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Background: Although treatment advances have increased childhood and adolescent cancer survival, whether patient subgroups have benefited equally from these improvements is unclear., Methods: Data on 42,865 malignant primary cancers diagnosed between 1995 and 2019 in individuals ≤ 19 years were obtained from 12 Surveillance, Epidemiology, and End Results registries. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for cancer-specific mortality by age group (0-14 and 15-19 years), sex, and race/ethnicity were estimated using flexible parametric models with a restricted cubic spline function in each of the periods: 2000-2004, 2005-2009, 2010-2014 and 2015-2019, versus 1995-1999. Interactions between diagnosis period and age group (children 0-14 and adolescents 15-19 years at diagnosis), sex, and race/ethnicity were assessed using likelihood ratio tests. Five-year cancer-specific survival rates for each diagnosis period were further predicted., Results: Compared with the 1995-1999 cohort, the risk of dying from all cancers combined decreased in subgroups defined by age, sex and race/ethnicity with HRs ranging from 0.50 to 0.68 for the 2015-2019 comparison. HRs were more variable by cancer subtype. There were no statistically significant interactions by age group (P interaction =0.05) or sex (P interaction =0.71). Despite non-significant differences in cancer-specific survival improvement across different races and ethnicities (P interaction =0.33) over the study period, minorities consistently experienced inferior survival compared with non-Hispanic Whites., Conclusions: The substantial improvements in cancer-specific survival for childhood and adolescent cancer did not differ significantly by different age, sex, and race/ethnicity groups. However, persistent gaps in survival between minorities and non-Hispanic Whites are noteworthy., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Low-income Americans have higher rates of smoking and a greater burden of smoking-related disease. In the United States, smokers in every state can access evidence-based telephone counseling through free tobacco quitlines. However, quitlines target smokers who are ready to quit in the next 30 days, which can exclude many low-income smokers. A smoke-free homes intervention may help engage smokers in tobacco control services who are not yet ready to quit. Previous research in low-income populations suggests that receiving a smoke-free homes intervention is associated with higher quit rates. This study tests whether, at a population level, expanding on quitlines to include a smoke-free homes intervention for smokers not ready to quit could engage more low-income smokers and increase long-term cessation rates., Methods: In a Hybrid Type 2 design, participants are recruited from 211 helplines in 9 states and randomly assigned to standard quitline or quitline plus smoke-free homes intervention arms. Participants in both arms are initially offered quitline services. In the quitline plus smoke-free homes condition, participants who decline the quitline are then offered a smoke-free homes intervention. Participants complete a baseline and follow-up surveys at 3 and 6 months. Those who have not yet quit at the 3-month follow-up are re-offered the interventions, which differ by study arm. The primary study outcome is self-reported 7-day point prevalence abstinence from smoking at 6-month follow-up., Conclusion: This real-world cessation trial involving 9 state tobacco quitlines will help inform whether offering smoke-free homes as an alternative intervention could engage more low-income smokers with evidence-based interventions and increase overall cessation rates. This study has been registered at ClinicalTrials.gov (Study Identifier: NCT04311983)., Competing Interests: Declaration of Competing Interest Kelly Carpenter declares that she is employed by RVO Health and has no other competing interests. All other authors declare that they have no competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study was to examine parental preferences for researchers accessing their child's electronic health record across 3 groups: those with a child with (1) a known genetic condition (fragile X syndrome FXS), (2) a suspected genetic condition (autism spectrum disorder [ASD]), and (3) no known genetic condition (typically developing)., Methods: After extensive formative work, a discrete choice experiment was designed consisting of 5 attributes, each with 2 or 3 levels, including (1) type of researcher, (2) the use of personally identifiable information, (3) the use of sensitive information, (4) personal importance of research, and (5) return of results. Stratified mixed logit and latent class conditional logit models were examined., Results: Parents of children with FXS or ASD had relatively higher preferences for research conducted by nonprofits than parents of typically developing children. Parents of children with ASD also preferred research using non-identifiable and nonsensitive information. Parents of children with FXS or ASD also had preferences for research that was personally important and returned either summary or individual results. Although a few child and family characteristics were related to preferences, they did not overall define the subgroups of parents., Conclusions: Although electronic health record preference research has been conducted with the general public, this is the first study to examine the opinions of parents who have a child with a known or suspected genetic condition. These parents were open to studies using their child's electronic health record because they may have more to gain from this type of research., (Copyright © 