Health Insurance Literacy Improvements Among Recently Diagnosed Adolescents and Young Adults With Cancer: Results From a Pilot Randomized Controlled Trial.

PURPOSE: Adolescents and young adults (AYAs; age 18-39 years) with cancer report needing support with health insurance. We conducted a pilot randomized controlled trial to assess the feasibility and acceptability of a virtual health insurance navigation intervention (HIAYA CHAT) to improve health insurance literacy (HIL), awareness of Affordable Care Act (ACA) protections, financial toxicity, and stress. MATERIALS AND METHODS: HIAYA CHAT is a four-session navigator delivered program; it includes psychoeducation on insurance, navigating one's plan, insurance-related laws, and managing costs. Participants were eligible if they could access an internet-capable device, were <1 year from diagnosis, and received treatment from University of Utah Healthcare or Intermountain Health systems. We assessed the feasibility, acceptability, and preliminary efficacy of HIAYA CHAT compared with usual navigation care, including HIL (nine items), insurance knowledge (13 items), ACA protections (eight items), COmprehensive Score for financial Toxicity (COST; 11 items), and Perceived Stress Scale (PSS; four items), using t tests and Cohen's d. RESULTS: From November 2020 to December 2021, N = 86 AYAs enrolled (44.6% participation) and 89.3% completed the 5-month follow-up survey; 68.6% were female, 72.1% were White, 23.3% were Hispanic, 65.1% were age 26-39 years, and 87.2% were privately insured. Of intervention participants (n = 45), 67.4% completed all four sessions; among an exit interview subset (n = 10), all endorsed the program (100%). At follow-up, compared with usual navigation care, intervention participants had greater improvements in HIL, insurance and ACA protections knowledge, and PSS; effect sizes ranged from moderate to large (0.42-0.77). COST did not differ. CONCLUSION: The results support the feasibility and acceptability of HIAYA CHAT with related improvements in HIL.

Countermovement Jump Force-Time Curve Analyses: Reliability and Comparability Across Force Plate Systems.

ABSTRACT: Merrigan, JJ, Strang, A, Eckerle, J, Mackowski, N, Hierholzer, K, Ray, NT, Smith, R, Hagen, JA, and Briggs, RA. Countermovement jump force-time curve analyses: reliability and comparability across force plate systems. J Strength Cond Res 38(1): 30-37, 2024-Considering the growing prevalence of commercial force plates providing automated force-time analyses, understanding levels of agreement across force plate systems is warranted. Countermovement jump (CMJ) metrics across Vald ForceDecks (FD), Hawkin Dynamics (HD), and Sparta Science (SS) force plate systems were compared. Twenty-two subjects completed CMJ testing (∼128 comparisons) on each force plate system separately with rest between jumps. Baseline testing occurred 3 times and demonstrated poor test-retest reliability for modified reactive strength index (mRSI) and rate of force development (RFD). ForceDecks and HD comparisons yielded acceptable agreement for concentric/propulsive relative force and net impulse, jump height, eccentric/braking RFD, and mRSI, but systematic and proportionate bias existed for RFD. Sparta Science jump height and reactive strength index (RSI) demonstrated systematic overestimations compared with HD and FD, but jump height had acceptable agreement according to concordance correlation coefficients (CCC = 0.92-0.95). Agreement between SS load (eccentric RFD) and HD braking RFD was acceptable (CCC = 0.91), whereas agreement between SS load and FD deceleration RFD was considered acceptable (CCC = 0.81-0.87) but demonstrated systematic and proportionate bias. ForceDecks (CCC = 0.89) and HD (CCC = 0.85) average relative concentric/propulsive force yielded acceptable agreement with SS explode (average relative concentric force), but SS explode demonstrated systematically lower values than FD and HD. Sparta Science drive (concentric impulse) yielded acceptable agreement with HD relative propulsive impulse (CCC = 0.85), but not FD concentric impulse. Human performance practitioners need to be aware of inconsistencies among testing procedures and analyses across force plate systems, such as differences in metric definitions and units of measurement, before making comparisons across systems.

COVID-19-Related Employment Disruptions and Increased Financial Burden Among Survivors of Adolescent and Young Adult Cancer.

