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This report describes an approach to regional anaesthesia of the dorsal nerves of the penis in a Great Dane, as part of an anaesthetic protocol for surgical urethral resection and anastomosis. Bupivacaine (0.5%) was infiltrated around the left and right dorsal nerves of the penis, with ultrasound guidance. The locoregional approach was trans-perineal, with the ultrasound probe orientated at a right angle to the anus, at the level of the ischial symphysis. The described technique provided good visualisation of the urethra and dorsal arteries of the penis. No adverse events relating to the nerve blockade were encountered and no additional analgesia, other than the methadone premedication, was required intra-operatively. The locoregional approach was subsequently repeated on a cadaver using the same technique and, on dissection, demonstrated deposition of injectate next to the target neurovascular bundles. The technique described may provide a simple method of distal penile anaesthesia in the dog, where ultrasound is available.

The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2021 Canadian guidelines for the management of pancreatic incidental findings. Topics covered include anatomic variants, fatty atrophy, pancreatic calcifications, ductal ectasia, and management of incidental pancreatic cysts.

OBJECTIVES: Psychological science has taken up investigations of the effectiveness of mindfulness-based programs (MBPs) and mechanisms through which people benefit from mindfulness. Reliable and valid psychometric tools are essential components of psychological science, and efforts have been made to produce tools for the accurate measurement of mindfulness as a construct. However, trait measurement methods, which are commonly used, may not adequately assess mindfulness and mental health outcomes in a way that allows for mechanisms to be adequately tested. Intensive longitudinal assessment methods sample behavior and experience multiple times over a brief period of several days or weeks, and may be more appropriate methods for testing mechanisms of action. We provide a systematic review of published, peer-reviewed studies that used intensive longitudinal methods to investigate the effects of mindfulness on mental health outcomes. METHODS: Articles were included in the systematic review if mindfulness measures and/or mindfulness interventions were a part of the study design and if intensive longitudinal methods were used to assess mindfulness or mental health outcomes. RESULTS: Findings consistently demonstrated a positive association between mindfulness and mental health. Only two studies collected both trait and state measurements of either mindfulness or mental health outcomes, and results indicated that EMA produced larger effect sizes between mindfulness and mental health outcomes. CONCLUSIONS: Theorized associations between mindfulness and mental health are supported by the current EMA literature. Intensive longitudinal methods may produce more consistent and reliable results through increased sensitivity and ecological validity in that they examine the momentary relationships between mindfulness and mental health outcomes. Thus, intensive longitudinal assessment may be a more appropriate method for investigating hypothesized mechanisms of action in MBPs.

The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation.

BACKGROUND AND PURPOSE: Brain metastases are a common finding on brain MRI. However, the factors that dictate their size and distribution are incompletely understood. Our aim was to discover a statistical model that can account for the size distribution of parenchymal metastases in the brain as measured on contrast-enhanced MR imaging. MATERIALS AND METHODS: Tumor volumes were calculated on the basis of measured tumor diameters from contrast-enhanced T1-weighted spoiled gradient-echo images in 68 patients with untreated parenchymal metastatic disease. Tumor volumes were then placed in rank-order distributions and compared with 11 different statistical curve types. The resultant R2 values to assess goodness of fit were calculated. The top 2 distributions were then compared using the likelihood ratio test, with resultant R values demonstrating the relative likelihood of these distributions accounting for the observed data. RESULTS: Thirty-nine of 68 cases best fit a power distribution (mean R2 = 0.938 ± 0.050), 20 cases best fit an exponential distribution (mean R2 = 0.957 ± 0.050), and the remaining cases were scattered among the remaining distributions. Likelihood ratio analysis revealed that 66 of 68 cases had a positive mean R value (1.596 ± 1.316), skewing toward a power law distribution. CONCLUSIONS: The size distributions of untreated brain metastases favor a power law distribution. This finding suggests that metastases do not exist in isolation, but rather as part of a complex system. Furthermore, these results suggest that there may be a relatively small number of underlying variables that substantially influence the behavior of these systems. The identification of these variables could have a profound effect on our understanding of these lesions and our ability to treat them.

Hunter, JR, Gordon, BA, Bird, SR, and Benson, AC. Exercise supervision is important for cardiometabolic health improvements: a 16-week randomized controlled trial. J Strength Cond Res 34(3): 866-877, 2020-Exercise supervision enhances health and fitness improvements in clinical populations compared with unsupervised or home-based exercise, but effects of supervision type are unknown in healthy employees. Eighty-five Australian university employees (62 females; mean ± SD 43.2 ± 9.8 years) were randomized to personal (1:1; SUP, n = 28), nonpersonal (typical gym-based; NPS, n = 28) supervision or unsupervised control (CON, n = 29) exercise groups. Subjects received a 16-week individually tailored, moderate-to-high intensity aerobic and resistance exercise program completed at an onsite exercise facility (SUP and NPS) or without access to a specific exercise facility (CON). Repeated-measures ANOVA analyzed changes to cardiometabolic outcomes. Mean ± SD increases to V[Combining Dot Above]O2 peak were greater (p < 0.01) with SUP (+10.4 ± 11.1%) vs. CON (+3.8 ± 8.9%) but not different to NPS (+8.6 ± 8.2%). Compared to CON (+1.7 ± 7.7%), upper-body strength increases were greater with SUP (+12.8 ± 8.4%; p < 0.001) and NPS (+8.4 ± 7.3%; p < 0.05). Lower-body strength increases were greater with SUP (+26.3 ± 12.7%) vs. NPS (+15.0 ± 14.6%; p < 0.05) and CON (+4.1 ± 12.4%; p < 0.001), and NPS vs. CON (p < 0.01). Body fat reductions were greater with SUP (-2.2 ± 2.2%) vs. NPS (-0.6 ± 1.9%; p < 0.05) and CON (-0.7 ± 1.9%; p < 0.05). Access to an onsite exercise facility with personal or nonpersonal exercise supervision was important for improving several cardiometabolic outcomes, with greater improvements to lower-body strength and body composition from personal 1:1 exercise supervision.

