Cardiovascular toxicities after anthracycline and VEGF-targeted therapies in adolescent and young adult cancer survivors

BACKGROUND: Cancer survival rates have been steadily improving in the adolescent and young adult (AYA) population, but survivors are at increased risk for cardiovascular disease (CVD). The cardiotoxic effects of anthracycline therapy have been well studied. However, the cardiovascular toxicity associated with newer therapies, such as the vascular endothelial growth factor (VEGF) inhibitors, is less well understood. OBJECTIVE: This retrospective study of AYA cancer survivors sought to gain insight into their burden of cardiovascular toxicities (CT) following initiation of anthracycline and/or VEGF inhibitor therapy. METHODS: Data were extracted from electronic medical records over a fourteen-year period at a single institution. Cox proportional hazards regression modeling was used to examine risk factors for CT within each treatment group. Cumulative incidence was calculated with death as a competing risk. RESULTS: Of the 1,165 AYA cancer survivors examined, 32%, 22%, and 34% of patients treated with anthracycline, VEGF inhibitor, or both, developed CT. Hypertension was the most common outcome reported. Males were at increased risk for CT following anthracycline therapy (HR: 1.34, 95% CI 1.04-1.73). The cumulative incidence of CT was highest in patients who received both anthracycline and VEGF inhibitor (50% at ten years of follow up). CONCLUSIONS: CT was common among AYA cancer survivors who received anthracycline and/or VEGF inhibitor therapy. Male sex was an independent risk factor for CT following anthracycline treatment. Further screening and surveillance are warranted to continue understanding the burden of CVD following VEGF inhibitor therapy

Indirect evidence and the poverty of the stimulus: the case of anaphoric one

It is widely held that children’s linguistic input underdetermines the correct grammar, and that language learning must therefore be guided by innate linguistic constraints. In contrast, a recent counterproposal holds that apparently impoverished input may contain indirect sources of evidence that allow the child to learn without such constraints. Here, we support this latter view by showing that a Bayesian model can learn a standard “poverty-of-stimulus” example, anaphoric one, from realistic input without a constraint traditionally assumed to be necessary, by relying on indirect evidence. Our demonstration does however assume other linguistic knowledge; thus we reduce the problem of learning anaphoric one to that of learning this other knowledge. We discuss whether this other knowledge may itself be acquired without linguistic constraints.Stephani Foraker, Terry Regier, Naveen Khetarpal, Amy Perfors and Joshua B. Tenenbau

Testing a brief web-based intervention to increase recognition of tobacco constituents

Objective: We examined website formats to increase smokers\u27 recognition of harmful and potentially harmful constituents (HPHCs) in cigarettes. Methods: Adult, daily smokers (N = 279) were randomized to view a brief, single-page study website showing HPHC names and uses. The intervention site was tailored + interactive, labeled by cigarette brand/subbrand showing color imagery and pop-up boxes; the generic + static website (control) was unbranded in greyscale. Eye tracking equipment measured attention (dwell time) to precise website features. Linear regression analyses compared attention to HPHC descriptions and the correct recognition of 15 HPHC chemicals. A randomly selected sub-sample (N = 30) of participants qualitatively rated website usability. Results: Despite spending less dwell time on the HPHC text and entire website, adult smokers who viewed the generic + static website had greater improvement in HPHC recognition compared to the tailored + interactive website (4.6 vs 3.6; p = .02); this finding contrasts with current literature on tailoring and interactivity. Both websites were rated highly on ease-of-use and readability. Conclusions: Basic formats and narrative HPHC Web-based content attracted less visual attention, yet increased recognition of these chemicals in cigarettes, compared to brand-tailored, interactive web-based content

Enhancement and suppression effects resulting from information structuring in sentences

Information structuring through the use of cleft sentences increases the processing efficiency of references to elements within the scope of focus. Furthermore, there is evidence that putting certain types of emphasis on individual words not only enhances their subsequent processing, but also protects these words from becoming suppressed in the wake of subsequent information, suggesting mechanisms of enhancement and suppression. In Experiment 1, we showed that clefted constructions facilitate the integration of subsequent sentences that make reference to elements within the scope of focus, and that they decrease the efficiency with reference to elements outside of the scope of focus. In Experiment 2, using an auditory text-change-detection paradigm, we showed that focus has similar effects on the strength of memory representations. These results add to the evidence for enhancement and suppression as mechanisms of sentence processing and clarify that the effects occur within sentences having a marked focus structure

Carcass Yield and Subprimal Cutout Value of Beef, High- and Low-Yielding Beef × Dairy, and Dairy Steers