Background: Financial burden is a major concern for survivors of adolescent and young adult (AYA) cancers. We identified if employment disruptions during the COVID-19 pandemic affected AYA survivors' financial burden. Methods: AYAs who were enrolled in a cancer patient navigation program were e-mailed a survey in fall 2020. Survey items included sociodemographics, employment disruption, and two measures of financial burden: COmprehensive Score for Financial Toxicity (COST) and material and behavioral financial hardship items (for any reason, COVID-19 induced, cancer induced). Financial burden outcomes were dichotomized at the median (COST = 21; financial hardship = 3). The association of employment disruptions and sociodemographics with financial burden was assessed using multivariable logistic regression models. Results: Reduced hours/job loss was reported by 24.0% of 341 participants. Survivors with a high school education or less (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.21-6.03) or who had decreased hours or job loss (OR: 3.97; 95% CI: 2.01-7.84) had greater odds for high financial toxicity. Reduced hours/job loss was the only factor associated with high material and behavioral financial hardship for both any reason (OR: 2.75; 95% CI: 1.41-5.33) and owing to COVID-19 (OR: 4.98; 95% CI: 2.28-10.92). Cancer treatment since March 2020 was associated with cancer-induced high material and behavioral financial hardship (OR: 3.31; 95% CI: 1.96-5.58). Conclusion: Employment disruptions owing to the COVID-19 pandemic, lower education levels, and cancer treatment were associated with high financial burden among AYA cancer survivors. Our findings suggest the need for multilevel interventions to identify and address financial burden among vulnerable cancer survivors.

Sources of informal financial support among adolescent and young adult cancer survivors: a mixed methods analysis from the HIAYA CHAT study.

PURPOSE: The purpose of this exploratory sequential mixed methods study was to describe the sources of informal financial support used by adolescent and young adult (AYA) cancer survivors and how financial toxicity and demographic factors were associated with different types and magnitudes of informal financial support. METHODS: This analysis is part of a larger health insurance literacy study that included pre-trial interviews and a randomized controlled trial (RCT) for AYA cancer survivors. Eligible study participants were 18 years of age, diagnosed with cancer as an AYA (15-39 years), insured, and for the RCT sample less than 1 year from diagnosis. Interview audio was transcribed, quality checked, and thematically analyzed. RCT baseline and follow-up surveys captured informal financial support use. Chi-squared and Fisher's exact tests were used to assess differences in informal financial support type use and frequency by financial toxicity and AYA demographics. RESULTS: A total of N = 24 and N = 86 AYAs participated in pre-trial interviews and the RCT respectively. Interview participants reported a variety of informal financial support sources including savings, community, family/friends, and fundraisers. However, only half of participants reported their informal financial support to be sufficient. High financial toxicity was associated with the most types of informal financial support and a higher magnitude of use. The lowest income group accessed informal financial supports less frequently than higher income groups. CONCLUSION: Our study demonstrates that AYA survivors experiencing financial toxicity frequently turn to informal sources of financial support and the magnitude is associated with financial toxicity. However, low-income survivors, and other at-risk survivors, may not have access to informal sources of financial support potentially widening inequities.

Adaptation and Development of a Health Insurance Education Program for Adolescent and Young Adult Cancer Patients.

Introduction: Adolescent and young adult (AYA) cancer patients report low health insurance literacy. We interviewed AYAs to gain their perspectives on the content and delivery of the Huntsman-Intermountain adolescent and young adult cancer health insurance (HIAYA CHAT) program. Methods: From October 2019 to March 2020, we interviewed N = 24 insured AYAs with cancer aged 18-39 years. Participants were recruited by study staff and social media. We elicited feedback on proposed HIAYA CHAT content including insurance terms/definitions, insurance coverage components, insurance legislation, cost management, and the suitability of the intervention delivery. Interviews were audio recorded, transcribed, and inductively analyzed using NVivo 12. We coded feedback into three categories of results: (1) delivery of HIAYA CHAT, (2) endorsements of proposed HIAYA CHAT content, and (3) recommendations to expand and improve HIAYA CHAT. Results: Participants were 58% female, 79% non-Hispanic white, and 79% receiving cancer treatment. First, AYAs felt that three to four different content areas, each 30 minutes or less, seemed feasible and that delivery should be through an online platform. Second, participants reflected on times during their treatment when having more insurance knowledge (e.g., appeals process) would have been useful, endorsing content about insurance policies, legal protections, and legislative impacts on health care costs. Third, AYAs recommended evaluating patients' health insurance literacy before starting HIAYA CHAT and wanted concrete learning tools (e.g., sample medical bills and budgeting). Conclusion: AYAs with cancer wanted health insurance education to include information about insurance policies and protections using tangible examples through an online delivery. Describing AYAs preferences for interventions may improve relevance and efficacy of the program. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04448678.