Long-term maintenance of changes in cardiovascular risk factors and physical capacity once patients leave the supervised program environment have not previously been reported. This study investigated the changes in physical capacity outcomes and cardiovascular risk factors in an Australian cardiac rehabilitation setting, and the maintenance of changes in these outcomes in the 12 months following cardiac rehabilitation attendance. Improvements in mean (95% CI) cardiorespiratory fitness (16.4% (13.2–19.6%), p &lt, 0.001) and handgrip strength (8.0% (5.4–10.6%), p &lt, 0.001) were observed over the course of the cardiac rehabilitation program, and these improvements were maintained in the 12 months following completion. Waist circumference (p = 0.003) and high-density lipoprotein cholesterol (p &lt, 0.001) were the only traditional cardiovascular risk factors to improve during the cardiac rehabilitation program. Vigorous-intensity aerobic exercise was associated with significantly greater improvements in cardiorespiratory fitness, Framingham risk score, and waist circumference in comparison to moderate-intensity exercise. An increase in the intensity of the exercise prescribed during cardiac rehabilitation in Australia is recommended to induce larger improvements in physical capacity outcomes and cardiovascular risk. A standardized exercise test at the beginning of the rehabilitation program is recommended to facilitate appropriate prescription of exercise intensity.

PURPOSE: The patterns or trajectories of serious antisocial behavior (ASB) in children are examined in order to determine the extent to which context, gender, and the severity and persistence of ASB from childhood/early adolescence to later adolescence/early adulthood is associated with negative outcomes. METHODS: A four wave longitudinal study obtained data on two multi-stage probability household samples of Puerto Rican background children (5 to 13 years at baseline)living in the San Juan Metropolitan Area of Puerto Rico (PR) and the South Bronx (SBx) of New York. The outcomes studied were any psychiatric disorder including substance use disorders and teenage pregnancy. RESULTS: Both males and females raised in the SBx had much higher risk of serious ASB (42.3%) as compared to those in PR (17.8%). Concurrent ASB4+ in the fourth wave was strongly related to SUD and MDD for both males and females at Wave 4. CONCLUSIONS: Serious ASB is likely to persist at least to the next developmental period of a child and is likely to be associated with substance use disorders and major depression later in life.

This study investigated the influence of cardiac intervention and physical capacity of individuals attending an Australian outpatient cardiac rehabilitation program on the initial exercise prescription. A total of 85 patients commencing outpatient cardiac rehabilitation at a major metropolitan hospital had their physical capacity assessed by an incremental shuttle walk test, and the initial aerobic exercise intensity and resistance training load prescribed were recorded. Physical capacity was lower in surgical patients than nonsurgical patients. While physical capacity was higher in younger compared with older surgical patients, there was no difference between younger and older nonsurgical patients. The initial exercise intensity did not differ between surgical and nonsurgical patients. This study highlights the importance of preprogram exercise testing to enable exercise prescription to be individualized according to actual physical capacity, rather than symptoms, comorbidities and age, in order to maximize the benefit of cardiac rehabilitation.

Few longitudinal studies have explored to date whether minority status in disadvantaged neighborhoods conveys risk for negative mental health outcomes, and the mechanisms possibly leading to such risk. We investigated how minority status influences four developmental mental health outcomes in an ethnically homogeneous sample of Puerto Rican youth. We tested models of risk for major depressive disorder (MDD) and generalized anxiety disorder (GAD), depressive and anxiety symptoms (DAS), and psychological distress, as Puerto Rican youth (aged 5-13 years) transitioned to early adulthood (15-29 years) in two sites, one where they grew up as a majority (the island of Puerto Rico), and another where they were part of a minority group (South Bronx, New York). At baseline, a stratified sample of 2,491 Puerto Rican youth participated from the two sites. After baseline assessment (Wave 1), each youth participant and one caregiver were assessed annually for two years, for a total of three time points (Waves 1-3). From April 2013 to August 2017, participants were contacted for a Wave 4 interview, and a total of 2,004 young people aged 15 to 29 years participated in the assessment (response rate adjusted for eligibility = 82.8%). Using a quasi-experimental design, we assessed impacts of minority status on MDD, GAD, DAS and psychological distress. Via mediation analyses, we explored potential mechanisms underlying the observed relationships. Data from 1,863 Puerto Rican youth (after exclusion of those with MDD or GAD during Waves 1-3) indicated links between minority status and higher rates of lifetime and past-year GAD, DAS and past 30-day psychological distress at Wave 4, and a marginal trend for MDD, even after adjustments. Childhood social support and peer relationships partially explained the differences, as did intercultural conflict, neighborhood discrimination, and unfair treatment in young adulthood. The experience of growing up as a minority, as defined by context, seemingly elevates psychiatric risks, with differences in social relationships and increased social stress as mediators of this relationship. Our findings suggest that interventions at the neighborhood context rather than at the individual level might be important levers to reduce risks for the development of mood disorders in minority youth.

BACKGROUND Conventional wheat-based foods contain high concentrations of readily digestible starch that commonly give these foods a high postprandial glycemic response and may contribute to the development of type 2 diabetes and cardiovascular disease. OBJECTIVES The aim of this study was to determine if bread made from high-amylose wheat (HAW) and enriched in resistant starch dampens postprandial glycemia compared with bread made from conventional low-amylose wheat (LAW). METHODS This single-center, randomized, double-blinded, crossover controlled study involved 7 consecutive weekly visits. On separate mornings, 20 healthy nondiabetic men and women (mean age 30 ± 3 y; body mass index 23 ± 0.7 kg/m2) consumed a glucose beverage or 4 different breads (each 121 g); LAW-R (refined), LAW-W (wholemeal), HAW-R, or HAW-W. The starch contents of the LAW and HAW breads were 24% and 74% amylose, respectively. Venous blood samples were collected at regular intervals before and for 3 h after the breakfast meal to measure plasma glucose, insulin, ghrelin, and incretin hormone concentrations, and the incremental area under the curve (AUC) was calculated (mmol/L × 3 h). Satiety and cravings were also measured at 30-min intervals during the postprandial period. RESULTS HAW breads had a glycemic response (AUC) that was 39% less than that achieved with conventional wheat breads (HAW 39 ± 5 mmol/L × 3 h; LAW 64 ± 5 mmol/L × 3 h; P

Background The Paleolithic diet is promoted worldwide for improved gut health. However, there is little evidence available to support these claims, with existing literature examining anthropometric and cardiometabolic outcomes. Objective To determine the association between dietary intake, markers of colonic health, microbiota, and serum trimethylamine-N-oxide (TMAO), a gut-derived metabolite associated with cardiovascular disease. Design In a cross-sectional design, long-term (n = 44, > 1 year) self-reported followers of a Paleolithic diet (PD) and controls (n = 47) consuming a diet typical of national recommendations were recruited. Diets were assessed via 3-day weighed diet records; 48-h stool for short chain fatty acids using GC/MS, microbial composition via 16S rRNA sequencing of the V4 region using Illumina MiSeq. TMAO was quantified using LC–MS/MS. Results Participants were grouped according to PD adherence; namely excluding grains and dairy products. Strict Paleolithic (SP) (n = 22) and Pseudo-Paleolithic (PP) (n = 22) groups were formed. General linear modelling with age, gender, energy intake and body fat percentage as covariates assessed differences between groups. Intake of resistant starch was lower in both Paleolithic groups, compared to controls [2.62, 1.26 vs 4.48 g/day (P P Hungatella in both Paleolithic groups (P P r = − 0.34, P Conclusions Although the PD is promoted for improved gut health, results indicate long-term adherence is associated with different gut microbiota and increased TMAO. A variety of fiber components, including whole grain sources may be required to maintain gut and cardiovascular health. Clinical trial registrations Australian and New Zealand Clinical Trial Registry (ANZCTRN12616001703493).

