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Using a participatory research approach, we enlisted 12 U.S. Centers for Independent Living (CILs) to recruit and enroll 170 adults with intellectual disability (ID) to be randomized to either The Safety Class, an abuse prevention group program, or usual care. Participants were asked to complete pre, post, and 3-month follow-up questionnaires. CIL staff members facilitated the eight-session, interactive program. Quantitative and qualitative findings suggest that participation in a brief safety program may improve safety protective factors among men and women with ID. The Safety Class serves as one model for delivering an abuse prevention and education intervention to adults with significant safety needs but extremely limited access to relevant community resources.

Joanna Emilio,1 Michelle Schwartz,2–4 Eleanor Feldman,2–4 Amy Kalowitz Bieber,2–4 Amanda Bienenfeld,2–4 Min-Kyung Jung,1 Daniel M Siegel,2,3 Orit Markowitz2–4 1Department of Dermatology, NYIT College of Osteopathic Medicine, Old Westbury, 2Department of Dermatology, SUNY Downstate Medical Center, 3Department of Dermatology, NY Harbor Healthcare System, Brooklyn, 4Department of Dermatology, Mount Sinai Medical Center, New York, NY, USA Abstract: Actinic keratoses (AKs), especially on areas of the face, have a negative impact on a patient's quality of life (QoL). These lesions manifest on sun-damaged skin and have the potential to progress to squamous cell carcinoma. Field-directed therapy alone and in combination with lesion-directed treatment is effective in clearing both visible and nonvisible AK lesions. Topical treatments of AKs thus have the potential to improve a patient's well-being. However, evidence demonstrating improvements in patient QoL is limited, and is mostly based on observational or retrospective studies. Some prospective studies have reported unchanged or even worsening QoL despite excellent treatment outcomes. Our prospective, pilot study demonstrated a significant increase in QoL in 28 subjects with AKs of the face treated with ingenol mebutate gel 0.015%. QoL was assessed at days 0 and 60 using the Skindex-16 survey. Mean overall scores improved from 24.5% at baseline to 15.5% at day 60 (P=0.031). Improvements in QoL were consistent with an 80% reduction in AK lesion number at day 60. These improved QoL findings are in line with those from a recent retrospective study using ingenol mebutate 0.015% gel. This study therefore further demonstrates the potential for field therapy to improve both treatment outcomes and patient satisfaction. Keywords: actinic keratosis, squamous cell carcinoma, ingenol mebutate gel, local skin reaction, quality of life, Skindex-16

There is increased emphasis on self-determination as an important outcome for youth with disabilities if they are to achieve positive adult outcomes after they leave school. However, the causal link between self-determination and positive adult outcomes has remained untested. The Arc conducted a follow-up study of students with mental retardation or learning disabilities for whom data regarding self-determination had been collected prior to their high school exit. Data regarding adult outcomes for these students nearly 1 year after graduation were collected. The resulting analysis determined that self-determined students were more likely to have achieved more positive adult outcomes, including being employed at a higher rate and earning more per hr than peers who were not self-determined. A framework for promoting self-determination as an educational outcome is presented.

BACKGROUND Stage-specific survival for colon cancer improves when more lymph nodes are reported in the surgical specimen. This has led to a minimum standard of identifying 12 lymph nodes as a quality indicator. OBJECTIVE The aim of this study was to determine whether the addition of Schwartz solution increases node yield and impacts pathologic staging. DESIGN This is a prospective cohort study. SETTING The study was conducted in an academic medical center. PATIENTS Included were 104 consecutive patients with colorectal cancer. MAIN OUTCOME MEASURES Lymph node counts before and after specimen treatment with Schwartz solution and incidence of upstaging were measured. RESULTS An additional 20 minutes (interquartile range, 15-40 minutes) was spent searching for lymph nodes, increasing the median number of nodes from 22.5 to 29.0 nodes. However, only 1 patient was upstaged. Schwartz solution decreased the number of specimens with less than 12 lymph nodes from 15 to 6. The following factors were associated with Schwartz solution leading to the detection of additional nodes: number of nodes detected initially with formalin only (p < 0.000), mesenteric fat volume (p < 0.000), mesenteric fat weight (p < 0.000), length of specimen (p < 0.016), tumor greatest dimension (p < 0.016), patient body surface area (p < 0.034), and patient age (p < 0.003). LIMITATIONS Clinical data for this study were obtained retrospectively and were not available for all of the patients. CONCLUSIONS Although Schwartz solution increased the number of nodes detected in 95% of patients and improved compliance with the 12-node standard for colon resection, there was minimal impact on cancer staging. Upstaging is unlikely to explain the increase in overall survival in patients with higher lymph node counts, casting doubt on the validity of this process measure as a meaningful quality indicator. Rather, the lymph node count may be a reflection of inherent tumor biology or host-related factors.

Non-invasive imaging devices are currently being utilized in research and clinical settings to help visualize, characterize, anddiagnose cancers of the skin. Speckle-variance optical coherence tomography (svOCT) is one such technology that offers considerable promise for non-invasive, real time detection of skin cancers given its added ability to show changes in microvasculature. We present four early lesions of the face namely sebaceous hyperplasia, basal cell skin cancer, pigmented actinic keratosis, and malignant melanoma in situ that each display different important identification markers on svOCT. Up until now, svOCT has mainly been evaluated for lesion diagnosis using transversal (vertical) sections. Our preliminary svOCT findings use dynamic en face (horizontal) visualization to differentiate lesions based on their specific vascular organizations. These observed patterns further elucidate the potential of this imaging device to become a powerful tool in patient disease assessment.