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Objective: To examine the cross‐sectional associations between diabetes distress, BMI (zBMI; BMI z‐score), objectively measured mean daily blood glucose readings and insulin boluses administered, and A1C in adolescents with type 1 diabetes (T1D) using insulin pumps. Methods: T1D self‐management behaviour data were downloaded from adolescents' (N = 79) devices and mean daily frequency of blood glucose readings and insulin boluses were calculated. Diabetes distress was measured (Problem Areas in Diabetes–Teen questionnaire [PAID‐T]), A1C collected, and zBMI calculated from height and weight. Three multiple linear regressions were performed with blood glucose readings, insulin boluses, and A1C as the three dependent variables and covariates (age, T1D duration), zBMI, diabetes distress, and the diabetes distress x zBMI interaction as independent variables. Results: Participants (55.7% female) were 14.9 ± 1.9 years old with T1D for 6.6 ± 3.4 years. zBMI moderated the relationship between diabetes distress and mean daily insulin boluses administered (b = −0.02, p = 0.02); those with higher zBMI and higher diabetes distress administered fewer daily insulin boluses. zBMI was not a moderator of the association between diabetes distress and blood glucose readings (b = −0.01, p = 0.29) or A1C (b = 0.002, p = 0.81). Conclusions: Using objective behavioural data is useful for identifying how adolescent diabetes distress and zBMI affect daily bolusing behaviour amongst adolescent insulin pump users. Although distinct interventions exist to improve T1D self‐management or diabetes distress, none addresses them together while considering zBMI. Decreasing diabetes distress could be especially important for youth with high zBMI. [ABSTRACT FROM AUTHOR]

Background: Multiple myeloma (MM) is an incurable hematologic malignancy requiring long‐term, continuous therapy. Despite its chronic and unrelenting course, studies examining quality of life (QOL), psychological distress, and perceptions of prognosis by line of therapy are lacking. Methods: The authors conducted a cross‐sectional, multisite study of patients undergoing treatment for MM (excluding maintenance) between June 2020 and January 2021. The authors conducted purposeful sampling and recruited patients to 3 cohorts based on lines of therapy: 1) newly diagnosed receiving first‐line therapy; 2) 2 to 3 lines; and 3) 4 or more lines. Patients completed validated questionnaires to assess their QOL, fatigue, psychological distress, and perceptions of prognosis. Results: A total of 180 patients with MM were enrolled (newly diagnosed [n = 60], 2 to 3 lines [n = 60], and ≥4 lines of therapy [n = 60]). QOL, symptom burden, and fatigue scores did not differ by lines of therapy. There were no statistically significant differences in psychological distress by line of therapy. The rates of clinically significant depression, anxiety, and post‐traumatic stress disorder symptoms were 23.9% (43 of 180), 23.9% (43 of 180), and 24.4% (44 of 180), respectively. Most patients (84.7%, 149 of 176) reported that their oncologist told them their cancer was incurable, but only 30.6% (53 of 173) acknowledged that they were terminally ill, and 42.0% (73 of 174) reported that they thought their cancer was incurable. Conclusions: Patients with MM undergoing treatment experience impaired QOL and elevated psychological distress across the disease continuum, regardless of line of therapy. A substantial proportion of patients with MM have significant misperceptions about their prognosis and the curability of their illness despite reporting being informed of the prognosis by their oncologist. Lay Summary: This study discusses 180 patients with MM (newly diagnosed [n = 60], 2‐3 lines [n = 60], and ≥4 lines of therapy [n = 60]). Quality of life, symptom burden, and fatigue scores do not differ by lines of therapy. There are also no statistically significant differences in psychological distress by line of therapy.The rates of clinically significant depression, anxiety, and post‐traumatic stress disorder symptoms are 23.9%, 23.9%, and 24.4%, respectively.Most patients (84.7%) report that their oncologist told them their cancer was incurable, but only 30.6% acknowledge that they are terminally ill, and 42.0% report that they thought their cancer was incurable. Patients with multiple myeloma undergoing treatment experience impaired quality of life and elevated psychological distress across the disease continuum. Although the majority reported that their oncologist had told them that their cancer is incurable, a substantial proportion still reported that they believed their cancer was curable. [ABSTRACT FROM AUTHOR]

