Oral Endocrine Therapy Nonadherence, Adverse Effects, Decisional Support, and Decisional Needs in Women With Breast Cancer

BACKGROUND: Oral endocrine therapy (OET) such as tamoxifen or aromatase inhibitors reduces recurrence and mortality for the 75% of breast cancer survivors (BCSs) with a diagnosis of estrogen receptor-positive breast cancer. Because many BCSs decide not take OET as recommended because of adverse effects, understanding BCSs' decisional supports and needs is foundational to supporting quality OET decision making about whether to adhere to OET. OBJECTIVE: The aim of this study was to examine literature pertaining to OET nonadherence and adverse effects using the Ottawa Decision Support Framework categories of decisional supports and decisional needs because these factors potentially influence OET use. METHODS: A systematic literature search was performed in PubMed and CINAHL using combined search terms "aromatase inhibitors and adherence" and "tamoxifen and adherence." Studies that did not meet criteria were excluded. Relevant data from 25 publications were extracted into tables and reviewed by 2 authors. RESULTS: Findings identified the impact of adverse effects on OET nonadherence, an absence of decisional supports provided to or available for BCSs who are experiencing OET adverse effects, and the likelihood of unmet decisional needs related to OET. CONCLUSIONS: Adverse effects contribute to BCSs decisions to stop OET, yet there has been little investigation of the process through which that occurs. This review serves as a call to action for providers to provide support to BCSs experiencing OET adverse effects and facing decisions related to nonadherence. IMPLICATIONS FOR PRACTICE: Findings suggest BCSs prescribed OET have unmet decisional needs, and more decisional supports are needed for BCSs experiencing OET adverse effects

The Oral Endocrine Therapy Decision Making Process in Women with Breast Cancer

poster abstractBackground: Oral endocrine therapy (OET) is life-saving for women with estrogen receptorpositive (ER+) breast cancer because it reduces the incidence of recurrence and mortality. An estimated 75% of women with breast cancer receive a recommendation for life-saving OET such as Tamoxifen or aromatase inhibitors. OET adherence is not a single event decision, but rather is a psychosocial process unfolding over time involving an initial decision to initiate therapy or not, and for those who do initiate OET, several additional decisions. Our understanding of OET decision making is limited, but non-adherence is a common response to OET side effects. By obtaining first-person narratives from women who have been prescribed OET and report experiencing side effects, an explanatory framework can be developed that describes their decision making processes. Purpose: The purpose of this grounded theory study is to develop an explanatory framework of decision making by women with ER+ breast cancer who report experiencing OET side effects. Aims: Specific aims are (1) describe responses to side effects among women with ER+ breast cancer, (2) identify common decisional needs of women with ER+ breast cancer who report experiencing OET side effects, (3) identify common decisional supports sought by and provided to women with ER+ breast cancer who report experiencing OET side effects, and (4) describe how women with ER+ breast cancer who report experiencing OET side effects make decisions about initiating, continuing, switching, and/or discontinuing OET. Methods: In this study, 30 women with ER+ breast cancer who report experiencing OET side effects will take part in a single, face-to-face, audio-recorded interview. Demographic and breast cancer treatment information will be collected and then analyzed using descriptive statistics. A constant comparative method of inductive and deductive processes will be used to discover common patterns and variations in the narrative data. The final products of the analysis will include typologies of responses to side effects, common decisional needs, and common decisional support as well as a framework of common trajectories of decision making related to OET in women who report experiencing side effects. Findings: Findings to date will be discusse

Integrating Cover Crops in High Tunnel Crop Production

High tunnels are plastic-covered, passively ventilated and heated structures where crops are grown directly in soil. They have become important tools for Iowa specialty crop producers to increase production of quality crops, extend the season, and increase profitability. The environment in a high tunnel, without rainfall, limited space, and potential climate control requires a unique set of crop management skills. High tunnel production is primarily dominated by tomatoes. Interest among growers focuses on year-round production in high tunnels. A cohesive and focused approach is needed to tackle issues that arise due to continuous production under these structures. One emerging issue is the intensive use of fertilizers to manage crop nutrient demand and the lack of crop rotation within high tunnels. This could lead to problems such as high salt build up, resurgence of soil-borne and foliar diseases, poor soil structure, lack of microbial diversity, and reduced crop yields

Validating the Postdischarge Surgical Recovery Scale 13 as a Measure of Perceived Postoperative Recovery After Laparoscopic Sacrocolpopexy