Sexual distress is associated with a variety of negative outcomes. Unique contributors to sexual distress exist among transgender individuals. The current study examined the impacts of gender-affirming interventions (i.e., hormone therapy [HT], gender-affirmation surgery [GAS]) and body satisfaction on sexual distress among 317 transgender adults recruited nationally to participate in an anonymous online survey. As expected, individuals who had received HT and/or GAS reported better body satisfaction compared to those who wanted these interventions but had not yet received them. Sexual distress did not differ by transition status. As hypothesized, time since transition began was positively associated with body satisfaction, and there was an indirect relationship between time since transition began and sexual distress through body satisfaction. These results replicated findings in the extant literature suggesting that body satisfaction is improved by GAS. Furthermore, this was the first study of which we are aware to examine the role of time since transition began with respect to body satisfaction and the resulting impact on sexual distress. Results from this study may have clinical implications that could help improve the gender-affirmation experience for transgender individuals.

The authors present a case report of a previously healthy 15-year-old male who experienced global weakness in the presence of profound hypokalaemia following a high-voltage electrical arc injury. The clinical picture is discussed in the context of our evolving understanding of electrical injuries and potassium homeostasis.

An emerging body of work suggests a link between childhood maltreatment and attention-deficit hyperactivity disorder (ADHD). However, research examining the role of maltreatment in the early course of the disorder lacks robust evidence from longitudinal studies. Our aim was to examine concurrent and prospective associations between maltreatment experiences and ADHD diagnosis and sex differences, and to estimate the association between repetitive maltreatment exposure and ADHD through childhood and adolescence. Data were obtained from the Boricua Youth Study, a longitudinal study of 2480 children and adolescents of Puerto Rican background. Neglect, physical, emotional and sexual abuse, and foster placement were regressed on ADHD diagnosis measured at each of three waves using the Diagnostic Interview Schedule for Children-IV. Multilevel regressions estimated the effects of exposure on ADHD, adjusted by age, sex, income, household education, parental psychopathology, comorbidity and ADHD medication status. Emotional abuse and foster placement had robust associations with ADHD diagnosis. For girls, physical abuse had a threefold increase in the odds of having ADHD diagnosis; for boys, associations were observed only for emotional abuse. Prospective models examining the risk of ADHD following maltreatment provided initial evidence for the effects of physical abuse on ADHD, and a linear trend for repetitive exposure suggested increased probability for disorder persistence. Associations between early maltreatment and ADHD were robust. Different categories of maltreatment increase the likelihood of ADHD for girls and boys. Increased exposure to maltreatment may predict symptom persistence. Interventions addressing ADHD must consider the effects of both sex and family environment.

The Paleolithic diet excludes two major sources of fibre, grains and legumes. However, it is not known whether this results in changes to resistant starch (RS) consumption. Serum trimethylamine-N-oxide (TMAO) is produced mainly from colonic fermentation and hepatic conversion of animal protein and is implicated in CVD, but changes in RS intake may alter concentrations. We aimed to determine whether intake of RS and serum concentrations of TMAO varied in response to either the Paleolithic or the Australian Guide to Healthy Eating (AGHE) diets and whether this was related to changes in food group consumption. A total of thirty-nine women (mean age 47 (sd 13) years, BMI 27 (sd 4) kg/m2) were randomised to AGHE (n 17) or Paleolithic diets (n 22) for 4 weeks. Serum TMAO concentrations were measured using liquid chromatography–MS; food groups, fibre and RS intake were estimated from weighed food records. The change in TMAO concentrations between groups (Paleolithic 3·39 μmv. AGHE 1·19 μm, P = 0·654) did not reach significance despite greater red meat and egg consumption in the Paleolithic group (0·65 serves/d; 95 % CI 0·2, 1·1; P P P

Progression of prescribed exercise is important to facilitate attainment of optimal physical capacity during cardiac rehabilitation. However, it is not clear how often exercise is progressed or to what extent. This study evaluated whether exercise progression during clinical cardiac rehabilitation was different between cardiovascular treatment, age, or initial physical capacity. The prescribed exercise of sixty patients who completed 12 sessions of outpatient cardiac rehabilitation at a major Australian metropolitan hospital was evaluated. The prescribed aerobic exercise dose was progressed using intensity rather than duration, while repetitions and weight lifted were utilised to progress resistance training dose. Cardiovascular treatment or age did not influence exercise progression, while initial physical capacity and strength did. Aerobic exercise intensity relative to initial physical capacity was progressed from the first session to the last session for those with high (from mean (95%CI) 44.6% (42.2–47.0) to 68.3% (63.5–73.1), p &lt, 0.001) and moderate physical capacity at admission (from 53.0% (50.7–55.3) to 76.3% (71.2–81.4), 0.001), but not in those with low physical capacity (from 67.3% (63.7–70.9) to 85.0% (73.7–96.2), p = 0.336). The initial prescription for those with low physical capacity was proportionately higher than for those with high capacity (p &lt, 0.001). Exercise testing should be recommended in guidelines to facilitate appropriate exercise prescription and progression.

