Hockey FIT for Women (HFIT for Women): Evaluating reach and implementation of a gender-sensitized healthy lifestyle program

Context: 57% of Canadian women have obesity or are overweight, indicating a need for novel mitigation strategies. Research suggests health promotion programs tailored to at-risk groups are more likely to be effective in improving health and sustaining implementation and outcomes long-term. Hockey FIT for Women (HFIT for Women) was adapted from Hockey Fans In Training (HFIT), a 12-week gendersensitized healthy lifestyle program for men who were hockey fans with obesity/overweight. Process evaluation findings from both a HFIT pilot and large-scale trial indicated a need to adapt to women. Objective: Evaluate reach and implementation of the HFIT for Women program from participant and coach perspectives. Study Design & Analysis: Participant data was collected from an intake survey, virtual focus groups (n=2), and program exit survey (n=59). Coach data was collected through interviews (n=2). Transcripts and open-ended responses were analyzed thematically. Setting: Three local community fitness facilities and major junior hockey teams in Ontario, Canada. Population Studied: Participants included those who coached or completed the HFIT for Women program (i.e., identify as a woman, 18+ years of age, and passed safety screen). Intervention: HFIT for Women was 90 minutes (50% in-class education; 50% exercise), once a week, for 12 weeks. Outcome Measures: Focus groups, coach interviews, and exit surveys. Results: Majority of participants were white (98.2%), with a mean age of 41 years (±11.3 SD), and largely college educated (45.6%), employed (91.2%), and married (47.4%). Reasons for joining the program included a desire to connect with others sharing similar interests, and the experience of a partner or relative who completed HFIT. There was a desire for more novel and engaging information from both coaches and participants. Participants expressed their wish for more informal discussion time and competition to encourage each other, and coaches noted value in seeing the bonds created between participants. Suggestions focused on building a greater connection to hockey with competitive drills and playing floor hockey. Conclusion: Social connection was a key driver for participating in HFIT for Women. Future iterations should focus on leveraging the social connection through providing more group-based activities for the in-class portion of the program and increasing hockey-related competitive drills and games

CAF subpopulations: a new reservoir of stromal targets in pancreatic cancer

Cancer-associated fibroblasts (CAFs) are one of the most significant components in the tumour microenvironment (TME), where they can perform several protumourigenic functions. Several studies have recently reported that CAFs are more heterogenous and plastic than was previously thought. As such, there has been a shift in the field to study CAF subpopulations and the emergent functions of these subsets in tumourigenesis. In this review, we explore how different aspects of CAF heterogeneity are defined and how these manifest in multiple cancers, with a focus on pancreatic ductal adenocarcinoma (PDAC). We also discuss therapeutic approaches to selectively target protumourigenic CAF functions, while avoiding normal fibroblasts, providing insight into the future of stromal targeting for the treatment of PDAC and other solid tumours

Can the power of sport help men with overweight/obesity improve their health through a tailored healthy lifestyle program?

Abstract Context: In Canada and the U.S., a greater proportion of men (vs. women) have overweight or obesity. Despite this, men are underrepresented in weight loss research and fewer are recruited into weight loss services. Objective: To determine whether participants who received an innovative gender-sensitized healthy lifestyle program (Hockey Fans in Training: Hockey FIT) would have greater weight loss and reduced waist circumference (WC), after 3 and 12 months, compared with a wait-list control group. Study Design and Analysis: Cluster randomized controlled trial whereby 42 sites were randomly assigned to either the intervention (i.e., Hockey FIT) or a wait-list control group (i.e., usual activities for 12 months). Analyses were conducted using linear mixed effects models for cluster design and repeated measures. Setting: Sites in Canada and the U.S. were selected based on availability/interest of both a local major junior/professional hockey team and a community implementation partner (e.g., YMCA). Population Studied: Men aged 35-65 years with a body mass index (BMI) ≥27 kg/m2, recruited primarily through the hockey team’s social media and email communications. Intervention: Hockey FIT is an office, group-based program, designed to appeal to hockey fans through support from their local team and is grounded in men’s preferences (e.g., competition, humour). During the 3-month active phase, participants attended 12 weekly, 90-minute sessions incorporating both education and exercise, and led by certified coaches. During the 9-month minimally-supported phase, participants were encouraged to sustain their health behaviour changes. Outcome Measures: In-person assessments were completed at baseline, 3 and 12 months, and included measurements of weight, height, and WC. Results: Participants (n=997) averaged 48.6 years of age (± 8.3 SD) and had mean baseline BMI values of 35.3 kg/m2 (± 6.1). By 3 months, participants in the Hockey FIT group lost 2.50 kg more (95% CI -3.36 to -1.64, p\u3c0.0001) than the wait-list control group, and by 12 months this difference between groups remained (-1.61 kg, 95% CI: -2.55 to -0.67, p=0.001). Similarly, Hockey FIT led to greater WC reduction at both 3 and 12 months, compared with the wait-list control group. Conclusions: A gender-sensitized healthy lifestyle program for men, using the power of sport as an engagement strategy, had a positive impact on both short and long-term weight-related outcomes