Objectives No postoperative recovery measurement tools have been validated among women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse, which impedes development and testing of strategies to improve recovery. The purpose of this study was to evaluate the performance of the Postdischarge Surgical Recovery Scale (PSR) as a measure of perceived recovery in laparoscopic sacrocolpopexy patients. Methods Women (N = 120) with stage 2 or higher pelvic organ prolapse undergoing laparoscopic sacrocolpopexy completed a 15-minute postoperative survey (days 7, 14, 42, and 90 [each ± 3 days]) which included the 15-item PSR. A confirmatory factor analysis was conducted using data from 14 days postsurgery, when patients would have begun to recover, but there was likely to be substantial variability in recovery across patients. We also assessed validity and explored sensitivity to change over time and minimally important difference values. Results Confirmatory factor analysis indicated a good fitting model for a reduced version of the PSR (ie, PSR13). Regressions showed that the PSR13 prospectively predicted single-item recovery scores. The PSR13 recovery significantly improved from days 7 to 42, suggesting the PSR13 is sensitive to change. Descriptive statistics including minimally important differences are reported. The minimally important difference was estimated to be around 5 points. Conclusions The PSR13 is a psychometrically sound tool for measuring recovery over time in this population. Its short length makes it an ideal postoperative recovery measure in clinical practice or research

Predictors of Postdischarge Surgical Recovery Following Laparoscopic Sacrocolpopexy: A Prospective Cohort Study

Objectives Our aim was to identify sociodemographic/clinical, surgical, and psychosocial predictors of postdischarge surgical recovery after laparoscopic sacrocolpopexy. Methods Study participants (N=171) with ≥ stage 2 pelvic organ prolapse completed a preoperative survey measuring hypothesized sociodemographic/clinical, surgical, and psychosocial recovery predictors followed by a postoperative survey at four time points (day 7, 14, 42, and 90) that included the Postdischarge Surgical Recovery (PSR)13 scale. One multivariate linear regression model was constructed for each time point to regress PSR13 scores on an a priori set of hypothesized predictors. All variables that had p values less than 0.1 were considered significant predictors of recovery because of the exploratory nature of this study and focus on model building rather than model testing. Results Predictors of recovery at one or more time points included the following: Sociodemographic/clinical predictors: older age, higher body mass index, fewer comorbidities, and greater preoperative pain predicted greater recovery. Surgical predictors: fewer perioperative complications and greater change in the leading edge of prolapse after surgery predicted greater recovery. Psychosocial predictors: less endorsement of doctors locus of control, greater endorsement of others locus of control, and less sick role investment predicted greater recovery. Conclusions Identified sociodemographic/clinical, surgical, and psychosocial predictors should provide physicians with evidence based guidance on recovery times for patients and family members. This knowledge is critical for informing future research to determine if these predictors are modifiable by changes to our narrative during the preoperative consultation visit. These efforts may reduce the postdischarge surgical recovery for patients with pelvic organ prolapse after laparoscopic sacrocolpopexy, accepting the unique demands on each individual’s time

An ALMA Survey of H₂CO in Protoplanetary Disks

H₂CO is one of the most abundant organic molecules in protoplanetary disks and can serve as a precursor to more complex organic chemistry. We present an Atacama Large Millimeter/submillimeter Array survey of H₂CO toward 15 disks covering a range of stellar spectral types, stellar ages, and dust continuum morphologies. H₂CO is detected toward 13 disks and tentatively detected toward a fourteenth. We find both centrally peaked and centrally depressed emission morphologies, and half of the disks show ring-like structures at or beyond expected CO snowline locations. Together these morphologies suggest that H₂CO in disks is commonly produced through both gas-phase and CO-ice-regulated grain-surface chemistry. We extract disk-averaged and azimuthally-averaged H₂CO excitation temperatures and column densities for four disks with multiple H₂CO line detections. The temperatures are between 20–50 K, with the exception of colder temperatures in the DM Tau disk. These temperatures suggest that H₂CO emission in disks generally emerges from the warm molecular layer, with some contributions from the colder midplane. Applying the same H₂CO excitation temperatures to all disks in the survey, we find that H₂CO column densities span almost three orders of magnitude (~5 × 10¹¹–5 × 10¹⁴ cm⁻²). The column densities appear uncorrelated with disk size and stellar age, but Herbig Ae disks may have less H₂CO compared to T Tauri disks, possibly because of less CO freeze-out. More H₂CO observations toward Herbig Ae disks are needed to confirm this tentative trend, and to better constrain under which disk conditions H₂CO and other oxygen-bearing organics efficiently form during planet formation

Neuroimaging Correlates of Suicidality in Decision-Making Circuits in Posttraumatic Stress Disorder