Financial burdens during the COVID-19 pandemic are related to disrupted healthcare utilization among survivors of adolescent and young adult cancers.

PURPOSE: We examined whether financial burdens occurring during the COVID-19 pandemic impacted healthcare utilization among survivors of adolescent and young adult cancers. METHODS: We surveyed survivors enrolled in a patient navigation program to obtain self-reports of delayed/skipped cancer care or other care, changes to medication obtainment, and changes to medication use since the COVID-19 pandemic began. Reported financial burdens were defined as financial toxicity in the past 4 weeks (COmprehensive Score for financial Toxicity [COST] ≤ median 21) and material hardships (range = 4-11) since March 2020. Adjusted logistic regression models calculated associations and effect modification by gender. RESULTS: Survivors (n = 341) were mostly female (61.3%) and non-Hispanic White (83.3%). Nearly 20% delayed/skipped cancer care, 35.2% delayed/skipped other care, 19.1% changed medication obtainment, and 12.6% changed medication use. Greater material hardships were associated with delayed/skipped cancer care (odds ratio (OR) = 3.13, 95% CI = 1.44-6.81) and other care (OR = 2.17, 95% CI = 1.18-3.98), and changed medication obtainment (OR = 2.72, 95% CI = 1.43-5.18) or use (OR = 4.49, 95% CI = 2.05-9.80). Financial toxicity was associated with delayed/skipped other care (OR = 2.53, 95% CI = 1.31-4.89) and changed medication obtainment (OR = 1.96, 95% CI = 1.01-3.83) and medication use (OR = 3.73, 95% CI = 1.59-8.73). The association of material hardships and any changes in healthcare utilization was greater among female compared to male survivors. CONCLUSION: Financial burdens experienced during the pandemic impeded survivors' ability to utilize necessary healthcare, with worse impacts among female survivors. IMPLICATIONS FOR CANCER SURVIVORS: Delayed or skipped healthcare may lead to an increased cancer mortality or severity of therapy-related conditions. Providing resources that enable survivors experiencing financial burdens to continue critical cancer and preventive care during the COVID-19 pandemic is a priority.

HIAYA CHAT study protocol: a randomized controlled trial of a health insurance education intervention for newly diagnosed adolescent and young adult cancer patients.

BACKGROUND: For adolescent and young adult (AYA) cancer patients aged 18 to 39 years, health insurance literacy is crucial for an effective use of the health care system. AYAs often face high out-of-pocket costs or have unmet health care needs due to costs. Improving health insurance literacy could help AYAs obtain appropriate and affordable health care. This protocol illustrates a randomized controlled trial testing a virtual health insurance education intervention among AYA patients. METHODS: This is a two-arm multisite randomized controlled trial. A total of 80 AYAs diagnosed with cancer in the Mountain West region will be allocated to either usual navigation care or tailored health insurance education intervention with a patient navigator that includes usual care. All participants will complete a baseline and follow-up survey 5 months apart. The primary outcomes are feasibility (number enrolled and number of sessions completed) and acceptability (5-point scale on survey measuring satisfaction of the intervention). The secondary outcomes are preliminary efficacy measured by the Health Insurance Literacy Measure and the COmprehensive Score for financial Toxicity. DISCUSSION: This trial makes a timely contribution to test the feasibility and acceptability of a virtual AYA-centered health insurance education program. TRIAL REGISTRATION: ClinicalTrials.gov NCT04448678. Registered on June 26, 2020.

"I thought there would be more I understood": health insurance literacy among adolescent and young adult cancer survivors.