Introduction: Increasing physical activity among posttreatment breast cancer survivors is essential, as greater physical activity reduces the relative risk of cancer-specific mortality. This trial examines how a fitness tracker-based intervention changes the physical activity behaviour of inactive posttreatment breast cancer survivors. Methods: Seventeen physically inactive posttreatment breast cancer survivors participated in a randomised cross-over controlled trial. Participants underwent a 12-week intervention of a fitness tracker combined with a behavioural counselling and goal-setting session and 12 weeks of normal activity (control). The primary outcome was the change in physical activity assessed by accelerometry over seven days. Results: The intervention achieved a mean increase of 4.5 min/day of moderate-vigorous physical activity, representative of a small-moderate effect (d = 0.34). Changes in time spent as a proportion of the day in light physical activity (-8.3%) and in sedentary behaviour (7.9%), were both significantly different to baseline (t (16) = 3.522, p < 0.01; t (16) = -3.162, p < 0.01). Conclusion: Interindividual differences in the change of patterns of physical activity behaviour suggest that only for some, fitness trackers can achieve a change in the level of moderate-vigorous physical activity.

Background. Accurate laboratory reference intervals (RIs) are essential to differentiate between health and disease. There are variations in haematological indices within populations relating to gender, age, ethnicity and environment. Iron deficiency is common, has a wide range of clinical morbidities and affects red cell indices. Locally derived RIs for full blood count (FBC) parameters are needed for the Western Cape region of South Africa, after the exclusion of iron deficiency. In addition, information regarding the prevalence of iron deficiency in first-time blood donors would inform blood transfusion services regarding policies to screen for and treat iron deficiency. Objectives. To establish locally derived RIs for FBC and white blood cell (WBC) differential count parameters in healthy adults in the Cape Town area, by including first-time blood donors and excluding those with iron deficiency and thalassaemic indices. These new locally established RIs could update those in use by the local National Health Laboratory Service. A secondary objective was to establish the prevalence of iron deficiency in first-time blood donors. This would inform blood donation policies regarding screening and appropriate iron supplementation in high-risk groups prior to blood donation. Methods. This was a prospective, descriptive study with direct convenience sampling. Participants were prospective voluntary blood donors aged between 18 and 60 years, presenting for first-time blood donation. Ethnicity was self-identified. Participants who tested positive for HIV or hepatitis B and/or C viruses were excluded. Prospective participants with iron deficiency, defined by serum ferritin levels below the RI, and those with red cell indices suggestive of an underlying thalassaemia trait were excluded. FBC samples were analysed using a Sysmex XN-1000 cell counter. Statistical non-parametric methods were used to calculate the RIs, according to international guidelines. Results. Of the 774 participants screened, 82 (11%) had iron deficiency and were excluded. Six hundred and sixty-two patients were included for analysis, 409 (62%) female and 253 (38%) male. The majority of the participants, 348 (53%), were between 20 and 29 years of age, with a mean age of 29 years for females and 28 years for males. Participants comprised a mix of the various ethnic groups residing in Western Cape Province. The mean haemoglobin concentration for females was lower than that for males ( p

Background Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. Aim This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. Methods A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. Clinical Implications Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. Strengths & Limitations This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one’s emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings.

OBJECTIVES: An Antisocial Behavior index (ASB-I) for children (ages 5 to 15) was previously developed by obtaining clinician ratings of the seriousness or severity of various behaviors with the goal of improving assessment of antisocial behaviors (ASB) longitudinally. We extend the instrument for use in late adolescence/young adulthood, as socially unacceptable conduct manifests differently across developmental stages. As in the original study, this extension (the ASB-I YA) is based on independent ratings of ASB seriousness/severity during late adolescence/young adulthood (16 to 28 years) made by nine experienced clinicians. METHODS: The items rated were drawn from the Oppositional Defiant Disorder and Conduct Disorder schedules of the NIMH Diagnostic Interview Schedule for Children (DISC-IV) and the Elliott Delinquency scales, plus new or modified items developmentally appropriate for late adolescence/young adulthood. Specific ratings were based on the developmental stage and reported frequency of the behaviors. The study also describes the distribution of ASB-I YA scores in the Boricua Youth Study. RESULTS: Reliability was substantial for the average ratings of each subscale and for the total score [ICC(3,9): .88 to .95]. Certain items were rated as more severe when occurring in late adolescence/young adulthood compared to childhood/early adolescence (e.g., hitting someone on purpose); however, most ratings were similar across developmental periods. Most importantly, raters reliably and consistently rated the items describing ASB in young adulthood, allowing the computation of the ASB-I YA score. CONCLUSIONS: Together with the ASB-I, the ASB-I YA can further advance the study of ASB progression from childhood into young adulthood.

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Background Polypharmacy is associated with an increased risk of falls and adverse events in the elderly. Factors such as inappropriate infrastructure for resolving language barriers can make people with migration backgrounds more vulnerable to polypharmacy. This study aimed to assess barriers in the drug therapy of elderly migrants and to obtain input for an e-health application supporting medication management and interprofessional communication. Methods 10 expert interviews were conducted with health professionals working with chronically ill patients of Turkish descent. The sample included physicians, pharmacists, social workers and nursing professionals. The interviews were analyzed using structuring content analysis. Results Respondents perceived language barriers and discontinuities in medication prescription as key problems in the drug therapy of elderly migrants. Changes in the brand of medication prescribed were highlighted as particularly damaging to patient-provider relationships. Interprofessional communication was deemed important, with physicians and pharmacists expressing dissatisfaction in this area. Some respondents saw potential in the e-health application, while others cited concerns about data protection or the digital capabilities of elderly migrants. Conclusions Healthcare professionals may require support in providing information in a variety of languages. Additionally, more interprofessional collaboration is desired but it is necessary to first establish better channels of communication. An e-health application could help achieve clearer communication between stakeholders. However, it is necessary to work in close cooperation with professionals when designing the application to ensure that it can be implemented in practice. Key messages Language barriers and inconsistent prescription practices harm patient-provider relationships. Better channels of communication are needed to provide less fragmented care to elderly migrants.

Coccidioidomycosis is a dimorphic fungus endemic to the southwestern United States, Central and South America. We report a case of a previously healthy person who presented with respiratory failure and disseminated Coccidioidomycosis who eventually had a fatal outcome. Coccidioidomycosis, or “Valley Fever” has been called the “great imitator” (1) as it can have a wide variety of clinical presentations. This case is unique as it represents the first described case of an immunocompetent host with rapidly progressing, disseminated coccidioidomycosis with clinically apparent splenomegaly and hepatomegaly.

