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Background The experience of cancer can create considerable emotional distress for patients and their committed partners. How couples communicate about cancer-related concerns can have important implications for adjustment. However, past research has primarily utilized cross-sectional designs and retrospective self-reports of couple communication. While informative, little is known about how patients and partners express emotion during conversations about cancer, and how these emotional patterns predict individual and relational adjustment. Purpose The current investigation examined how patterns of emotional arousal within couples’ communication about cancer was associated with concurrent and prospective individual psychological and relational adjustment. Methods At baseline, 133 patients with stage II– breast, lung, or colorectal cancer and their partners completed a conversation about a cancer-related concern. Vocally expressed emotional arousal (f0) was extracted from recorded conversations. Couples completed self-report measures of individual psychological and relational adjustment at baseline and at 4, 8, and 12 months later. Results Couples who started the conversation higher in f0 (i.e., greater emotional arousal) reported better individual and relational adjustment at baseline. If the non-cancer partner had lower f0 relative to patients, this predicted worse individual adjustment across follow-up. Additionally, couples who maintained their level of f0 rather than decreasing later in the conversation reported improvements in individual adjustment across follow-up. Conclusions Elevated emotional arousal within a cancer-related conversation may be adaptive for adjustment, as it may reflect greater emotional engagement and processing of an important topic. These results may suggest ways for therapists to guide emotional engagement to enhance resilience in couples experiencing cancer.

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

In a Fe/(Cd,Mg)Te/CdTe quantum well hybrid structure, short-range and long-range ferromagnetic proximity effects are found to coexist. The former is observed for conduction band electrons, while the latter is observed for holes bound to shallow acceptors in the CdTe quantum well. These effects arise from the interaction of charge carriers confined in the quantum well with different ferromagnets, where electrons interact with the Fe film and holes with an interfacial ferromagnet at the Fe/(Cd,Mg)Te interface. The two proximity effects originate from fundamentally different physical mechanisms. The short-range proximity effect for electrons is determined by the overlap of their wave functions with d-electrons of the Fe film. On the contrary, the long-range effect for holes bound to acceptors is not associated with overlapping wave functions and can be mediated by elliptically polarized phonons. The coexistence of the two ferromagnetic proximity effects reveals the presence of a nontrivial spin texture within the same heterostructure.

Patients undergoing hematopoietic cell transplantation (HCT) are at risk for psychological and social impairment given the rigors and multiple sequelae of treatment. The purpose of this pilot study was to test the feasibility of a digital storytelling (DS) intervention for HCT patients, and to examine limited efficacy of the intervention relative to control arm on psychological distress and perceived social support. Adult HCT patients (n = 40, M age = 59.2 years) were enrolled immediately post-HCT and randomly assigned to either DS intervention or information control (IC). DS participants viewed four 3-min personal, emotionally rich digital stories, and IC condition participants viewed four videos containing information about post-HCT care. Feasibility regarding recruitment, enrollment efforts, and change scores from pre- to post-intervention (Δs) on depression, anxiety, and perceived social support were tracked. Fifty-four (51.4%) of 105 eligible patients consented. Forty (74%) patients completed the intervention. All but one completed the post-intervention assessments demonstrating that HCT patients can be recruited and retained for this intervention. On average, perceived social support increased for the DS group (Δ = 0.06) but decreased for the IC group (Δ = - 0.05). Anxiety and depression improved over time in both conditions. Viewing digital stories with content evoking emotional contexts similar to one's own health challenges may improve perceptions of social support among HCT patients. How DS can improve perceived social support for both short-term and longer-term sustained effects in a longitudinal study is an area ripe for additional investigation.

The dynamics of the photoluminescence negative circular polarization of an ensemble of InP/(In,Ga)P quantum dots is studied. It was found that, the time-resolved polarization has no oscillations in the magnetic field in the Voigt geometry. At the same time, with increasing field, the polarization decreases to zero. This effect is explained by the specificities of the spin dynamics of a negatively charged exciton; in particular, by the fact that, in the ground state, its spin dynamics is determined by a heavy hole. It is shown that, in order that the photoluminescence be depolarized by a magnetic field, it is necessary to overcome the field of dynamically polarized nuclear spins acting on the electron spins.

This essay traces the author’s initial intellectual and imaginative encounters with Holocaust atrocity, beginning with his visit to Dachau in 1955 long before Nazi camps had become a tourist destination. He describes in detail his response to the landscape of death, the impact of its crematorium and small gas chamber, and his attempts to establish a connection with the history of a site which provided almost no signage and about which he knew virtually nothing. He continues with accounts of his visits to Mauthausen (1963) and Auschwitz (1964), still responding more to the visual impact of the sites rather than to a familiarity with how they operated. The essay continues with the author’s reflections upon attending the war crimes trials of SS General Karl Wolff (Himmler’s adjutant and liaison to Hitler) in Munich and of 20 Auschwitz personnel in Frankfurt in the summer of 1964. This leads to a consideration of the value and the limits of “justice” as a response to the monstrous crimes of the Third Reich, as he watched defense attorneys belittle the testimony of Holocaust survivors while the defendants smiled in the dock and denied everything. This leads to a consideration of how survivors have tried to describe their ordeal outside the legal confine of a courtroom, and to the further realization that conventional moral concepts are insufficient to support their efforts. When one survivor exclaims, “What horror! This death without dying, this prolonged living death,” she introduces an idea that threads through most of the chapters in this volume. The essay concludes with a brief analysis of how Holocaust literature can help to shape a new vocabulary for our understanding of the event.

The surgical management of children with rectal prolapse is wide ranging and without consensus within the pediatric surgical community. While the majority of rectal prolapse in infants and children resolves spontaneously or with the medical management of constipation, a small but significant subset of patients may require intervention for persistent symptoms. In this review, we discuss the etiology and pathophysiology of rectal prolapse in both infants and children, options for medical management, described interventions and surgical options and their outcomes, and future avenues for research and investigation.