Hypoglycemia is a common and dangerous complication of type 1 diabetes (T1D). Although some worry about hypoglycemia is adaptive, some individuals develop severe and impairing anxiety symptoms about hypoglycemic episodes. This presentation, known as severe fear of hypoglycemia (FOH), is similar to a specific phobia, and becomes problematic when it interferes with one's quality of life or T1D management. Although FOH is common, there have not yet been any treatment studies to address severe and impairing levels of FOH in the T1D population. The purpose of the following case report is to: (a) describe the presentation of a severe case of FOH in a young adult with T1D; (b) demonstrate the effectiveness of graduated exposure therapy for treatment of severe FOH; and (c) provide implications for clinical practice. A previously developed conceptual model for FOH management guided treatment. Treatment using graduated exposure therapy for FOH resulted in reduced worry about low blood glucose (BG) and significant reduction in behaviors to maintain high BG levels. Assessment of FOH and the risk and benefits of using a continuous glucose monitor among individuals with T1D and their families are discussed. [ABSTRACT FROM AUTHOR]

Abstract: We sought a regimen that incorporates optimal novel agents and balances efficacy with toxicity in transplant‐ineligible multiple myeloma (MM) patients. Our study evaluated modified lenalidomide‐bortezomib‐dexamethasone (RVD lite) in this population and was administered over a 35‐day cycle. Lenalidomide 15 mg was given orally on days 1–21; bortezomib 1·3 mg/m2 weekly subcutaneously on days 1, 8, 15 and 22; and dexamethasone 20 mg orally was given on the day of and day after bortezomib for 9 cycles followed by 6 cycles of consolidation with lenalidomide and bortezomib. The primary objective was to evaluate the overall response rate (ORR); secondary objectives included safety, progression‐free survival (PFS) and overall survival (OS). Fifty‐three eligible patients were screened between April 2013 and May 2015; 50 received at least one dose of therapy. Median age at study entry was 73 years (range 65–91). The ORR was 86% and 66% of patients achieved a very good partial response or better. Median PFS was 35·1 months (95% confidence interval 30·9–not reached) and median OS was not reached at a median follow‐up of 30 months. Peripheral neuropathy was reported in 31 (62%) patients with only 1 patient experiencing grade 3 symptoms. RVD lite is a well‐tolerated and highly effective regimen, with robust PFS and OS, in the transplant‐ineligible MM population. [ABSTRACT FROM AUTHOR]

Proteasome inhibitors ( PI) and immunomodulatory agents ( IMIDs) have improved the overall survival (OS) of patients with multiple myeloma ( MM), but concerns have been raised about increased incidence of extramedullary disease ( EMD) after the combined use of PIs and IMIDs for upfront therapy. We evaluated whether the addition of lenalidomide to bortezomib-based front-line regimens precipitated earlier development of EMD. We reviewed the charts of 117 MM patients (median follow-up from diagnosis 6·1 years; range 0·1-10·2 years) enrolled in eight clinical trials of first-line treatment with bortezomib-based regimens, with or without lenalidomide. We assessed development of EMD as extraosseous (distant from bone) or osseous (originating from bone) plasmacytomas. The primary endpoint was time from diagnosis until development of EMD, based on imaging, biopsy and/or physical examination. Any form of EMD at progression was observed in 40 (34·2%) patients, including 21 (18%) osseous, 8 (7%) extraosseous and 11 (9%) both osseous and extraosseous. Median OS was 0·9 years (range 0·1-4·8 years) after extraosseous EMD development. Sensitivity analyses with follow-up times truncated at 5 years detected no statistically significant difference in rates of any EMD form between the two groups ( P > 0·2 for each comparison). Therefore, we observed no evidence that bortezomib-lenalidomide-based front-line therapy precipitates earlier EMD. [ABSTRACT FROM AUTHOR]