Objective Evidence stemming largely from retrospective studies suggests that childhood adversity (CA) is associated with earlier age at menarche, a marker of pubertal timing, among girls. Little is known about associations with pubertal tempo among boys or racial/ethnic minorities. We examined the association between CA and timing and tempo of pubertal development among boys and girls. Methods The Boricua Youth Study is a longitudinal study of Puerto Rican youth residing in the San Juan metro area in Puerto Rico and the South Bronx, New York. CA was based on caretaker reports of parental loss and parental maladjustment and youth reports of child maltreatment and exposure to violence. Youth completed the Pubertal Development Scale (PDS) yearly for 3 years. In linear mixed models stratified by sex, we examined the association between CA and pubertal timing and tempo, adjusting for site, socioeconomic status, and age. Results Among the 1949 children who were 8 years or older by wave 3, cumulative CA was associated with higher PDS scores among girls compared with girls not exposed to CA (PDS score: 2.63 [95% confidence interval {CI} = 2.55-2.71] versus 2.48 [95% CI = 2.37-2.58]). In contrast, among boys, experiencing adversities was associated with lower pubertal developmental stage or later timing (PDS: 1.77 [95% CI = 1.67-1.87] versus 1.97 [95% CI = 1.85-2.10]) compared with those not exposed to adversities. Conclusions Associations between CA and pubertal development may vary by sex. Understanding the etiological role of adversities on pubertal development and identifying targets for intervention are of utmost importance in ameliorating the impact of CA on child health.

Objective To estimate the prevalence of psychiatric disorders and their continuity since childhood among young adults from the same ethnic group living in 2 low-income contexts. Method Young adults (N = 2,004; ages 15–29) were followed (82.8% retention) as part of the Boricua Youth Study, a study of Puerto Rican youths recruited at ages 5–13 in the South Bronx (SBx), New York, and Puerto Rico (PR). We estimated prevalence (lifetime; past year) of major depressive (MDD), mania, hypomania, generalized anxiety (GAD), tobacco dependence, and any other substance use disorders (SUD). Results The prevalence of every disorder was higher among young women from the SBx compared with those from PR (eg, 9.2% versus 4.1% past-year SUD; 14% versus 6.8% for MDD/GAD). Among SBx young men, tobacco dependence and illicit SUD were elevated. Across both contexts, men had higher adjusted odds of illicit SUD than women, while women had higher GAD than men. MDD did not differ by gender. Young adulthood disorders (except for alcohol use disorder and GAD) followed childhood disorders. For example, childhood externalizing disorders preceded both MDD (young men and women) and illicit SUD (young women only). Conclusion Young women raised in a context where adversities like ethnic discrimination concentrate are at high risk for psychiatric disorders. In certain high-poverty contexts, young men may present with MDD as often as women. Interventions to prevent psychiatric disorders may need to address gender-specific processes and childhood disorders. However, SUD prevention among young men may need to address other factors.

BACKGROUND: Exposure to childhood adversities (CA) is associated with sleep disturbances; however, evidence has largely been drawn from cross-sectional data and has not addressed the relationship across developmental stages. Also, most studies have primarily focused on non-Hispanic White cohorts with a dearth of longitudinal evidence about racial/ethnic minorities. We examined the longitudinal association between CA and sleep disturbances in Puerto Rican youth. METHOD: The Boricua Youth Study is a longitudinal study of Puerto Rican youth living in San Juan, Puerto Rico, and the South Bronx, NY (N = 2491). Among youth 5–9 and 10–16 years old, sleep disturbances were assessed through three yearly interviews. Lifetime exposure to CA included parental loss, child maltreatment, parental maladjustment, and exposure to violence. Weighted generalized linear mixed models examined the longitudinal association between CA and sleep disturbances in youth adjusting for sociodemographic and contextual covariates. RESULTS: The prevalence of sleep disturbances was similar in both age groups (ages 5–9 and 10–16). In multivariable mixed models, CA were associated with sleep disturbance across three Waves among 10–16-year-olds. For example, having 2–3 or ≥ 4 types of CA were related to a higher prevalence of trouble falling/staying asleep in models adjusting for social context, gender, welfare status, or mother’s education. No associations were observed among 5–9-year-olds. CONCLUSION: The results suggest that cumulative adversities in childhood may lead to sleep problems in adolescence. These findings highlight the utility of addressing CA during childhood to help reduce sleep-wake disorders throughout adolescence, a known risk factor for future mental and physical health problems.

Interval exercise training is increasingly recommended to improve health and fitness; however, it is not known if cardiovascular risk is different from continuous exercise protocols. This systematic review with meta-analyses assessed the effect of a single bout of interval exercise on cardiovascular responses that indicate risk of cardiac fibrillation and infarction compared to continuous exercise. Electronic databases Medline, CINAHL, Embase, Scopus and Cochrane were searched. Key inclusion criteria were: (1) intervals of the same intensity and duration followed by a recovery period and (2) reporting at least one of blood pressure, heart rate variability, arterial stiffness or function. Cochrane Risk of Bias tool and GRADE approach were used. Meta-analyses found that systolic blood pressure responses to interval exercise did not differ from responses to continuous exercise immediately (MD 8 mmHg [95% CI -32, 47]

Low treatment utilization, relapse, and chronicity are characteristic of substance use disorders (SUDs). Craving is an important predictor of relapse. Individuals with an SUD report using various coping strategies in response to negative affect, two of which are investigated in the current study: suppression and acting with awareness. Suppression is typically understood to be avoidance of unwanted experience through turning attention away from unwanted stimuli. Acting with awareness (AWA) is a facet of mindfulness, which includes turning toward experience with kindness and curiosity, even when the experience is unwanted. Evidence suggests mindfulness may reduce craving, while suppression has been associated with increased craving. In the current study, participants (N = 210) had recently completed inpatient or intensive outpatient SUD treatment followed by a randomized controlled trial of aftercare. Participants completed measures within 2 weeks following the completion of the aftercare intervention. Negative affect and severity of dependence were both positively associated with craving. Structural equation modeling evaluated AWA and suppression as partial mediators of the link between negative affect and craving. Suppression was positively associated and AWA was negatively associated with craving. Mediation analyses revealed the indirect effect of negative affect on craving through AWA was significant, but the path through suppression was not. These findings suggest that AWA may inhibit the development of craving from negative affect, but further research is needed. Future research should investigate the path from negative affect to craving with greater temporal resolution to evaluate how these phenomena function with increased ecological validity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background Emergency abdominal surgery is associated with a high risk of postoperative pulmonary complications (PPCs). The primary aim of this study was to determine whether patients undergoing emergency laparotomy are ventilated using a lung-protective ventilation strategy employing tidal volume ≤8 ml kg−1 ideal body weight−1, PEEP >5 cm H2O, and recruitment manoeuvres. The secondary aim was to investigate the association between ventilation factors (lung-protective ventilation strategy, intraoperative FiO2, and peak inspiratory pressure) and the occurrence of PPCs. Methods Data were collected prospectively in 28 hospitals across London as part of routine National Emergency Laparotomy Audit (NELA). Patients were followed for 7 days. Complications were defined according to the European Perioperative Clinical Outcome definition. Results Data were collected from 568 patients. The median [inter-quartile range (IQR)] tidal volume observed was 500 ml (450–540 ml), corresponding to a median tidal volume of 8 ml kg−1 ideal body weight−1 (IQR: 7.2–9.1 ml). A lung-protective ventilation strategy was employed in 4.9% (28/568) of patients, and was not protective against the occurrence of PPCs in the multivariable analysis (hazard ratio=1.06; P=0.69). Peak inspiratory pressure of Conclusions Both intraoperative peak inspiratory pressure and FiO2 are independent factors significantly associated with development of a postoperative pulmonary complication in emergency laparotomy patients. Further studies are required to identify causality and to demonstrate if their manipulation could lead to better clinical outcomes.