Objective To develop an educational intervention to empower patients to manage their financial health better. Participants and Methods This study was conducted from September 1, 2017, to January 31, 2019. Focus groups were held with social workers, case managers, and patient financial service staff and interviews were conducted with patients and caregivers to inform the content, delivery format, and timing of an intervention for mitigating financial hardship from treatment (phase 1). Based on qualitative data, theories of adult learning, and a review of the literature, we created an educational presentation to be delivered in a classroom setting. Two patient focus groups were then held for feedback on the presentation (phase 2). Results In phase 1, both patients and allied health care staff providers believed that an educational intervention about financial aspects of care early during treatment would help them cope and plan better. Participants’ suggestions for the intervention’s content included billing information, insurance, authorization processes, employment policies related to health care and disability benefits, and alternative financial resources. Based on these suggestions, a preliminary educational presentation was developed with 3 main themes: insurance issues, employment issues, and financial health. Phase 2 focus group participants suggested refinement of the presentation, including targeting specific groups, adding graphics, and more information about resources. Conclusion Our study provides the basis for a patient-centered education module for emotional, instrumental, and informational support for financial distress for use in a clinical setting.

Purpose: The purpose of this study was to qualitatively analyze metacommunication during the digital storytelling (DST) workshop process for patients undergoing hematopoietic cell transplantation (HCT). Methods: HCT survivors who had undergone transplant within the past 2 years were recruited at a cancer center in the Phoenix Metropolitan area. Participants (M age = 51.5 years) attended a 3-day DST workshop telling and creating digital stories around their HCT experiences. Using a constructivist grounded theory approach, line by line coding and content analysis were conducted with four research team members. Results: Four themes emerged from the data: (1) communal connection; (2) expressing and processing emotions; (3) self-empowerment; and (4) multi-dimensional coping. Participants described telling and sharing their story with other HCT patients as therapeutic. Conclusion: DST shows promise as a potential coping tool and offers multiple dimensions of the role of narrative as a coping technique, in community building, and in patient-centered contexts within HCT.

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples’ ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being.

An emerging area of research extends work on couple functioning and physical health to gut health, a critical marker of general health and known to diminish with age. As a foray into this area, we conducted a pilot study to (1) determine the feasibility of remote data collection, including a fecal sample, from older adult couples, (2) examine within-couple concordance in gut microbiota composition, and (3) examine associations between relationship functioning and gut microbiota composition. Couples (N = 30) were recruited from the community. The participants’ demographic characteristics were as follows: M (SD) age = 66.6 (4.8), 53% female, 92% White, and 2% Hispanic. Two of the couples were same-sex. All 60 participants completed self-report measures and supplied a fecal sample for microbiome analysis. Microbial DNA was extracted from the samples, and the 16S rRNA gene V4 region was amplified and sequenced. The results indicated that individuals shared more similar gut microbial composition with their partners than with others in the sample, p < 0.0001. In addition, individuals with better relationship quality (greater relationship satisfaction and intimacy and less avoidant communication) had greater microbial diversity, p < 0.05, a sign of healthier gut microbiota. Further research with a larger and more diverse sample is warranted to elucidate mechanisms.

Cancer poses a threat to well-being that may activate the attachment system and influence interpersonal dynamics, such as communication. Research indicates that avoidant and anxious attachment, as well as communication, are independently associated with poorer psychosocial well-being, yet studies examining links between attachment, communication, and long-term physical well-being are lacking. We examined (a) associations between patient and partner attachment (measured with the adult attachment scale [AAS-Revised]) and observed communication (across affect [the Relational Affective Topography System (RATS) coding system] and behavior [the Asymmetric Behavior Coding System (ABCS) coding system]) and (b) the extent to which attachment and communication independently predicted long-term physical well-being (measured by the Functional Assessment of Cancer Therapy-General Population [FACT-GP]). Participants were 134 couples [mean age 53.9 (SD = 13.4), 86.2% Caucasian, 66% of patients, 36% of partners female]. Patient participants had either breast, colorectal, or lung cancer. Couples individually completed self-report measures of attachment (baseline) and physical well-being (baseline and 4, 8, and 12 months later). At baseline, couples engaged in a 15 min videorecorded cancer-related conversation coded for communication behavior and affective expression. Patients and partners with higher anxious and avoidant attachment exhibited more negative affect and negative approach behaviors. A greater avoidant attachment was associated with less positive affective expression. Attachment insecurity and affective expression were prospectively linked with physical well-being. Findings indicate that attachment is associated with overt communication behaviors and that insecure attachment and affective expression may be risk factors for poorer health outcomes.

The medical and psychological sequelae of hematopoietic cell transplantation (HCT) are well established, but less is known about the impact on intimate relationships. We sought to describe the prevalence of relationship distress among married HCT survivors and to identify factors associated with relationship distress. The study was cross-sectional. HCT survivors treated at a National Cancer Institute-designated cancer center completed a survey that included measures of psychological and relationship distress (Revised Dyadic Adjustment Scale [RDAS]), demographic, and medical factors. A total of 1047 respondents reported being married and completed the RDAS. Sample characteristics were a mean age of 58 years (range, 22 to 83 years), a mean interval post-HCT of 12.3 years (range,1 to 43 years), 42% female, and 89% non-Hispanic white. RDAS total adjustment scores were comparable to published community sample values. Nineteen percent of the respondents were classified as relationship-distressed. Three factors were associated with greater odds of relationship distress: cancer and treatment distress (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.09 to 2.31); depression (OR, 1.44; 95% CI, 1.17 to 1.76), and time post-transplantation (OR, 1.03; 95% CI, 1.01 to 1.04). These findings were qualified by sex-stratified analyses. Depression was associated with relationship distress among females; the other 2 variables were associated with relationship distress among males. Our results paint an overall picture of positive long-term marital functioning among HCT survivors, with a subset reporting relationship distress. Screening is warranted to identify survivors at risk for relationship distress and to inform targeted intervention.

The vast majority of consumer products fail to attract sufficient consumer demand. Word of mouth marketing and online feedback from other consumers have become focal marketing strategies for many products as social media has increased the size of networks and amplified the impact of messages from other consumers. The current literature on the influence that consumer feedback can have on consumers' willingness to pay (WTP) for food products is mixed and often draws upon studies with small samples and hypothetical situations. This study investigates how this feedback can impact other consumers' food preferences using an economic field experiment involving 1,068 adult consumers who make choices on oysters, mushrooms, and chocolate. Results suggest that knowledge of peer preferences, such as the willingness to pay for similar products and/or how often they consume these products, caused a decrease (5%-9%) in consumers' willingness to pay.