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Objective: Limited data describe patient preferences for the growing number of antiretroviral therapies (ARTs). We quantified preferences for key characteristics of modern ART deemed relevant to shared decision making., Methods: A discrete choice experiment survey elicited preferences for ART characteristics, including dosing (frequency and number of pills), administration characteristics (pill size and meal requirement), most bothersome side effect (from diarrhea, sleep disturbance, headaches, dizziness/difficulty thinking, depression, or jaundice), and most bothersome long-term effect (from increased risk of heart attacks, bone fractures, renal dysfunction, hypercholesterolemia, or hyperglycemia). Between March and August 2017, the discrete choice experiment was fielded to 403 treatment-experienced persons living with human immunodeficiency virus (HIV), enrolled from 2 infectious diseases clinics in the southern United States and a national online panel. Participants completed 16 choice tasks, each comparing 3 treatment options. Preferences were analyzed using mixed and latent class logit models., Results: Most participants were male (68%) and older (interquartile range: 42-58 years), and had substantial treatment experience (interquartile range: 7-21 years). In mixed logit analyses, all attributes were associated with preferences. Side and long-term effects were most important, with evidence of substantial preference heterogeneity. Latent class analysis identified 5 preference classes. For classes 1 (40%), 2 (24%), and 3 (21%), side effects were most important, followed by long-term effects. For class 4 (10%), dosing was most important. Class 5 (4%) was largely indifferent to ART characteristics., Conclusion: Overall, treatment-experienced persons living with HIV valued minimizing side effects and long-term toxicities over dosing and administration characteristics. Preferences varied widely, highlighting the need to elicit individual patient preferences in models of shared antiretroviral decision making., (Copyright © 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Objectives: To summarize the value adults place on child health and functional status and provide a new quantitative tool that enhances our understanding of the benefits of new health technologies and illustrates the potential contributions of existing data sets for comparative effectiveness research in pediatrics., Methods: Respondents, ages 18 years and older, were recruited from a nationally representative panel between August 2012 and February 2013 to complete an online survey. The survey included a series of paired comparisons that asked respondents to choose between child health and functional status outcomes, which were described using the National Survey of Children with Special Health Care Needs, a 14-item descriptive system of child health outcomes. Using respondent choices regarding an unnamed 7- or 10-year-old child, generalized linear model analyses estimated the value of child health and functional status on a quality-adjusted life-year scale., Results: Across the domains of health and functional status, repeated or chronic physical pain, feeling anxious or depressed, and behavioral problems (such as acting out, fighting, bullying, or arguing) were most valuable, as indicated by adult respondents' preference of other health problems to avoid outcomes along these domains., Discussion: These findings may inform comparative effectiveness research, health technology assessments, clinical practice guidelines, and public resource allocation decisions by enhancing understanding of the value adults place on the health and functional status of children., Conclusions: Improved measurement of public priorities can promote national child health by drawing attention to what adults value most and complementing conventional measures of public health surveillance., (Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Background: Continuous peripheral nerve block (CPNB) is an important therapeutic tool in the anaesthetic and analgesic management of combat casualties at Walter Reed Army Medical Center (WRAMC). We describe our experience using CPNB techniques in combat trauma patients treated with low-molecular weight heparin (LMWH). Guidelines used at our institution for managing CPNB catheters in patients being treated with LMWH are introduced., Methods: From March 2003 to April 2005, 187 combat casualties treated by the WRAMC regional anaesthesia/acute pain section using CPNB were evaluated retrospectively by electronic chart review. Patient characteristic data, CPNB type, duration of CPNB, indication for LMWH [enoxaparin sodium injection (Lovenox-Sanofi Aventis, Bridgewater, NJ, USA)], enoxaparin dose (mg) before and after catheter insertion and removal, time from CPNB placement and removal to enoxaparin dose, and complications were recorded., Results: Median enoxaparin dose and time given before catheter insertion were 30 mg and 21 h, respectively. Median enoxaparin dose was also 30 mg given a median of 12 h after peripheral nerve catheter placement. Catheters remained in situ for a median of 8 days (range 1-33 days). Catheter specific complications were infrequent and identified in 7 (3.7%) patients (two catheter malfunction-kinking, catheter tip dislodgement in situ, two superficial catheter site infections and two catheter dislocations). There were no catheter-related bleeding complications evident in this study., Conclusions: Information regarding the safety of CPNB in patients treated with LMWH for perioperative venous thromboembolism prevention is scarce. Our initial experience with CPNB and concurrent LMWH has not been complicated by catheter-related bleeding.