1. Increasingly, river managers are turning from hard engineering solutions to ecologically based restoration activities in order to improve degraded waterways. River restoration projects aim to maintain or increase ecosystem goods and services while protecting downstream and coastal ecosystems. There is growing interest in applying river restoration techniques to solve environmental problems, yet little agreement exists on what constitutes a successful river restoration effort.2. We propose five criteria for measuring success, with emphasis on an ecological perspective. First, the design of an ecological river restoration project should be based on a specified guiding image of a more dynamic, healthy river that could exist at the site. Secondly, the river's ecological condition must be measurably improved. Thirdly, the river system must be more self-sustaining and resilient to external perturbations so that only minimal follow-up maintenance is needed. Fourthly, during the construction phase, no lasting harm should be inflicted on the ecosystem. Fifthly, both pre- and post-assessment must be completed and data made publicly available.3. Determining if these five criteria have been met for a particular project requires development of an assessment protocol. We suggest standards of evaluation for each of the five criteria and provide examples of suitable indicators.4. Synthesis and applications. Billions of dollars are currently spent restoring streams and rivers, yet to date there are no agreed upon standards for what constitutes ecologically beneficial stream and river restoration. We propose five criteria that must be met for a river restoration project to be considered ecologically successful. It is critical that the broad restoration community, including funding agencies, practitioners and citizen restoration groups, adopt criteria for defining and assessing ecological success in restoration. Standards are needed because progress in the science and practice of river restoration has been hampered by the lack of agreed upon criteria for judging ecological success. Without well-accepted criteria that are ultimately supported by funding and implementing agencies, there is little incentive for practitioners to assess and report restoration outcomes. Improving methods and weighing the ecological benefits of various restoration approaches require organized national-level reporting systems.Journal of Applied Ecology(2005)doi: 10.1111/j.1365-2664.2005.01004.x [ABSTRACT FROM AUTHOR]

This study analysed sera from 390 llamas (Lama glama) from nine farms located in three different Argentine provinces: Buenos Aires, Cordoba and Jujuy. The samples were tested for antibodies against 8 virus known to infect cattle: bovine herpesvirus type 1 (BHV-1), bovine viral diarrhea virus (BVDV), bovine adenovirus (BAdV III), bovine enterovirus (BEV), bovine rotavirus (BRV), bluetongue virus (BTV), bovine leukaemia virus (BLV), and foot-and-mouth virus (FMDV) by conventional methods such as seroneutralization, immunoperoxidase staining, and agar gel immunodiffusion. The antibody prevalences detected in llamas were: BHV-1 in 0.77 % (3/390), BVDV in 2.05 % (8/390), BAdV III in 5.13 % (20/390), BEV in 4.10 % (16/390), BRV in 87.69 % (342/390). No antibodies against BTV, BLV and VIAA (FMDV infection associated antigen) were detected. [ABSTRACT FROM AUTHOR]

An experimental trial was conducted to evaluate the ability of foot-and-mouth-disease (FMD) virus (serotypes A79, C3, O1) to infect susceptible ***llamas exposed either directly to affected livestock, or indirectly to llamas that had been directly exposed to affected livestock. In addition, susceptible livestock species (cattle, pigs, goats, and sheep) were exposed to those llamas that had been both directly and indirectly exposed to the FMD virus to further look at potential transmission possibilities. Of 30 llamas directly exposed to the FMD virus, only three (3/30) showed evidence of infection, and of those, only two (2/30) had mild clinical signs. No FMD virus was isolated from either oesophageal-pharyngeal (OP) fluid or blood samples collected from the infected llamas beyond 14 days post-exposure. There was no evidence of virus transmission between the directly exposed and indirectly exposed llamas or between both groups of llamas and susceptible domestic livestock, as determined by the lack of clinical signs, by virus isolation, and by serology results. These results provide further evidence that llamas are resistant to FMD infection, and that they play a minor role, if any, in transmitting the virus to domestic livestock. [ABSTRACT FROM AUTHOR]