BACKGROUND: Health insurance literacy is crucial for navigating the US healthcare system. Low health insurance literacy may be especially concerning for adolescent and young adult (AYA) cancer survivors. To describe AYAs' health insurance literacy, we conducted semi-structured interviews with AYA survivors, on and off of treatment. METHODS: We interviewed 24 AYA cancer survivors (aged 18-39 years) between November 2019 and March 2020. Interviews were recorded, transcribed, and quality-checked. Using two cycles of structured coding, we explored AYAs' health insurance literacy and examined thematic differences by policy holder status and age. RESULTS: AYAs were 58.3% female, 79.2% non-Hispanic White, 91.7% heterosexual, and 62.5% receiving cancer treatment. Most participants had employer-sponsored health insurance (87.5%), and 41.7% were their own policy holder. Four themes emerged; in the first theme, most AYAs described beginning their cancer treatment with little to no understanding of their health insurance. This led to the three subsequent themes in which AYAs reported: unclear expectations of what their insurance would cover and their out-of-pocket costs; learning about insurance and costs by trial and error; and how their health insurance literacy negatively impacted their ability to navigate the healthcare system. CONCLUSIONS: Our findings, while requiring confirmation in larger samples and in other health systems, suggest that the health insurance literacy needed to navigate insurance and cancer care is low among US AYA survivors and may have health and financial implications. As the burden of navigating insurance is often put on patients, health insurance education is an important supportive service for AYA survivors on and off of treatment.

COVID-19 Vaccine Hesitancy Among Adolescent and Young Adult Cancer Survivors.

The study objective was to identify sociodemographic and coronavirus disease 2019 (COVID-19) factors that are associated with COVID-19 vaccine hesitancy among adolescent and young adult (AYA) cancer survivors. Eligible participants were 18 years or older and were diagnosed with cancer as an AYA (ages 15-39 years) and received services through an AYA cancer program. A total of 342 participants completed a cross-sectional survey. Our primary outcome-COVID-19 vaccine hesitancy-was surveyed as a 5-point Likert scale and operationalized as a binary outcome (agree vs hesitant). A large proportion of participants reported COVID-19 vaccine hesitancy (37.1%). In the multivariable regression, female survivors (odds ratio = 1.81, 95% confidence interval = 1.10 to 2.98) and survivors with a high school education or less (odds ratio = 3.15, 95% confidence interval = 1.41 to 7.04) reported higher odds of vaccine hesitancy compared with their male or college graduate or higher counterparts. COVID-19 vaccine hesitancy persists among AYA survivors despite their recommended priority vaccination status and higher chances of severe COVID-19 outcomes.

Combined user-driven treadmill control and functional electrical stimulation increases walking speeds poststroke.

The variety of poststroke impairments and compensatory mechanisms necessitate adaptive and subject-specific approaches to locomotor rehabilitation. To implement subject-specific, adaptive training to treadmill-based gait training, we developed a user-driven treadmill (UDTM) control algorithm that adjusts the user's speed in real-time. This study examines the response of individuals poststroke to the combination of UDTM control and electrical stimulation of the paretic ankle musculature to augment forward propulsion during walking. Sixteen individuals poststroke performed a randomized series of walking tasks on an instrumented split-belt treadmill at their self-selected speeds 1) with fixed speed treadmill (FSTM) control only, 2) FSTM control and paretic limb functional electrical stimulation (FES), 3) UDTM control only, and 4) UDTM control and FES. With UDTM control and FES, participants selected speeds that were 0.13 m/s faster than their speeds with fixed speed control only. This instantaneous increase is comparable to the gains in SS speed seen after 12 weeks of training with FES and fast walking with fixed speed treadmill control by Kesar and colleagues (Δ = 0.18 m/s). However, we saw no significant differences in the corresponding push-off forces or trailing limb position. Since individuals can use a variety of strategies to change their walking speeds, it is likely that the differences among individual responses obscured trends in the group average changes in mechanics. Ultimately, the combination of UDTM control and functional electrical stimulation (FES) allows individuals to increase speeds after a short exposure and may be a beneficial addition to poststroke gait training programs.

User-driven treadmill walking promotes healthy step width after stroke.

