 1021 women aged 40 to 64 years were recruited from the Illinois Breast and Cervical Cancer Program. The women were randomized to either a minimum intervention (MI) or an enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational materials, and the EI group received a 12-week lifestyle change intervention. METHODS: Demographic and clinical data were collected in addition to data on CVD risk, which was measured in terms of nutritional and physical activity behavior, using culturally adapted versions of three valid and reliable questionnaires. IWP data were analyzed for demographic characteristics and clinical and behavioral outcomes at baseline, post-intervention, and follow-up at 1 and 2 years from baseline. This article reports the change in these outcomes up to the 1-year follow-up. RESULTS: Participants in the EI group showed significant improvement on some of the dietary and physical activity outcomes both at post-intervention and 1-year follow-up. Compared with the MI group, the EI group showed more improvement in dietary fat- and fiber-related behaviors and increased physical activity levels. There were improvements in all of the cardiovascular outcomes at post-intervention in both the EI and MI groups; however, these changes were not statistically significant. CONCLUSION: As an integrated physical activity and nutrition intervention, the IWP has shown its strength in addressing some of the lifestyle behaviors for CVD prevention in this at-risk target population.

Computerized self-monitoring and technology-assisted feedback for weight loss with and without an enhanced behavioral component.

OBJECTIVE: The purpose of this study was to develop and evaluate a 12-week weight management intervention involving computerized self-monitoring and technology-assisted feedback with and without an enhanced behavioral component. METHODS: 120 overweight (30.5±2.6kg/m(2)) adults (45.0±10.3 years) were randomized to one of three groups: computerized self-monitoring with Basic feedback (n=45), Enhanced behavioral feedback (n=45), or wait-list control (n=30). Intervention participants used a computer software program to record dietary and physical activity information. Weekly e-mail feedback was based on computer-generated reports, and participants attended monthly measurement visits. RESULTS: The Basic and Enhanced groups experienced significant weight reduction (-2.7±3.3kg and -2.5±3.1kg) in comparison to the Control group (0.3±2.2; p<0.05). Waist circumference and systolic blood pressure also decreased in intervention groups compared to Control (p<0.01). CONCLUSIONS: A program using computerized self-monitoring, technology-assisted feedback, and monthly measurement visits produced significant weight loss after 12 weeks. However, the addition of an enhanced behavioral component did not improve the effectiveness of the program. PRACTICE IMPLICATIONS: This study suggests that healthcare professionals can effectively deliver a weight management intervention using technology-assisted strategies in a format that may complement and reduce face-to-face sessions.

A web-based intervention to support increased physical activity among at-risk adults.

Physical inactivity is an important contributor to the development of numerous chronic conditions and alone is an independent risk factor for diabetes, cardiovascular disease, and depression and yet, most Americans consistently fail to achieve the recommended amount of physical activity. As part of Project HealthDesign, we designed and prototyped a personal health record application (PHA) that delivers and supports a highly individualized, behaviorally based lifestyle physical activity intervention for sedentary adults. Through a user centered design approach, we engaged consumers, health care providers, and personal trainers for multiple facilitated group discussions and structured interviews to determine their needs and wants related to an activity PHA. The PHA was developed to include elements of evidence-based approaches which help participants adopt cognitive and behavioral skills such as goal-setting, self-monitoring, accepting social support, cognitive restructuring, contingency management, decisional balance, and relapse prevention. This PHA demonstrated the potential for research-based behavioral interventions to be delivered via a web portal. This finding is important for both consumers and their providers who have the desire to implement physical activity recommendations, but lack the tools to facilitate or undertake such interventions.

A lifestyle approach to reducing cardiovascular risk factors in underserved women: design and methods of the Illinois WISEWOMAN Program.

BACKGROUND: Few lifestyle intervention programs address the needs of financially disadvantaged, low literacy populations. The overall goal of the Illinois WISEWOMAN Program (IWP) was to design such a program and test its effectiveness in reducing cardiovascular disease (CVD) risk, specifically physical activity and nutrition factors. The purpose of this paper is to describe the IWP study design and methods, development of the evidence-based curriculum appropriate for a low socioeconomic status (SES) population, and baseline characteristics of IWP participants. METHODS: The Cooper Institute, in collaboration with the Illinois Department of Public Health and the University of Illinois at Chicago, adapted evidence-based interventions for financially disadvantaged, low literacy populations. The study used a randomized, two-group, experimental design. In total, 1021 women were recruited from the Illinois Breast and Cervical Cancer Program, which serves uninsured and underinsured women, aged 40-64, at or below 200% of poverty. The women were randomized to either a minimum intervention (MI) or an enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational materials. Additionally, the EI group received a 12-week lifestyle intervention. RESULTS: Baseline comparisons show equivalent groups. IWP participants had a higher prevalence of obesity and smoking than similar national samples. CONCLUSIONS: IWP addressed many of the cultural and implementation barriers in programs that seek to improve the health of financially disadvantaged, low literacy populations. Because of the high burden of disease, the unique study population, and the sound design, we anticipate that our future results will contribute to the translation literature, which has largely ignored significant health disparities.

IgG avidity assay firms up the diagnosis of acute toxoplasmosis on the first serum sample in immunocompetent pregnant women.

Rapid diagnosis of acute toxoplasmosis during pregnancy permits timely treatment and prevents or attenuates congenital toxoplasmosis. Specific IgM antibodies to Toxoplasma as marker of acute infection are often poorly informative, meaning that a complementary technique is needed to reach a diagnosis on the first sample. Here we evaluated 2 commercial kits designed to assist with the diagnosis of acute toxoplasmosis: Platelia Toxo IgG Avidity Complementary Reagents and Platelia Toxo IgA, both from BIO-RAD (Marnes La Coquette, France). We tested 2 groups of subjects: 36 patients with acute toxoplasmosis and 55 patients with chronic toxoplasmosis. The IgG avidity test had a sensitivity of 100% (36/36), a specificity of 92.7% (51/55), a positive predictive value of 90%, and a negative predictive value of 100%. Among the immunocompetent women population, the avidity test had perfect sensitivity and specificity, and positive and negative predictive values of 100%. The IgA test had a sensitivity of 88.8% (32/36) and a specificity of 85.4% (47/55), and positive and negative predictive values of 80% and 92.1%, respectively. When the 2 tests were combined, there was only 1 case in which the diagnosis of chronic toxoplasmosis could not be confirmed. The IgG avidity test can therefore be used to rapidly distinguish between chronic and acute infection on the first sample from a pregnant woman, provided there is no underlying immunodepression and no ongoing antitoxoplasmic treatment. In these 2 situations, the results must be interpreted with care, and other serologic markers, including IgA, should be tested. Determination of a pregnant woman's status on a first serum sample allows therapeutic and preventive management to be started without delay.