Comparison of Tissue Architectural Changes between Radiofrequency Ablation and Cryospray Ablation in Barrett’s Esophagus Using Endoscopic Three-Dimensional Optical Coherence Tomography

Two main nonsurgical endoscopic approaches for ablating dysplastic and early cancer lesions in the esophagus have gained popularity, namely, radiofrequency ablation (RFA) and cryospray ablation (CSA). We report a uniquely suited endoscopic and near-microscopic imaging modality, three-dimensional (3D) optical coherence tomography (OCT), to assess and compare the esophagus immediately after RFA and CSA. The maximum depths of architectural changes were measured and compared between the two treatment groups. RFA was observed to induce 230~260  m depth of architectural changes after each set of ablations over a particular region, while CSA was observed to induce edema-like spongiform changes to ~640 μm depth within the ablated field. The ability to obtain micron-scale depth-resolved images of tissue structural changes following different ablation therapies makes 3D-OCT an ideal tool to assess treatment efficacy. Such information could be potentially used to provide real-time feedback for treatment dosing and to identify regions that need further retreatment.National Institutes of Health (U.S.) (Grant R01-CA75289-15)National Institutes of Health (U.S.) (Grant K99-EB010071-01A1)National Institutes of Health (U.S.) (Grant R44-CA101067-06)United States. Air Force Office of Scientific Research (Contract FA9550-10-1-0063)Medical Free Electron Laser Program (Contract FA9550-10-1-0551

Structural markers observed with endoscopic 3-dimensional optical coherence tomography correlating with Barrett's esophagus radiofrequency ablation treatment response

Background Radiofrequency ablation (RFA) is effective for treating Barrett's esophagus (BE) but often involves multiple endoscopy sessions over several months to achieve complete response. Objective Identify structural markers that correlate with treatment response by using 3-dimensional (3-D) optical coherence tomography (OCT; 3-D OCT). Design Cross-sectional. Setting Single teaching hospital. Patients Thirty-three patients, 32 male and 1 female, with short-segment (<3 cm) BE undergoing RFA treatment. Intervention Patients were treated with focal RFA, and 3-D OCT was performed at the gastroesophageal junction before and immediately after the RFA treatment. Patients were re-examined with standard endoscopy 6 to 8 weeks later and had biopsies to rule out BE if not visibly evident. Main Outcome Measurements The thickness of BE epithelium before RFA and the presence of residual gland-like structures immediately after RFA were determined by using 3-D OCT. The presence of BE at follow-up was assessed endoscopically. Results BE mucosa was significantly thinner in patients who achieved complete eradication of intestinal metaplasia than in patients who did not achieve complete eradication of intestinal metaplasia at follow-up (257 ± 60 μm vs 403 ± 86 μm; P < .0001). A threshold thickness of 333 μm derived from receiver operating characteristic curves corresponded to a 92.3% sensitivity, 85% specificity, and 87.9% accuracy in predicting the presence of BE at follow-up. The presence of OCT-visible glands immediately after RFA also correlated with the presence of residual BE at follow-up (83.3% sensitivity, 95% specificity, 90.6% accuracy). Limitations Single center, cross-sectional study in which only patients with short-segment BE were examined. Conclusion Three-dimensional OCT assessment of BE thickness and residual glands during RFA sessions correlated with treatment response. Three-dimensional OCT may predict responses to RFA or aid in making real-time RFA retreatment decisions in the future.Center for Integration of Medicine and Innovative Technology (Medical Engineering Fellowship)United States. Dept. of Veterans Affairs. Boston Healthcare SystemNational Institutes of Health (U.S.) (Grant R01-CA75289-15)National Institutes of Health (U.S.) (Grant R44CA101067-06)National Institutes of Health (U.S.) (Grant K99-EB010071-01A1)United States. Air Force Office of Scientific Research (Grant FA9550-10-1-0063)United States. Air Force Office of Scientific Research. Medical Free Electron Laser Program (Grant FA9550-10-1-0551

Computer-Aided Analysis of Gland-Like Subsurface Hyposcattering Structures in Barrett’s Esophagus Using Optical Coherence Tomography