BACKGROUND: Walking with user-driven treadmill control is believed to be more like overground walking than fixed-speed treadmill walking. Walking speed and ground reaction forces differ between overground and fixed-speed treadmill walking, but not between overground and user-driven treadmill walking in healthy and post-stroke subjects. However, studies assessing spatiotemporal gait parameters during user-driven treadmill walking are limited. This information may help confirm that user-driven treadmill walking is more like overground walking than fixed-speed treadmill walking, as well as inform the development of post-stroke gait rehabilitation programs. RESEARCH QUESTION: How do spatiotemporal gait parameters for individuals post-stroke differ between fixed-speed and user-driven treadmill walking? METHODS: Eighteen subjects (10 M, 8 F; 62 ± 12 years; 1.73 ± 0.12 m; 84.9 ± 12.9 kg; 40 ± 30 months post-stroke) with chronic post-stroke hemiparesis participated in this study. Participants walked on an instrumented treadmill in its fixed-speed and user-driven modes at their self-selected and fastest comfortable walking speeds. Subjects wore retroreflective markers for motion capture. Shapiro-Wilk tests were used to assess for normality and one-way repeated measures ANOVAs were used to compare between conditions with α = 0.05. Bonferroni corrections were used for multiple comparisons. RESULTS: Step width was significantly smaller with user-driven control (13.7 cm, 95 % CI: [0.131, 0.145]) than fixed-speed control (16.8 cm, 95 % CI:[0.160, 0.174]), while step length and step time did not differ across treadmill conditions. Step length and step time differed between self-selected and fast walking speeds, but not treadmill control conditions. SIGNIFICANCE: The results of this study show that user-driven treadmill control encourages healthy gait biomechanics and a greater sense of stability in post-stroke subjects. Individuals post-stroke walked with smaller step width with user-driven treadmill control, which has been associated with increased balance. Post-stroke gait rehabilitation may benefit from programs with user-driven treadmill training paradigms to improve mobility following stroke.

Walking speed changes in response to user-driven treadmill control after stroke.

The objective of this study was to determine how individuals poststroke respond to user-driven treadmill (UDTM) controlin terms ofwalking speeds, peak anterior ground reaction forces (AGRF), peak posterior ground reaction forces (PGRF), and trailing limb angles (TLA). Twenty individuals with chronic stroke walked overground during a 10-meter walk test to determine their self-selected (SS) speeds before walking on a treadmill in its fixed-speed (FSTM) and UDTM control modes at their SS and fastest comfortable (Fast) speeds. Paired t-tests were used to compare the walking speeds, peak AGRF, peak PGRF, and TLA among test conditions (α = 0.05). Participants selected similar SS (p > 0.05) and faster Fast walking speeds (p < 0.05) with the UDTM control compared to the FSTM control. There were no changes in their peak AGRF or PGRF for either limb or speed between UDTM and FSTM conditions (p > 0.05). Individuals used greater paretic TLA at SS speeds with UDTM control (p < 0.05). There was no difference in the AGRF required at Fast speeds with FSTM and UDTM control even though participants selected faster speeds with UDTM control. In work with young, healthy adults, we found that the treadmill control condition did not affect the amount of forward propulsion needed. Therefore, it is likely that when walking with UDTM control, individuals poststroke adjust their posture to make better use of their forward propulsion. This means they can reach faster walking speeds without increasing their push-off forces. Future work should assess how to most effectively prescribe UDTM control for gait training programs.

Dynamic structure of variability in joint angles and center of mass position during user-driven treadmill walking.

BACKGROUND: Overground locomotion exhibits greater movement variability and less dynamic stability compared to typical fixed-speed treadmill walking. To minimize the differences between treadmill and overground locomotion, researchers are developing user-driven treadmill systems that adjust the speed of the treadmill belts in real-time based on how fast the subject is trying to walk. RESEARCH QUESTION: Does dynamic structure of variability, quantified by the Lyapunov exponent (LyE), of joint angles and center of mass (COM) position differ between a fixed-speed treadmill (FTM) and user-driven treadmill (UTM) for healthy subjects? METHODS: Eleven healthy, adult subjects walked on a user-driven treadmill that updated its speed in real-time based on the subjects' propulsive forces, location, step length, and step time, and at a matched speed on a typical, fixed-speed treadmill for 1-minute. The LyE for flexion/extension joint angles and center of mass position were calculated. RESULTS: Subjects exhibited higher LyE values of joint angles on the UTM compared to the FTM indicating that walking on the UTM may be more similar to overground locomotion. No change in COM LyE was observed between treadmill conditions indicating that subjects' balance was not significantly altered by this new training paradigm. SIGNIFICANCE: The user-driven treadmill may be a more valuable rehabilitation tool for improving gait than fixed-speed treadmill training, as it may increase the effectiveness of transitioning learned behaviors to overground compared to fixed-speed treadmills.