STUDY QUESTION When couples have to face recurrent pregnancy loss (RPL), what are the partners’ wishes and needs and what is their perception of helpful and unhelpful factors with regard to their own, their partners’ and their families’ and friends’ ways of dealing with the problem? SUMMARY ANSWER Women and men with repeated miscarriages want open communication about their losses, but expect a sensitive and empathetic attitude from others, not pity or trivialization. WHAT IS KNOWN ALREADY RPL not only causes the women affected and their partners considerable emotional distress; it also has an impact on the couples’ relationships and the way they relate to their families and friends. Studies suggest that women have a greater need than their male partners to talk about their losses and that these differences may lead to dissatisfaction and cause relational tension. In addition, men often assume a ‘mainstay’ role, supporting their partners and displaying fortitude in the face of distress. As yet, however, little research has been conducted so far on the question of what the members of couples with RPL expect from one another and from their families and friends. STUDY DESIGN, SIZE, DURATION The study sample consisted of 147 couples and 17 women with at least 2 miscarriages attending the special unit for RPL at the University Women’s Hospital in Heidelberg (Germany) for the first time between September 2018 and October 2020 (response rate: 82.7%). The patients were asked to participate in this combined qualitative and questionnaire study. PARTICIPANTS/MATERIALS, SETTING, METHODS In order to explore the wishes and needs of those affected in more detail, the free text responses obtained were examined in this study by using qualitative content analysis. Categories and subcategories were created inductively to summarize and systematize content. MAIN RESULTS AND THE ROLE OF CHANCE Patients affected by RPL want their partners and their families and friends to deal with the topic openly and empathically. In the partnership itself, acceptance of individual grieving modes and sharing a common goal are important factors. Men, in particular, want their partners to be optimistic in facing up to the situation. Regarding communication with family and friends, it transpired that ‘good advice’, playing the matter down, inquiries about family planning, pity and special treatment are explicitly not appreciated. LIMITATIONS, REASONS FOR CAUTION The sample was a convenience sample, so self-selection effects cannot be excluded. In addition, the level of education in the sample was above average. Accordingly, the sample cannot be regarded as representative. The results of the content analysis are based on the respondents’ written answers to open-ended questions in the questionnaire. Unlike qualitative interview studies, further questioning was not possible in the case of ambiguities or to request more details. WIDER IMPLICATIONS OF THE FINDINGS Frank and sincere communication about miscarriages and about one’s own emotions and needs should be promoted both in the partnership and among family members and friends in order to strengthen the potential of social support as a resource. Open communication about the different needs of both partners is necessary to create mutual understanding. The results show the importance not only of empathy and consideration for the couples concerned but also their desire not to be pitied. Striking a fine balance between fellow-feeling and pity may also lead to tension, and this potential dilemma should be addressed in psychosocial counselling. Overall, the study contributes to a better understanding of what couples want from their families and friends when they are attempting to come to terms with RPL and highlights potential challenges in the interaction between affected couples and their families and friends. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. None of the authors declared any conflicts of interest. TRIAL REGISTRATION NUMBER DRKS00014965.

Acquired von Willebrand syndrome can occur in the setting of myeloproliferative neoplasms; plasma cell dyscrasias and other lymphoproliferative disorders; autoimmune conditions; and causes of increased shear forces, such as aortic stenosis or other structural heart disease and mechanical circulatory support. The depletion of von Willebrand factor, especially high-molecular-weight multimers, can lead to mucocutaneous bleeding and the formation of arteriovenous malformations, particularly in the gastrointestinal tract. Management focuses on correction of the underlying cause when possible, but may include intravenous immunoglobulins, von Willebrand factor concentrate, rituximab, or antiangiogenic therapy depending on the clinical context.

OBJECTIVES To evaluate the impact of F-fluorodeoxyglucose PET/CT examinations on the management of patients with plasma cell disorders. METHODS This is a retrospective review of patients in a provincial database with PET/CT performed for plasma cell disorders between 2011 and 2018. The impact of PET/CT on actual patient management and outcome was assessed by two independent readers who compared planned pre-PET/CT management, documented at time of PET/CT requisition, to actual management received through linkages to administrative databases. PET/CT was considered of high impact if it altered the provision of active treatment, changed the modality of treatment or chemotherapy regimen. Change in management and the proportion of patients with high impact PET/CT were assessed. RESULTS There were 44 patients with plasma cell disorders, including multiple myeloma, solitary plasmacytoma, Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, Skin changes syndrome, or monoclonal gammopathy of undetermined significance or biclonal gammopathy of undetermined significance. Management was altered after 38/56 (67.9%) PET/CT scans. Considering just the initial PET/CT scan in patients who underwent multiple scans, 31/44 (70.5%) patients had their management altered subsequent to PET/CT. CONCLUSION PET/CT resulted in a change in planned management in more than two-thirds of patients with plasma cell disorders in the current selected patient cohort. These results should be validated in a larger prospective trial.

Literature describes that a well-maintained moist wound healing environment leads to faster healing by preventing scabbing and drying of the wound. A moist wound speeds healing by allowing for unimpeded movement of newly dividing epidermal cells in the wound. Contrary to what is described in literature and practiced by clinicians, first-aid dressings used at home by consumers advertise breathability and absorptivity as benefits. This manuscript examines the effects of dressing breathability and highly absorptive pads on healing and wound appearance in a porcine dermatome wound model, designed to mimic an abrasion injury. Partial thickness wounds were covered with an experimental silicone-polymer film dressing and various over-the-counter bandages for time frames ranging from 4 to 11 days. The progression of healing was quantified by histology and wound-size reduction measurements. The thickness and persistence of a scab or serocellular crust (SCC) over the injury was measured using both pixel density and optical coherence tomography to supplement visual observations, demonstrating new tools for quantification of SCC over wounds. The results of the experiments illustrate the impact of dressing features on the rate of wound reepithelialization and the formation of SCC. Both a low moisture vapor transmission rate (MVTR) and the absence of an absorptive layer were important in speeding wound healing. Surprisingly, use of a dressing with a low MVTR and a highly absorptive pad healed significantly more slowly than a comparative dressing with a low MVTR and no absorptive pad, even though both dressings had very little scab formation over the wound. This study shows that breathability and absorbency of dressings play independent roles in providing an optimal healing environment, and that these properties can vary widely among commercially available dressings.