Introduction Sexual assault history and alcohol use are associated with higher likelihood of subsequent sexual assault. Alcohol use and drinking to cope are associated with re-assault, but it is unclear whether these factors are associated with malleable constructs like sexual assault risk perception. This study examined typical weekly drinking and drinking to cope motive as factors underlying the association between sexual assault history and risk perception. Methods Both perceived likelihood of experiencing incapacitated sexual assault and when to leaving a hypothetical sexual assault scenario were assessed as indicators of sexual assault risk perception. 660 female college students recruited from psychology courses completed questionnaires online. Results Results revealed that sexual assault history severity was positively associated with perceived incapacitated sexual assault likelihood and when to leave a risky scenario. Drinking to cope with anxiety was positively associated with perceived incapacitated sexual assault likelihood. Among women who reported regular drinking, typical weekly drinking was positively associated with when to leave a risky scenario, such that women who reported more weekly drinks stayed in a potentially risky scenario longer than women who reported fewer weekly drinks. Conclusions These findings suggest that alcohol use and drinking to cope with anxiety are associated with risk perception. Sexual assault history was associated with both perceived incapacitated sexual assault likelihood and when to leave a hypothetical scenario. Alcohol use and drinking to cope are two potential points of intervention for sexual assault risk reduction programs, but further examination is needed.

Importance Racial/ethnic and sex disparities in suicide ideation and attempts are well established, with higher risk of suicide ideation and attempt among US racial/ethnic minority school-aged youths (than their White peers) and girls and women (than boys and men). The suicide-related risk of racial/ethnic minority young adults, especially young women, may be strongly influenced by adverse childhood experiences, known early determinants of suicide ideation and attempts. Objectives To assess lifetime and past-year prevalence estimates of suicide ideation and suicide attempt and to examine sex differences in the role of adverse childhood experiences as a prospective risk factor for Puerto Rican young adults from 2 sociocultural contexts. Design, setting, and participants Data in this longitudinal cohort study are from 4 waves of the Boricua Youth Study, a population-based cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico, and the South Bronx, New York, 5 to 17 years of age (N = 2491; waves 1-3: 2000-2004) and 15 to 29 years of age (wave 4: 2013-2017). Data analysis was performed from February 26, 2019, to October 16, 2020. Exposures Adverse childhood experiences were assessed by interview in childhood and early adolescence (waves 1-3) and included child maltreatment (physical, sexual, and emotional abuse and neglect), exposure to violence, parental loss (separation, divorce, and death), and parental maladjustment (mental health problems, substance or alcohol abuse, intimate partner violence, and incarceration). Main outcomes and measures Lifetime and past-year suicide ideation and attempt were assessed in young adulthood (wave 4) using the World Health Organization Composite International Diagnostic Interview. Results Among 2004 Puerto Rican young adults (80.4% of the original cohort; mean [SD] age, 22.9 [2.8] years; 1019 [50.8%] male), young women compared with young men had a higher prevalence of lifetime suicide attempt (9.5% vs 3.6%) and lifetime suicide ideation (16.4% vs 11.5%), whereas past-year suicide ideation (4.4% vs 2.4%) was not statistically different. Logistic regression models, adjusting for demographics and lifetime psychiatric disorders, found that young women but not young men with more adverse childhood experiences had higher odds of suicide ideation (lifetime; odds ratio [OR], 2.44; 95% CI, 1.54-3.87; past year: OR, 2.56; 95% CI, 1.18-5.55). More adverse childhood experiences were also prospectively associated with lifetime suicide attempt (OR, 1.16; 95% CI, 1.04-1.29), irrespective of sex. Conclusions and relevance The findings of this cohort study suggest that, among Puerto Rican young adults from 2 different sociocultural contexts, adverse childhood experiences were relevant to understanding suicide attempt and suicide ideation, the latter specifically among young women. The prevention of cumulative adverse childhood experiences could reduce later risk of suicide attempts and, among young women, for suicide ideation.

The goal of this study was to determine whether ultrasound measures of muscle architecture can be used to infer strength and functional capacity in older adults. Thirty-six healthy older adults (aged 68.2 ± 5.3 y) undertook isokinetic dynamometry for isometric and isokinetic concentric knee extensor strength, the 6-m fast walk, timed up and go, stair climb and descent and vertical jump tests. Longitudinal brightness-mode ultrasound scans (probe frequency, 10 MHz) of the vastus lateralis, vastus intermedius, rectus femoris and gastrocnemius medialis were obtained, and muscle architecture measures (thickness, fascicle pennation angle and fascicle length) were correlated with the aforementioned strength and functional measures. Quadriceps thickness was a significant (p

Reliable measures of muscle strength and functional capacity in older adults are essential. The aim of this study was to determine whether coefficients of variation (CVs) of individuals obtained at the first session can infer repeatability of performance in a subsequent session. Forty-eight healthy older adults (mean age 68.6 ± 6.1 years; age range 60–80 years) completed two assessment sessions, and on each occasion undertook: dynamometry for isometric and isokinetic quadriceps strength, 6 meter fast walk (6MFWT), timed up and go (TUG), stair climb and descent, and vertical jump. Significant linear relationships were observed between CVs in session 1 and the percentage difference between sessions 1 and 2 for torque at 60, 120, 240 and 360°/s, 6MFWT, TUG, stair climb, and stair descent. The results of this study could be used to establish criteria for determining an acceptably reliable performance in strength and functional tests.