The complex nature of combat-related injuries requires frequent operative interventions and prolonged analgesic therapy. The application of continuous peripheral nerve block (CPNB) has been an important anaesthetic tool in the management of combat soldiers wounded from the current conflicts. The severe, destructive nature of combat injuries makes placement of CPNB difficult or impossible using more common neurostimulation approaches. The use of ultrasound technology has improved our success in placing CPNB in the presence of such injuries. We report the application of ultrasound technology in placing CPNB in a combat-injured soldier, whose injuries precluded other CPNB options.

Objective: To assess the rate of annual eye examinations over time among older Americans with diabetes and chronic eye diseases., Design: Longitudinal analysis of Medicare claims data., Participants: Random sample of Medicare beneficiaries aged 65 years or older., Methods: Beneficiaries were followed between 1991 and 1999, unless mortality or enrollment in a health maintenance organization for > 6 months in a given 12-month period intervened. All claims data (both physician and facility) during this time were analyzed for the presence of International Classification of Diseases 9 codes consistent with 1 of the 3 study conditions and the performance of eye examinations., Main Outcome Measures: Claims submitted by optometrists, ophthalmologists, or other providers of eye care for subjects with diabetes, glaucoma, or age-related macular degeneration (ARMD). Rates were calculated on the basis of a 15-month time window for annual examinations rather than for 12 months to allow for less than full compliance with the guidelines for various reasons (e.g., bad weather)., Results: Among those with diabetes in this population, 50% to 60% had annual eye examinations in a 15-month period. Of those followed for at least 75 months after diagnosis, about three quarters had one or more 15-month gaps between visits. For subjects diagnosed with glaucoma, most visit rates were in the 70% to 90% range per 15-month period. The percentage of subjects with at least one 15-month period with no visits was considerably lower than for diabetes. The patterns for those with ARMD were in between those for diabetes and glaucoma. Over a nine-year period, only slightly over half of persons with at least one of the study conditions complied with practice guidelines., Conclusions: Annual eye examinations for persons diagnosed with diabetes, glaucoma, and ARMD are important for detecting potentially treatable vision loss among those already diagnosed with these conditions. Currently, actual rates of eye examinations for persons diagnosed with the study conditions fall far short of recommended rates. As such, approaches to enhancing longitudinal follow-up of those already in the eye care system are needed.

Maternal protein deficiency during pregnancy is associated with changes in glucose tolerance and hypertension in the offspring of rats. In this study the growth of rat fetuses was examined when the dams were fed diets containing 18% casein, 9% casein or 8% casein supplemented with threonine. The extra threonine was added to reverse the decrease in circulating threonine concentrations that occurs when pregnant rats are fed protein-deficient diets. The fetuses of the group fed the low protein diet supplemented with threonine were significantly smaller than those of the control group and not significantly different from those fed low protein. Homogenates prepared from the livers of dams fed the diet containing 9% casein oxidized threonine at approximately twice the rate of homogenates prepared from dams fed the diet containing 18% casein. We conclude that circulating levels of threonine fall as a consequence of an increase in the activity of the pathway that metabolizes homocysteine produced by the transulfuration of methionine. Serum homocysteine was unaffected in the dams fed low protein diets compared with controls, but was significantly greater in dams fed the low protein diet supplemented with threonine. Elevated levels of homocysteine are associated with changes in the methylation of DNA. The endogenous methylation of DNA was greater than that of controls in the livers of fetuses from dams fed the 9% protein diets and increased further when the diet was supplemented with threonine. Our results suggest that changes in methionine metabolism increase homocysteine production, which leads to changes in DNA methylation in the fetus. An increase in maternal homocysteine may compromise fetal development, leading to the onset of glucose intolerance and hypertension in adult life.