Pectopexy, a laparoscopic method for prolapse surgery, showed promising results in previous transient testing by this group. It was shown that a single suture, yielding an ultimate load of 35 N, was equivalent to continuous suturing. This was demonstrated in an in vitro cadaver study. This transient data were used to establish an elastic stress–strain envelope. It was now possible to proceed to dynamic in vitro analysis of this surgical method to establish time to functional stability. Cyclic testing of this fixation method was performed on human female embalmed cadaver (cohort 1) and fresh, non-embalmed cadaver (cohort 2) pelvises. The testing envelope was 5–25 N at a speed of 1 mm/s. 100 load regulated cycles were applied. 100 cycles were completed with each model; no overall system failure occurred. Steady state, i.e., functional stability was reached after 14.5 (± 2.9) cycles for the embalmed group and after 19.1 (± 7.2) cycles for the non-embalmed group. This difference was statistically significant p = 0.00025. This trial showed in an in vitro cyclic testing of the pectopexy method that functional stability may be achieved after no more than 19.1 cycles of load exposure. When remaining within the established load envelope of below 25 N, patients do not need to fear global fixation failure. Testing did demonstrate differences in non-embalmed and embalmed cadaver testing. Embalmed cadaver testing tends to underestimate time to steady state by 26.3%.

Inhaled mometasone was shown to improve pain scores and decrease soluble vascular cell adhesion molecule (sVCAM) concentration in a randomized controlled trial of nonasthmatic patients with sickle cell disease. We sought to explore potential changes in systemic inflammation as a mechanism underlying this effect. Serum samples from 41 trial participants (15 placebo- and 26 mometasone-treated) were analyzed using a 92 inflammatory marker panel at baseline and after 8 weeks of mometasone therapy. Individual marker analysis and correlation analysis were conducted. Adjusted for age, the mometasone-treated group decreased the concentration of CXCL9, CXCL11, CD40, IL-10, and IL-18 relative to placebo-treated participants. Hierarchical clustering and correlation analysis identified additional evidence for a decrease in cytokines linking to macrophage signaling and migration. There was no statistically significant change in markers of asthma and allergy, indicating that the improvement was unlikely mediated by modulation of occult reactive airway disease. This analysis of inflammatory markers suggests that decrease in macrophage activity may be involved in the mediation of the clinical benefit seen with use of inhaled mometasone in nonasthmatic patients with sickle cell disease. Trial registration: clinicaltrials.gov identifier: NCT02061202.

Purpose To determine the relationship of PET/CT staging to the management and outcomes of participants with apparent limited-stage (LS) Hodgkin lymphoma (HL) or aggressive non-HL (ANHL) treated with curative intent. Materials and Methods This prospective multicenter registry included 850 participants (467 men and 383 women; median age, 54.1 years) from nine centers who had LS HL or ANHL on the basis of clinical data and CT, or with equivocal CT for advanced stage, who were considered for curative-intent first-line therapy. Participants were recruited between May 1, 2013, and December 31, 2015. Pre-PET/CT treatment plan was compared with treatment provided. Survival and second-line therapy initiation were compared with an historical control pool staged by using CT alone. Administrative data sources were used to control for baseline characteristics. Outcomes were assessed by using adjusted Cox proportional hazards regression and propensity score matching. Results PET/CT helped to upstage 150 of 850 participants (17.6%). There was a change in planned therapy in 224 of 580 (38.6%) of participants after PET/CT. There was a lower 1-year mortality for participants with ANHL in the PET/CT versus CT cohort (hazard ratio, 0.63; 95% confidence interval: 0.40, 1.0; P < .05) and for those with LS at PET/CT compared with those with LS at CT (hazard ratio, 0.40; 95% confidence interval: 0.21, 0.74; P = .004). For participants with HL, no 1-year outcome difference was found (P = .16). Conclusion PET/CT helped to upstage approximately 18% of participants and planned management was frequently altered. Participants with aggressive non-Hodgkin lymphoma whose first-line therapy was guided by PET/CT had significantly better survival compared with participants whose treatment was guided by CT. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Scott in this issue.

Study question What are the psychological impacts of recurrent pregnancy loss (RPL) on men and women and their interdependencies? Summary answer Women show higher psychological risks than men, except for lack of social support. Avoidance behaviour of men correlates with higher posttraumatic stress of their partner. What is known already About 1-3% of all couples trying to conceive are affected by RPL. The loss of the unborn child can be the most traumatic experience in a woman’s life and is associated with significant psychological distress besides the instant grief. RPL can also be stressful for the partner, even though being at a lower risk for psychiatric morbidities. The man’s gender role expects him to support and not to show weakness which may result in a suppression of his feelings and a disenfranchised grief. Study design, size, duration Cross-sectional study. All women and men referred to the special unit for RPL between March 2019 and October 2020 were asked to participate voluntarily with a total sample size of 105 couples and 17 women. Exclusion criteria were less than two pregnancy losses, inadequate knowledge of the German language and incomplete data. Participants/materials, setting, methods Couples were invited to fill out a questionnaire package estimating their psychological risks (e.g. posttraumatic stress disorder, anxiety, depression, perceived social support) and coping strategies with established instruments. Clinical history was obtained from medical records. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as the unit of analysis. Main results and the role of chance The response rate was 82.3%. The following psychological risks were measured among women versus men: posttraumatic stress disorder (PTSD): 13.7% versus 3.9% (p = 0.017); anxiety: 50.4% versus 17.3% (p Limitations, reasons for caution The data show only correlations between the measured variables, as cross-sectional studies are not suitable to analyse causal relationships. The sample was obtained in a special unit for RPL at a university hospital, so the findings may not be generalizable to all couples with RPL. Wider implications of the findings Screening psychological risks in couples with RPL may be reasonable considering the high risks in both sexes and the extent of PTSD diagnoses in women, their interdependencies and the potential risk of chronification. Professionals should encourage affected couples to support each other and provide targeted information on mental health services. Trial registration number DRKS 00014965