Stakeholder Acceptability of the Hockey Fans In Training Healthy Lifestyle Intervention

Context: Canadian men have a higher likelihood of having excess weight or obesity than Canadian women, which puts them at a significant risk of developing preventable chronic diseases. To address this issue, we created the Hockey Fans In Training (Hockey FIT) healthy lifestyle program designed for middle-aged male hockey fans with overweight or obesity. Objective: In parallel to a cluster randomised trial of Hockey FIT, we conducted a process evaluation of the acceptability of the Hockey FIT program from the perspective of program participants, implementation partners, and program coaches. This included identifying areas to be improved for future delivery beyond this trial. Study Design and Analysis: Data was collected through virtual focus groups (n = 8) with Hockey FIT participants (n = 34) and interviews with local program coaches (n = 16) and implementation partners (n = 21). A process of deductive analysis by question and inductive analysis by response was conducted by multiple members of the research team until data saturation was reached. Setting or Dataset: Program sites included a major junior or professional hockey team paired with a local implementation partner (e.g., fitness facility). Population Studied: Hockey FIT participants (i.e., men, aged 35-65 with a BMI ≥ 27 kg/m2), coaches, and implementation partners. Intervention/Instrument: Hockey FIT was a 12-week, group-based healthy lifestyle program delivered to middle-aged male hockey fans who have excess weight or obesity. Outcome Measures: Acceptability of the Hockey FIT program, current strengths of the initiative, and recommendations for future modifications. Results: Eight overarching themes emerged regarding the acceptability of the program and areas to optimize for future delivery. The themes included participants’ motivations for joining the program, the positive group dynamic, overall positive experience, the positive experience of program coaches, and the effective program components, such as the nutrition information. Opportunities for optimization and adaptation included incorporating more exercise earlier, greater connection to hockey, and improving the usability of app technology. Conclusions: Overall, the Hockey FIT program was perceived as acceptable with minor adaptations needed to improve delivery. The findings can inform future scale-up of the Hockey FIT program

Recruitment and characteristics of men with overweight/obesity from a trial of a gender-sensitized healthy lifestyle program

Context: Engaging men in chronic disease prevention is critical as rates of obesity in men continue to increase, coupled with men being less likely to proactively seek preventative health care services. Objective: To report on the recruitment and baseline characteristics of a healthy lifestyle program using the power of sport (hockey) to engage men. Study Design and Analysis: Cluster randomized controlled trial where 42 sites were randomly assigned to either the intervention or wait-list control group. The intervention group received the Hockey Fans in Training (Hockey FIT) program (3-month active phase; 9-month minimally-supported phase) while the control group continued with usual activities for 12 months. Setting: Sites were located across 40 cities in Canada and the U.S., selected based on the availability/interest of both a local major junior/professional hockey team and an implementation partner. Population Studied: Men aged 35-65 years with a body mass index (BMI) ≥ 27 kg/m2 and who were fans of the local hockey team. Participants were recruited through the hockey team (i.e., social media, email blasts, website) and using other traditional recruitment methods. Intervention: Hockey FIT is a gender-sensitized, off-ice, healthy lifestyle program, designed to appeal to hockey fans through support from their local team and based on men’s preferences (e.g., group-based competition, humour, being with like-minded and -sized men). Outcome Measures: In-person assessments (weight, height, waist circumference, blood pressure, glycated hemoglobin, fitness) and online questionnaires (physical activity, sedentary time, healthy eating, health-related quality of life, and demographics) were completed at baseline, 3, and 12 months. Accelerometry-based step counters were also used to measure steps over 7 days at each time point. Results: 1,397 individuals were assessed for eligibility and 997 men were enrolled. Most participants heard about Hockey FIT through social media and team email blasts (41% and 29%, respectively). Participants averaged 48.6 years of age (± 8.3 SD), had mean BMI values of 35.3 kg/m2 (± 6.1), were predominately white, and had varying levels of education. Conclusions: By partnering with local hockey teams, we were able to engage men in a healthy lifestyle program. While participants were among the target audience intended for the study, targeted recruitment is needed to attract more diverse populations

The Spitzer c2d Survey of Weak-line T Tauri Stars II: New Constraints on the Timescale for Planet Building