Walking speed changes in response to novel user-driven treadmill control.

Implementing user-driven treadmill control in gait training programs for rehabilitation may be an effective means of enhancing motor learning and improving functional performance. This study aimed to determine the effect of a user-driven treadmill control scheme on walking speeds, anterior ground reaction forces (AGRF), and trailing limb angles (TLA) of healthy adults. Twenty-three participants completed a 10-m overground walking task to measure their overground self-selected (SS) walking speeds. Then, they walked at their SS and fastest comfortable walking speeds on an instrumented split-belt treadmill in its fixed speed and user-driven control modes. The user-driven treadmill controller combined inertial-force, gait parameter, and position based control to adjust the treadmill belt speed in real time. Walking speeds, peak AGRF, and TLA were compared among test conditions using paired t-tests (α = 0.05). Participants chose significantly faster SS and fast walking speeds in the user-driven mode than the fixed speed mode (p > 0.05). There was no significant difference between the overground SS walking speed and the SS speed from the user-driven trials (p < 0.05). Changes in AGRF and TLA were caused primarily by changes in walking speed, not the treadmill controller. Our findings show the user-driven treadmill controller allowed participants to select walking speeds faster than their chosen speeds on the fixed speed treadmill and similar to their overground speeds. Since user-driven treadmill walking increases cognitive activity and natural mobility, these results suggest user-driven treadmill control would be a beneficial addition to current gait training programs for rehabilitation.

Mechanical Properties of Titanium Nitride Nanocomposites Produced by Chemical Precursor Synthesis Followed by High-P,T Treatment.

We investigated the high-P,T annealing and mechanical properties of nanocomposite materials with a highly nitrided bulk composition close to Ti3N4. Amorphous solids were precipitated from solution by ammonolysis of metal dialkylamide precursors followed by heating at 400-700 °C in flowing NH3 to produce reddish-brown amorphous/nanocrystalline materials. The precursors were then densified at 2 GPa and 200-700 °C to form monolithic ceramics. There was no evidence for N2 loss during the high-P,T treatment. Micro- and nanoindentation experiments indicate hardness values between 4-20 GPa for loads ranging between 0.005-3 N. Young's modulus values were measured to lie in the range 200-650 GPa. Palmqvist cracks determined from microindentation experiments indicate fracture toughness values between 2-4 MPa·m1/2 similar to Si3N4, SiC and Al2O3. Significant variations in the hardness may be associated with the distribution of amorphous/crystalline regions and the very fine grained nature (~3 nm grain sizes) of the crystalline component in these materials.

Protein phosphatase 2A plays an important role in stromal cell-derived factor-1/CXC chemokine ligand 12-mediated migration and adhesion of CD34+ cells.

Migration of hemopoietic stem and progenitor cells (HSPC) is required for homing to bone marrow following transplantation. Therefore, it is critical to understand signals underlying directional movement of HSPC. Stromal cell-derived factor-1 (SDF-1)/CXCL12 is a potent chemoattractant for HSPC. In this study, we demonstrate that the serine-threonine protein phosphatase (PP)2A plays an important role in regulation of optimal level and duration of Akt/protein kinase B activation (a molecule important for efficient chemotaxis), in response to SDF-1. Inhibition of PP2A, using various pharmacological inhibitors of PP2A including okadaic acid (OA) as well as using genetic approaches including dominant-negative PP2A-catalytic subunit (PP2A-C) or PP2A-C small interfering RNA, in primary CD34(+) cord blood (CB) cells led to reduced chemotaxis. This was associated with impairment in polarization and slower speed of movement in response to SDF-1. Concomitantly, SDF-1-induced Akt phosphorylation was robust and prolonged. Following SDF-1 stimulation, Akt and PP2A-C translocate to plasma membrane with enhanced association of PP2A-C with Akt observed at the plasma membrane. Inhibition of PI3K by low-dose LY294002 partially recovered chemotactic activity of cells pretreated with OA. In addition to chemotaxis, adhesion of CD34(+) cells to fibronectin was impaired by OA pretreatment. Our study demonstrates PP2A plays an important role in chemotaxis and adhesion of CD34(+) CB cells in response to SDF-1. CD34(+) CB cells pretreated with OA showed impaired ability to repopulate NOD-SCID mice in vivo, suggesting physiological relevance of these observations.