This essay examines two directions that Holocaust discourse may follow. What I call the Hopescape of the Holocaust leads into the terrain of what Viktor Frankl called “man’s search for meaning.” It assumes that there are lessons to be learned from the catastrophe that enhance mental and spiritual recovery, enabling survivors to resume normal equilibrium despite the painful memories that assault their sense of loss. On the other hand, the Deathscape of the Holocaust—the one with which I am primarily concerned—draws us toward the dismal conclusion that some events have no meaning, no justifying explanation that can be reconciled with any moral scheme of the universe we inhabit. Some events simply happen, driven by a human—or inhuman—agency that we will never fully understand. I offer examples of what it is like to dwell in an intermediate realm between life and death, like the survivor of the Vilna ghetto and the Kaiserwald and Stutthof camps. who explains, “I put up appearance, and probably no one would believe me, that I’m only pretending to be alive.” Living the death of others cancels any possible meaning for this survivor, and the essay close with an extended discussion of a little-known memoir by Boris Pahor first published in 1967 under the title Nekropolis and only translated into English as Pilgrim among the Shadows in 1995. Years after the war Pahor’s narrator revisits the camps where he had been imprisoned in an effort to retrieve the existence of his dead, not in order to find meaning in their fate but to help his readers understand what it means to have lived the death of others. Pahor’s strategy is to enable his narrator’s vivid memory of “then” to invade our sense of “now” until the two merge and grow virtually indistinguishable. He becomes, in fact, a guide to the Deathscape of the Holocaust.

H. G. Adler bears the singular honor of having been simultaneously a prominent Holocaust historian, novelist, and poet. His diligence and discipline as a writer were nothing short of phenomenal. Although he returned from his ordeal in Theresienstadt, Auschwitz and several labor camps physically and mentally exhausted and in despair at the loss of his wife and her mother to the Auschwitz gas chambers, he completed his massive study of the Theresienstadt labor and transit camp in 1948. In addition, his major works of fiction, Panorama and The Journey, were written in 1948 and 1950. Adler faced the same challenge that originally confronted many authors who were also survivors of the camp experience: how to find a language that might convey to their readers the unconveyable, a way of describing events to help them imagine what continues to be called unimaginable. The harsh resonance of poems he wrote while still in Theresienstadt manages to approach this goal. His son says of these poems that “they show the bodily torment of human beings condemned to extermination. Besides physical details the poems evoke an all-pervasive sense of fear and a tangible, suffocating feeling of anguish.” In one of them he introduces the idea of a “gestrige Zukunft,” a “yesterday future,” the notion that after the Holocaust conventional chronology cease to function. An “afterdeath” of the Holocaust stains memory and coexists with any future one chooses to pursue. Adler concentrates in a single turn of phrase the violation of se.quential time that remembrance of atrocity has added to the thesaurus of the literary imagination. In his Theresienstadt volume, in his poetry and in his fiction Adler developed styles that would compel his readers to “see differently” the subjects of his writing, creating unconventional pathways to our appreciation of the unfamiliar landscape of catastrophe we call the Holocaust.

As a child survivor of the Vilna ghetto who saw his father and four grandparents murdered by the Germans, Samuel Bak carried into the post-war years a burden of memory that centered on the destruction of members of his immediate family and of the Jewish culture and traditions that had once flourished in his native city. The patched civilization that emerged after the war and efforts to re-form it visually in his art infiltrated many of his earliest works and eventually came to dominate it as the central themes of his later career. In the paintings of Ner-Ot (Hebrew for “The Candle is a Symbol”), Bak uses the image of the candle in various guises and disguises to move his viewers from the habit of looking to the experience of seeing, from sight to insight. His imagery addresses his audience with questions they are forced to confront as they are drawn into a landscape of devastation that is the scenario of so many of these paintings. The Jahrzeit or memorial candle is traditionally lighted to commemorate the death of a loved one. But as we gaze at the variations on memorial candles and recall the sacred role they once played in the act of remembering, we are challenged to ask how memory is to honor the loss of loved ones when we don’t know when they died, or how, or where. When memory is profaned by the manner of death, is a familiar ritual sufficient to restore a connection? Bak’s candles shift their shape, their cylindrical form becoming trees uprooted, or crematorium chimneys whose swirling smoke replaces the lighted (and often extinguished) wicks of the original candles. Occasionally, they resemble missiles destined for some destructive mission. The Holocaust has desecrated both life and death, and Bak’s candle series invites the imagination to journey through a wholly alien territory of remembering.

The growing indifference to the details of the Holocaust encourages not only a spread in the habit of forgetting but also an increase in the ease with which misinformation is accepted without objection. A Letter to the Editor of a respected daily publication in 2014 begins: “My father was liberated when the American soldiers entered Auschwitz.” The opening paragraph of a 2011 study of The Science of Evil begins: When I was seven years old, my father told me that the Nazis had turned Jews into lampshades.” It continues: “He also told me the Nazis turned Jews into bars of soap. It sounds so unbelievable, yet it is actually true.” Actually, neither claim is true, any more than is the assertion that American soldiers freed Auschwitz, which was in fact liberated by Soviet troops. This essay examines some of the consequences of such anecdotes spreading among audiences too uniformed to challenge them. The dilemma reflects not the failure but the absence of historical memory. As a result, the distinction between not remembering and never having known blurs and slowly disappears. One of the best ways to counter the accidental or intentional tendency toward misrepresentation is to focus Holocaust education on the texts and the voices of those who endured the atrocities themselves, who have found an explicit language to describe an abnormal world unrelated to the one we are familiar with. The rest of the essay explores examples of such persuasive representation. Consider the following, from Giuliana Tedeschi’s memoir of Auschwitz: “There is a place on earth, a desolate heath, where the shadow of the dead are multitudes, where the living are dead, where there is only death, hate and pain.” As we slowly became acquainted with, and then accustomed to this new reality of representation, we grow more qualified to discredit anecdotes that continue to mislead unwary audiences.