Objectives: To determine the validity of energy expenditure estimation made by the Fitbit One, Garmin Vivofit and Jawbone UP activity trackers during treadmill walking and running. Determining validity of such trackers will inform the interpretation of the data they generate. Design: Cross-sectional study. Method: Fourteen adults walked at 0.70, 1.25, 1.80 ms−1 and ran at 2.22, 2.78, 3.33 ms−1 on a treadmill wearing a Fitbit One, Garmin Vivofit and Jawbone UP. Estimation of energy expenditure from each tracker was compared to measurement from indirect calorimetry (criterion). Paired t-tests, correlation coefficients and Bland–Altman plots assessed agreement and proportional bias. Mean percentage difference assessed magnitude of difference between estimated and criterion energy expenditure for each speed. Results: Energy expenditure estimates from the Fitbit One and Garmin Vivofit correlated significantly (p

In adults, fermentation of high amylose maize starch (HAMS), a resistant starch (RS), has a prebiotic effect. Were such a capacity to exist in infants, intake of RS might programme the gut microbiota during a critical developmental period. This study aimed to determine if infant faecal inocula possess the capacity to ferment HAMS or acetylated-HAMS (HAMSA) and characterise associated changes to microbial composition. Faecal samples were collected from 17 healthy infants at two timepoints: Preweaning and within 10 weeks of first solids. Fermentation was assessed using in vitro batch fermentation. Following 24 h incubation, pH, short-chain fatty acid (SCFA) production and microbial composition were compared to parallel control incubations. In preweaning infants, there was a significant decrease at 24 h in pH between control and HAMS incubations and a significant increase in the production of total SCFAs, indicating fermentation. Fermentation of HAMS increased further following commencement of solids. Fermentation of RS with weaning faecal inocula increased Shannon&rsquo, s diversity index (H) and was associated with increased abundance of Bifidobacterium and Bacteroides. In conclusion, the faecal inocula from infants is capable of RS fermentation, independent of stage of weaning, but introduction of solids increases this fermentation capacity. RS may thus function as a novel infant prebiotic.

Suicidal behavior increases substantially during early adolescence, a critical understudied developmental period. This study reports on the prevalence of suicidal ideation, suicide attempts, and course of suicidal ideation among Puerto Rican early adolescents, a high-risk group for suicidal behavior in adulthood. Gender differences and the prospective association of psychiatric disorders with course of suicidal ideation are examined. Participants were 1,228 Puerto Rican adolescents (ages 10–13 at wave 1; 48% female) and parents, selected through probability-based sampling, assessed yearly across three waves. Adolescents and parents reported via Diagnostics Interview Schedule for Children-IV about 12-month suicide attempts and suicidal ideation (further categorized as never present, onset, recurrence, and remission), mood and anxiety disorders; parents reported on disruptive disorders. Over the three waves, 9.5% early adolescents thought about suicide and 2.1% attempted suicide. In adjusted multinomial regression models, compared to those with never present suicidal ideation, female gender was related to onset of suicidal ideation (OR = 2.60; 95% CI, 1.22–5.55). Disruptive disorders were related to onset (OR = 5.80; 95% CI, 2.06–16.32) and recurrence of suicidal ideation (OR = 5.07, 95% CI, 1.14–22.47), mood disorders were related to remission (OR = 14.42, 95% CI, 3.90–53.23), and anxiety disorders to onset of suicidal ideation (OR = 3.68, 95% CI, 1.75–7.73). Our findings inform strategies tailored for early adolescents. To address onset of suicidal ideation, prevention should focus on girls and those with anxiety or disruptive disorders. When ideation is recurrent, interventions oriented to reduce disruptive behavior and its consequences may help achieve remission.

PURPOSE Merkel cell carcinoma (MCC) is an aggressive skin cancer often caused by the Merkel cell polyomavirus. Clinical trials of programmed cell death-1 pathway inhibitors for advanced MCC (aMCC) demonstrate increased progression-free survival (PFS) compared with historical chemotherapy data. However, response durability and overall survival (OS) data are limited. PATIENTS AND METHODS In this multicenter phase II trial (Cancer Immunotherapy Trials Network-09/Keynote-017), 50 adults naïve to systemic therapy for aMCC received pembrolizumab (2 mg/kg every 3 weeks) for up to 2 years. Radiographic responses were assessed centrally per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. RESULTS Among 50 patients, the median age was 70.5 years, and 64% had Merkel cell polyomavirus–positive tumors. The objective response rate (ORR) to pembrolizumab was 56% (complete response [24%] plus partial response [32%]; 95% CI, 41.3% to 70.0%), with ORRs of 59% in virus-positive and 53% in virus-negative tumors. Median follow-up time was 14.9 months (range, 0.4 to 36.4+ months). Among 28 responders, median response duration was not reached (range, 5.9 to 34.5+ months). The 24-month PFS rate was 48.3%, and median PFS time was 16.8 months (95% CI, 4.6 months to not estimable). The 24-month OS rate was 68.7%, and median OS time was not reached. Although tumor viral status did not correlate with ORR, PFS, or OS, there was a trend toward improved PFS and OS in patients with programmed death ligand-1–positive tumors. Grade 3 or greater treatment-related adverse events occurred in 14 (28%) of 50 patients and led to treatment discontinuation in seven (14%) of 50 patients, including one treatment-related death. CONCLUSION Here, we present the longest observation to date of patients with aMCC receiving first-line anti–programmed cell death-1 therapy. Pembrolizumab demonstrated durable tumor control, a generally manageable safety profile, and favorable OS compared with historical data from patients treated with first-line chemotherapy.

Background: Storage lesions occur in red blood cell products when potassium ions, haemoglobin and lactate dehydrogenase are released into the extracellular plasma due to post-irradiation storage or cellular degeneration. The South African blood transfusion establishments do not comply with the universal leucocyte-reduction policy due to cost and the current HIV pandemic. Various studies regarding storage lesions have been completed in well-developed countries but not in Cape Town, South Africa. Objective: This study aimed to determine cellular degeneration occurring in non-irradiated and irradiated red blood cells (RBC) by comparing the measured biochemical and haematological indices during storage of up to 42 days. Method: Eighty whole blood units were collected from voluntary, non-remunerated donors. Blood components tested weekly until expiry were whole blood, RBC concentrate, leucocyte-reduced RBC concentrate (pre-storage) and paediatric RBC concentrate ( n = 20). Ten units per product were irradiated and 10 were not. Evaluations included potassium, sodium, glucose, lactate dehydrogenase, phosphate, haemoglobin, haematocrit, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentrate, mean cell volume and plasma haemoglobin. Plasma haemolysis levels were calculated using an approved formula. Results: The haemolysis levels evaluated on Day 35 and Day 42 were higher than the recommended 0.8%, whereas results for the non-irradiated components up to expiry were all below 0.8%. Conclusion: This study confirms that gamma irradiation aggravates the RBC storage lesions. The products tested yielded similar results to other studies in developed countries, however the South Africa transfusion medicine policy should remain unchanged.