One of the central goals of the Spitzer Legacy Project ``From Molecular Cores to Planet-forming Disks'' (c2d) is to determine the frequency of remnant circumstellar disks around weak-line T Tauri stars (wTTs) and to study the properties and evolutionary status of these disks. Here we present a census of disks for a sample of over 230 spectroscopically identified wTTs located in the c2d IRAC (3.6, 4.5, 4.8, and 8.0 um) and MIPS (24 um) maps of the Ophiuchus, Lupus, and Perseus Molecular Clouds. We find that ~20% of the wTTs in a magnitude limited subsample have noticeable IR-excesses at IRAC wavelengths indicating the presence of a circumstellar disk. The disk frequencies we find in these 3 regions are ~3-6 times larger than that recently found for a sample of 83 relatively isolated wTTs located, for the most part, outside the highest extinction regions covered by the c2d IRAC and MIPS maps. The disk fractions we find are more consistent with those obtained in recent Spitzer studies of wTTs in young clusters such as IC 348 and Tr 37. From their location in the H-R diagram, we find that, in our sample, the wTTs with excesses are among the younger part of the age distribution. Still, up to ~50% of the apparently youngest stars in the sample show no evidence of IR excess, suggesting that the circumstellar disks of a sizable fraction of pre-main-sequence stars dissipate in a timescale of ~1 Myr. We also find that none of the stars in our sample apparently older than ~10 Myrs have detectable circumstellar disks at wavelengths < 24 um. Also, we find that the wTTs disks in our sample exhibit a wide range of properties (SED morphology, inner radius, L_DISK/L*, etc) which bridge the gaps observed between the cTTs and the debris disk regimes.Comment: 54 pages, 13 figures, Accepted by Ap

The Spitzer c2d Survey of Large, Nearby, Interstellar Clouds. IV. Lupus Observed with MIPS

We present maps of 7.78 square degrees of the Lupus molecular cloud complex at 24, 70, and $160\:\mu$m. They were made with the Spitzer Space Telescope's Multiband Imaging Photometer for Spitzer (MIPS) instrument as part of the Spitzer Legacy Program, ``From Molecular Cores to Planet-Forming Disks'' (c2d). The maps cover three separate regions in Lupus, denoted I, III, and IV. We discuss the c2d pipeline and how our data processing differs from it. We compare source counts in the three regions with two other data sets and predicted star counts from the Wainscoat model. This comparison shows the contribution from background galaxies in Lupus I. We also create two color magnitude diagrams using the 2MASS and MIPS data. From these results, we can identify background galaxies and distinguish them from probable young stellar objects. The sources in our catalogs are classified based on their spectral energy distribution (SED) from 2MASS and Spitzer wavelengths to create a sample of young stellar object candidates. From 2MASS data, we create extinction maps for each region and note a strong corresponence between the extinction and the $160\:\mu$m emission. The masses we derived in each Lupus cloud from our extinction maps are compared to masses estimated from $^{13}$CO and C$^{18}$O and found to be similar to our extinction masses in some regions, but significantly different in others. Finally, based on our color-magnitude diagrams, we selected 12 of our reddest candidate young stellar objects for individual discussion. Five of the 12 appear to be newly-discovered YSOs.Comment: 15 pages, 17 figures, uses emulateapj.cls. Accepted for publication in ApJ. A version with high-quality figures can be found at http://peggysue.as.utexas.edu/SIRTF

Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models

BACKGROUND: In this so-called treat-all era, antiretroviral therapy (ART) interruptions contribute to an increasing proportion of HIV infections and deaths. Many strategies to improve retention on ART cost more than standard of care. In this study, we aimed to estimate the upper-bound costs at which such interventions should be adopted. METHODS: In this combined analysis, we compared the infections averted, disability-adjusted life-years (DALYs) averted, and upper-bound costs of interventions that improve ART retention in three HIV models with diverse structures, assumptions, and baseline settings: EMOD in South Africa, Optima in Malawi, and Synthesis in sub-Saharan African low-income and middle-income countries (LMICs). We modelled estimates over a 40-year time horizon, from a baseline of Jan 1, 2022, when interventions would be implemented, to Jan 1, 2062. We varied increment of ART retention (25%, 50%, 75%, and 100% retention), the extent to which interventions could be targeted towards individuals at risk of interrupting ART, and cost-effectiveness thresholds in each setting. FINDINGS: Despite simulating different settings and epidemic trends, all three models produced consistent estimates of health benefit (ie, DALYs averted) and transmission reduction per increment in retention. The range of estimates was 1·35-3·55 DALYs and 0·12-0·20 infections averted over the 40-year time horizon per additional person-year retained on ART. Upper-bound costs varied by setting and intervention effectiveness. Improving retention by 25% among all people receiving ART, regardless of risk of ART interruption, gave an upper-bound cost per person-year of US$2-6 in Optima (Malawi),$43-68 in Synthesis (LMICs in sub-Saharan Africa), and $28-180 in EMOD (South Africa). A maximally targeted and effective retention intervention had an upper-bound cost per person-year of US$93-223 in Optima (Malawi), $871-1389 in Synthesis (LMICs in sub-Saharan Africa), and$1013-6518 in EMOD (South Africa). INTERPRETATION: Upper-bound costs that could improve ART retention vary across sub-Saharan African settings and are likely to be similar to or higher than was estimated before the start of the treat-all era. Upper-bound costs could be increased by targeting interventions to those most at risk of interrupting ART. FUNDING: Bill & Melinda Gates Foundation