Throughout his life Primo Levi insisted that If This is a Man (Survival in Auschwitz) was simply a memoir and not a work of literature. But there is considerable evidence in his narrative that invites us to challenge that claim. This essay examines such evidence. Levi the writer introduced certain motifs that suggest he was very much concerned with the structure of his work. For example, he introduces a journey motif, elaborates its significance in the chapter called “The Canto of Ulysses,” and reminds the reader at crucial moments that transports continue to arrive at Auschwitz to discharge their victims. And after the Germans leave, the reader realizes that a new journey is about to begin, though its destination and consequences are uncertain. This theme is developed in the work’s final chapter, “The Last Ten Days,” which Levi admitted was one of the first that he had written. A simple memoir does not begin at the end, at least in the writer’s imagination. As the Germans abandon the camp, Levi and his fellow inmates in quarantine are left behind, and he begins to date his entries. We are reminded that we have left the timeless landscape of atrocity and entered the world of time, as the narrative assumes the form of a diary, a clear transition to the world of literature. Of the ten sick inmates in Levi’s barrack five have died and five remain alive when Soviet troops arrive, leaving the reader in a limbo of ambiguity as life and death continue their rivalry beyond the pages of this so-called memoir. As autobiography If This is a Man offers an account of Levi’s experience in the anguished atmosphere of Auschwitz, but its literary design avoids celebrating his survival and instead carefully leads the reader toward a search for mental clarity amidst the physical chaos of the camp.

The essay focuses on Delbo’s three-volume autobiography, Auschwitz and After, which recounts Delbo’s ordeal in Auschwitz and her efforts to re-enter French society after her liberation. She was part of a convoy of 230 Frenchwomen, most of them arrested for political or resistance activity, who were deported to Auschwitz in January of 1943. With the exception of one or two who may have been Jewish or part-Jewish (though the Germans had no way of knowing this) they were not subject to selection upon arrival, nor were they ever constant candidates for the gas chamber, though a small number who proved too old or too ill to work suffered that fate. Delbo’s memoir offers a classic refutation of the myth of “gendered heroism” in Auschwitz, which argues that women, because of their greater social skills, were better able to survive than men in the camps. Although the Frenchwomen shared the same barracks, spoke the same language, for the first few months toiled in the same work details and devoted their energy to a system of determined mutual support, Delbo reports that after 73 days only 70 were still alive. The spirit of survival proved powerless against the real enemies in Auschwitz: the physical assaults on the body of dysentery, exhaustion, malnutrition and disease. Delbo’s narrative is not just one more version of the deathcamp ordeal. She was a literary artist who forged a unique style for conveying almost viscerally the bodily anguish suffered by the Auschwitz inmate, especially as experienced by women. After the war she wrote a volume called Convoy to Auschwitz: Women in the French Resistance, in which she supplied brief biographies of all but one of her 230 fellow deportees, describing the fate of those who did not return and the long-term debilitating impact on the health of many of those who did.

A culture of hope instinctively adapts its sense of the past to its vision of the future, and when the Holocaust is the subject of discussion, especially in America, it is natural for a redemptive rhetoric to emerge as an antidote to the darker narrative that beckons from the landscape of atrocity. Although occasions of resistance, uprisings, aiding and indeed saving the lives of Jews must be included when remembering the catastrophe, if the vocabulary of redemptive memory is allowed to override the language of the lived (and died) experience of Auschwitz and other sites of starvation, torture and murder, readers—and especially students—may be tempted to embrace encounters with the best as a convenient escape mechanism from confronting the worst.This essay argues that it is more important to examine the testimonies of individual survivors and witnesses than to rely on collective abstractions like resilience, endurance, courage and faith. The rhetoric of redemptive memory disregards the painful (and often futile) efforts of separate individuals to stay alive, or help each other stay alive, and instead bestows on them a collective identity, like “Heroes of the Warsaw Ghetto” or “Righteous Gentiles.” In doing so, this rhetoric avoids the assaults on the self that gave birth to a complex inner life after the war for many of those who survived. Unredemptive memory examines that inner life, enshrined in a single line by one survivor who exclaims, “The war was over, but it was eating us up inside.” It takes moral courage and mental tenacity to follow the trajectory of unredemptive memory into areas of Holocaust atrocity that continue to afflict this woman. The best way to animate such memory is to accumulate details of Nazi crimes in such abundance that they become a permanent part of human consciousness.

Introduction: Vertically integrating physiology into patient care has the potential to improve clinical reasoning. Clinical Physiology Grand Rounds (CPGR) is a case-based teaching method that brings together students from all years of medical school to focus on linking clinical presentations to core basic science concepts including anatomy, physiology, and pathophysiology. In this study, we describe the implementation of CPGR at two different institutions in the United States and assess student-reported outcomes. Methods: We survey students who participated in CPGR at Columbia University College of Physicians & Surgeons (P&S) and Medical University of South Carolina (MUSC). Subjects were queried across three domains: the benefits of attending, the impact of concept maps, and the impact of the mixed-learner environment. Results: Despite differences in session leadership and the underlying medical school curricula, conference attendees reported similar benefits at the two schools included in this study. Students overwhelmingly (92.9%) reported that remembering clinical presentations was easier when they understood the underlying physiology. They also reported gaining a true understanding of concepts that were previously memorized (87.5%). Both clinical (92.5%) and preclinical students (93.1%) valued the mixed-learner environment as a component of the conference. Discussion: By assuring a mixed-learner environment with near-peer interactions, using concept maps as a teaching tool, and rigorously linking clinical presentation and management to physiological concepts, we found that the key benefits of CPGR were replicable across different institutions, despite several local differences in how CPGR was implemented, led, and conducted.