Potato (Solanum tuberosum) tuber lectin is a chitin-binding, hydroxyproline-rich glycoprotein, which may be involved in the defence mechanism of the plant. We had previously obtained evidence that it consists of at least two very dissimilar domains. The aim was to use a combination of accurate determinations of molecular weight and protein sequencing to gain more accurate information on the domains. Accurate determinations of the molecular weight of the lectin by a MALDI mass spectrometer have shown that the subunit molecular weight is 65,500 (+/- 1100) and that of a totally deglycosylated sample is 31,250 (+/- 30). This means that the lectin is 52.3 (+/- 1)% carbohydrate with a considerable number of glycoforms being present. Partial sequences and other analyses are consistent with the existence of three distinct domains. These are: (1) an N-terminal region which is rich in proline but poor in hydroxyproline; (2) a glycosylated region with a glycosylated molecular weight of 45,300 (+/- 1100) and a deglycosylated molecular weight of 11,050 (+/- 50) which is extremely rich in glycosylated hydroxyproline residues with a similar sequence to extensins; and (3) a cystine-rich domain which has the sugar binding site shows partial conservation of a repeated motif common to many chitin-binding proteins of the hevin family including wheat-germ agglutinin. The closest similarity seems to be to the sequence of potato basic chitinase.

Digestion/absorption and nutritional utilization of starch, protein and lipids were studied in rats fed diets containing purified kidney bean alpha-amylase inhibitor at levels of 0, 1.6, 3.3 and 6.6 g/kg diet. At the two higher levels, the growth rate of rats and the apparent digestibilities and utilization of dietary starch and protein were significantly less than in control rats, and losses of nitrogen, lipids and carbohydrate resulted in a significant reduction in dry body weight. Some organs of the body were also affected: the relative dry weights of the intestines and the pancreas were higher, whereas liver and thymus weights were lower than in control rats. As starch digestion in the small intestine was negligible at higher inhibitor concentrations, the cecum was practically blocked by solidified digesta. This effect and the ensuing bacterial fermentation stimulated the growth of this tissue by hyperplasia and hypertrophy. However, as the distension was not always sufficient, the organ was occasionally ruptured and the rats had to be killed. Inhibitor doses in this work were comparable to those in clinical studies, implying that the use of the inhibitor is not without health risks. Moreover, diets rich in alpha-amylase inhibitor such as those containing transgenic plants with high levels of inhibitor gene expression cannot be recommended in intensive animal production.

A rapid high-performance liquid chromatographic method for the separation of polyamines as their dansyl derivative has been developed. The chromatographic system used consisted of a reversed-phase column and a mobile phase of acetonitrile and water. The separation of 1,3-diaminopropane, putrescine, cadaverine, spermidine and spermine takes only 9 min. This method provides a good resolution between 1,3-diaminopropane and putrescine. It has been applied to quantify polyamines from seeds of wheat, petals of Phalaenopsis hybrids and various rat tissues.

The amino acid fraction from rat liver, heart and skeletal muscle was prepared by the separation of sulphosalicylic acid extract on Dowex 50 H+ form. The presence of L-methionine-dl-sulphoxide in these extracts was identified and compared by three independent chromatographic methods: ion-exchange, Pico-Tag and reversed-phase high-performance liquid chromatography after precolumn derivatisation with diethylethoxymethylenemalonate. Quantitative data indicate that L-methionine-dl-sulphoxide is present in the intracellular pool at the levels of free methionine.

A high-performance liquid chromatographic assay has been developed for quantitating oxytocin in common large volume parenteral intravenous solution matrices. Separation is accomplished by a reversed-phase mechanism using a C18 column. The analyte is detected fluorimetrically after post-column derivatization with fluorescamine. Reaction efficiency is controlled by the use of a reaction buffer which is added separately from the fluorescamine via a dual pump reactor system. Given the low analyte concentration [40 parts per billion (10(9)) or less], the samples are concentrated on-line through the use of a trapping column and switching valve. To improve productivity, pre-concentration and analysis of adjacent samples is timed to occur concurrently. Performance of the assay is characterized by a high degree of accuracy, precision and ruggedness; the system is capable of distinguishing between the analyte, matrix components, impurities and common degradates.