(1) Background: Barrett's esophagus (BE) is a complication of chronic gastroesophageal reflux disease and is a precursor to esophageal adenocarcinoma. The clinical implication of subsurface glandular structures of Barrett's esophagus is not well understood. Optical coherence tomography (OCT), also known as volumetric laser endomicroscopy (VLE), can assess subsurface glandular structures, which appear as subsurface hyposcattering structures (SHSs). The aim of this study is to develop a computer-aided algorithm and apply it to investigate the characteristics of SHSs in BE using clinical VLE data; (2) Methods: SHSs were identified with an initial detection followed by machine learning. Comprehensive SHS characteristics including the number, volume, depth, size and shape were quantified. Clinical VLE datasets collected from 35 patients with a history of dysplasia undergoing BE surveillance were analyzed to study the general SHS distribution and characteristics in BE. A subset of radiofrequency ablation (RFA) patient data were further analyzed to investigate the pre-RFA SHS characteristics and post-RFA treatment response; (3) Results: SHSs in the BE region were significantly shallower, more vertical, less eccentric, and more regular, as compared with squamous SHSs. SHSs in the BE region which became neosquamous epithelium after RFA were shallower than those in the regions that remained BE. Pre-ablation squamous SHSs with higher eccentricity correlated strongly with larger reduction of post-ablation BE length for less elderly patients; (4) Conclusions: The computer algorithm is potentially a valuable tool for studying the roles of SHSs in BE. Keywords: Barrett;s esophagus; glands; optical coherence tomographyNational Institutes of Health (U.S.) (Grant R01-CA075289-19)National Institutes of Health (U.S.) (Grant RO1-CA178636-04)National Institutes of Health (U.S.) (Grant R01-EY011289-30)United States. Air Force Office of Scientific Research (Contract FA9550-12-1-0551)United States. Air Force Office of Scientific Research (Contract FA9550-15-1-0473

Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos)

Background Radiofrequency ablation (RFA) is an endoscopic technique used to eradicate Barrett's esophagus (BE). However, such ablation can commonly lead to neosquamous epithelium overlying residual BE glands not visible by conventional endoscopy and may evade detection on random biopsy samples. Objective To demonstrate the capability of endoscopic 3-dimensional optical coherence tomography (3D-OCT) for the identification and characterization of buried glands before and after RFA therapy. Design Cross-sectional study. Setting Single teaching hospital. Patients Twenty-six male and 1 female white patients with BE undergoing RFA treatment. Interventions 3D-OCT was performed at the gastroesophageal junction in 18 patients before attaining complete eradication of intestinal metaplasia (pre–CE-IM group) and in 16 patients after CE-IM (post–CE-IM group). Main Outcome Measurements Prevalence, size, and location of buried glands relative to the squamocolumnar junction. Results 3D-OCT provided an approximately 30 to 60 times larger field of view compared with jumbo and standard biopsy and sufficient imaging depth for detecting buried glands. Based on 3D-OCT results, buried glands were found in 72% of patients (13/18) in the pre–CE-IM group and 63% of patients (10/16) in the post–CE-IM group. The number (mean [standard deviation]) of buried glands per patient in the post–CE-IM group (7.1 [9.3]) was significantly lower compared with the pre–CE-IM group (34.4 [44.6]; P = .02). The buried gland size (P = .69) and distribution (P = .54) were not significantly different before and after CE-IM. Limitations A single-center, cross-sectional study comparing patients at different time points in treatment. Lack of 1-to-1 coregistered histology for all OCT data sets obtained in vivo. Conclusion Buried glands were frequently detected with 3D-OCT near the gastroesophageal junction before and after radiofrequency ablation.National Institutes of Health (U.S.) (Grant R01-CA75289-15)National Institutes of Health (U.S.) (Grant R44CA101067-06)National Institutes of Health (U.S.) (Grant R01-HL095717-03)National Institutes of Health (U.S.) (Grant R01-NS057476-05)National Institutes of Health (U.S.) (Grant K99-EB010071-01A1)United States. Air Force Office of Scientific Research (Contract FA9550-10-1-0063)United States. Air Force Office of Scientific Research. Medical Free Electron Laser Program (Contract FA9550-10-1-0551)Center for Integration of Medicine and Innovative Technolog

Strategies for classroom physical activity in schools

Less than one-third of children and adolescents in the United States are meeting the recommendation from the 2008 Physical Activity Guidelines for Americans to get 60 minutes or more of physical activity each day. Schools can help students meet this national recommendation because close to 60 million children and adolescents attend school. Schools have also shown that they are capable of helping students get up to 20 to 60 minutes of physical activity during the school day. This finding underscores that schools are the most strategic and practical place for students to learn about and practice being physically active.The Whole School, Whole Community, Whole Child model can help schools strategically identify and promote policies, practices, and programs that increase physical education and physical activity. Within the context of this model, schools can develop, implement, and evaluate a Comprehensive School Physical Activity Program.This document was prepared by the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health in collaboration with Springboard to Active Schools, an initiative of the National Network of Public Health Institutes (NNPHI) and Health Resources in Action (HRiA) through Cooperative Agreement CDC-RFA-DP16-1601 with CDC. It was supported by conceptual, technical, and editorial assistance from subject matter experts at CDC and others from the fields of health and education.Centers for Disease Control and Prevention. Strategies for Classroom Physical Activity in Schools. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2018.CS296182-AClassroomPAStrategies_508.pdf2018Cooperative Agreement CDC-RFA-DP16-160