BACKGROUND Team-based learning (TBL) is associated with improved end-of-course exam performance, but the impact on long-term retention is unknown. We compared the impact of three teaching methods: traditional case-based small group discussion (TSG), TBL or no small group reinforcement on short-term understanding and long-term retention after a haematology course. METHODS Knowledge assessments were conducted prior to, immediately after and 14 months after course completion. Several topics covered by TSG were switched to TBL and could be directly compared. RESULTS We recruited 24% of eligible students (n = 70). Of these, 48 completed the final assessment (69% retention). Pre-course, participants scored 31% correctly, which increased to 78% post-course with significant differences: TBL 87%; TSG 78%; no small group 76% (p

This investigation characterized sexual activity and sexual function in hematopoietic cell transplantation (HCT) survivors, compared them with norms, and examined factors associated with sexual dysfunction, with the goal of identifying targets for intervention to improve sexual health. Surviving adults from a large transplantation center were asked to complete an annual survey with a core of health questions and a module on sexual activity and function. Participants completed the Sexual Function Questionnaire, Cancer and Treatment Distress form, and Revised Dyadic Adjustment Scale. Clinical data were collected from the transplantation medical database. Multivariate logistic regressions identified factors associated with sexual activity and function. Participating survivors (n = 1742) were a mean of 11.9 years (range, .4 to 43.1 years) after HCT, mean age 57.6 years, and 53% male. Women were more likely than men to report being sexually inactive in the past year (39% versus 27%) and, among those sexually active, to report low sexual function (64% versus 32%). Male and female survivors reported lower rates of sexual activity and function than comparison norms (all P < .01). In regressions, factors associated with being sexually inactive included older age, having

This article presents a focused review of the available tests to assess the effect of direct oral anticoagulants on coagulation and the use of reversal agents in the perioperative setting for practicing anesthesiologists.

Patients affected by hemophilia A often require frequent prophylactic and therapeutic self-infusion. For those who develop inhibitors, treatment options are limited and mortality is increased. Emicizumab, a bispecific antibody to Factors IXa and X that carries out the function of Factor VIII (FVIII), represents a novel therapeutic approach. Areas covered: We review the clinical trials and key laboratory assay research for emicizumab. Emicizumab reduced the annualized bleeding rate by 87% compared to placebo in patients with inhibitors. For patients without inhibitors, emicizumab reduced the annualized bleeding rate 96-97% compared to no prophylaxis and 68% compared to prior FVIII prophylaxis. Three patients developed a thrombotic microangiopathy (TMA) and two patients had thrombotic events while on emicizumab in combination with activated prothrombin complex concentration (aPCC) alone or concurrent with activated recombinant factor FVII (rFVIIa). Expert opinion: Emicizumab represents a much-needed alternative approach to managing Factor VIII deficiency, especially for those with inhibitors or limited ability to self-infuse. For patients with inhibitors, thrombotic complications including TMA, not seen with other bypassing agents, raises concern about the use of emicizumab in combination with aPCC and how patients who have breakthrough bleeding can be safely managed.

Background. Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the “black box” of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. Aim. To compare the implementation of three features of a phone-based intervention for parents (time spent discussing weight-related behaviors, behavior change techniques used in sessions, and intervention activities implemented by parents between sessions) with study outcomes. Methods. A random selection of 100 parent–child dyads in the intervention arm of a phone-based obesity prevention trial was included in this analysis. Sessions were coded for overall session length, length of time spent discussing specific weight-related behaviors, number of behavior change techniques used during the sessions, and number of intervention-recommended activities implemented by the parents between sessions (e.g., parent-reported implementation of behavioral practice/rehearsal between sessions). The primary study outcome, prevention of unhealthy increase in child body mass index (BMI) percentile, was measured at baseline and 12 months. Results. Overall session length was associated with decreases in child BMI percentile ( b = −0.02, p = .01). There was no association between the number of behavior change techniques used in the sessions and decreases in child BMI percentile ( b = −0.29, p = .27). The number of activities the parents reported implementing between sessions was associated with decreases in child BMI percentile ( b = −1.25, p = .02). Discussion. To improve future interventions, greater attention should be paid to the intended and delivered session length, and efforts should be made to facilitate parents’ implementation of intervention-recommended activities between sessions (ClinicalTrials.gov, No. NCT01084590).

Many training programs have implemented Resident-as-Teacher curricula. Previous evaluations of such programs have largely focused on direct, often self-assessed benefits to the learner in the curriculum, without evaluating higher-level educational outcomes such as behavioral changes that benefit other trainees and the program as a whole. We developed a 2-week Resident-as-Teacher (RaT) rotation, during which senior medicine residents lecture, lead morning report, teach exam maneuvers, and rehearse feedback skills, under direct faculty observation. We surveyed participating RaT residents, interns who worked with RaT residents, and interns who did not work with RaT residents, and we examined rates of program evaluation completion. All 42 Post Graduate Year 3 residents completed the rotation during the 2015–16 academic year, 26 (62%) during the study period. Of these 26 residents, 21 (81%) responded to the pre-rotation survey and 24 (92%) to the immediate post-rotation and 6-month follow-up surveys. RaT residents reported increased confidence in all teaching formats. Interns who worked with these residents were more satisfied with the feedback they received than their co-interns who did not (92 vs. 63%). Residents who completed the RaT rotation were more likely to fill out online evaluations (mean completion rate 82 vs. 69%). Our 2-week intensive curriculum on teaching and feedback improved self-reported comfort with teaching and preparedness for careers in academic medicine. Moreover, our analysis suggests the intervention changed resident behaviors, improving the experience of other trainees and rates of online evaluation completion.

Hematopoietic cell transplant (HCT) patients are required to have a caregiver present for up to 100 days post-transplant. Caregivers provide essential support during HCT but experience immense stress and burden. Increasing research has developed interventions for HCT caregivers. This review systematically evaluates psychosocial interventions for caregivers of HCT patients. The search yielded 12 studies (7 efficacy and 5 feasibility studies) enrolling 931 caregivers. Interventions were feasible and acceptable as evidenced by high rates of completion (70–100%) with attrition due to patient morbidity or mortality. Feasibility was augmented by flexible delivery (in-person, teleconference, smartphones, or Web-based platforms). Acceptability was demonstrated by objective measures of satisfaction. Effectiveness was found for fatigue and mental health service use, but not for burden, sleep-quality, and inconsistently for caregiver depression, anxiety, coping, and quality of life. Psychosocial interventions are feasible, acceptable, and show mixed effects on HCT caregiver outcomes.