This study compared carcass yield and cutout value of conventional beef and dairy cattle to high-yielding (HY) and low-yielding (LY) crossbred beef × dairy cattle and identified the contribution of carcass regions to carcass yield andcutout value among beef × dairy crossbreds. Carcasses of conventional beef, beef × dairy crossbred, and dairy cattle were selected according to industry-average slaughter endpoints for their cattle type. Carcasses were fabricated at a commercial processing facility, and weights of carcass components were obtained. Post hoc subsampling was used to segregate HY and LY beef × dairy crossbreds based on subprimal yield. Multiple linear regression was used to assess carcass yield and sub-primal cutout value between the 4 cattle types (n=21 to 26 per cattle type). Beef cattle and HY crossbreds produced 1.59 to 3.04 percentage units greater (P<0.05) subprimal yield than LY crossbreds and dairy cattle. Dairy cattle produced at least 1.16 percentage units more (P<0.05) bone than any other cattle type. Subprimal to bone was not different (P>0.05) between HY crossbreds and beef cattle, and subprimal to fat was lesser (P<0.05) in HY crossbreds than beef cattle. Subprimal cutout value was more than 5 US dollars (USD)/45.4 kg different (P<0.05) between cattle types, which were ranked HY crossbreds > beef cattle > LY crossbreds > dairy cattle. In beef × dairy cattle, subprimal to bone in the round contributed most greatly to an increase (P=0.02), by 3.79 USD/45.4 kg, in subprimal cutout value. Together, these results suggested carcass value of beef × dairy cattle may be maximized when cattle are harvested at a lesser overall fatness than conventional beef cattle and when considerable muscling, especially in the round, is achieved

Trajectories of self-rated health in people with diabetes: Associations with functioning in a prospective community sample

© 2013 Schmitz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: Self-rated health (SRH) is a single-item measure that is one of the most widely used measures of general health in population health research. Relatively little is known about changes and the trajectories of SRH in people with chronic medical conditions. The aims of the present study were to identify and describe longitudinal trajectories of self-rated health (SRH) status in people with diabetes. Methods: A prospective community study was carried out between 2008 and 2011. SRH was assessed at baseline and yearly at follow-ups (n=1288). Analysis was carried out through trajectory modeling. The trajectory groups were subsequently compared at 4 years follow-up with respect to functioning. Results: Four distinct trajectories of SRH were identified: 1) 72.2% of the participants were assigned to a persistently good SRH trajectory; 2) 10.1% were assigned to a persistently poor SRH trajectory; 3) mean SRH scores changed from good to poor for one group (7.3%); while 4) mean SRH scores changed from poor to medium/good for another group (10.4%). Those with a persistently poor perception of health status were at higher risk for poor functioning at 4 years follow-up than those whose SRH scores decreased from good to poor. Conclusions: SRH is an important predictor for poor functioning in diabetes, but the trajectory of SRH seems to be even more important. Health professionals should pay attention to not only SRH per se, but also changes in SRH over time.This work was supported by Operating Grant MOP-84574 from the Canadian Institutes of Health Research (CIHR). GG was supported by a doctoral fellowship from the CIHR. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Change in longitudinal trends in sleep quality and duration following breast cancer diagnosis: results from the Women's Health Initiative

Breast cancer survivors frequently report sleep problems, but little research has studied sleep patterns longitudinally. We examined trends in sleep quality and duration up to 15 years before and 20 years after a diagnosis of breast cancer, over time among postmenopausal women participating in the Women's Health Initiative (WHI). We included 12,098 participants who developed invasive breast cancer after study enrollment. A linear mixed-effects model was used to determine whether the time trend in sleep quality, as measured by the WHI Insomnia Rating Scale (WHIIRS), a measure of perceived insomnia symptoms from the past 4 weeks, changed following a cancer diagnosis. To examine sleep duration, we fit a logistic regression model with random effects for both short (<6 h) and long (≥9 h) sleep. In addition, we studied the association between depressive symptoms and changes in WHIIRS and sleep duration. There was a significantly slower increase in the trend of WHIIRS after diagnosis (β = 0.06; p = 0.03), but there were non-significant increases in the trend of the probability of short or long sleep after diagnosis. The probability of depressive symptoms significantly decreased, though the decrease was more pronounced after diagnosis (p < 0.01). Trends in WHIIRS worsened at a relatively slower rate following diagnosis and lower depression rates may explain the slower worsening in WHIIRS. Our findings suggest that over a long period of time, breast cancer diagnosis does not adversely affect sleep quality and duration in postmenopausal women compared to sleep pre-diagnosis, yet both sleep quality and duration continue to worsen over time.WHI - National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services [HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, HHSN268201600004C]; Ohio State University Susan G Komen Graduate Trainee Program [GTDR15334082]Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Addressing cancer survivors\u27 cardiovascular health using the Automated Heart Health Assessment (AH-HA) EHR tool: Initial protocol and modifications to address COVID-19 challenges