Educating Future Nursing Scientists: Recommendations for Integrating Omics Content in PhD Programs

Preparing the next generation of nursing scientists to conduct high-impact, competitive, sustainable, innovative, and interdisciplinary programs of research requires that the curricula for PhD programs keep pace with emerging areas of knowledge and health care/biomedical science. A field of inquiry that holds great potential to influence our understanding of the underlying biology and mechanisms of health and disease is omics. For the purpose of this article, omics refers to genomics, transcriptomics, proteomics, epigenomics, exposomics, microbiomics, and metabolomics. Traditionally, most PhD programs in schools of nursing do not incorporate this content into their core curricula. As part of the Council for the Advancement of Nursing Science\u27s Idea Festival for Nursing Science Education, a work group charged with addressing omics preparation for the next generation of nursing scientists was convened. The purpose of this article is to describe key findings and recommendations from the work group that unanimously and enthusiastically support the incorporation of omics content into the curricula of PhD programs in nursing. The work group also calls to action faculty in schools of nursing to develop strategies to enable students needing immersion in omics science and methods to execute their research goals

Quality and Publication of Emergency Medicine Trials Registered in ClinicalTrials.gov

Introduction: Promoting emergency medicine (EM) clinical trials research remains a priority. To characterize the status of clinical EM research, this study assessed trial quality, funding source, and publication of EM clinical trials and compared EM and non-EM trials on these key metrics. We also examined the volume of EM trials and their subspecialty areas.Methods: We abstracted data from ClinicalTrials.gov (February 2000 - September 2013) and used individual study National Clinical Trial numbers to identify published trials (January 2007 - September 2016). We used descriptive statistics and chi-square tests to examine study characteristics by EM and non-EM status, and Kaplan-Meier curves and log-rank tests to compare time to publication of completed EM and non-EM studies.Results: We found 638 interventional EM trials and 59,512 non-EM interventional trials conducted in the United States between February 2000 and September 2013, registered on ClinicalTrials.gov. EM studies were significantly less likely than non-EM studies to be National Institutes of Health-funded or to evaluate a drug or biologic. However, EM studies had significantly larger sample sizes, and were significantly more likely to use randomization and blinding. Overall, 34.3% of EM and 26.0% of non-EM studies were published in peer-reviewed journals. By subspecialty, more EM trials concerned medical/surgical and psychiatric/neurological conditions than trauma.Conclusion: Although EM studies were less likely to have received federal or industry funding, and the EM portfolio consisted of only 638 trials over the 14-year study period, the quality of EM trials surpassed that of non-EM trials, based on indices such as randomization and blinding. This novel finding bodes well for the future of clinical EM research, as does the higher proportion of published EM than non-EM trials. Our study also revealed that trauma studies were under-represented among EM studies. Periodic assessment of EM trials with the metrics used here could provide an informative and valuable longitudinal view of progress in clinical EM research

Identification of delivery models for the provision of predictive genetic testing in Europe: protocol for a multicentre qualitative study and a systematic review of the literature

Introduction: The appropriate application of genomic technologies in healthcare is surrounded by many concerns. In particular, there is a lack of evidence on what constitutes an optimal genetic service delivery model, which depends on the type of genetic test and healthcare context considered. The present project aims to identify, classify, and evaluate delivery models for the provision of predictive genetic testing in Europe and in selected Anglophone extra-European countries (the USA, Canada, Australia, and New Zealand). It also sets out to survey the European public health community’s readiness to incorporate public health genomics into their practice. Materials and equipment: The project consists of (i) a systematic review of published literature and selected country websites, (ii) structured interviews with health experts on the genetic service delivery models in their respective countries, and (iii) a survey of European Public Health Association (EUPHA) members’ knowledge and attitudes toward genomics applications in clinical practice. The inclusion criteria for the systematic review are that articles be published in the period 2000–2015; be in English or Italian; and be from European countries or from Canada, the USA, Australia, or New Zealand. Additional policy documents will be retrieved from represented countries’ government-affiliated websites. The results of the research will be disseminated through the EUPHA network, the Italian Network for Genomics in Public Health (GENISAP), and seminars and workshops. Expected impact of the study on public health: The transfer of genomic technologies from research to clinical application is influenced not only by several factors inherent to research goals and delivery of healthcare but also by external and commercial interests that may cause the premature introduction of genetic tests in the public and private sectors. Furthermore, current genetic services are delivered without a standardized set of process and outcome measures, which makes the evaluation of healthcare services difficult. The present study will identify and classify delivery models and, subsequently, establish which are appropriate for the provision of predictive genetic testing in Europe by comparing sets of process and outcome measures. In this way, the study will provide a basis for future recommendations to decision makers involved in the financing, delivery, and consumption of genetic services