Background: Evidence suggests that aerobic exercise (AE) soon after concussion may facilitate earlier recovery in athletes. The purpose of this pilot study was to investigate the feasibility and effects of early sub-symptom threshold AE on symptom trajectory and recovery time in a heterogeneous adult population. Methods: Adults presenting within 7 days of concussion were randomized to either the experimental group: prescribed AE (90% of symptom-limited heartrate achieved on Buffalo Concussion Treadmill Test [BCTT]), 30 minutes/day, 5 days/week, or the control group: standard of care exercise recommendations. Participants were assigned a heartrate monitor bracelet to track activity. They underwent serial treadmill testing to monitor exercise tolerance, update prescriptions and determine recovery. Results: 20 participants (10 per arm) completed the BCTT protocol within 7 days of injury, with 8/20 demonstrating exercise tolerance at week 1. 66% (4/6) of those in the experimental group were recovered by week 4, compared to only 43% (3/7) in the control group. Average heart rate monitor compliance was 32% of the prescribed time among all participants, and self-reported exercise prescription compliance was 43% in the experimental group. Conclusions: Early post-concussion aerobic exercise in the general adult population is a promising intervention; this study will inform the design of a larger trial.

For patients with Crohn disease (CD), symptom reporting may not coincide with disease state; patients in remission may continue to report symptoms and pain, whereas other patients may be symptom-free despite a flare. This phenomenon has been documented in adults but only recently assessed in pediatric patients. The present study assessed the role of pain reporting and disease state in pediatric patients with CD in understanding psychological distress and quality of life.Participants included 116 children and adolescents ages 8 to 18 years with CD who completed self-report questionnaires assessing pain, disease symptoms, depression, anxiety, functional disability, and quality of life. Physicians completed the Pediatric Crohn's Disease Activity Index to assess disease activity (scores ≤10 = remission, scores10 = flare).Approximately two thirds of participants reported pain concordant with disease state. For patients in remission, those with pain experienced significantly increased disability and decreased quality of life compared to patients in remission without pain. For patients in a flare, those without pain experienced significantly decreased disability and depressive symptoms, and improved quality of life compared to patients in a flare with pain.For pediatric patients with CD, report of pain, while in remission or a flare, is associated with increased disability and reduced quality of life. Although levels of depression did not differ by disease state, depressive symptoms did differ by pain report (presence or absence) for those in a flare. Pain reporting in CD appears to be associated with both physical and psychological state and should be assessed regardless of disease activity.

Objective To extend existing research on the pain burden experienced by youth with inflammatory bowel disease (IBD) by examining the complexity of psychosocial factors involved in pain-related distress. Methods Parents completed measures of family stress and their child's pain-related expressions of distress and coping. Youth with IBD rated their depressive symptoms (n = 183 dyads). Mediation analyses were performed using regression-based techniques and bootstrapping. Results Greater family stress was positively related to children's pain-related expressions of distress and passive coping. Significant indirect effects were found in the relationship between family stress and expressed pain-related distress through parent-reported passive coping, depressive symptoms, and both passive coping and depressive symptoms sequentially. Conclusions Results suggest that family stress can place children at risk for greater expressed pain-related distress through effects on coping and depressive symptoms. Addressing psychosocial difficulties is important for closing the gap between disability and health in youth with IBD.

Aim To compare the detection rate of extra-regional metastases in patients with recurrent gynaecological malignancies being considered for radical salvage surgery with combined 2-[ 18 F]-fluoro-2-deoxy- d- glucose ( 18 F-FDG) positron-emission tomography (PET)/computed tomography (CT) compared to conventional imaging. Materials and methods A retrospective review was performed of all patients in a provincial database with recurrent gynaecological malignancies being considered for pelvic exenteration that underwent restaging with CT/PET between March 2011 and October 2014. Findings on PET and conventional imaging (CT ± pelvic MRI) were abstracted. Disease sites were classified according to the location (regional nodal metastases, extra-regional nodal metastases, peritoneum, or other distant sites) and diagnostic certainty (definitive or equivocal). The proportion of patients positive for extra-regional recurrence was calculated for PET and conventional imaging. In addition, the proportion of patients with indeterminate lesions only was calculated for each modality and the sites of indeterminate findings were tabulated. Results There were 85 patients (median age, 50 years; range: 30–81 years) with carcinoma of cervix ( n =51), endometrium ( n =18), vagina ( n =6), or vulva ( n =10). Extra-regional recurrence was detected in 8/85 (9.4%) and 24/85 (28.2%) patients on conventional imaging and PET, respectively ( p =0.0017). The greatest impact of PET compared to conventional imaging was in the detection of extra-regional nodal metastases. PET had significantly fewer examinations equivocal for extra-regional recurrence versus conventional imaging (6/85 [7.1%] and 38/85 [44.7%], respectively, p Conclusion In patients with recurrent gynaecological malignancies being considered for radical salvage surgery, PET may identify significantly more extra-regional recurrence than conventional imaging. PET may also result in fewer equivocal lesions. The impact of these results on patient management and outcome should be confirmed in future prospective trials.

Standardized methods are needed to evaluate what occurs within the 'black box' of behavioral interventions to prevent pediatric obesity. The purpose of this research is to evaluate methods to specify the behavior change techniques used and the amount of time spent discussing target weight-related behaviors in an intervention for parents of children at risk for becoming overweight or obese. Independent coders were trained to identify behavior change techniques and time spent discussing weight-related behaviors in audio recordings and transcripts of intervention sessions from 100 randomly selected participants. The behavior change technique taxonomy (BCTTv1) was used to code techniques present in sessions. A newly-developed tool was used to code time spent discussing each target weight-related behavior (e.g., physical activity, screen time). Sessions from a subset of these participants (N = 20) were double coded to evaluate inter-rater reliability. After revisions to coding protocols, coders reliably coded behavior change techniques used and time spent discussing target weight-related behaviors in sessions from the subset of 20 participants. The most commonly discussed target weight-related behavior was physical activity followed by energy intake and fruit and vegetable intake. On average, 13.9 (SD = 2.8) unique behavior change techniques were present across sessions for a given participant. These results offer reliable methods for systematically identifying behavior change techniques used and time spent discussing weight-related behaviors in a pediatric obesity prevention intervention. This work paves the way for future research to identify which specific target behaviors and techniques are most associated with the prevention of unhealthy weight gain in children.