In depression, brain and behavioral correlates of decision-making differ between individuals with and without suicidal thoughts and behaviors. Though promising, it remains unknown if these potential biomarkers of suicidality will generalize to other high-risk clinical populations. To preliminarily assess whether brain structure or function tracked suicidality in individuals with posttraumatic stress disorder (PTSD), we measured resting-state functional connectivity and cortical thickness in two functional networks involved in decision-making, a ventral fronto-striatal reward network and a lateral frontal cognitive control network. Neuroimaging data and self-reported suicidality ratings, and suicide-related hospitalization data were obtained from 50 outpatients with PTSD and also from 15 healthy controls, and all were subjected to seed-based resting-state functional connectivity and cortical thickness analyses using a priori seeds from reward and cognitive control networks. First, general linear models (GLM) were used to evaluate whether ROI-to-ROI functional connectivity was predictive of self-reported suicidality after false discovery rate (FDR)-correction for multiple comparisons and covariance of age and depression symptoms. Next, regional cortical thickness statistics were included as predictors of ROI-to-ROI functional connectivity in follow-up GLMs evaluating structure-function relationships. Functional connectivity between reward regions was positively correlated with suicidality (p-FDR ≤ 0.05). Functional connectivity of the lateral pars orbitalis to anterior cingulate/paracingulate control regions also tracked suicidality (p-FDR ≤ 0.05). Furthermore, cortical thickness in anterior cingulate/paracingulate was associated with functional correlates of suicidality in the control network (p-FDR < 0.05). These results provide a preliminary demonstration that biomarkers of suicidality in decision-making networks observed in depression may generalize to PTSD and highlight the promise of these circuits as transdiagnostic biomarkers of suicidality

Examining the Relationship Between Trait Energy and Fatigue and Feelings of Depression in Young Healthy Adults

Depression is usually co-morbid with fatigue. However, we are unaware of studies exploring the relationship between trait energy and fatigue and feelings of depression. Recent evidence suggests that energy and fatigue are two distinct moods. PURPOSE: To examine the association between trait mental and physical energy and fatigue and feelings of depression, within an otherwise healthy young adult cohort. METHODS: Using a cross-sectional design, healthy respondents (n=495) completed a series of self-reported surveys measuring depression, lifestyle factors (sleep, diet, physical activity), and trait mental and physical energy and fatigue. Using a step-wise regression, we controlled for demographics and lifestyle and added trait mental and physical energy and fatigue to the second model. RESULTS: When trait mental and physical energy and fatigue were added to the models, the adjusted R2 increased by 5% (R2 = .112, F(13, 457) = 4.455, p \u3c .001). In our second model, trait mental fatigue was the only significant predictor of depressive mood states (Β = .159, t (457) = 2.512, p = 0.01). CONCLUSION: Young adults, who struggle with high mental fatigue, may also be more likely to report feeling depressed suggesting that fatigue and depression are co-morbid, while low energy and depression are not. Future research should aim to identify epigenetic/genetic factors that influence mental fatigue and how those may be associated with feelings of depression

Portland State University Spring Symposium Report

The 2023 Spring Symposium arose in response to a request to PSU administrators in a Faculty Senate Resolution. That resolution noted the high level of interest by the Faculty Senate in both understanding and engaging in the university’s budgeting processes. The Symposium offered an opportunity for all PSU employees to come together to identify priorities and shared purpose regarding the university’s approach to long term financial planning. The recommendations created during the symposium are being shared with incoming president Ann Cudd to inform her thinking as PSU pursues a path toward financial sustainability. Table of Contents 04 Statement from President and Faculty Senate 05 2023 Faculty & Staff Spring Symposium Event Overview 08 Collaborative Governance Overview 10 Report Purpose & Intention 11 Process Recommendations 13 Next Steps 15 Acknowledgements 16 Appendix: Process Recommendation Too

Adolescent Substance Use Following a Deadly U.S. Tornado Outbreak: A Population-Based Study of 2,000 Families

Despite conceptual links between disaster exposure and substance use, few studies have examined prevalence and risk factors for adolescent substance use and abuse in large, population-based samples affected by a recent natural disaster. We addressed this gap using a novel address-based sampling methodology to interview adolescents and parents who were affected by the 4th deadliest tornado outbreak in U.S. history. Postdisaster interviews were conducted with 2,000 adolescent–parent dyads living within a 5-mile radius of the spring 2011 U.S. tornadoes. In addition to descriptive analyses to estimate prevalence, hierarchical linear and logistic regression analyses were used to examine a range of protective and risk factors for substance use and abuse. Approximately 3% reported substance abuse since the tornado. Greater number of prior traumatic events and older age emerged as consistent risk factors across tobacco and alcohol use and substance abuse since the tornado. Tornado incident characteristics, namely, greater loss of services and resources after the tornado and posttraumatic stress disorder since the tornado, were associated with greater alcohol consumption. Service loss increased risk for binge drinking, whereas, for substance abuse, posttraumatic stress disorder increased risk and parent presence during the tornado decreased risk. Greater family tornado exposure was associated with a greater number of cigarettes smoked in female but not male teen participants. Both trauma and non-trauma-related factors are relevant to postdisaster substance abuse among adolescents. Future research should examine the role of broader ecological systems in heightening or curtailing substance use risk for adolescents following disaster exposure