Community Assessment on Colorectal Cancer Screening Knowledge, Attitudes, Behavior, and Health Literacy in American Samoa: Methods and Results

urpose/Background: “Weaving” Indigenous and Western knowledges are understood to advance health equity for the Indigenous community whose own knowledge and values are often subsumed. Partnerships that support Indigenous leadership and bring Indigenous knowledge to greater parity with Western knowledge are imperative. Indigenous people living in Small Island Developing States like the U.S. territories experience health disparities. The WHO has declared non- communicable diseases as a global health epidemic, including cancer disparities. In American Samoa (AS) less than 7% of age-eligible adults participated in colorectal cancer (CRC) screening, while the Healthy People 2020 target is 70% screened. CRC may be prevented through screening and early detection. The relationship between CRC screening with knowledge, attitudes, beliefs (KAB), and health literacy has never been locally assessed in AS. AS based community researchers partnered with regional academic researchers in local research training, instrument development, data collection, and data analysis. Community relevant approaches guided assessment of CRC screening rates, CRC screening KAB, and health literacy. Objective: This abstract describes the community engaged approaches and results through the National Institute of Minority Health Disparities funded INdigenous Samoan Partnership to Initiate Research Excellence (INSPIRE), introduced at the 2015 CTR-IN annual meeting. Materials & Methods: INSPIRE principal Investigators are based in AS, operated through the American Samoa Community Coalition, a community-based organization, partnering with academic co-investigators in Hawaii and California. To assess CRC KAB and health literacy, two validated assessment instruments were adapted: The KAB survey, from self-developed and population-based instruments, and Short Test for Functional Health Literacy in Adults (S-TOFHLA). Community partners translated then back translated both surveys with three focus groups. Twenty cognitive interviews were conducted to test translation cogency. Seven AS INSPIRE research trainees participating in year-long workshops were trained on Respondent Driven Sampling (RDS). Initial participants (seeds) were recruited by social characteristics. Upon survey completion participants received coupons to each recruit three eligible participants. 713 community respondents participated in three months. An INSPIRE researcher (epidemiologist) analyzed data, with technical assistance from an academic biostatistician in Hawaii when needed fostering research capacity training. Bivariate and multivariate statistics analyzed CRC knowledge, attitudes, health literacy as correlates and predictors of self-reported screening. Results: About 65 percent of respondents finished high school; 68.9% had no insurance. Only 2 respondents completed CRC screening, but 63.3% and 82.3% of English vs Samoan survey respondents respectively would get colonoscopy. Among the 11 knowledge questions, 5 items were “don’t know” while 2 items were incorrect responses on English and Samoan surveys respectively. Almost twice as many Samoan compared to English survey respondents (81% vs. 44%) scored “inadequate” in the S-TOFHLA. Correlates and predictors of CRC screening behavior and differences in results between the respondents who took English vs Samoan surveys will be reported. Discussion/Conclusion: Almost all participants have not received CRC screening, lower than other reported AS nationwide figures. This first ever study, led by and for American Samoans obtained robust results on knowledge, attitudes, and health literacy of CRC screening to allow continued research and interventions to increase very low CRC screening rates

CUCHILD: A Large-Scale Cantonese Corpus of Child Speech for Phonology and Articulation Assessment

This paper describes the design and development of CUCHILD, a large-scale Cantonese corpus of child speech. The corpus contains spoken words collected from 1,986 child speakers aged from 3 to 6 years old. The speech materials include 130 words of 1 to 4 syllables in length. The speakers cover both typically developing (TD) children and children with speech disorder. The intended use of the corpus is to support scientific and clinical research, as well as technology development related to child speech assessment. The design of the corpus, including selection of words, participants recruitment, data acquisition process, and data pre-processing are described in detail. The results of acoustical analysis are presented to illustrate the properties of child speech. Potential applications of the corpus in automatic speech recognition, phonological error detection and speaker diarization are also discussed.Comment: Accepted to INTERSPEECH 2020, Shanghai, Chin

Association of mitochondrial variants and haplogroups identified by whole exome sequencing with Alzheimer's disease

Introduction: Findings regarding the association between mitochondrial DNA (mtDNA) variants and Alzheimer's disease (AD) are inconsistent. Methods: We developed a pipeline for accurate assembly and variant calling in mitochondrial genomes embedded within whole exome sequences (WES) from 10,831 participants from the Alzheimer's Disease Sequencing Project (ADSP). Association of AD risk was evaluated with each mtDNA variant and variants located in 1158 nuclear genes related to mitochondrial function using the SCORE test. Gene-based tests were performed using SKAT-O. Results: Analysis of 4220 mtDNA variants revealed study-wide significant association of AD with a rare MT-ND4L variant (rs28709356 C&gt;T; minor allele frequency = 0.002; P = 7.3 × 10 −5) as well as with MT-ND4L in a gene-based test (P = 6.71 × 10 −5). Significant association was also observed with a MT-related nuclear gene, TAMM41, in a gene-based test (P = 2.7 × 10 −5). The expression of TAMM41 was lower in AD cases than controls (P =.00046) or mild cognitive impairment cases (P =.03). Discussion: Significant findings in MT-ND4L and TAMM41 provide evidence for a role of mitochondria in AD.</p