BACKGROUND: The purpose of this paper is to describe the Automated Heart-Health Assessment (AH-HA) study protocol, which demonstrates an agile approach to cancer care delivery research. This study aims to assess the effect of a clinical decision support tool for cancer survivors on cardiovascular health (CVH) discussions, referrals, completed visits with primary care providers and cardiologists, and control of modifiable CVH factors and behaviors. The COVID-19 pandemic has caused widespread disruption to clinical trial accrual and operations. Studies conducted with potentially vulnerable populations, including cancer survivors, must shift towards virtual consent, data collection, and study visits to reduce risk for participants and study staff. Studies examining cancer care delivery innovations may also need to accommodate the increased use of virtual visits. METHODS/DESIGN: This group-randomized, mixed methods study will recruit 600 cancer survivors from 12 National Cancer Institute Community Oncology Research Program (NCORP) practices. Survivors at intervention sites will use the AH-HA tool with their oncology provider; survivors at usual care sites will complete routine survivorship visits. Outcomes will be measured immediately after the study visit, with follow-up at 6 and 12 months. The study was amended during the COVID-19 pandemic to allow for virtual consent, data collection, and intervention options, with the goal of minimizing participant-staff in-person contact and accommodating virtual survivorship visits. CONCLUSIONS: Changes to the study protocol and procedures allow important cancer care delivery research to continue safely during the COVID-19 pandemic and give sites and survivors flexibility to conduct study activities in-person or remotely

Expression of Beef- Versus Dairy-Type in Crossbred Beef × Dairy Cattle Does Not Impact Shape, Eating Quality, or Color of Strip Loin Steaks

Phenotypic expression of dairy influence often carries negative implications in beef production; thus, considerable variation in expression of beef- versus dairy-type might adversely affect value of crossbred beef × dairy cattle. This study evaluated effects of phenotype in crossbred beef × dairy cattle, specifically that associated with beef- versus dairy-type, on meat quality. Effects were blocked within commercial feedlot pens because cattle within a pen were contemporaries for sex, age, management, and source. On their harvest date, 592 Angus or [Simmental × Angus] × Holstein cattle from 9 pens were assessed by 3 expert evaluators. Scores for muscling and frame size were used to categorize and subset cattle in a pen into 4 phenotype groups: (1) fully dairy-type, (2) partially dairy-type, (3) partially beef-type, and (4) fully beef-type. Strip loin steaks were obtained from selected cattle (n = 82 to 84 per group) and evaluated for descriptive sensory attributes, shear force, pH, color at retail display, steak dimensions, muscle fiber type, and fatty acid composition. Data were tested for fixed effects of phenotype group with random effects of pen. Despite distinct expression of visual beef- versus dairy-type among cattle sampled, phenotype groups were largely not different (P &gt; 0.05) in shape, sensory attributes, color, or biochemical properties of strip loin steaks. Other body regions, separate from the loin, were likely responsible for differences in live animal muscling. Additional research is needed on effects of sire breed, individual sire, and management strategies on meat quality in beef × dairy crossbreds. Complementarity of beef breeds and sires to produce more profitable beef-type cattle from the beef × dairy mating system should not be expected to negatively influence meat quality. Marketing programs rooted in production of consistent and premium products may benefit from including beef from beef × dairy crossbreds

Evaluation of the modified FINDRISC to identify individuals at high risk for diabetes among middle-aged white and black ARIC study participants

Objective: To evaluate a modified Finnish Diabetes Risk Score (FINDRISC) for predicting the risk of incident diabetes among white and black middle-aged participants from the Atherosclerosis Risk in Communities (ARIC) study. Research design and methods: We assessed 9754 ARIC cohort participants who were free of diabetes at baseline. Logistic regression and receiver operator characteristic (ROC) curves were used to evaluate a modified FINDRISC for predicting incident diabetes after 9 years of follow-up, overall and by race/gender group. The modified FINDRISC used comprised age, body mass index, waist circumference, blood pressure medication and family history. Results: The mean FINDRISC (range, 2 [lowest risk] to 17 [highest risk]) for black women was higher (9.9 ± 3.6) than that for black men (7.6 ± 3.9), white women (8.0 ± 3.6) and white men (7.6 ± 3.5). The incidence of diabetes increased generally across deciles of FINDRISC for all 4 race/gender groups. ROC curve statistics for the FINDRISC showed the highest area under the curve for white women (0.77) and the lowest for black men (0.70). Conclusions: We used a modified FINDRISC to predict the 9-year risk of incident diabetes in a biracial US population. The modified risk score can be useful for early screening of incident diabetes in biracial populations, which may be helpful for early interventions to delay or prevent diabetes