5570 Background: In Study 309/KEYNOTE-775, lenvatinib + pembrolizumab (L+P) demonstrated significant and clinically meaningful improvement in OS, PFS, and ORR compared with TPC in aEC pts following prior platinum-based systemic therapy. Given the medical complexity/age of EC pts, QoL analyses are critical, but often under-reported. We present results of pt-reported HRQoL for Study 309/KEYNOTE-775. Methods: Pts were randomized 1:1 to receive lenvatinib 20 mg QD PO + pembrolizumab 200 mg IV Q3W (n=411) or TPC (n=416; doxorubicin 60 mg/m2 IV Q3W or paclitaxel 80 mg/m2 IV QW, 3 wks on/1 wk off). Pt-reported HRQoL was assessed at cycle 1 day 1, day 1 of each subsequent cycle and at time of discontinuation using EORTC QLQ-C30, its EC module QLQ-EN24, and EQ-5D-5L in treated pts who had ≥1 HRQoL assessment available. Higher scores indicate better functioning/QoL (EORTC QLQ-C30, EQ-5D-5L) or worse symptom severity (QLQ-EN24). Changes in EORTC QLQ-C30 global health status (GHS)/QoL was a secondary endpoint. This was analyzed from baseline to the latest timepoint at which overall completion was ≥60% and overall compliance was ≥80%, using constrained longitudinal data analysis; other HRQoL analyses were exploratory. Results: Completion and compliance rates of EORTC QLQ-C30 were >95% in both groups at baseline. Primary analysis was conducted at wk 12 as completion rate was 80% for L+P and 62% for TPC; compliance rate was 93% for L+P and 87% for TPC. Baseline GHS/QoL scores were similar between the L+P group and TPC group: mean (SD) of 65.74 (21.87) vs 65.69 (22.71), respectively. Over 12 wks of follow-up, pts in both groups had slight decreases in GHS/QoL. Similar decreases were observed for pts receiving L+P vs TPC: -5.97 (95% CI: -8.36, -3.58) vs -6.98 (95% CI: -9.63, -4.33). The between-group difference in least-squares (LS) mean score change from baseline to wk 12 for L+P vs TPC was 1.01 points (95% CI: -2.28, 4.31). Over time, QoL scores were generally similar across treatments. Results were similar for other HRQoL endpoints (Table). Conclusions: No significant differences were observed in HRQoL scores between treatment groups. With no standard treatment approach following failure of platinum-based therapy, these data along with previously reported efficacy and safety findings from Study 309/KEYNOTE-775 further support that L+P has an overall favorable benefit/risk profile compared to chemotherapy. Clinical trial information: NCT03517449. [Table: see text]

Objectives Regular exercise is advocated for individuals with type 2 diabetes, without fully understanding the acute (0–72h post-exercise) glycaemic response. This study assessed post-exercise glycaemic profiles of non-exercising individuals with insulin treated type 2 diabetes, following resistance and aerobic exercise. Design Randomised cross-over trial. Methods Fourteen individuals with insulin treated type 2 diabetes (9 males, 5 females) aged 58.1±7.1 years (HbA1c: 8.0±0.6%) were allocated to single sessions of resistance (six whole-body exercises, three sets, 8–10 repetitions, 70% 1RM) and aerobic (30min cycling, 60% VO 2peak ) exercise, 7-days apart, with the day prior to the first exercise day of each intervention being the control condition. Immediately prior to exercise, insulin dosage was halved and breakfast consumed. Continuous glucose monitoring was undertaken to determine area under the curve and glucose excursions. Results Blood glucose initially increased (0–2h) following both resistance and aerobic exercise ( p −1 and 12.3±3.3mmolL −1 , respectively. Area under the glucose curve was not statistically different over any of the 24h periods ( p =0.12), or different in response to resistance (222±41mmolL −1 24h −1 ) or aerobic (211±40 mmolL −1 24h −1 ) exercise ( p =0.56). Incidence of hyperglycaemia did not differ between exercise modes ( p =0.68). Hypoglycaemic events were identified in three and four participants following resistance and aerobic exercise respectively: these did not require treatment. Conclusions Glycaemic response is not different between exercise modes, although 50% insulin dose reduction prior to exercise impairs the expected improvement. A common clinical recommendation of 50% insulin dose reduction does not appear to cause adverse glycaemic events.

This paper examines whether family structure and its transitions are associated with internalizing and externalizing psychiatric disorders among Puerto Rican-origin children. It uses longitudinal data (three waves) from the Boricua Youth Study, which includes probability samples of children in the South Bronx (New York) and San Juan (Puerto Rico) (n = 2,142). We also examine factors which may explain how family structure and transitions may be related to child psychiatric disorders. Our results show that for both internalizing and externalizing disorders there were no significant differences between children of cohabiting (biological or step) parents or of single parents compared to children of married biological parents. In Puerto Rico only, transitioning once from a two-parent family to a single-parent family was related to child internalizing disorders. Family transitions were not associated with externalizing disorders at either site. Context may be an important factor shaping the risk that family dissolution is followed by an internalizing disorder among children.

Purpose While there exists much literature devoted to identifying risk and protective factors for violence, Hispanic research in this area is still in its infancy. Methods The current study provides the most comprehensive study to date on this topic by utilizing data from 1138 Puerto Rican youth who were participants in the Bronx, NY sample of the Boricua Youth Study (BYS). Results Relying on a myriad of descriptive and multivariate analyses examining the nature and role of 8 risk factors and 9 protective factors distributed across 6 risk/protective factor domains, the results suggest that cumulative risk factors significantly increase a Hispanic youth's odds of violence participation whereas cumulative protective factors offset this risk to some degree by decreasing the odds of violence participation. These results largely hold across different developmental age groups (ages 5–9 and ages 10–13) and over time (Waves 1, 2, and 3). Conclusions These findings have theoretical and policy implications for violence prevention among Hispanic youth.