Cisplatin +/− rucaparib after preoperative chemotherapy in patients with triple-negative or BRCA mutated breast cancer

Patients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0-11.5 cm) with 1 (0-38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82-4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population

Immunoregulatory Protein Profiles of Necrotizing Enterocolitis versus Spontaneous Intestinal Perforation in Preterm Infants

Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are the most common acute surgical emergencies associated with high morbidity and mortality in preterm infants. We aimed to compare the profiles of immunoregulatory proteins and identify novel mediators in plasma of NEC and SIP infants. We also investigated the expression of target genes in resected intestinal tissues and an enterocyte cell line. Using Cytokine Antibody Array assay, we reported the first comparative profiles of immunoregulatory proteins in plasma of NEC and SIP infants, and showed that dysregulated proteins belonged to functionally diversified categories, including pro- and anti-inflammation, angiogenesis, cell growth, wound healing, anti-apoptosis, cell adhesion and extracellular matrix reorganization. Validation by ELISA confirmed significantly higher concentrations of interleukin (IL)-6, angiopoietin (Ang)-2, soluble type II interleukin-1 receptor (sIL-1RII), and soluble urokinase-type plasminogen activator receptor (suPAR) in NEC infants compared with gestational age-matched control, and a lower level of an epidermal growth factor receptor, secreted form of receptor tyrosine-protein kinase ErbB3 (sErbB3), compared with SIP infants. mRNA expressions of IL1-RII and uPAR were up-regulated in resected bowel tissues from NEC infants, indicating that immunoregulation also occurred at the cellular level. In FHs-74 Int cells, Ang-2, IL1-RII and uPAR mRNA expressions were significantly induced by the combined treatment with lipopolysaccharide (LPS) and platelet activating factor (PAF). Our study provided plasmatic signatures of immunoregulatory proteins in NEC and SIP infants, and demonstrated involvement of multiple functional pathways. The magnitude of changes in these proteins was significantly more extensive in NEC infants, reflecting the different nature of injury and/or severity of inflammation. We speculate that dysregulation of IL-6, Ang-2, IL-1RII and uPAR occurred at both systemic and cellular levels, and probably mediated via LPS and endogeneous PAF signals. Such exaggerated immunologic responses may account for the high morbidity and mortality in NEC compared with SIP patients

Randomized Controlled Pilot Trial of Mindfulness-Based Stress Reduction Compared to Psychoeducational Support for Persistently Fatigued Breast and Colorectal Cancer Survivors

Purpose Cancer-related fatigue (CRF) is a disruptive symptom for many survivors. Despite promising evidence for efficacy of Mindfulness-Based Stress Reduction (MBSR) in reducing CRF, no trials comparing it to an active comparator for fatigued survivors have been published. The purpose of this trial was to compare MBSR to psychoeducation for CRF and associated symptoms. Methods Breast (n=60) and colorectal (n=11) cancer survivors (stage 0–III) with clinically significant CRF after completing chemotherapy and/or radiation therapy an average of 28 months prior to enrollment were randomized to MBSR or psychoeducation/support groups (PES). MBSR focused on mindfulness training; PES focused on CRF self-management. Outcomes included CRF interference (primary), CRF severity and global improvement, vitality, depression, anxiety, sleep disturbance, and pain. Outcomes were assessed at baseline (T1), post-intervention (T2), and 6-month follow-up (T3) using intent-to-treat analysis. Results Between-group differences in CRF interference were not significant at any time point; however, there was a trend favoring MBSR (d=−0.46, p=0.073) at T2. MBSR participants reported significantly greater improvement in vitality (d=0.53, p=0.003) and were more likely to report CRF as moderately-to-completely improved compared to the PES group (χ2 (1)=4.1765, p=0.041) at T2. MBSR participants also reported significantly greater reductions in pain at T2 (d=0.53, p=0.014). In addition, both MBSR and PES produced moderate-to-large and significant within-group improvements in all fatigue outcomes, depression, anxiety, and sleep at T2 and T3 compared to T1. Conclusion MBSR and PES appear efficacious for CRF and related symptoms. Larger trials including a usual care arm are warranted

Information Communication Technology as Instrumental Activities of Daily Living for Aging-in-Place in Chinese Older Adults With and Without Cognitive Impairment: The Validation Study of Advanced Instrumental Activities of Daily Living Scale

Background: The capability in applying information communication technology (ICT) is crucial to the functional independence of older peoples of community living nowadays. The proper assessment of individuals' capability of ICT application is the corner stone for the future development of telemedicine in our aging population. Methods: With the recruitment of 300 participants of different functional and social background in home-living, hostel-living, and care-and-attention home living; and through assessing the ability of individuals in instrumental activities of daily living and cognitive assessments, this study aimed at capturing the content validity and construct validity of the Advanced Instrumental Activities of Daily Living (AIADL scale). In addition, this study assess the ability of older peoples in applying ICT and how the functional and social background affects their independence in aging-in-place. Results: The AIADL scale showed good test-retest reliability and good-to-excellent internal consistency. To determine if items of the AIADL scale measure various aspects of community living, exploratory factor analysis revealed a two-factor structure with “home living and management” and “community living”. Validity analysis with the known-groups method showed a high overall accuracy of prediction of individuals' capability of independent living in the community. Conclusions: The AIADL scale is a valid and reliable instrument to assess the ability of older adults in handling ICT as part of their instrumental activities in daily living. The scale can reflect capability of older peoples in applying ICT. This instrument can serve as a reference in measuring readiness of individuals in receiving telemedicine and their ability of aging-in-place

Multi-drug resistant Acinetobacter infections in critically injured Canadian forces soldiers

<p>Abstract</p> <p>Background</p> <p>Military members, injured in Afghanistan or Iraq, have returned home with multi-drug resistant <it>Acinetobacter baumannii </it>infections. The source of these infections is unknown.</p> <p>Methods</p> <p>Retrospective study of all Canadian soldiers who were injured in Afghanistan and who required mechanical ventilation from January 1 2006 to September 1 2006. Patients who developed <it>A. baumannii </it>ventilator associated pneumonia (VAP) were identified. All <it>A. baumannii </it>isolates were retrieved for study patients and compared with <it>A. baumannii </it>isolates from environmental sources from the Kandahar military hospital using pulsed-field gel electrophoresis (PFGE).</p> <p>Results</p> <p>During the study period, six Canadian Forces (CF) soldiers were injured in Afghanistan, required mechanical ventilation and were repatriated to Canadian hospitals. Four of these patients developed <it>A. baumannii </it>VAP. <it>A. baumannii </it>was also isolated from one environmental source in Kandahar – a ventilator air intake filter. Patient isolates were genetically indistinguishable from each other and from the isolates cultured from the ventilator filter. These isolates were resistant to numerous classes of antimicrobials including the carbapenems.</p> <p>Conclusion</p> <p>These results suggest that the source of <it>A. baumannii </it>infection for these four patients was an environmental source in the military field hospital in Kandahar. A causal linkage, however, was not established with the ventilator. This study suggests that infection control efforts and further research should be focused on the military field hospital environment to prevent further multi-drug resistant <it>A. baumannii </it>infections in injured soldiers.</p

Adoption and Handling Information Communication Technology as Instrumental Activities of Daily Living for Aging-in-Place in Chinese Older Adults

(Background) The use of information communication technology and smartphone application are crucial to individuals’ functional independence of community living. Previous studies did not reveal how older adults’ in applying the information communication technology will affect their aging-in-place in our contemporary community. (Methods) This study aimed at developing the psychometric properties of the instrument named Advanced Instrumental Activities of Daily Living (AIADL), and to explore the adoption and handling information communication technology in instrumental activities of daily living for aging-in-place of older adults. 100 home-living participants who are functionally and socially independent, 100 hostel-living participants who are functionally independent but need social assistance, and 100 care-and-attention home living participants who need environment support and assistance in daily functioning were recruited for this study. (Results) AIADL showed good test-retest reliability and good-to-excellent internal consistency. Exploratory factor analysis revealed a two-factor structure with “home living and management” and “community living”. Validity analysis with the known-groups method showed a high overall accuracy of prediction of individuals’ capability of independent living in the community. (Conclusions) AIADL is a valid and reliable instrument to assess older adults’ ability in handling contemporary instrumental activities in their daily life. This instrument can serve as a reference in measuring individuals’ ability of aging-in-place

Developing a research strategy to better understand, observe, and simulate urban atmospheric processes at kilometer to subkilometer scales

A Met Office/Natural Environment Research Council Joint Weather and Climate Research Programme workshop brought together 50 key international scientists from the UK and international community to formulate the key requirements for an Urban Meteorological Research strategy. The workshop was jointly organised by University of Reading and the Met Office